anomalies and curiosities of medicine-第175部分

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ere　distinct　signs　of　acute　peritonitis。　After　investigation　it　was　proved　that　a　drunken　glass…blower　had　been　seen　leaving　her　house　with　his　hand　and　arm　stained　with　blood。　In　his　drunken　frenzy　this　man　had　thrust　his　hand　into　the　vagina；　and　through　the　junction　of　its　posterior　wall　with　the　uterus；　up　into　the　abdominal　cavity；　and　grasped　the　uterus；　trying　to　drag　it　out。　Outside　of　obstetric　practice　the　injury　is　quite　a　rare　one。

There　is　a　case　of　death　from　a　ruptured　clitoris　reported　by　Gutteridge。　The　woman　was　kicked　while　in　a　stooping　position　and　succumbed　to　a　profuse　hemorrhage；　estimated　to　be　between　three　and　four　pounds；　and　proceeding　from　a　rupture　of　the　clitoris。

Discharge　of　Vaginal　Parietes。Longhi　describes　the　case　of　a　woman　of　twenty…seven；　an　epileptic；　with　metritis　and　copious　catamenia　twice　a　month。　She　was　immoderately　addicted　to　drink　and　sexual　indulgence；　and　in　February；　1835；　her　menses　ceased。　On　May　8th　she　was　admitted　to　the　hospital　with　a　severe　epileptic　convulsion；　and　until　the　18th　remained　in　a　febrile　condition；　with　abdominal　tenderness；　etc。　On　the　21st；　while　straining　as　if　to　discharge　the　contents　of　the　rectum；　she　felt　a　voluminous　body　pass　through　the　vagina；　and　fancied　it　was　the　expected　fetus。　After　washing　this　mass　it　was　found　to　be　a　portion　of　the　vaginal　parietes　and　the　fleshy　body　of　the　neck　of　the　uterus。　The　woman　believed　she　had　miscarried；　and　still　persisted　in　refusing　medicine。　Cicatrization　was　somewhat　delayed；　immediately　on　leaving　the　hospital　she　returned　to　her　old　habits；　but　the　pain　and　hemorrhage　attending　copulation　was　so　great　that　she　had　finally　to　desist。　The　vagina；　however；　gradually　yielding；　ceased　to　interfere　with　the　gratification　of　her　desires。　Toward　the　end　of　June　the　menses　reappeared　and　flowed　with　the　greatest　regularity。　The　portions　discharged　are　preserved　in　the　Milan　Hospital。

The　injuries　received　during　coitus　have　been　classified　by　Spaeth　as　follows：　Deep　tears　of　the　hymen　with　profuse　hemorrhage；　tears　of　the　clitoris　and　of　the　urethra　（in　cases　of　atresia　hymenis）；　vesicovaginal　fistula；　laceration　of　the　vaginal　fornices；　posteriorly　or　laterally；　laceration　of　the　septum　of　a　duplex　vagina；　injuries　following　coitus　after　perineorrhaphy。　In　the　last　century　Plazzoni　reports　a　case　of　vaginal　rupture　occurring　during　coitus。　Green　of　Boston；　Mann　of　Buffalo；　Sinclair　and　Munro　of　Boston；　all　mention　lacerations　occurring　during　coitus。　There　is　an　instance　recorded　of　extensive　laceration　of　the　vagina　in　a　woman；　the　result　of　coitus　with　a　large　dog。　Haddon　and　Ross　both　mention　cases　of　rupture　of　the　vagina　in　coitus；　and　Martin　reports　a　similar　case　resulting　in　a　young　girl's　death。　Spaeth　speaks　of　a　woman　of　thirty…one　who；　a　few　days　after　marriage；　felt　violent　pain　in　coitus；　and　four　days　later　she　noticed　that　fecal　matter　escaped　from　the　vagina　during　stool。　Examination　showed　that　the　columns　of　the　posterior　wall　were　torn　from　their　attachment；　and　that　there　was　a　rectovaginal　fistula　admitting　the　little　finger。　Hofmokl　cites　an　instance　in　which　a　powerful　young　man；　in　coitus　with　a　widow　of　fifty…eight；　caused　a　tear　of　her　fornix；　followed　by　violent　hemorrhage。　In　another　case　by　the　same　author；　coitus　in　a　sitting　posture　produced　a　rupture　of　the　posterior　fornix；　involving　the　peritoneum；　although　the　patient　lost　much　blood；　she　finally　recovered。　In　a　third　instance；　a　young　girl；　whose　lover　had　violent　connection　with　her　while　she　was　in　an　exaggerated　lithotomy　position；　suffered　a　large　tear　of　the　right　vaginal　wall。　Hofmokl　also　describes　the　case　of　a　young　girl　with　an　undeveloped　vagina；　absence　of　the　uterus　and　adnexa；　who　during　a　forcible　and　unsuccessful　attempt　at　coitus；　had　her　left　labium　majus　torn　from　the　vaginal　wall。　The　tear　extended　into　the　mons　veneris　and　down　to　the　rectum；　and　the　finger　could　be　introduced　into　the　vaginal　wound　to　the　depth　of　two　inches。　The　patient　recovered　in　four　weeks；　but　was　still　anemic　from　the　loss　of　blood。

