There is no difficulty in the diagnosis of vaginal luematomata. Even if the tumor remains hidden in the vagina, it is easily accessible to the finger and can be well exposed with the Sims speculum. Once exposed to view, its smoothness, softness, and hemorrhagic discoloration are char acteristic. As a rule the tumor is broad-based; but Fehling, Reich, and Anderson, as well as I, have seen some which were provided with a kind of pedicle; the columna rugiirum, or a rudimentary septum vaginale, being the seat of the tumor. The sudden origin of the mass, and the presence of the above-mentioned characteristics, will complete the diag nosis, if that be necessary. Not infrequently the nature of the tumor is rendered plain by certain parts of its walls being thin, or even being rup tured, so that the contained blood can be easily seen.
In regard to treatment, we will be careful to follow here also the gene ral rules laid down for hiematomata of the genitals. Incision should not be done unless necessary, and any openings which may exist are to be used for the removal of coagula. This can often be accomplished by sim ply compressing the mass between vagina and rectum. But incision may become necessary. If the tumor forms an obstacle to delivery, or if the tension it causes gives rise to too much pain, it should be done; at3 also when the tumor is no longer increasing in size, and the coagula are under going septic decomposition from infection through the niptured places or in some other way, and the orifices present are not sufficiently large to permit free outflow.
The danger of setting up renewed hemorrhage is greater, of course, the earliefan incision is made; and is not entirely absent even in cases several days old. If, as will in very exceptional cases be the fact, a spot in the ruptured tissue can be seen with the speculum, on compression of which the hemorrhage stops, it should be at once ligated. Usually, however, we must rely upon compression of the sac after it has been thoroughly washed out and disinfected. It is to be remembered, however, that a too firm tamponing may stretch the vagina too much; and that, besides being unreliable, it will not be borne by the patient. If the opening into the sac is large, small pledgets of absorbent cotton attached. to strings, and steeped in styptic solutions (liquor ferri), or strips of iodoform gauze may be introduced directly into the sac; and they can be retained in sites by vaginal tampons, while a T-bandage with a hypogastric compress may help to fix the uterus. When the hemorrhage has definitely ceased, we must turn our attention to the prevention of the stagnation of the accu mulated secretion in the vagina and the blood sac. For this purpose antiseptic injections are best, with antiseptic tamponade between times, to favor contact and union of the walls of the sac.