Reprinted from the NEW YORK JOURNAL OF GYNAECOLOGY AND 
OBSTETRICS for February, 1893. 
CASES OF HAEMATO-SALPINX AND HAEMATOMA 
RESEMBLING ECTOPIC GESTATION.1 
Edwin B. Cragin, M. D. 
New York. 
The present, more perhaps than any previous age in the medical 
world, seems to be characterized by ambition for long series of opera- 
tions ; nor is this confined to what might be called the younger mem- 
bers of the profession, for we see, apparently fired by the same 
ambition, men whose heads are gray and whose fame is far-reaching. 
Just as Appendicitis among the general surgeons has of late held 
the honor of being the popular condition for operation, so, among the 
gynaecologists, cases of ruptured ectopic gestation may be said to have 
held a similar position. 
Even the most conservative must allow that there is marked 
pleasure in saving by operation, patients on the verge of death from 
internal hemorrhage, and the writer admits that he has not been 
absolutely free from the prevailing ambition for a large experience in 
operations of that variety. Such being the case, while preparing a 
paper a few weeks ago on " Operative Experience with Ectopic Ges- 
tation," for the Orange Co. Medical Society, I was somewhat disap- 
pointed to find that my cases, then almost a dozen, resembling ectopic 
gestation, when studied under the light of the microscope and careful 
investigation, gave me only six (since increased by one), that I could 
honestly say were undoubted examples of that condition. 
Feeling that my experience must be paralleled by that of many 
others, and believing that cases are reported as ectopic which are open 
to doubt, it seemed best, when unexpectedly asked for a paper before 
this society, that I should present my doubtful cases and ask for a 
discussion of the same. 
Before proceeding further, I should like to state that in the use of 
the terms "Haemato-Salpinx" and " Haematoma," I mean by the former 
simply a collection of blood in the tube, and by the latter, an effusion 
of blood between the folds of the broad ligament without in either case 
implying a source or cause of the hemorrhage. 
'Read before The New York Obstetrical Society, December 6, 1892. 2 
Edwin B. Cragin, M. D. 
The patients were all operated upon by me at the Roosevelt 
Hospital and with the assistance of the house staff of that institution. 
Case I. Mrs. Z., aet. 43 ; native of Syria, admitted to the Roose- 
velt Hospital August 23, 1889. She speaks neither English, French nor 
German, hence her history is very incomplete; seems to be in pain. 
Vaginal examination shows a hard mass behind and to the right of 
the uterus. 
Temperature on admission, 100.5; pulse, 80. Patient had a rise 
of temperature for several days. 
August 28th. Abdominal section ; mass ligated in section and 
removed. It had the gross appearance of a gestation-sac and was so 
diagnosed at the time, but examination of the contents showed only 
blood-clots. During the operation the vermiform appendix was removed 
as it appeared diseased. 
September 5th, eight days after operation, the patient passed 
three feet of tape-worm. 
Patient made a good recovery. 
It was thought before operation that the temperature was due to 
the pelvic mass and this was one of the reasons for the operation, but 
as it continued for some little time after operation and finally responded 
to anti-periodic measures, it was probably of malarial origin. 
This case of itself has little value, as the previous history was 
negative. It is only cited as one resembling an ectopic gestation in 
gross appearance, but in which the positive proofs were not present in 
the sac. 
Case II. Mrs. H. F. ?Et. 30. Admitted to the Roosevelt 
Hospital, Sept, n, 1889. Has been married ten years; has had four 
children and no miscarriages; last child two years previous. Men- 
strual history normal in frequency and amount, but painful. Last 
menstruation ten days ago. Present illness began nine months ago 
with pain in left iliac region, increased at menstruation and continuing 
until the present. Examination on admission revealed a firm, sensitive 
mass at the left of and behind the uterus. 
Sept. 13th. Abdominal section. The mass was ligated in section 
and removed. The outer half proved to be the left ovary and tube 
the latter markedly distended with blood, and looking like a gestation- 
sac, but found on examination to be a hsemato-salpinx with retained 
menstrual blood,'for to my surprise the remaining half of the mass 
proved to be one horn of a uterus bicornis. The cavity of the ampu- 
tated horn had no communication with the canal of the cervix: thus we Cases of Hcemato-Salpinx and Hematoma, Etc. 
3 
had a hsemato-metra and hgemato-salpinx resulting from an atresia. 
Patient made an easy recovery. 
Case III. Mrs. B. yEt 26. Admitted to the Roosevelt 
Hospital, Sept. 19, 1889. Has been married three years; has had 
two children and no miscarriages; last child born eight months ago. 
