On effusions of blood in the neighbourhood of the uterus, or, The so-called periuterine haematocele : a thesis for the M.D. degree / by Henry M. Tuckwell.

  • Tuckwell, Henry M.
Date:
1863
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Licence: Public Domain Mark

Credit: On effusions of blood in the neighbourhood of the uterus, or, The so-called periuterine haematocele : a thesis for the M.D. degree / by Henry M. Tuckwell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    into the peritonaeum. If, on the contrary, both ostia are closed, the tuba becomes more and more distended, till rupture ensues, and all the symptoms of hsematocele declare themselves. In 2 only of 8 cases related in illustration of this had the former occurred, the phenomenon of simple regurgitation without rupture being best studied in cases that come under series A. In the remaining 6 the tuba was ruptured. The fact that the first symptoms of the attack shew themselves, as a rule, at a menstrual period in which the flux is prolonged and excessive, offers a strong argument in favour of the above explanation. In 6 of the above- mentioned 8 cases it came on during, or just after, the time of the catamenia, and in 5 menorrhagia was present. Such evidence as this renders it more than probable that the same cause was at work in several other similar cases related, but in which tlie hsemorrhage was not sufficiently formidable to destroy life: cf. cases 16 to 23. C. i?y rupture of the sac in extra uterine /(station, more espe- cially in tubal pregnancy: cf. cases 1 to iO. D. By rupture of the investing tunic of a congested ovary, and escape of blood either from a Graafian vesicle, which is the seat of extraordinary hcsmorrhage, or from the parenchyma of the organ into which a blood-vessel has burst, I have collected 11 cases in which the autopsy shewed clearly that this had occurred. To these observations may be added that made by Scanzoni^, and related by him under the head of Apoplexy of the Ovaryin which a girl, set. 18, suddenly died at the time of menstruation with symptoms of internal hsemorrhage, and in whom the autopsy disclosed a sac in the right ovary, about the size of a hen's egg, and filled with clotted blood, in the posterior wall of which was a rupture more than an inch in length, through which more than six pounds of blood had been poured out into the peritonseura. Here, too, we cannot avoid the conclusion that menstruation plays a most im- portant part. It is known that at each catamenial period a small and unimportant hgemorrhage takes place into the Graafian vesicle from whence the ovum is cast forth; but it happens occasionally that this hsemorrhage becomes excessive, and so distends the vesicle, that it forms a tumour of considerable size, which, yield- ing to the pressure from witliin, bursts and discharges its con- tents. Or, on the other hand, a sudden shock, as a blow or fall, 8 Scauzoni, op. cit., p. 354.