Remarks, Taken upon Dissecting the Body of A. M. a Maid of about Thirty Years of Age, Who Dyed of an Ascites, the First of August, 1689

III. Remarks, taken upon Dissecting the Body of A. M. a Maid of about Thirty Years of Age, who dyed of an Ascites, the First of August, 1689. To prevent the too impetuous Eruption of the contained Liquor (in case Incision had been presently made) we made a Perforation of the Abdomen, in the most prominent part, as the Body lay along, by a Paracentesis, extracting through a small Canula, to the quantity of three Gallons: Afterwards we laid the Corps upon a Table, in the same posture, where we made Incision, beginning between the Umbilicus and the Cartilago-Ensiiformis, dilating still as we emptied, till we had made room for a Quart-pot, with which we drew out, to the Number of Seventy Six good measured Quarts (accounting the three Gallons which were extracted before) of a subsaline and somewhat austere Serum, which amounts to the quantity of Nineteen Gallons, besides what was imbibed with our Spunges; not improbably two Quarts more. I did admire, whilst we were emptying this Liquor, that I could perceive none of the Viscera fluctuating in the same, which I have known customary, and I believe is common with most Hydropick Bodies; I remember 'twas the fear of this did once retard an Eminent Physician, from a Paracentesis upon his Patient, lest the Surgeon in making Perforation should Puncture the Intestines. In this Body there was no interposing Body, Parenchymatous or Glandulous, to augment the Circumference of this Prodigious Inundation. For after the drying up the residue of this Humour (which in colour and consistence did somewhat resemble Water, wherein upon a strict impress I could have buried three or four Fingers: And yet her upper Parts, as the Neck, Face, Arms, and Hands were so wonderfully emaciated, that she seemed much more like a Skeleton than a carnous Substance. To recite the Viscera in order as they appeared, after dividing of the Peritonæum, the first thing that should have occur'd, is the Omentum or Kell; yet in this Body it was really and absolutely wasted away, and had not left the least apparent sign, that there had ever been such a thing. The Intestines I could not perceive vitiated any other ways than in their colour, which was somewhat pallid, as if they had been seethed; and indeed the Internals for the most part, as the Ventricle, Pancreas, Liver, Spleen, Kidneys, &c. looked all of them like Flesh half boiled, and the Blood absorbed. For although, as I said before, neither of these Bowels did swim in, or communicate with the Serum, being separated by the aforesaid Membrane; yet the great nearness of the superincumbent Liquids had polluted and tinged the external Coats of the Viscera, with their preternatural as well as putrefactive heat. The Intestines were all of them distended with flatus's, particularly the Caecum was blown up to a very considerable bigness; I observed in the two lowermost of the great ones, (viz.) the Colon and Rectum, some of the Excrements contracted like little Balls, and as hard to bear any impression through the Coats of the Gut, as a Stone: From whence I do conjecture that she had laboured under a considerable constipation of the Belly, and that for some time past. The Liver (the Ancient's great Organ of Sanguification) which by some is adjudged to be particularly and principally misaffected in this Distemper, we found no more faulty than the rest of the Bowels. Flesh newly killed, had been washed, saving that it was of a somewhat deeper red, and had a more Crafts Hypostasis) we plainly perceived (which was very wonderful) that the whole Bulk of this so ponderous a Delege, was bore up and sustained between the Cutis and Peritonaeum; whereby there was made so great a Compression of the Intestines, and other Viscera, to the Vertebre Lumborum and Oss Sacrum, that 'tis very strange to think how there could be any protrusion of Excrement, per podicem; since of necessity (by the aforeaid Compression) the Motus Peristalticus must be very slow, if any at all, and secondly, the Musculi Retti of the Abdomen, which are said to be subservient to that so necessary an Excretion, were not only at a very considerable distance, but even to my apprehension quite obliterated, or at best if there were any Rudiment of them left, it could not be distinguished from the carnous Pannicle, or common Tegument of the Body; when at the same time the outward covering or Cutis itself (notwithstanding so vast and powerful a dilation) was full as thick (in some places much thicker) as in a sound Body; particularly in the Hypogastrick Region, where the Membrana adiposa, was observed to be above two Inches thick, and seemed to be no other than a Congeries of little Bladders, each of them contain'd in its proper Capsula, and imploct with a coagulated Lymphatic Juice. One would reasonably have conjectured, that the Blood in the Abdominal Vessels, had been stagniz'd for some time past, or at least had undergone a very depraved Circulation: For one might observe in many places, the grumous part had been thrown forth of its Vessels, and adher'd in great clots to the Membranes. Before I give you a more particular Description of the contained Parts, I shall Remark what is no more than usual; that her