166 DISEASES OF THE UTERUS. 



the term to those bloody effusions which are cut off from the peri- 

 toneal sac above them, and which are completely enclosed by inflam- 

 matory exudation and adhesion, so that they may exhibit all the 

 qualities of a tumor. It is true that a free extravasation, after the 

 blood has coagulated, may present to the examiner's touch an object 

 of a certain solidity and firmness ; but it does not offer the resist- 

 ance opposed by the tensely-stretched walls of the encapsulated 

 blood-tumor, into the cavity of which more and more blood is es- 

 caping, nor does it displace the neighboring organs. The effused 

 blood usually collects in the most dependent part of the peritoneal 

 cavity, the deep pouch between womb and rectum known as Doug- 

 las's cul-de-sac. It pushes the womb forward and upward, and the 

 rectum backward. Douglas's fold is forced downward upon the 

 posterior vaginal fornix, thus forming a large tumor, which may 

 even extend upward above the brim of the pelvis. 



An anteuterine hsematocele, which is a very great rarity, con- 

 sists in an encapsulated blood-tumor situated in the shallow anterior 

 pouch between the bladder and the womb. An intraperitoneal 

 haematoma may form in one of two ways : Either the haemorrhage 

 takes place within a closed pouch already formed by previous peri- 

 tonitic adhesions, or else the bleeding may come first, and the encap- 

 sulation follow as a result of adhesive peritonitis which the contact 

 of the effused blood excites in the peritonaeum of the superimposed 

 coils of intestine. The capsule once closed, a further extravasation 

 may distend the sac and gradually displace the neighboring organs. 



The sources of pelvic haemorrhage are many and diverse, and 

 during life they can, as a rule, only be conjectured. The bleeding 

 proceeds most often from the ovarian vessels, and the insignificant 

 physiological loss of blood which accompanies rupture of a Graafian 

 vesicle may be aggravated into a profuse and alarming haemorrhage. 

 This may take place as a consequence of an excessive hyperaemia of 

 the sexual organs, caused by violent exertion, or by blows, falls, 

 mental excitement, masturbation, or coitus. Various diseases of 

 the ovary, such as inflammation with abscess, bursting of a haemor- 

 rhagic cyst, or rupture of a superficial varicose vessel, may have a 

 like effect. In certain disorders of the tubes, so large an accumula- 

 tion of blood or of inflammatory exudation may form in them as 

 to result in rupture or perforation of their walls. It is less probable 

 that the blood can accumulate in the tubes (as it does in the womb 

 in haemometra), and thence can pass through the abdominal opening 

 into the peritonaeum in sufficient quantity to form a tumor. It has 

 long been known that by the bursting of a tubal or extrauterine preg- 

 nancy, if the resulting haemorrhage is not speedily fatal, a haematoma 