Previous menstrual history normal; last regular period occurring 
July 4th. July 14th patient had severe pain in lower part of abdomen, 
felt faint, and began flowing. This flow has continued till the present, 
seven weeks in all. This was the story given by the patient before 
operation. 
Examination showed a large mass on the right side of the uterus, 
and bulging downward. Patient was evidently septic. Temperature, 
102; pulse no. September 20th. Abdominal section. The mass was 
found to be a haematoma, with coils of intestine adherent all over the 
surface. The mass was then incised from the vagina, emptied of a 
large number of very foul-smelling blood-clots and drained. The case 
at the time of operation was considered one of ectopic gestation, but 
only blood-clots were found, and close investigation of the early history 
of the patient's illness revealed the fact that at the time of her first 
sharp pain and feeling of faintness, she was hanging out clothes upon 
the roof and made a misstep. This explains the case, I think, as one 
not of ectopic gestation but of pelvic haematoma from the rupture of 
one of the vessels between the folds of the broad ligament. The 
patient made a prompt recovery. 
Case IV. Mrs. L. ALt. 24. Admitted to the Roosevelt 
Hospital, August 10, 1891. Has been married two years; never 
pregnant. For the last four years has had pains, at in'.ervals, in the 
left iliac region and her menstrual periods have been irregular, patient 
going four and a half to seven and a half weeks without menstruating. 
Her menstruation appeared normally in May; none in June. In 
July, eight weeks from her last period, she noticed a dirty brownish 
discharge, and this has continued until the present. She has several 
times passed clots of blood preceded by crampy pains. One week 
before admission she had an attack of very severe pain, vomited and 
fainted; this was repeated in three hours. After this the patient 
improved but still had pain. On the right side of the uterus, an elon- 
gated doughy mass could be felt. 
After the employment of numerous palliative measures, with but 
little benefit, abdominal section was performed August 26, 1891. The 
ipass on the right side proved to be a hsemato-salpinx containing 4 
Edwin B. Cragin, M. D. 
organized blood-clots. The left appendage was also found diseased 
and removed. The haemato-salpinx was thought, at the time, both by 
the operator and by spectators, an example of ectopic gestation, but a 
careful examination by the pathologist showed only blood-clots and a 
salpingitis. 
I am sorry to say that the result of the operation was unfavorable, 
as the patient died on the eight day. At the time of her ■ death I con- 
soled myself with the thought that she died of nephritis, as her urine 
was markedly diminished for several days after operation, and con- 
tained albumen and casts, but a careful study of her temperature, pulse 
and urine, convince me that she probably died of sepsis, the source of 
which I know not, and that her nephritis was a result of her sepsis. 
Case V. Mrs. B. 2Et. 22. Admitted to the Roosevelt Hospital, 
July 27th, 1892. Has been married two years; has had one child 
five and a half months ago, the child dying on the third day. Since the 
birth of child, menstruation has been regular till 'two months ago, 
when she flowed for twelve days instead of the usual five. This flow 
appeared just 28 days from her last menstruation. After an interval 
of a few days the flow returned and she has suffered with menorrhagia 
and metrorrhagia until the present, now two months in all. She has 
had no attacks of pain. 
Examination disclosed a firm mass on the right of the uterus and 
posterior, pushing the uterus somewhat to the left. 
August 1 st. Abdominal section and removal of the right appendage. 
The mass was a hsemato-salpinx and resembled an ectopic gestation- 
sac, but here again we could find no proof of it. I made sections from 
a number of places in the sac and contents and a number of slides from 
each section, but could find only blood-clots and the tubal mucous 
membrane. Not satisfied with relying on my own examinations, I 
showed my slides to several pathologists, but with the same result; we 
could only call the case a haemato-salpinx. The patient made a rapid 
and perfect recovery. । 
Case VI. Mrs. C. 2Et. 23. Admitted to the Roosevelt Hospital 
Oct. 30th, 1892. Has been married six years; has had two children 
and two miscarriages. Her last miscarriage occurred May 30th, 1892. 
Three months after miscarriage, or two months before admission, she 
began to have crampy pains in the lower part of her abdomen; at 
first only occasional, then more frequent. Up to this time her men- 
struation had been normal, but since then she has had menorrhagia 
and metrorrhagia. She had gone six days past her time for menstrua- Cases of Hcemato-Salfinx and Hcematoma, Etc. 
5 
tion when she had her first attack of pain, felt faint, and began to flow. 
