Cosmetic(s) surgery

This unexpected discovery was reported in a French journal, the Répertoire Generale d’Anatomie, in 1827. The patient was treated by Guillaume Dupuytren, the leading French surgeon of the day – although this was far from being one of his most celebrated cases:

Ann G—, forty-five years old, presented herself at a consultation of the Hotel-Dieu, requesting assistance for a cancer of the womb, the existence of which was attested by a formal certificate, said to have been written by a physician of her province. The patient passed her urine through the urethra and vagina, and at the same time she suffered considerable pain in the vagina and in the hypogastrium.

As may be obvious, urine does not normally pass through the vagina. This suggests that the poor woman was suffering from a urogenital fistula, an anomalous opening between some part of the urinary system and the vagina.

There was a constant discharge of a mixture of foetid urine, blood, mucus, and purulent matter.

Typical accompaniments to infection. What the surgeon actually found was rather unexpected.

M. Dupuytren was surprised to feel, upon examination, a hard and rough body about two inches within the vagina. He at first conceived it was a urinary calculus formed in the vagina, in consequence of a vesico-vaginal fistula.

A vesico-vaginal fistula is an opening between the bladder and the vagina. Dupuytren believed that the flow of urine through the vagina had resulted in the formation of a concretion like a bladder stone.

The patient, however, confessed that the substance was a piece of stone, which had been placed there by force. Upon being questioned as to the circumstances of this unusual act of violence, she declared, that nine years ago she had been attacked upon the road to Dijon by two soldiers, who attempted to ravish her. For some time she defended herself stoutly. She was at length, however, overpowered: and they introduced a stone into the vagina!

It is a sound principle that the victims of sexual violence should always be believed. Unfortunately, in this case, any scepticism about this unorthodox mode of attack proved well founded.

She stated that she had afterwards much pain in making water, and considerable fever. Her suffering, however, had gradually diminished; and, for the last eight years, she had experienced but little inconvenience. The same train of symptoms again occurred, and they were even more severe than at first. She was attacked with violent fever; and could only sleep by the assistance of opium. Other symptoms of general disturbance existed from the local irritation in the vagina.

M. Dupuytren decided after some consideration that the woman’s symptoms would only improve if he could remove the foreign body. It was time for an operation.

Upon introducing a finger, M. Dupuytren discovered that the substance was a small pot, placed across the vagina. It was removed with some difficulty; and the woman now first confessed that she knew the pot was in the passage; that it was that which the soldiers had introduced, after having, with a due attention to economy, removed the pomatum it contained.

Pomatum, or pomade, was a scented ointment applied to the skin or hair. The reference to the soldiers’ unexpected parsimony is, of course, ironic.

It was covered with a saline incrustation, several lines in thickness. Emollient injections were subsequently employed, and the patient three days after the operation left the hospital. The fistulous opening between the bladder and vagina, which had been caused by the pressure of the foreign body, was completely cured.

An impressively quick recovery.

It was evident from the ridiculous and varying accounts given by the patient that she had introduced it herself. She was known to have laboured under an attack of nymphomania at about the time she stated the pot to have been forced into the vagina.

The overwhelming majority of such foreign objects do turn out to have been inserted by the patient, so this does seem a reasonable supposition. One question remains: what about the cancer from which she was supposed to be suffering? It seems that the pomatum pot was in fact her only ailment.