Identifier: diseasesofwomenc00herm (find matches)
Title: Diseases of women. A clinical guide to their diagnosis and treatment
Year: 1899 (1890s)
Authors: Herman, G. Ernest (George Ernest), 1849-1914
Subjects: Women
Publisher: New York, W. Wood & Co.
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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aemorrhage obliged you to open the belly, the previousvaginal incision would not, if the part had been kept clean,materially affect the risk. Extra-peritoneal hematocele.—This means bleeding intothe cellular tissue beneath the peritoneum, but above thedeep pelvic fascia. Its commonest cause is the rupture ofa pregnant tube where it is not covered with peritoneum,but is in contact with the cellular tissue (Fig. 106). It some-times happens after operations on the broad ligament, if avessel underneath the peritoneum is injured without a breachof that membrane. Mr. Lawson Tait thinks it commonfrom sudden arrest of haemorrhage from the uterus ; but I am 3U DISEASES OF WOMEN. sure it is not common, and I doubt whether it is producedby this cause. I know of no other causes for it. I havepublished a case in which it was thought due to the haemor-rhagic diathesis; * but the effusion was very old, and mayhave been from extra-uterine gestation, the frequency of whichwas not known at that time.
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Fig. 106.—Diagram illustrating modes of rupture of Fallopian tube. (Lawson Tait.) The left-hand figure shows rupture of tube on its peritoneal aspect: the right-hand figurerupture of the tube at the part in contact with the cellular tissue of the broad ligament.B, wall of tube ; a, seat oi rupture. Physical signs.—Bleeding in this situation takes placeunder pressure. The blood is confined above by the perito-neum, below by the pelvic fascia. It is poured out on one side.When there is enough to force its way across to the other side,it makes its way back by the side of the rectum to the pelvicwall. The shape of the blood effusion comes from its limits.Mr. Lawson Tait has happily compared it to a jelly-fish,rounded above, concave below. The effusion seldom rises * Obst. Journal, vol. t. PELVIC HEMATOCELE. 315 above the pelvic brim, but it may do so, and then it formsa rounded, well-defined tumour, over which, before the bloodhas clotted, fluctuation may be felt. Below, the mass slop

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