Vaginal Hernia and Uterine 
Fibroids, with Delusions 
of Pregnancy. 
BY , 
P. M. WISE, M. D., 
Willard, N. Y. 
FROM 
Shnerican of Ensamtn, 
July, 1889. 
UTICA, N. X. CLINICAL CASE. 
VAGINAL HERNIA AND UTERINE FIBROIDS, WITH DELUSIONS 
OF PREGNANCY. 
P. M. WISE, M. D., 
Superintendent of the State Asylum for the Insane, Willard, N. Y. 
The following case is not only unusual and curious, but adds 
another to the many instances where delusions have some physical 
basis, or are formed and maintained by peripheral irritation. 
J. S., colored woman, married, age about thirty, was admitted 
to the Willard Asylum April 11, 1884, as a case of chronic mania 
of several years' standing, with violent tendencies. When 
admitted she was garrulous and noisy; said she was the 
Almighty's wife's daughter; physical health good. For four 
years subsequently, she had periods of extreme excitement and 
violence lasting a few days, paroxysmal, but not periodical, three 
or four times a year. In March, 1888, she had a severe and pro- 
longed disturbance, when she constantly endeavored to seclude 
herself in her room and barricaded her door. Following this 
attack it was noticed, that at her menstrual periods she would 
become disturbed and seclude herself and remove her clothing. 
The attendants reported her as masturbating. This tendency 
was progressive, so that, recently, during the catamenia, 
she would take every opportunity to introduce her finger 
and even her whole hand in her vagina. She has said 
that she wanted to " take away the baby," " it must 
come away." Her delusions became more active and exalted and 
she called herself a queen ; she was painted black and her natural 
color was white; was violent when opposed and sometimes when 
approached. Erotic tendencies and onania particularly manifested 
during the menstrual period. 
June 11, 1889. Menstruation began on the 9th inst. Yester- 
day she made the same efforts she had at former periods and 
further complained that something " was down her." This 
morning an examination proved the vagina filled with a soft 
tumor, and protruding from it a soft cylindrical tumor about 
eight inches in length, cupped at its pendant extremity and 
slightly torn. Accompaning it posteriorly, a loop of uncovered 
intestine protruded. She struggled against its reduction, and 
was aetherized, when efforts were made to reduce the hernia. It 
appeared to be constricted at the vaginal rupture which was in 
the anterior wall of the vagina. It was partly reduced and the 2 
whole mass was replaced in the vagina with the exception of the 
cylindrical tumor, which was ligated and six inches of it ampu- 
tated. It was necrosed and no hemorrhage followed the amputa- 
tion. Efforts at reduction were checked by the depression 
occasioned by shock. The patient's condition was serious when 
the tumor was discovered. After anaesthesia passed away, and 
by stimulation the patient regained a fairly comfortable condition. 
The mental excitement continued unabated and she needed 
constant watching to prevent her from tearing the parts down 
again. There was no rise of temperature during the day; pulse 
120; respiration 26 at noon, and night condition not materially 
changed. 
June 12th, 1889. Temperature reached 100 deg. in the evening; 
no tympanites. Passed urine of sp. gr. 1022 showing traces of 
albumen, mucus, pus and blood. Stump of tumor dressed with 
iodoform; no tumefaction of tumor remaining in the vagina; 
continued vital depression and mental excitement; morphia 
hypodermically and stimulants continued. Could not retain food 
or drink taken in the stomach. 
On the 13th, 14th and 15 there was little change in her condition. 
Her temperature reached 101 3-5 deg. on the 13th but returned in a 
short time to below 100 deg. She had some tympanites on the 
15th. The vital depression continued, so that at no time was she 
considered in condition to survive an operation. 
June 16th. Collapse approaching. Urine passed at noon 
through catheter contained blood, pus and albumen. Stump of 
tumor sloughed off in shreds. Abdomen tympanitic and dis- 
tended, and marked symptoms of strangulation of bowel. She 
died at 4 p. m. 
Autopsy eighteen hours after death. Symphysis pubis was 
removed and the parts beneath exposed. A localized purulent 
peritonitis had formed a pocket posterior to the symphysis, and 
there were peritonitic adhesions throughout a circumscribed area. 
A section of transverse colon, about eight inches in length, with a 
thickened and matted mass of omentum lay on the posterior 
vaginal wall, and the epiplocele protruded through the vulva. A 
director was passed from the abdominal cavity along the course 
of the hernia, into the vagina and the constriction relieved by 
dissecting along the director, beginning at the left of the meatus, 
extending through the bladder. The hernia was then fully 
exposed as a loop of the transverse colon, with hypertrophied 
omentum, the whole showing evidence of strangulation caused by 3 
the recto-vesical fold, the bladder and the enlarged uterus. The 
posterior wall of the bladder was ulcerated along the line of the 
hernia, which had the appearance of passing through the bladder. 
The mucous surface of the bladder was covered with patches of 
croupous membrane. The uterus was covered with about twelve 
small fibroids, pediculated and sessile. The left ovary was cystic. 
Vaginal walls were very thick. 
The appearance of the omentum that was amputated was that 
of loose connective tissue filled with blood clot. It tore very 
easily and had no stability in situ. The duration of the hernia is 
only conjecture, but it seems plausible to suppose that the epiplo- 
cele had existed for some time and gave rise to the delusions in 
connection with the enlarged uterine body, that she was pregnant. 
The irritation of the omentum in the vagina may have been the 
chief cause of the onania. The working and pulling at the 
epiplocele stretched it and would account for its peculiar cup- 
shaped extremity and cylindrical form. 
With this handle within easy reach in the vagina, it is reasona- 
ble to suppose that in the excitement at her menstrual period she 
made unusual efforts to extract the foreign body, and that by 
traction she brought down the bowel into the vagina and caused 
the strangulation.