KETROUTERINE H^EMATOCELE. 



or less violence, according as the expulsion of the membrane and 

 blood is retarded or accelerated. The diagnosis depends upon dis- 

 covery of the membrane. 



The prognosis and treatment of dysmenorrhcea must of course 

 depend mainly upon a true understanding of its cause. Obstructive 

 dysmenorrhcea is best treated by artificial widening of the cervical 

 canal, either by bloodless dilatation, or else by incision or divulsion, 

 which give far better results. For details we refer to the text-books 

 on surgery. In membranous dysmenorrhcea, the objects of treatment 

 should be the metritis and endometritis, regarded by some as the 

 causes of the symptoms. When no complication forbids it, after 

 subsidence of the period we may resort to applications of nitrate of 

 silver, liquor ferri sesquichloridi, carbolic acid, or tincture of iodine 

 in the cavity of the uterus, always observing the precautions given 

 elsewhere. Although the result will probably not be perfect, yet a 

 thinning oj temporary arrest of the membranous formation may be 

 obtained. Here, too, in obstinate cases, dilatation of the uterine 

 neck may facilitate the escape of the decidua, and thus diminish the 

 uterine colic. Violent pain is to be allayed by opiates, either by 

 the mouth, rectum, or hypodermic injection, and by hot compresses 

 to the belly. If there be fever, and the pain assume an inflamma- 

 tory type, an acute metritis or perimetritis is to be feared, and 

 proper steps should be taken to meet it.] 



CHAPTER X. 



RETROUTERINE H^EMATOCELE H^EMATOMA RETRO UTERINTJM PEL- 

 VIC H^MATOCELE. 



[THE French were the first, and Nelaton was the foremost, 

 who investigated the subject of retrouterine hsematocele, and fixed 

 its position as a form of disease. The seat of a hsematoma may be 

 either within or without the peritoneal sac. The latter is very rare, 

 occurring from haemorrhages into the areolar tissue surrounding the 

 cervix and vagina, ..and into that between the folds of the broad 

 ligaments of the womb. These extravasations do not present any 

 very definite symptoms, but merely form a tumor of variable char- 

 acteristics. As regards the intraperitoneal haematoma, of which 

 alone we now treat, let us premise that it is not every free accu- 

 mulation of blood in the peritoneal sac that is included under this 

 term ; for a free collection of blood, like a free effusion of serum, 

 cannot at first present to the touch a well-defined tumor. "We limit 