The patient says that a fortnight previous to this, she had felt badly 
"all over" after diving at the seaside, but had very little pain then. 
Examination on admission showed, on the right side of the uterus, and 
somewhat posterior, a large sausage-shaped mass. 
November 5th. Abdominal section. The mass on the right side 
proved to be a haemato-salpinx and was removed; also the left append- 
age which was diseased. The haemato-salpinx had the gross appear- 
ance of an ectopic gestation-sac, but here again neither the pathologist 
of the hospital nor myself could find any evidence of impregnation. 
The patient made a prompt recovery. 
Regarding some of the cases the writer admits that he cannot posi- 
tively exclude ectopic gestation and yet he has failed to find proof of 
its presence even after the most careful search, and that too when pre- 
judiced in favor of finding it. Case IV gave perhaps the clearest his- 
tory of an ectopic gestation, as she had gone for eight weeks without 
menstruating, and at the end of three months had an attack of sharp 
pain, faintness, etc., so frequently seen in that condition. If we study 
the history of the case, however, we find that on previous occasions 
she had had periods of amenorrhoea of as long as seven and a half 
weeks' duration, so that the postponement of menstruation in her pre- 
sent illness was only three or four days longer than had occurred before, 
and if pregnant for a period at all commensurate with the duration of 
her amenorrhoea, it certainly seems probable that we should have found 
either a foetus or chorionic villi, as the blood clots were encapsulated 
and they and the sac were carefully preserved. 
Before accepting the probability that the cases of the above series 
were not those of ectopic gestation, we must first decide the question 
as to the possibility of a haemato-salpinx apart from the presence of an 
ectopic gestation. The writer from his own experience must answer 
this in the affirmative, nor does he stand alone. Galabin, at a meeting 
of the Obstetrical Section of the British Medical Association, July, 
1892, says1: "If there is no embryo, no obvious placental tissue, and 
merely a mass of clot distending the tube, or extending out of it, the 
opinion of microscopists might possibly differ as to the recognition o 
very scanty traces of chorionic villi amongst the clot. At any rate I 
have been convinced from my own experience that such a clot may be 
formed in a Fallopian tube, with open extremity, without any extra- 
uterine foetation at all." 
'British Medical Journal, August 6th, 1892. 6 
Edwin B. Cragin, M. D. 
Again, Bland Sutton at a meeting of the Medical Society of London, 
November 7th, 1892, makes the following statement1: "Every blood- 
clot in the tube is not necessarily a tubal mole, for it is certain that 
blood-clot may be present in the tube apart from pregnancy." 
There certainly was a similarity in the symptoms of most of the 
above cases and those of ectopic gestation, especially in menorrhagia 
and metrorrhagia, and yet we find it just as marked in case III as in the 
others, and here the condition was that of a haematoma, caused in all 
probability by the misstep and fall upon the roof. Furthermore we 
have probably all seen cases with menorrhagia and metrorrhagia asso- 
ciated with a tube distended with serum or pus. 
There was one feature presented in a number of these cases which 
is certainly not the rule in ectopic gestation, i. e. a recent pregnancy. 
Three of the six cases had been pregnant within nine months of their 
admission to the hospital; one, five months before ; another, five and 
a half; another, eight; and from one case we could get no previous 
history. 
Concerning the cause of hsemato-salpinx or a haematoma, apart 
from the presence of an ectopic gestation, we are still very much in 
the dark. It seems fairly clear, however, that of the abov,e six cases, 
in one the cause was atresia, in another a misstep, and in the last case 
it seems perfectly possible that the diving at the seaside, although it 
preceded by a fortnight the onset of the acute symptoms, may have 
been the cause of the hsemato-salpinx found at the operation. The 
presence of a recent pregnancy in some of the cases suggests also a 
possible cause in subinvolution or congestion of the tube. 
For the other cases I can assign no definite cause, but that a 
hemorrhage should occur from the mucous membrane of a tube the 
seat of a chronic inflammation or congestion does not seem at all 
improbable, the exciting factor being perhaps a traumatism' so slight as 
to be unnoticed or forgotten. 
In conclusion the writer believes that most of the cases of hsemato- 
salpinx and hsematoma are due to the presence of an ectopic gestation, 
but in many cases no proof of that condition can be found, and some 
are in all probability due to other causes ; furthermore that the cases 
in which we can find neither foetus, chorionic villi, nor decidua, should 
in the present state of our knowledge, not be reported as cases of 
ectopic gestation. 
62 West 50th Street. 
'British Medical Journal, November 12th, 1852.