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.
