A treatise on gynaecology, medical and surgical / by S. Pozzi.

  • Pozzi, Samuel, 1846-1918.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on gynaecology, medical and surgical / by S. Pozzi. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    of the internal os with a normal cervix; then we have to decide between pregnancy, fibroma, cancer of the fundus, and the haematometra, according to the signs proper to each and the statements of the patient. Where there is complete or partial division of the canal by a septum, the difficulties in the way of diagnosis are very great for haematocolpos or haema- tometra (Fig. 599) of one side. Lateral hamiatocolpos does notform a tumor which coincides with the vagina, but on account of an evolution, which Breisky has well described, it undergoes a semi-spiral torsion, so that its lower portion may be anterior and its upper posterior, or vice versa. Cysto- cele, vagina] cyst, vaginal enterocele, thrombus, and retro-uterine hematocele could hardly be confounded with haematometra or hamatocolpos if proper care were exercised. The difficulty is, however, great when, with a divided vagina, the accumulation of blood takes place in one segment of a bicornate, bilocular, or didelphic uterus. We should endeavor carefully to mark out the limits of the tumor by the aid of bimanual palpation, and to discover the non-dilated portion of the organ, which is generally pushed far to the side. It is especially in the case of haematometra of a rudimentary cornu that there would be doubt, and a danger of mistaking it for a cystic tube, all the more if the other tube were dilated; fibroma should also be excluded. Pregnancy may occur in the free portion of the uterus and complicate the signs still more. Exploratory puncture I consider very dangerous, and prefer explora- tory incision if necessary in a doubtful case. Prognosis.—Left to themselves, collections of blood from atresia; of the genital canal are very serious. Spontaneous evacuation does not produce a cure, but only a temporary relief, followed later by a return of the retention symptoms aggravated by suppuration. The spontaneous perforation is also generally insufficient, and quickly closes after permitting a partial evacuation and also the infection of the sac. \\ hen, as seldom happens, the accumulation is voided through an adjacent organ, like the intestine or even the stomach, the result is not the less fatal ; renewed menstruation fills the pouch again and the patient succumh.v Death occurs from septica:mia after spontaneous rupture of the sac or from peritonitis after opening into the peritoneum. In astresia of a single segment of a double canal, the prognosis is not so grave; lateral haematocolpos frequently terminates by rupture into the per- meable vagina at the intra-cervical septum. Put the suppuration of this cavity, which generally occurs, causes a pyocolpos which may be fatal if the opening is not freely enlarged. In partial hiematometra of a rudimentary segment, the accumulation of blood may cease and the tumor remain sta- tionary. Before the period of antiseptics, opening a large collection of blood in the genital canal was frequently followed by septicaemia, whether the opera- tion was a free incision without sufficient cleansing of the sac afterward, or a simple puncture with the idea of preventing the entrance of the air, which