A Remarkable Case of a Gentlewoman Who Died of a Hydrops Ovarii, in the Thirty-Third Year of Her Age, after Having Been Tapped Fifty-Seven Times. By Mr. John Belchier, Surgeon

Capt. Hoxton, when at Anchor in Chelsea-Peak Bay, found the Latitude $37^\circ 29'$ N. Off Cedar Point in Potuxon River $38^\circ 7'$ N. Off Cape Henry $37^\circ 6'$ N. And in a Letter to Mr. Elton he declares, "That he observed with his Quadrant both by the Sun and Stars, in all the various Sorts of Weather he met with in his late Voyage to and from Maryland, without regarding the Horizon, with as great Exactness, as with Davis's Quadrant when the Sun and Horizon were clear." There was likewise put into the Hands of the Publisher, another Letter from one Mr. John Walton to Mr. Elton, containing some Observations of the Latitude in Leghorn Road, and several of the Ports of Spain, which were found, after repeated Experiments, exactly to agree with the known Latitudes of those Places: Mr. Walton adds, That he made several Observations in his Passage Home, in hard Gales, and a great Sea, and when it was so hazy, that the common Quadrant was of no use, for want of an Horizon. --- III. A remarkable Case of a Gentlewoman who died of a Hydrops Ovarii, in the Thirty-third Year of her Age, after having been tapped Fifty-seven times. By Mr. John Belchier, Surgeon. In the Year 1725, the Wife of Mr. Newberry, a Merchant in this City, complained of a Pain in her Left-Side, near her Groin, internally, which sensibly fibly increased; and perceiving a Swelling in that Part, she at first thought herself with Child; but having other Symptoms not very common with gravid Women, she sent for a Physician, who immediately discovered it to be Hydropical, and after following his Prescriptions for some time, and finding little or no Benefit thereby, she sent for another, and so for a third and fourth; and after between two and three Years fruitless Trial of proper Medicines prescribed by the Physicians, she growing very big and uneasy with her Burden, was advised to be tapped, to which she accordingly submitted: And on May the 6th, 1728, sent for Mr. Cheselden, who took from her between four and five Gallons of Water; but in a Week or ten Days after the Operation she perceived herself to fill again, in which State she continued to the first Day of July following, when Mr. Cheselden tapped her again, and took from her about the same Quantity of Water as before; and in this Manner she continued to fill and be tapped every third or fourth Week, from the 6th Day of May, 1728, to the 3d of this Instant March, 1732, when she died, in the Thirty-third Year of her Age. During the last Thirty-seven times of her Tapping, I constantly attended her with Mr. Cheselden, when she always (till the two last times) appeared very brisk and lively the whole time of the Water's running from her, and was not in the least sick or faint after the Discharge of the Water, as is usual; and though she was a very thin emaciated Woman, she would frequently walk three or four Miles the Day before the Operation, and most commonly went abroad the third Day after it. The Quantity of Water taken from her each time of Tapping was between four and five Gallons; and during the whole Fifty-seven times Tapping, there never was above a Quart, or two Quarts at most, different in the Quantity, till the two last times, at each of which the Quantity did not exceed two Gallons: But in the Intervals of these two last Operations, she was frequently troubled with Reachings to Vomit, which burst open the Orifice twice where she was tapped, and at each time discharged about six Quarts. The Quantity of Water which was taken from her each time was always measured, and upon Computation the whole amounts to near Two hundred and fifty Gallons. The Water that was taken from her the two last times of Tapping was much more viscid than the former. At times she frequently complained of a violent Pain on her Right Side, and a heavy aching Pain in the Pelvis. She had likewise a Prolapsus Uteri; and some time before her Death she could not expel her Faeces but with great Difficulty and Pain, and at the same time laboured under an Incontinency of Urine. On Monday the 6th of this Instant I opened her in the Presence of her Physician, when I found the whole Viscera, from the Diaphragm to the Osse Pubis, covered with a thick gelatinous Substance, which seemed to be membranous, which at its first Appearance I took for the Omentum in a putrified State; but after a farther Examination, I found it to be only the