Thighs, Leggs, and Feet were Anasarcous, and so extremely elevated with a watry Humour, that There was a perfect adhesion of the whole Body of the Spleen to the Peritonæum, though with no great difficulty to be separated from the same; for its colour and complexion it was suitable to the other Bowels, unless somewhat more livid, as it Naturally should be. Upon dissecting the Kidneys, with a diligent inquisition and inspection of its parts, we discovered nothing (though before-hand Jealous) either in the Carunculae Papillares, or in the Infundibulum, that could be any ways an impediment or let to the Secretion of the Serum Sanguinis, in case an Attempt had been made upon those Parts by a Crihs. The Vesica Urinaria was empty, and to my apprehension (by reason of its more than ordinary smallness) did not seem capable of any great distention. At the upper end or bottom of the Vesica, a little inclining to the left side of the Rectum, I perceived the Uterus, almost three Inches in length, and about two in breadth, it seemed to be nothing else but a little carnous Substance: its Body was deprest, its Superficies smooth and glib, its internal part was somewhat rugous, although its Cavity when opened, would scarcely, I believe, have contained ones little Finger. It is really admirable that so small a part as this, should so wonderfully dilate and expand its Tunicles, as to afford Reception for a Human Fætus; after whose Expulsion, it doth as it were by a certain innate propensity, contract itself to its Pristine Magnitude; I cannot more fitly compare it (as I perceived it in this Body) to any thing, than the figure of a Pear somewhat deprest. The Ventricle had nothing contained in it but Wind, with which, like unto a blown Bladder, it would return after the least impression. We come now unto the Parts contain’d within the Thorax, but before we speak of them, I must tell you that I took notice of something, I account admirable, and and that was the unusual situation of the Diaphragm, which we found so forcibly impell'd upwards into the Chest, that its Dia-stole must needs be very obscurely assistant to Respiration: It was indeed so far contracted, that its Convex part bore hard against the Lobes of the Lungs, whose Substance, as I have seen in some that had dyed tabid, was very much decay'd and perisht, and looked just like par-boy'd Flesh. The next and last Part which we viewed, was the Heart, and in this Noble Viscus I discovered something memorable, for upon cutting of it open, I did not perceive the least drop of Water to fall from it: By which it may be justly thought that the Pericardium or Capsule of the Heart, being altogether destitute of its refrigerating Liquor, clung immediately to the proper Tunic of the Heart itself; upon cutting through whose Ventricles, we could not perceive one drop of Blood, no more than in the rest of the Bowels; nay, the Liver, which has been by some accounted the Store-house of the Bloody Mass, was destitute of so much as might be thought necessary for its own proper Nourishment, and yet its Salino-Sulphureous Particles, which constitute the Gall, were deposited into the Vesica Biliaria, to the quantity of about a Spoonful. We took no other Survey of the Parts within the Thorax, than by opening of the Diaphragm, and looking up into the same: For since we had seen sufficient Reason for the extinction of the Vital Flame, and by consequence the Dissolution of this Miserable Creature, we contented ourselves with what we had discovered in the Abdomen or lower Belly; and yet if we had been minded more narrowly to have viewed the Parts within the Chest, we might easily have come at them, without throwing up the Sternum, which is absolutely necessary, and no more than customary upon a Survey of those Parts: But in this Body I observed so large a protuberance rance of the Costæ and Sternum, that one might very easily have taken out either Heart or Lungs, without touching their Enclosure. Whether this might not be occasion'd from the rarify'd Effluvia of the Waters, pent up within the Breast, or rather a necessary Consequence of the Diaphragm's being so excessively pressed upwards, I leave to a more Critical Censure; neither shall I take upon me to determine whether the contained Liquor happened from any Rupture in the Lacteal or Lymphatick Vessels, according to Dr. Willis, or (as more probable to me) if it were not pure Serum (the Blood being dissolved in its constituent parts) breaking forth of the little mouths of the Cælic and other Arteries. There were present at this Dissection, Mr. James Wasse, Sen. & Jun. Daniel Turner, Chyrurgeons. IV. Observatio Casus non vulgaris De Hydrope intra Uteri Tunicae contento. E. R. a Person Aged 44, and upwards; sometime after she was married, had conceived (as she thought) by some supposed Symptoms of Pregnancy, and in order to her Delivery, at the expiration of the time of her Account, her Midwife was consulted. (Her fancy'd) Pains came on, and she thought her self very near her Labour. Her Belly was grown very big, and had gradually increased from the time of her (imagined) Conception; but alas, she found her self deceived in her Expectation, and her Preparations for this time all in vain. Her illnefs shortly after wore off, without leaving any Prognostick of an approaching Birth. Thus