Crandall　cites　instances　in　which　hemorrhage；　immediately　after　coitus　of　the　marriage…night；　was　so　active　as　to　almost　cause　death。　One　of　his　patients　was　married　three　weeks　previously；　and　was　rapidly　becoming　exhausted　from　a　constant　flowing　which　started　immediately　after　her　first　coitus。　Examination　showed　this　to　be　a　case　of　active　intrauterine　hemorrhage　excited　by　coitus　soon　after　the　menstrual　flow　had　ceased　and　while　the　uterus　and　ovaries　were　highly　congested。　In　another　case　the　patient　commenced　flooding　while　at　the　dinner　table　in　the　Metropolitan　Hotel　in　New　York；　and　from　the　same　cause　an　almost　fatal　hemorrhage　ensued。　Hirst　of　Philadelphia　has　remarked　that　brides　have　been　found　on　their　marital　beds　completely　covered　with　blood；　and　that　the　hemorrhage　may　have　been　so　profuse　as　to　soak　through　the　bed　and　fall　on　the　floor。　Lacerations　of　the　urethra　from　urethral　coitus　in　instances　of　vaginal　atresia　or　imperforate　hymen　may　also　excite　serious　hemorrhage。

Foreign　Bodies　in　the　Vagina。The　elasticity　of　the　vagina　allows　the　presence　in　this　passage　of　the　most　voluminous　foreign　bodies。　When　we　consider　the　passage　of　a　fetal　head　through　the　vagina　the　ordinary　foreign　bodies；　none　of　which　ever　approximate　this　size；　seem　quite　reasonable。　Goblets；　hair…pins；　needles；　bottles；　beer　glasses；　compasses；　bobbins；　pessaries；　and　many　other　articles　have　been　found　in　the　vagina。　It　is　quite　possible　for　a　phosphatic　incrustation　to　be　found　about　a　foreign　body　tolerated　in　this　location　for　some　time。　Hubbauer　speaks　of　a　young　girl　of　nineteen　in　whose　vagina　there　was　a　glass　fixed　by　incrustations　which　held　it　solidly　in　place。　It　had　been　there　for　six　months　and　was　only　removed　with　great　difficulty。　Holmes　cites　a　peculiar　case　in　which　the　neck　of　a　bottle　was　found　in　the　vagina　of　a　woman。　One　point　of　the　glass　had　penetrated　the　bladder　and　a　calculus　had　formed　on　this　as　well　as　on　the　vaginal　end。

When　a　foreign　body　remains　in　the　vagina　for　a　long　time　and　if　it　is　composed　of　material　other　than　glass；　it　becomes　influenced　by　the　corrosive　action　of　the　vaginal　secretion。　For　instance；　Cloquet　removed　a　foreign　body　which　was　incrusted　in　the　vagina；　and　found　the　cork　pessary　which　had　formed　its　nucleus　completely　rotted。　A　similar　instrument　found　by　Gosselin　had　remained　in　the　vagina　thirty…six　years；　and　was　incrustated　with　calcareous　salts。　Metal　is　always　attacked　by　the　vaginal　secretions　in　the　most　marked　manner。　Cloquet　mentions　that　at　an　autopsy　of　a　woman　who　had　a　pewter　goblet　in　her　vagina；　lead　oxid　was　found　in　the　gangrenous　debris。

