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Case of Pessary Impacted within the Vagina for Two YearsAuthor(s): Jesse LeachSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 13, No. 7 (Apr. 4, 1849), pp.177-178Published by: BMJStable URL: http://www.jstor.org/stable/25500744 .

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PESSARY IMPACTED WITHIN THE VAGINA. 177

American vessel. They fell in with a vessel which

supplied them with fresh onions and potatoes, and these

speedily cured them. One man, in a most deplorable

condition, who could not chew the onions, had the

juice of the bruised raw potatoes and onions given him.

-" This course soon restored his appetite and strength, and ten days after we spoke the Solon, so rapid was

his recovery, that from lying helpless and almost

hopeless in his berth, he was at the mast head furling a royal." The writer says,-" This disease is not so

common now as formerly, and is attributed generally to salt provisions, want of cleanliness, the free use of

grease and fat, (which is the reason of its prevalence among whalemen,) and, last of all, to laziness. It was

probably from our having none but salt provisions, and

from our having run very rapidly into hot weather,

after having been so long in the extremest cold." He

says that medicines would have been of no use,-their's were exhausted,--' for nothing but fresh provisions, and terra firma, has any effect upon the scurvy." How striking a proof is this of the amount of ignorance still prevailing on this subject, even amongst those

most interested in being acquainted with it as most

subject to its evils; and it shows that the neglect of merchants to provide their ships' crews with the

Rpveentive of scurvy, is not peculiar to this country

W her If. Budd has animadverted on it, but extends to

America, and would really seem to arise, in some mea

sure, incredible as it may appear, from ignorance of it.

But may not the potato derive its great value partly from another circumstance ? I have long considered it

a stimulating food, and that it derived its value in a

great measure from this. Now, it belongs to the same

natural order as the capsicum; and if the doctrine of

homomorphism be true, "that plants, having similar structures, havesimilar properties likewise."-Burnett's

Botany, p. 985.) May it not possesssome of the stimu

lating properties of the capsicum ? " It is a fact," says De Candolle, " which should never be lost sight of,

thatkall ouWfalimeats contain a small proportion of an

exciting principle, which, should it occur in a greater quantity, might become injurious, but which is neces

sary as a natural condiment; and that, when this

stimulating principle is naturally in very small propor tion, we increase it by art, or supply its place by the

addition of spice'-Burnett's Botany.

There is a way in which the potato is used which V nUotieave been thought of, but which I think may

l, inA.t-od. do in preserving public health,-I mean

mixed with wheaten flour in bread; I believe very few bakers omit to ue it, and perhaps we may have acted

unwisely in condemning this adulteration. One of the

questions I put to my correspondents was, "Do you consider that the potato, as an article of diet, may be

safely dispensed with ?-or can you suggest any suffi

cient substitute? Do you consider that rice would

be " Mr. Gore says, that the impression left on his

mind was, that vegetable food is indispensable to health, and that the potato is one of the best or most

convenient forms. The inmates of the Union House

soon absolutely loathed rice. And his observations on

these circumstances strongly confirmed a previous opinion, that rice is a very poor and inadequate article of diet. Mr. Lloyd says, that potatoes cannot be safely dispensed with, there is no good substitute for them; rice is a bad substitute, and produces disease of the

mucous membrane of the bowels. Dr. Tunstall looks on bread and cheese as the best substitute for potatoes. Dr. Lindoe thinks that in warm climates rice might be

found a useful substitute for the potato, but in England he is not aware of any vegetable that could supply its

place. Mr. Hutchins does not consider that rice would

be a safe substitute for the potato; thinks bread would

suit the English constitution; finds peas, and grits, and salted meats, readily induce obstinate skin-disease; and carrots and parsnips do not well agree as a work

house diet without some bread. Rice, with broth or

soup, and a small quantity of bread, he finds makes a

very wholesome and palatable meal. Rice, even with

treacle, is seldom liked; suet pudding, or bread and

cheese, is always preferred. Mr. Perrin considers

parsnips nearly as good as potatoes, though not near so

palatable; rice will never be used, from the strong aversion the poor have to it. My brother believes that

potatoes may be dispensed with, provided in their place we use some fresh succulent vegetables, as turnips,

carrots, celery, cabbage, &c. In the Tisbury Union

House, when the potatoes were becoming scarce, and

the diet table was altered, he requested that turnips,

carrots, or greens, might be given twice a-week, and

potatoes once, and not a single symptom of land scurvy

occurred to any inmate. He also found that those in

his district who had the first symptoms of the disease,

were speedily relieved from them by a vegetable diet.

Rice he believes to be useless as a preventive of land

scurvy, because in the Crediton Union, where it was an

article of diet, several, cases of land scurvy occurred.

The same weight of boiled rice had been substituted for

potatoes in that Union House. Mr. Shorland considers

it most unadvisable that the potato should constitute,

as heretofore, the general diet of the lower orders, but

as an adjunct considers it preferable to rice.

(To be continued.)

