412 Diseases of the Genital Organs 



When the hematoma is discovered during the examination 

 of the genital organs, it is doubtful just what course is best 

 to pursue. I have followed the plan of dislodging it and 

 turning it free into the peritoneal cavity, but have always 

 taken the precaution of applying digital compression to the 

 ovary for some minutes after the dislodgment of the hema- 

 toma, and watching very closely to see that the hemorrhage 

 did not recur. This appears to me to be the better course 

 because, unless the hematoma is dislodged, so far as I am 

 able to determine, it will result in a hemorrhagic corpus 

 luteum, which will undergo cystic degeneration and will 

 inhibit estrum for a long period of time. 



The cause of this excessive hemorrhage is undetermined, 

 but it is apparently due to the presence of an infection in 

 the ovary which has depressed the tonicity of the blood ves- 

 sels, causing them to bleed freely upon the slightest inter- 

 ference. So far as I have observed, the prognosis is good. 



5. Hemorrhagic Corpus Luteum 



The excessive hemorrhage into the crater of the ruptured 

 ovisac, described in the preceding paragraph, when left un- 

 disturbed, regularly leads to a hemorrhagic corpus luteum, 

 so far as I am able to determine. Eventually, also, the 

 hemorrhagic corpus luteum generally, if not always, results 

 in cystic degeneration. The lutein tissue itself, under these 

 conditions, ordinarily acquires its normal volume, or may 

 exceed it somewhat. Accordingly the blood clot adds to the 

 volume of the corpus luteum, so that in numerous instances 

 it reaches, as palpated per rectum, a diameter of one to two 

 or more inches (Hypertrophied Corpus Luteum). Between 

 the physiologic blood clot in the corpus luteum and the maxi- 

 mum amount of blood described, there is every possible 

 gradation in amount. 



Clinically it is impossible to diagnose directly the hemor- 

 rhagic corpus luteum. A tentative diagnosis may be made, 

 based upon the increased size of the corpus luteum. The 

 hemorrhagic corpus luteum tends to persist for an indefinite 

 period, inhibiting estrum until it finally disappears by cystic 