Long　Retention　of　Pessaries；　etc。The　length　of　time　during　which　pessaries　may　remain　in　the　vagina　is　sometimes　astonishing。　The　accompanying　illustration　shows　the　phosphatic　deposits　and　incrustations　around　a　pessary　after　a　long　sojourn　in　the　vagina。　The　specimen　is　in　the　Musee　Dupoytren。　Pinet　mentions　a　pessary　that　remained　in　situ　for　twenty…five　years。　Gerould　of　Massilon；　Ohio；　reports　a　case　in　which　a　pessary　had　been　worn　by　a　German　woman　of　eighty…four　for　more　than　fifty　years。　She　had　forgotten　its　existence　until　reminded　of　it　by　irritation　some　years　before　death。　It　was　remarkable　that　when　the　pessary　was　removed　it　was　found　to　have　largely　retained　its　original　wax　covering。　Hurxthal　mentions　the　removal　of　a　pessary　which　had　been　in　the　pelvis　for　forty…one　years。　Jackson　speaks　of　a　glove…pessary　remaining　in　the　vagina　thirty…five　years。　Mackey　reports　the　removal　of　a　glass　pessary　after　fifty…five　years'　incarceration。

There　is　an　account　of　a　young　girl　addicted　to　onanism　who　died　from　the　presence　of　a　pewter　cup　in　her　vagina；　it　had　been　there　fourteen　months。　Shame　had　led　her　to　conceal　her　condition　for　all　the　period　during　which　she　suffered　pain　in　the　hypogastrium；　and　diarrhea。　She　had　steadily　refused　examination。　Bazzanella　of　Innsbruck　removed　a　drinking　glass　from　the　vagina　by　means　of　a　pair　of　small　obstetric　forceps。　The　glass　had　been　placed　there　ten　years　previously　by　the　woman's　husband。　Szigethy　reports　the　case　of　a　woman　of　seventy…five　who；　some　thirty　years　before；　introduced　into　her　vagina　a　ball　of　string　previously　dipped　in　wax。　The　ball　was　effectual　in　relieving　a　prolapsed　uterus；　and　was　worn　with　so　little　discomfort　that　she　entirely　forgot　it　until　it　was　forced　out　of　place　by　a　violent　effort。　The　ball　was　seven　inches　in　circumference；　and　covered　with　mucus；　but　otherwise　unchanged。　Breisky　is　accredited　with　the　report　of　a　case　of　a　woman　suffering　with　dysmenorrhea；　in　whose　vagina　was　found　a　cotton　reel　which　had　been　introduced　seven　years　before。　The　woman　made　a　good　recovery。　Pearse　mentions　a　woman　of　thirty…six　who　had　suffered　menorrhagia　for　ten　days；　and　was　in　a　state　of　great　prostration　and　suffering　from　strong　colicky　pains。　On　examination　he　found　a　silk…bobbin　about　an　inch　from　the　entrance；　which　the　patient　had　introduced　fourteen　years　before。　She　had　already　had　attacks　of　peritonitis　and　hemorrhage；　and　a　urethrovaginal　fistula　was　found。　The　bobbin　itself　was　black。　This　patient　had　been　married　twice；　and　had　been　cared　for　by　physicians；　but　the　existence　of　a　body　3/4　inch　long　had　never　been　noticed。　Poulet　quotes　two　curious　cases：　in　one　a　pregnant　woman　was　examined　by　a　doctor　who　diagnosticated　carcinomatous　degeneration　of　the　neck　of　the　uterus。　Capuron；　who　was　consulted　relative　to　the　case；　did　not　believe　that　the　state　of　the　woman's　health　warranted　the　diagnosis；　and　on　further　examination　the　growth　was　found　to　have　been　a　sponge　which　had　previously　been　introduced　by　the　woman　into　the　vagina。　The　other　case；　reported　by　Guyon；　exemplified　another　error　in　diagnosis。　The　patient　was　a　woman　who　suffered　from　continuous　vaginal　hemorrhage；　and　had　been　given　extensive　treatment　without　success。　Finally；　when　the　woman　was　in　extreme　exhaustion；　an　injection　of　vinegar…water　was　ordered；　the　use　of　which　was　followed　by　the　expulsion　from　the　vagina　of　a　live　leech　of　a　species　very　abundant　in　the　country。　The　hemorrhage　immediately　ceased　and　health　retu