RUPTURES OF THE VAGINA.
Usually there is tension and stretching of the walls of the canal up to the limit of distensibility; or sharp or pointed bodies may penetrate from without.
Among the traumatic causes of the awident are falls upon the genitals and the entrance of foreign bodies (see under that head). Reckwitz saw a vagina that had been ruptured by the horn of a bull, and Curran records a recto-vaginal tear from penetration of the horn of a goat. I have seen 2 cases of complete perineal rupture into the rectum in young girls; the one was caused by the breaking of a wooden sled upon which she was ' straddling and sliding down hill; and the other was caused by the horn of a cow. It may well be doubted if violent coitus can cause a fatal rup ture when the vagina is in normal condition, although Diemerbroeck, Colombat, and Meissner record such cases. If senile involution, and pathological changes such as stenoses, etc., are present, rupture might occur from intercourse; I have myself seen such a case, which, however, recovered. Hymenal ruptures of some depth, which may bleed consider ably, are often made by defloration, and are not to be looked upon as vaginal ruptures. It has lately been denied by F.. Hofmann ' that the severe vaginal lesions which have been seen in certain cases of rape upon children have been caused by attempts at coitus; he claiming justly that they were more probably due to rude manipulation. Maschkal expresses a similar opinion Finally, instruments, and even the hand of the phy sician or the midwife, may tear and even rupture the vagina, most often during childbirth. More rarely this has occurred during violent attempts at the reposition of chronic inversio uteri, the extraction of large utero fibromata. etc.
The location and extent of the ruptures vary greatly, in accordance with their cause. As in all wounds which do not immediately destroy organs necessary for life, the two chief factors of hemorrhage and infection will decide the result. Fatal hemorrhage is comparatively rare in vaginal rupture; when it has occurred it has been in pregnant women, and has been near the introitus and involved the erectile tissues. Complications, such as the opening into neighboring organs or the peritoneum, always make the wound a dangerous one, but are not necessarily fatal unless very considerable hemorrhage or septic infection occur. We can nowa
days better understand the isolated and apparently wonderful cases of recovery after such injuries; though there are some in which infection did not occur, although the patient was most unfavorably situated. Thus, Reckwitz had a case in which the lower portion of the vagina, one inch above the introitus, was torn in three places, and the patient recovered after the wounds were sutured. Colombat ' relates a case of recovery after the posterior vaginal wall of a young girl had been pierced by an iron pitchfork, in jumping from a hay-stack; and Rey records the recovery, after fourteen days, of a case where a long wooden rake had penetrated the perit,oneum through the wall of the vagina. Ruhfus I saw the intestines protrude through the wound after withdrawing a pitch fork which had penetrated the posterior vaginal vault. He replaced them, although they had already become cold, and held them in situ with a sponge soaked in oil. The patient was kept upon ber back with the pel vis elevated, and " antiphlogistic treatment " ordered; and she recovered. Fleury ' records a more recent case in which a fall from a grain wagon against a piece of wood caused rupture of the anterior vaginal wall and the bladder, and which healed of itself. The cases to be related later, in which large ruptures of the posterior vaginal vault occurred post-partum, are still more remarkable.
The spontaneous ruptures of the vaginal walls occur almost exclusively during childbirth, although a few cases have been observed under other conditions. Thus Grenser ' reports that in a pregnant woman with writes the first-sized retroverted uterus prolapsed through a spontaneous rupture of the posterior wall of the vagina, and appeared at the vulva. The fatal result was hastened by the attempts made by a surgeon who was called in to remove the prolapsed body, which he took to be a mole. Samples (1.c.) reports a case of spontaneous rupture of the posterior vaginal vault in a woman who violently exerted herself some three months post partum. The finger could be passed into a cavity which had no connection with the peritoneal sac. Fallen closed the rupture with a few sutures, and the patient got well. The physician suspected, probably correctly, that the rupture had been caused by the bursting of a lifematoma.