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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    disease with the anatomical relations of different portions of the pelvic fascia ; but hitherto this attempt has been only in words, or in descriptions having a confused hypothesis for their basis. The question is one which morbid anatomy alone can settle, and it is to be ardently desired that autopsies bearing on this point should be recorded. I do not say autopsies only of women dying of this dis¬ ease, for it may well happen that the greater fatality of the intra- peritoneal form may lead to an erroneous opinion of its frequency and importance. It is natural to suppose that the extraperitoneal form of the disease should seldom cause death, and the opportunity of examining it after death be very seldom met with ; but this rarity of the extraperitoneal form in autopsies is not a conclusive argu¬ ment for the rarity of its occurrence when compared with that of the probably more fatal intraperitoneal affection. Pathologists must, therefore, anxiously wait tor autopsies in cases of death from any cause, in women who have had uterine hsematocele complicating the disease producing the fatal result. That intraperitoneal hsematocele often occurs is proved by numer¬ ous post-mortem examinations, and it is as natural to expect its occasional occurrence as it is easy to find in various sources of the haemorrhage a satisfactory explanation of it. The occurrence of extraperitoneal hsematocele has been but seldom verified by post-mortem observation. But it has always appeared to me to be probably a common form of the disease. The remote analogies of cephalhematoma, of pulmonary, splenic, and placental apoplexies easily suggest themselves. It is more to the point to recall to mind the well-known thrombus of the vulva, and the occurrence of similar effusions beneath the walls of the vagina, which last I have several times seen in post-mortem examinations of women dying in childbed. It is, besides, ascertained that sanguineous effusions do sometimes take place between the two layers of peritoneum forming the broad ligaments, and I have, in pregnant pigs made the subject of vivisection, seen extensive effusions of the same nature in a corresponding situation. Further, it has appeared to me difficult, if not impossible, to expect the complete, or nearly complete, return of the mobility of the uterus, and of the softness of tlie root of the vagina, if the effusion be intraperitoneal, the blood enclosed by adhesions of the viscera, and the disease cured by evacu¬ ation of the sac, its suppuration and gradual collapse. Pregnancy even has been prosperously completed in women who have previously suffered from uterine hsematocele. This returning mobility and general state ot health I have observed in a retro-uterine luematocele of great extent to be presently recorded. Again, in what I call the characteristic retro-uterine hsematocele there is strong and far advancing pressure downwards of the effused blood, great distension apparently of the recto-vaginal septum, so close approximation of the tumour to the perineum, and so great elevation of the uterus, that it is difficult to suppose that the advancing mass is pushing the