An Account of a Dropsy in the Left Ovary of a Woman, Aged 58. Cured by a Large Incision Made in the Side of the Abdomen, by Dr. Robert Houstoun

III. An Account of a Dropsy in the left Ovary of a Woman, aged 58. Cured by a large Incision made in the Side of the Abdomen, by Dr. Robert Houstoun. August 1701. I was in the Country, with a Patient, the Lady Anne Houstoun, Wife to Sir John Houstoun, Baronet; in the Shire of Renfrew, ten Miles from Glasgow, North Britain. This charitable Lady press'd me with great Earnestness to visit a Tenant's Wife, who lay bedridden, of an uncommon Disease, which no Physician, or Surgeon, who had seen her, could give any Name to, or account for. She inform'd me, the ablest of that Country had forsaken her, and declared her incurable, so that I could lose no Reputation by the Result of my Endeavours. In order to oblige this worthy Lady, and in Compassion to the Distress of a poor Woman in so deplorable Condition, deserted and given over on all sides, I went, determined to do every thing in my Power for her Relief. She was in the 58th Year of her Age, her Name was Margaret Millar. She inform'd me that her Midwife, in her last lying-in, at 45 Years old, having violently pull'd away the Burthen, she was so very sensibly affected by a Pain, which then seiz'd her in the left Side, between the Umbilicus and Groin, that she scarce ever had been free from it after, but that it had troubled her more, or less, during 13 Years together; that for two Years past she had been extremely uneasy, her Belly grew very large, large, and a Difficulty of breathing increased continually upon her; insomuch that for the last six Months, she had scarce breath'd at all but with the utmost Difficulty. That in all that Space of Time, having quite lost her Appetite, she had scarce eat so much as would nourish a sucking Child; and that for three Months together she had now been forc'd to lie constantly on her Back, not daring to move at all, to one side or other. This Tumour was grown to so monstrous a Bulk, that it engros'd the whole left Side, from the Umbilicus to the Pubes, and stretch'd the Abdominal Muscles, to so unequal a Degree, that I don't remember ever to have seen the like in the whole Course of my Practice. It drew towards a Point. Her being so long confined to lie continually on her Back, having grievously excoriated her, added much to her Sufferings, which, with want of Rest and Appetite, had wasted her to Skin and Bone, as the poor Woman herself expressed it. Indeed she needed not to have told me so, my Eyes were too faithful Witness of her low and wretched Condition. Scarce able to speak out, she told me, that having heard much of my Success, she had strong Hopes of Relief, provided I would try at least, and do something in Pity to her Affliction. I answer'd her that I was willing, but afraid, in her low State, she would want Strength to undergo a large Incision; that in order effectually to relieve her, I must be oblig'd to lay open a great Part of her Belly, and remove the Cause of all that Swelling: she seem'd not frightened, but heard me without Disorder, and, as if inspir'd with sudden Courage, press'd, and urg'd me to the Operation. I drew (I must confess) almost all my Confidence from her unexpected Resolution, so that without loss of Time, I prepared what the Place would allow, and with an Imposthume Lancet, laid open about an Inch, but finding nothing issue, I enlarged it two Inches, and even then nothing came forth but a little thin yellowish Serum, so I ventured to lay it open about two Inches more: I was not a little startled, after so large an Aperture, to find only a glutinous Substance bung up this Orifice. All my Difficulty was to remove it; I try'd my Probe, I endeavour'd with my Fingers, but all was in vain; it was so slippery that it eluded every Touch, and the strongest hold I could take. I wanted, in this place, almost every thing necessary, but bethought myself of a very odd Instrument, yet as good as the best in its Consequence, because it answer'd the End propos'd. I took a strong Firr-Splinter, such as the Poor in that Country ordinarily use to burn instead of Candles; I wrapt about the End of this Splinter some loose Lint, and thrust it into the Wound, and by turning and winding it, I drew out above two Yards in Length of a Substance thicker than any Gellie, or rather like Glue that's fresh made and hung out to dry; the Breadth of it was above ten Inches; this was followed by nine full Quarts of such