The pathology and treatment of childbed : a treatise for physicians and students. ... From the second German edition with many additional notes by the author / by Dr. F. Winckel; translated by James R. Chadwick.

Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: The pathology and treatment of childbed : a treatise for physicians and students. ... From the second German edition with many additional notes by the author / by Dr. F. Winckel; translated by James R. Chadwick. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    giv'e WRV during tli6 foriiiJitiou of the tumor, tlie rupture Rud evacuation take place on the following days (N'o. 11); I found that this occurred spontaneously within the iirst eight days in 23 cases out of 50 reported in modern literature; it happens generally, however, in the first tliree days; in Hugenberger’s 11 cases it took place spontaneously five times. After evacuation a secondary hemorrhage may set in, and the cavity be filled anew (Haase, D’Outrepont, and Dewees). If gangrene of the vulva follows perforation, septicemia may succeed, to which women often succumb (Lubanski, Braun). Fistulous passages have frequently formed, leading from the suppurating cavity to the vagina, through the perineum (D’Outrepont, 2 cases), or into the rectum, Avhich processes reduce the patient by the tedious fever and great suppuration thereby superinduced, while they heal but slowly. The various results are: (1) death by hemor- rhage without an antecedent rupture, or subsequently to it; (2) death from suppuration of the sac with subsequent septi- cemia or septico-pyemia; most commonly after rupture or perforation of the walls; (3) rupture and recovery ; (4) rup- ture and subsequent fistulse ; (5) absorption without rupture, and perfect recovery. Diagnosis.—The recognition of these effusions of blood are, on the whole, simple. Deneux, to be sure, narrates several in- stances in which they were mistaken for varicose tumors of the labia majora, with labial hernia or inversion of the vagina, and Dryer describes a case in which he reduced a tumor of the right vulva, as large as a fist, bj'- means of compression (?),but the tumor returned (1826). The cases date, however, from a period when these tumors were but little known. Their rapid development and growth, the bluish color of the overlying integument, the pain, the elastic nature, occasionally even the fiuctuation, besides the sudden symptoms of anemia, without hemorrhage within the uterus or externally, can admit of no doubt that we have to do with an effusion of blood into the parenchyma. The distended condition of the parts must be ascertained by digital exploration through the vagina and rectum. It is only in those cases where the physician is present during the formation of the tumor itself, that it can be defi- nitely determined whether the wounded vessel belongs to the 10