An Extraordinary Case in Surgery, Communicated by Mr. Joseph Atkinson Senior, Surgeon

An extraordinary Case in Surgery, communicated by Mr. Joseph Atkinson Senior, Surgeon. A Maiden, about 20 Years of Age, was brought to me about Christmas 1723; who had a Tumour on the inside of her right Thigh, extending from the Groin to the Knee, which was so large, that I judg'd it contained at least the Quantity of a Gallon; the Cutis was exceedingly distended, but of the natural Colour, only, the capillary Veins appear'd varicous, and very numerous; she had also a large Tumour on the Buttock of the same Side, of the Bigness of a Quarter Loaf; but when the Tumour on the Thigh was pressed, the Tumour above very much encreas'd, which shew'd a Communication, and prov'd afterwards so to be: She had also another Tumour on her right Side, stretching from the left Side of the Vertebrae of the Back to the Hypochondrium, about the Bigness of a Penny Loaf, her Body was very much emaciated, and she could hardly breathe, and the little Victuals she eat very difficultly passed out of the Stomach. She had had the Menstrues but twice or thrice, about 12 Months before the Beginning of those Tumours, and it is to be marked, that the Tumour of her Thigh began first, and increased to near the Magnitude I first saw it, before the Tumour of the Buttock and Hip began; after that, the Tumour of her Back began, which, as it increas'd, brought on great Difficulty in Breathing. She had been with several other Persons, who advised against opening the Tumour of her Thigh, most of them being of the Opinion it was from Blood, and that her Case was incurable: I confess, confess, I was of a contrary Opinion; but being told what so many others had said, I declin'd meddling with it at that Time, though her Parents and herself were willing to it: At this Time I dismissed her, saying, that, if she liv'd, a little Time wou'd discover more of her Case. About two Months after I was desired to visit her again, which I did, but the Tumours were so monstrously increased, and her Body so wasted, that I wonder'd she could live under such Circumstances; the Tumour of the Thigh was every Way yielding to the Pressure of the Finger, nor was there the least Hardness about the Extremities of it, so that it might be easily mistaken for an Aneurisma, had it not wanted the grand Characteristic, Pulsation, which some say, is not to be felt when those are very large, the Middle of this then look'd a little red, and shining, and seem'd to point a little; I told them I believed it would break with a small Orifice, and shew what was contain'd, willing them to notify it to me if such a Thing happen'd: Three Days after they call'd me in haste to this Patient, saying, the Swelling of her Thigh was broke; when I came, I found there had been discharg'd a small Quantity of matterish Substance, much like what is contain'd in a Meliceris, but the Opening was so small or closed, that I could not enter my Probe; however, though she seem'd to me (and to Mr. Wall, an Apothecary then present) to be ready to expire, yet, at the Desire of her Parents, I open'd this Tumour with my Launcet, making an Incision about an Inch and an half long, through which poured three Pint Basons full of Matter, besides several smaller, which together contain'd about five Quarts, it was very foetid and bloody towards the latter End of this Discharge; upon this, the Tumour wholly subsided, in- somuch that the Thigh instantly became as small as the other; I put my Finger into the Wound, and found the Fascia lata quite consum'd, the Muscles lay all loose, so that I fairly touch'd the Thigh-Bone between them, as I would. But I should acquaint you, that, immediately upon the Discharge of this Humour, the Tumour on the Buttock was considerably abated, but there followed about two or three Spoonfuls of florid Blood; I dress'd it up for this Time with a proper Digestive, and a suitable Bandage; the Day following I visited her again, and found she had slept pretty well, and was much refresh'd, and not the least Faintness had attended her, during my Absence, which shews the imaginary Syncope, that is feared to follow such, Evacuations, to be groundless; the Day following, taking off my Dressings, I found the Limb, in its Figure, bigger than the other; at the third Dressing there appear'd a small hard Swelling a little below the Orifice, which was made by some grumous Blood that lay there, which I turn'd out with my Finger, in Quantity about four Ounces, this was follow'd by a florid Blood, which much surprized me; I then judg'd this proceeded from some Hypogastrick Vessel that supplied this Tumour, and I despair'd of Success, unless I could meet with this Spring; so, in order to it, I laid open the Sinews to the Groin, and, though I could not discover the Vessel, yet I so successfully applied my Astringent, that from that Time it bled no more; however, there was, for a Week, a great Flowing of a ferous Matter, which wholly sunk the Tumour of the Buttock and Hip, and, by bolstering and compressing with suitable Bandage, the so long separated Cutis clos'd with the Muscles, Muscles, and all Things, in about a Fortnight seem'd to be in a fair Way of healing, yet, it was near three Months, before this Cure was compleated. But still (that is, a Fortnight after the Opening of the Thigh) the Tumour on her Back continu'd, and she much straitened for Breath; saying, if that was opened, she should be presently reliev'd; this Tumour I then open'd (which was, I said, as big as a Penny white Loaf, and there issued out about two Quarts of Matter, or rather more: I was again greatly surprized that such a Quantity, so much more than what possibly this visible Tumour could contain, should run out of this Orifice; I enter'd my Probe, and found it penetrate into the Cavity of the Thorax, between the second and third spurious Rib, reckoning from beneath, on which she respired with all Freedom, but there was a Halitus at this Wound; I continu'd to dress this and believe, before this tended towards Healing, not less (at Times) than a Gallon, or rather five Quarts of Matter, was discharg'd; but, when I thought all was over, it filled again, the external Tumour became almost as big as before, and her Breathing as difficult as ever, so that I now thought all my Labour had been in vain; yet I open'd it again with a larger Orifice, and from that Time dressed it successfully, to the perfect Healing; the Menses are return'd, the Patient continuing well to this Day, and in a good State of Health. This Patient has been viewed by Mr. John Douglass, and he has had an ample Account of this Affair.