

CONTRACTIONS AND CLOSURES OF THE UTERUS. 139 



In the monthly attacks the pains become very severe. The patients 

 emaciate, and may become marasmic ; or, if no mode of escape be 

 furnished for the blood, the uterus may rupture, or they may die of 

 peritonitis. The latter disease is particularly apt to occur if the 

 tubes be also filled with blood, and their contents escape into the 

 abdomen. Hsemometra cannot be recognized with certainty, or 

 distinguished from other forms of amenorrhoea or dysmenorrhcea, 

 particularly at its commencement, without a careful local examina- 

 tion. If, at the commencement of puberty, there be uterine colic 

 at regular intervals of four weeks, while there is no escape of blood, 

 and if there be, at the same time, a distention of the abdomen, 

 which periodically increases slightly, we should suspect the develop- 

 ment of a haemometra, and urge an examination. If the haemome- 

 tra depend on atresia of the vagina, we find the latter distended to 

 a tense tumor, whose lower end extends into the vestibule. If the 

 external os uteri be closed, the vaginal portion is often entirely 

 obliterated, and the position of the os uteri may not be recogniza- 

 ble. If, on the other hand, the internal os uteri be closed, the vagi- 

 nal portion may retain its normal length. Besides this, we find the 

 uterus distended to a considerable size ; sometimes, but not always, 

 there is fluctuation. The treatment of haemometra is purely sur- 

 gical. 



It is rarely that a haemometra terminates favorably without the 

 intervention of skilled assistance. In such exceptional cases the 

 blood finds a way either through the normal passages or else into 

 one of the abdominal cavities. Sometimes menstruation ceases pre- 

 maturely, or the climacteric arrives, when the symptoms abate, and 

 the bloody contents of the uterus assume the character of hydro- 

 metra. The treatment of haemometra is purely surgical, and con- 

 sists in opening the sac between two menstrual periods. The mode 

 of operation must necessarily vary greatly according to the circum- 

 stances of the case. The procedure is a somewhat dangerous one, 

 and demands attentive study in the books of surgery and gyne- 

 cology. 



Of course, hydrometra can only result from acquired closure of 

 the os uteri or vagina, and after the menses have ceased. Mild 

 cases of the disease #re seen quite often ; severer cases, where the 

 uterus is distended to the size of a head or larger, are rare. The 

 most important symptom of bydrometra is an enlargement of the 

 uterus, which usually occurs gradually, and without exciting atten- 

 tion, while in some few cases it is quite rapid and decided. This 

 may be detected on physical examination, and is often even per- 

 ceived by the patient. If the walls of the distended uterus be 



