Volume 1

System of gynecology / by American authors ; edited by Matthew D. Mann.

Date:
1887-1888
Catalogue details

Licence: Public Domain Mark

Credit: System of gynecology / by American authors ; edited by Matthew D. Mann. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    775/806 (page 765)
    ■fluid filled, fii-st, the vesico-iitei-ine cul-de-sac, and secondly, the ])ostc- rior cul-de-sac, both sides at once. He made the remarkable experi- ment of using a pressure syringe connected M ith a manometei, and measured the force necessary to rupture the broad ligament by disten- sion. It equalled two atmospheres. Poncet explains this great strength by the character and distribution of the connective tissue of the liga- ment. These experiments, further than testing the resistance of llie peritoneum and the channels of connection through the connective-tis- sue spaces when distended by fluid under j^ressui'o, prove nothing. The difference between the living and the dead subject is too great. AYe may also observe that the fluid in Tripier's experiments was distributed in a manner never recorded in pelvic haematoma. Beigel verified by post-mortem examination a large htematoma in the folds of that i)ortion of the broad ligament known as the ala ves]iertilionis. The subject died from pneumonia, and the discovery of the luematoma was acci- dental. Nona says that the effused blood is generally covered by false membrane, but this is not so, and in the carefully-made dissections by Ball, so frequently referred to by Poncet, no covering of this character was observed. As already referred to, there is great ditference of opinion as to the frequency of htematoma. Bandl asserts that it is rarely met with out- side of the puerperal condition. All those who follow Bernutz hold that hajmatocele is very frequent and haematoma veiy rare. Tait on his individual experience believes that haematoma is ten or twelve times more frequent than the intraperitoneal effusion. Causes.—Olshausen relates a case of anteuterine hfematoma follow- ing acute dysmenorrhoea. The anterior liji of the cervix was shortened, and the anterior vaginal vault driven backward by a tumor of half-soft consistency. Many cases of haematoma attend forced abortion at the •early weeks and rough manipulation in gynecological opei'ations. These cases are frequently mistaken for cellulitis. Careful attention to the order of morbid events will define it from the latter condition. In hrematoma the local lesion precedes pain and fever. In inflammatory deposits fever and pain ai'e preludes to the development of the pelvic mass. Further, the induration in cellulitis is detected in regions in which the minor forms of hajmatocele are rarely observed. We find the latter developing, as it were, in the vaginal wall, forming small, well-defined masses, usually posterior to the vaginal portion, rarely lateral, with a slight degree of utei'ine immobility, while cellulitis is dif- fused and generally lateral. The termination is the same in both cases, and unless the distinction is made early it may be difficult, if not impos- sible, to recognize the difference. It may be said that we have passed through the period of cellulitis in pelvic pathology, and other condi- tions will now come to the front that were formerly confounded with it.