CASE OF PESSARY IMPACTED WITHIN THE

VAGINA FOR TWO YEARS.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR,

Conceiving the following ease of impacted oval box

wood pessary within the vagina for the space of two

years, with the singular and simple method employed

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178 CASE OF PLACENTA PRiEV1A.

for its removal, after every other means had been

resorted to, possesses a peculiar claim for publication, I will briefly give you the particulars in order that you

may allow it a space in your Journal, should you, upon

perusal, think it merits one.

Mrs. W., aged 60, married, but without children, about two years ago consulted a practising empiric, with symptoms of general debility and tenesmus during urination, for which he advised the use of a pessary, and prevailed upon her to allow him to introduce one, which he did with some difficulty. Her existing symp toms became subsequently much aggravated, with additional weight, heat, pain and uneasiness about the

loins and vagina, with a constant dribbling away of

urine. She applied again to her adviser and requested him to remove the pessary. He tried to do so by

adopting different expedients, but after fruitless efforts for the space of two hours, he gave up the task and

coolly assured her, she need be under no apprehension, as the pessary in a short time would rot away, without

the slightest injury to her. She still consoled herself with the belief that time would remove what her adviser

could not. However, her general health became more

alarming, and among other practitioners, she con

sulted my brother, Mr. R. H. Leach, of Cowlishaw, near Oldham, who carefully examined the vagina, and

found a pessary so firmly wedged therein that he

could not remove it with his fingers. The other

medical gentlemen whom she had consulted prior to

my brother, had likewise failed to relieve her of it.

On the 1st of September, I went with my brother

armed with every little invention calculated to dis

lodge such a foreign body from the vagina, and found

the case exactly as he had described it; the woman

had a care-worn countenance, was dejected in spirits.

cough, disordered digestion, incontinence of urine, much emaciation of body and general debility. The

sphincter ani was paralysed, most probably from long continued pressure of a large foreign body upon the

muscular nerve supplying it with motion. The mucous

folds of the rectum were relaxed and much congested. The pessary could be distinctly felt through the rectum

in the vagina. The perineum was rigid, and though I could move the pessary within the vagina, the rigid

perineum prevented an extraction. The lower orifice

of the vagina was very small. The woman was now

placed upon her left side and her shoulders slightly

elevated; the vagina was well lubricated with lard.

Two fingers of the left hand were passed into the rectum

behind the pessary and traction thereby made, whilst

the index finger of the right hand, which was with

difficulty passed within the vagina behind the pessary, acted as a second traction. In this way the pessary could be brought to the lower part of the vagina, but

the small outer orifice and rigid perineum would not

allow its broad diameter to pass. Scoops, a small

vectis, and various other means were then tried without

success. Perforation or crushing were now the only

expedients, and being distant some miles from town, we thought it probable that the best perforator would

be the joiner's gimlet; and as the pessary was hollow

and made of box wood, perforating with a gimlet

would most probably fracture the sphere of the pessary into different segments, which would then be readily removed by a forceps. My brother now brought the pessary as low as he could in the vagina by using traction with two fingers, introduced behind the pessary within the rectum, and steadily held it fixed against the perineum and outer orifices of the vagina with his right hand, protecting the soft parts by means of a towel, whilst I perforated the pessary with a.

gimlet. On the groove of the gimlet, behind the

worm, passing within the hollow of the pessary, its walls fractured into three segments, the parts of which were now readily brought away with a forceps, and

the operation completed. We found that granulations had formed on the

cervix uteri, which had passed within the opening

usually left for a pessary tape, and were torn away with the extraction and found within the hollow of

the pessary after extraction. The woman has since

done very well and nearly recovered her wonted

strength and spirits. Such cases as the one I have described are rarely met

with in practice. I have only heard of two, one was

in the practice of Mr. Jesse, of Frodsham, who is a

practical and very intelligent surgeon, and the other

case was in Liverpool. I am not aware the gimlet has

been tried before in such a case, but as it effectualy answered my purpose, after more complicated instru

ments had failed, I can with confidence recommend

it to the profession, as an instrument always near at

hand, and calculated to realize the best wishes of the

operator in such a case. Should you deem the case

worthy a space in your practical Journal, you will

much oblige, Sir, your obedient servant,

JESSE LEACH. Heywood, Lancashire,

March 10, 1849.

CASE OF PLACENTA PRXEVIA.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND'

SURGICAL JOURNAL.

SIR, If your valuable Journal has not already been inun

dated to too great an extent with cases of placenta

praevia, I beg to submit to the notice of your readers

the following case, which occurred in my practice, and was attended by my friend Mr. William Peck, of

Bedford. The case appears to me to be confirmatory of the

plan first practised by Mr. Kinder Wood, of Manchester, and since, so prominently brought before the notice of the profession by the writings of Dr. Radford, of

Manchester, and Professor Simpson, of Edinburgh. If you think the case worthy of insertion, I forward it to you as concisely sketched by Mr. Peck himself.

I am, Sir, your obedient servant, T. HERBERT BARKER, M.D.

Bedford, March 14, 1849.

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