Matter, as I have met with in Steatomatous and Atheromatous Tumours, with several Hydatides, of various Sizes, containing a yellowish Serum, the least of 'em bigger than an Orange, with several large Pieces of Membranes, which seem'd to be Parts of the distended Ovary. Then I squeez'd out all I could, and stitch'd up the Wound in three Places, almost equi-distant: I was oblig'd to make use of Lucatellus's Balsam, which was made by her Lady for the Use of the Poor; with this Balsam I covered a Pledget, the whole Length of the Wound, and over that laid several Compresses, dipp'd in warm French Brandy, and because I judg'd that the Parts might have lost their Spring, by so vast and so long a Distention Distention, I dipt in the same Brandy a large Napkin four times folded, and applied it over all the Dressings, and with a couple of strong Towels, which were also dipt, I swathed her round the Body, and then gave her about four Ounces of the following Mixture, which I had from her Lady. \textbf{R. Aq. Mentha} \textit{ts} \textit{fs}. \textbf{Aq. Cinnamomi} \textit{fort.} \textit{ts} \textit{fs}. \textbf{Syr. Diacodii} \textit{3 vi. M}. The Cinnamon-Water was drawn off from Canary and the best Cinnamon; indeed it was the finest and most fragrant Cinnamon-Water I ever tasted; of this Mixture I ordered her 2 or 3 Spoonfuls 4 times a Day. Next Morning I found her in a breathing Sweat, and she informed me, with great Tokens of Joy, that she had not slept so much, nor found herself so well refresh'd, at any Time for three Months past. I carefully attended her once every Day, and as constantly dressed her Wound in the same Manner as above, for about eight Days together; I kept in the lower Part of the Wound a small Tent, which discharged some Serosities at every Dressing for 4 or 5 Days. But Business calling me elsewhere, I left her, having first instructed her two Daughters (both Women, who carefully attended her) how to dress her Wound, and told 'em what Diet I thought most proper, enjoining 'em strictly to observe what I order'd. Her chief Food was strong Broth made of an old Cock, in each Porringer of which was one Spoonful of the Lady's Cinnamon-Water; this was repeated 4 times a day, and gave her new Life and Spirits. After three Weeks Absence, I called at her House, and finding it shut up, was a little surpriz'd, but had not gone far before I was much more surprized, when I found her sitting wrapt up in Blankets, giving Directions to some Labourers who were cutting down her Corn. She mended apace to the Admiration of every body thereabouts, recovered surprizingly, and lived in perfect Health from that time, which was in August 1701, till October 1714, when she died in ten Days Sickness. That this Tumour, or rather Dropsy of the Ovarium, proceeded from the Midwife's Rashness in pulling away the Placenta, not knowing how to separate it from the Uterus skilfully, seems to me plain from what the Woman herself told me, and what fell out afterwards. The Placenta adhering fast to the Uterus, required more Art to bring it away than she was Mistress of, which probably induc'd her to use Violence; by which she forc'd down the Fundus Vteri; so overstrain'd the Ligaments, and all that's appended to 'em; especially the Ligamentum latum of the left Side and its Ovarium, which may be reasonably allow'd to have been hurt in the Relaxation with the rest. Hence the Elasticity of these lased Parts was not only impair'd, but the small Lymphaticks ruptur'd, so that the extravasated Lympha rushing out, thicken'd, and not being able to recirculate, dilated the injur'd Ovarium, and thus increas'd the Tumour, and the Parts being already excessively distended, and being no longer able to resist the new Influx of fresh Secretions, ruptur'd also, and by Degrees augmented to that huge and enormous Bulk. Cyprianus in his Letter to Sir Thomas Millington, gives several Instances of the Mischiefs committed by Midwives, and other ignorant Persons. When a Placenta adheres, then (says he) they tear all before 'em, by pulling rudely, they force down the Fundus Vteri; consequently do Violence to the Ovaria and other Parts, whence follow Inflammations, &c. Forestus, l. 28. Obs. 80. says, that an over-bold Midwife pulled out the Placenta too hastily, and that the Woman presently fell into a Swoon, and died immediately. Frederick Ruysch attributes the Cause of a Placenta's adhering close, to a central Insertion of the Navel-String into the Placenta, in which Case it is hard to separate; a