Hematoma of the Vulva 865 



curred along the floor of the vulva near the median line ; in the 

 other it was well up along the side of the organ. 



The symptoms are very characteristic when the blood has be- 

 come collected in a large mass, because it pushes the mucous mem- 

 brane outward into the cavity of the vulva, so that the volume 

 of the tumor projects beyond the surface of the surrounding tis- 

 sues and may become pedunculated or pear-shaped. It may pro- 

 ject quite beyond the lips of the vulva, especially when the ani- 

 mal is lying down, and may usually be seen very well by parting 

 the lips of the vulva with the hands. Upon palpation the tumor is 

 comparatively soft and painless. When so situated that it can 

 be seen, it is observed to be of very dark color, which indicates its 

 character. 



It is important to make a clear differential diagnosis of 

 hematoma. In one of our cases the tumor was distinctly pedun- 

 culated, and so extensive that it protruded beyond the lips of 

 the vulva whenever the animal was lying down, and it was .so 

 near to the median line and immediately in the neighborhood of 

 the meatus urinarius that it was at first mistaken for the everted 

 bladder. Further examination revealed the meatus, and estab- 

 lished the fact that the bladder w^as in its normal position. 



In some cases there may be a very general extravasation of the 

 blood into the ti-ssues, over a large area. This we frequently 

 meet with in practice, where dystokia has existed, especially if 

 rudely handled by laymen or empirics, and the vulva and vagina 

 greatly abraded and irritated by rough hands and apparatus, or 

 with hard, rough cords. vSuch extravasations are not of a char- 

 acter generally to cause serious trouble, but are after a time 

 absorbed . 



The handling of hematoma usually consists merely of making 

 a free opening through the mucous membrane and pressing out 

 the blood clots, after which the vulva should be cleansed with 

 an antiseptic solution. In our experience it is easy to thrust a 

 finger through the mucous membrane, and thus produce an 

 extensive opening, which will not adhere and retain discharges 

 later. This method of evacuating the blood coagula has an 

 element of safety in it, because there is no danger of wounding 

 any blood vessels which by chance may be di.splaced because of 

 the lesion. 

 55 



