Cases with the gravest aspect generally recover if kept absolutely at rest and under the influence of opium; and meddling by making repeated examinations and explorations is to be condemned. Many remedies may be tried with the view of arresting the internal haemorrhage; of these, Ergot is the one most useful; it may be given hypodermically, or by the mouth in full doses. Chloride of Calcium, 20 grs. every two hours, is sometimes very efficient. Suprarenal Gland substance, in closes of 5 to 15 grs., will sometimes give striking results. Gallic or Tannic Acid, Digitalis, Turpentine, Acetate of Lead, Iron, &c., may possibly only tend to divert the physician's mind from the administration of opium, which, after all, is the remedy upon which the patient's safety depends.
In the face of a rapidly increasing internal haemorrhage, the operation of opening the abdomen and securing the bleeding vessels may be weighed. If extra-uterine gestation or an ovarian saris is diagnosed this will be justified, but the hope of securing the vessels, from which an ordinary pelvic hmmatoma is fed, is indeed visionary, and the vast majority of cases so treated would probably have their chances of recovery sadly minimised by such an attempt.
The subsequent treatment will be that of peritonitis, pelvic cellulitis, or pelvic abscess. When the shock and collapse have passed away, the resulting peritoneal mischief will call for sedative measures constitu tionally and locally. Opium should be still our mainstay, and until all danger of further has passed away cold compresses are to be preferred to hot poultices. These local anodynes are invaluable at
a later stage when pelvic cellulitis is established. Iodide of Potassium, or mild Ifercurials, may be given with the view of causing absorption.
In the great majority of cases, the effused blood will either become absorbed, or an abscess will form, which, if left alone, will find its way into the bladder, bowel, vagina, uterus, or through the skin. The practice of puncturing the tumour through the rectum or vagina is followed by some surgeons; there cannot he a doubt that such a routine practice is a serious mistake. When there is evidence that suppuration is already established, and the symptoms and signs lead one to believe that there is danger of the sac bursting into the peritoneal cavity, if a bulging soft point is felt in the vagina or rectum, to wait for spontaneous rupture might he a fatal blunder. The aspirator should be discarded, and a large trochar and canula, such as is used for puncturing the bladder, may be selected, and the canula should be driven well home after the withdrawal of the trochar. Should the contents of the cavity consist of coagula, as well as purilorm fluid, the opening should be freely enlarged, and the sac well washed out with warmed solutions of Corrosive Sublimate or Condv's fluid, injected from time to time through the ordinary enema apparatus, to which a large, soft catheter may be attached. Vaginal puncture is preferred to anal.