more viscid Parts of the extravasated Fluid, which could not be discharged by the Operation: After removing this, I found several Portions of a hard schirrous sclerous Substance arising from the Fundus of the Stomach, one large Portion of which was inserted into that Part of the Colon near the Right Kidney, and in Appearance resembled the Pancreatic Gland. Another Portion, which was Cylindrical, and about two Thirds of an Inch in Diameter, passed straight over the Intestines, adhering strongly to that Part of the Colon which lies under the Stomach, and was inserted into the Rectum, in the Pelvis. Another Portion of this Substance passed directly over the Intestines to the Pelvis, but about the Middle of the Abdomen it sent out two smaller Portions, the one was inserted into the Mesentery, the other reflecting back, was inserted into the Colon on the left Side near the Stomach. As soon as I cut into one of these Portions, I discovered it to be a Part of the Omentum twisted up, and contained in a very thick capsular Membrane. The Diaphragm was forced up so far by the Contents of the Abdomen, that the Cavity of the Thorax was decreased to near one Third. The Liver was much larger than in a natural State, and of one entire Substance, and not divided into Lobes, the whole Convex Surface adhering firmly to the Diaphragm. The Stomach was very small, as to its Cavity, but the Coats of it were increased to six times their natural Thickness (as were likewise all the Coats of the Intestines and Mesentery) and very much inflamed. Two Thirds of the Stomach adhered to that Part of the Diaphragm which did not cover the Liver, and the other Part adhered to the concave Surface of the Liver; as did likewise the Duodenum, whose Cavity was was very large. Below the Duodenum, the Colon adhered to the lower Part of the Concave Surface of the Liver, so that the whole Liver was contained in a kind of Bursa composed of the Diaphragm, Stomach, Duodenum and Colon. The Cecum, Colon and Rectum were much larger than in a natural State, and adhered so very strongly to the Parts over which they passed, that it was with much difficulty I could separate them. The Spleen was not one Fourth of its natural Size, and one Half of its external Surface was entirely Cartilaginous. The Pancreas was smaller than usual, as were likewise the Kidneys, Ureters and Bladder; and in the Pelvis of each Kidney there were small fabulous Concretions. The left Ovarium was distended to so large a Size, as to fill the whole Cavity of the Pelvis up to the Os Pubis; its Surface was Cartilaginous, like that of the Spleen, and in it were contained a great Number of Hydatides of different Sizes, whereas the right Ovary was no ways diseased in the least. The Difficulty and Pain complained of in the Expulsion of the Faeces, naturally arise from the Pressures on the diseased Ovarium, at the same time that its increased Bulk, by compressing the Intestinum Rectum impeded the Egress of the Faeces, and brought on the Inflammation of the Intestines, which we observed. The Prolapsus Uteri, and the Incapacity of the Bladder's retaining a proper Quantity of Urine, were likewise occasioned by the Pressures of this diseased Ovarium upon those Parts. But what seems most material in this Case, is the viscid Matter found in the Cavity of the Abdomen; which as the Waters were originally incysted in the Ovary, was properly extravasated from the Cythus into the Abdomen in the two last Operations; by which, as well the Quantity drawn off as the customary Relief, were very much diminished; in lieu of which the Stimulus, from such a Fluid, might reasonably bring on the Vomiting observed from that time. Quer. Therefore, if such a Vomiting ensuing the Operation is not a fatal Symptom? Quer. If any Method can be found to prevent such Extravasations? The Relations of this Gentlewoman are of Opinion, that her Disease was occasioned by pulling off her Cloaths, when she was very hot, to go into a Bathing-Tub of Water to cool her, when finding the Water excessive cold, she put only her Legs in, the other Part of her Body being out of the Water, and naked at the same time; which happened a few Weeks before she perceived the Swelling and Pain in her Pelvis; and probably this might be the Cause. As the Constriction of the lower Parts by the cold Water might, in a great measure, impede the Fluids circulating through the lower Parts, and the Blood being at the same time rarified and expanded by the Heat, might therefore burst through the more tender Lymphatics, and produce the Extravasation.