. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. y be lesscircumscribed, and in some cases the tumor is felt to surround theuterus on all sides. The vaginal Avail is pressed downwards, andits canal thus encroached upon, according to the size and relationsof the tumor. * Obstetrical Transactions, vol. v. f Ed. Med. Journ., Sept., 1862. PEKI-UTERINE HiEMATOCELE. 171 The physical examination of the tumor, as eflfected by a vaginaldio-ital examination, may, or may not, enable us to arrive at adiagnosis of its nature, but the physical examination,
. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. y be lesscircumscribed, and in some cases the tumor is felt to surround theuterus on all sides. The vaginal Avail is pressed downwards, andits canal thus encroached upon, according to the size and relationsof the tumor. * Obstetrical Transactions, vol. v. f Ed. Med. Journ., Sept., 1862. PEKI-UTERINE HiEMATOCELE. 171 The physical examination of the tumor, as eflfected by a vaginaldio-ital examination, may, or may not, enable us to arrive at adiagnosis of its nature, but the physical examination, the symp-toms presented by the patient, and the history of the case, alltaken together, usually render the formation of a diagnosis com-paratively easy. Diagnosis of Peri-uterine Hoematocele from other Tumors. The history is of the most assistance in a doubtful case. Thetumor most resembles that produced by pelvic cellulitis ; from itit is distinguished by the suddenness of its occurrence, by theabsence of that hot, puffy condition of the vagina, characteristic of Fig. 7.* /, ^ / ///, I ij;t- I. the induration stage of pelvic cellulitis, by the absence of constitu-tional fever, and by the absence of the thickened brawn-like con-dition of the vaginal wall. (Simpson.) The tenderness may bepretty nearly equal in both. In some cases, the hemorrhagiceffusion undergoes after a time a sort of suppuration, and thephysical characters may then be identical with those of pelvicabscess. It will thus be seen that the diagnosis of hsematocele * Fig. 7 shows the position of the tumor, as felt from the vagina, in a caseunder my care at University College Hospital. Further illustrations will befound in the chapter on Hsematocele. 172 DIAGNOSIS. from abscess is at first easy, but that it maybe more difficult fibroid tumor, peri-uterine hpematocele is distinguished byits want of uniformity and comparative want of solidity. Thediagnosis of (unruptured) extra-uterine pregnancy, from peri
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