Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan.

  • Duncan, J. Matthews (James Matthews), 1826-1890.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan. Source: Wellcome Collection.

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    It is an extraordinary and inexplicable fact, that uterine hmmatocele —a disease not of very great rarity, frequently forming tumours of enormous bulk—should have almost completely escaped the atten¬ tion even of special practitioners in the diseases of women until about twelve years ago. Text-books and teachers were all silent on this important disease, till the clinical lessons of M. Nelaton on the subject were published. Now, the disease will never be for¬ gotten. It is, indeed, easily identified ; and out of several cases which I have seen, I shall in this article relate six which have come under my care in the Royal Infirmary during the last eighteen months. To the reader it will be evident that these cases have all similar symptoms ; but that the physical characters are very different in different examples; so different, indeed, as to preclude the supposition that the effusion of blood has taken place in all of them in the same anatomical situation and conditions. Although the disease is easily identified, and its general charac¬ ters are well known, many important points in its pathology are still unsettled. It appears to me that the chief of these regard the difficult questions of its various origins and of its various situations. That in both of these matters there is no uniform law, but difference in different cases, I am convinced. To explain its origin, every possible source of bleeding in the neighbourhood of the affected parts has on different occasions been invoked ; and many have been substantiated by post-mortem investigation. In regard to its anatomical site, two principal theories are enunciated. The first, that the blood is as a rule effused into the peritoneal cavity, is held by most continental pathologists, and has been defended at very great length by M. Bernutz, in his clinical work on the diseases of women. It has also the important support of a great majority of the recorded careful post-mortem examinations. The second theory, that the blood is effused into the cellular tissue of the higher parts of the pelvis, is entertained by several physicians in this country, but chiefly on theoretical grounds, for post-mortem observations confirm¬ atory of this view are unfortunately few in number. It has been attempted to connect some points in the progress and history of the