Train of dismal Accidents attend those who, not knowing how to do it, venture to pull it away by Force. Vide Obs. Anat. 97. Dionis and la Motte have made the same Remark, by the latter of which we are told of innumerable Accidents, which he has known happen to Women in hard Labour, by the Rashness and Ignorance of bold Pretenders, who, without Rule, Precepts, Practice, or any suitable Instructions, venture to practise Deliveries. The aforesaid Ruysch has a remarkable Instance of the Effects of Violence in hard Labour: The Case is curious. Vide Obs. Anat. 63. Manget, in his Theatrum Anat. tells us that in all hard Labours, where the Placenta sticks, the Ligaments suffer more or less by a rash and ignorant Way of Pulling; Examples of which see in Platerus's Obs. lib. 3. Bartholin. Cent. 2. Hist. 91. Cent. 5. Hist. 19. Marchett. Anat. cap. 7. and others, of which Blasius has given us an ample Lift in his Commentaries on Veslingius. He likewise tells us, that the Ovaria grow to a wonderful Bulk, and contain such a huge Quantity of Liquor, that they become dropsical, whereof Skenckius in his Obs. has recorded many Examples, as hath Riolan, and many others. Munnicks in his Bibliothec. Anat. gives us the History of a large Dropsy of the right Ovarium. Mortgagni has told us, that he has often met with large Vesicles in the Ovaria, and, in morbid Bodies, sometimes full of purulent Matter. Sylvius Sylvius. Ex lymphaticis lasis tam Virilium, quam Muliebrium Testiculorum, &c. Hydrops particularis excitari potest. Veslingius cap. 7. has often met with large Tumours, from Obstructions in the Ovaria of Women. Vesalius found in the right Ovarium, 9 or 10 Glanules, like Goose Eggs, with Matter not unlike the Whites of Eggs, or rather thicker. Gul. Ballon, paradig. vi. found an Imposthume of the Nature of a Steatoma, near the Collum Uteri; The Woman had a large Tumour on her Side 16 Years, and had only one Ovarium, which was shown as a wonderful thing. At Westminster, about two Years ago, I opened the Body of a Gentlewoman, about 60, whose left Ovarium, of a great Bulk, weigh'd vi. lb. to which adher'd several Hydatides like Pullets Eggs. Hildan mentions an Hydropick Tumour of the right Ovarium, of a prodigious bulk, stuff'd with Hair, vide Gul. Fab. Hild. Cent. 5 Obs. 48. Greg. Horst. Tom. 2. l. 4. Ob. 53. Ruysch Obs. Anat. 17. A Dropsie (says he) of the Ovarium, or (if you please) of the Eggs, is an Affection, or Disease, well enough known to others, but I am afraid not so well consider'd; Authors have agreed to call it Hydatis, with which name I shall rest satisfied, provided we agree about the subject of the Distemper. I observe this, most frequently, if not always, to be the Eggs, but so chang'd, and sometimes swell'd to such a Bulk, that I have often seen them larger than a Child's Head. Drelincourt has given us a very full and exact Account of a Dropsie of the left Ovarium, in a Lady of 35 Years. The Tumour, of an enormous Bulk, continu'd three Years. The Body of the Ovarium, with all contain'd in it, weigh'd, 60 lb. It was nothing but but a number of little Globules, cluster'd together, that differ'd in their Roundness, Form, Colour, and Consistence, proceeding from little seminary Vesicles in a Cluster. Some had Water extremely clear and liquid, others a yellowish Serum thin, others a glutinous Matter; some were as big as Pullets Eggs, others bigger than one's Fist. Let these few, out of the many Instances which I could produce from Authors of undoubted Reputation, suffice to prove, that the Ovaria, as well as the Tubæ Falloppianæ, Ligaments, and Uterus itself, are not free from Dropsies, &c. and that they proceed from Obstructions, often occasioned by rude and violent dealing with Women in difficult Labours, which generally bring on a train of dismal Symptoms, that sooner or later, according to the Strength of the Sufferer, after a miserable, painful, languishing Life, end in Death. The manifest Success in this uncommon Case may be of use, and may shew, that we ought not to despair too soon, in Distempers that are seemingly most dangerous. IV. Præparatio Cærulei Prussiaci ex Germaniâ missa ad Johannem Woodward, M.D. Prof. Med. Gresh. R. S. S. Tartari crudi & Nitri crudi Siccati ad 3iivi. Pulverifentur minutissime, & commisceantur, deinde admoto igneo carbone detonentur, & habebis Salis Tartari extemporanei 3iivi. Dum adhuc calidum est hoc Sal, pulverifetur subtilissime, & addantur sanguinis Bovini probe exsiccati & subtiliss. pulv. 3iivi. Hæc bene