Two Remarkable Medical Cases, One of an Extraordinary Haemorrhage, the Other an Ascites Cured by Tapping; Communicated by Henry Banyer, M. D. Extra-Licentiate of the College of Physicians, London, to C. Mortimer, M. D. Secr. R. S.

XV. Two remarkable Medical Cases, one of an Extraordinary Hæmorrhage, the other an Ascites cured by Tapping; communicated by Henry Banyer, M.D. Extra-Licentiate of the College of Physicians, London, to C. Mortimer, M.D. Secr. R. S. Read Dec. 22. In the Month of January 1729. Daniel Goddard, a Gardener, about the Age of Twenty-four Years, at Wisbech in the Isle of Ely, Cambridgeshire, happened of a slight Puncture from a rusty Nail in the Sole of his Right Foot. And, notwithstanding there was not wounded any Tendon, or Blood-vessel, larger than small Branches of Veins, the whole Foot was immediately swelled to a very unusual Degree, without any Fever, or other apparent Cause for it. It was also attended with great Pain, and an extraordinary Pulsation upon the Part, as in Wounds of Arteries; and so distended as if the Blood would burst out of its Vessels. Accordingly, after Two Days, upon opening a superficial Sinus, to inlarge the Wound, there rushed out immediately such an obstinate Flux of Blood, as would not yield to any styptic Means, longer than the Bandage was holden on by some strong Hand. And, although, by this Incision, no Vessels were wounded, but Capillary Veins; yet this Hæmorrhage continued to shew itself as violent as at first, for Six Days successively, whenever the necessary Means were relaxed. Upon which, for the sake of Revulsion, the Patient had had a Vein opened on the Arm of the opposite Side; and it had such a sudden and surprising Effect, that the Flux of Blood in the Foot instantly ceased, and the Wound healed very soon without any further Trouble; but the Flux of Blood, consequent upon Venesection, became equally as difficult to restrain, as that in the Foot, for the Space of Four Days; all which time it would have continued to flow most violently without the strictest Bandage, as the same Care of the Hand, as before. Perhaps the Period of this Hemorrhage might have been much longer, if I had not suffered the Ligature on the Arm to be loosened now-and-then, as I judged the Redundancy of Blood required, for the sake of some Evacuation, at each time. After the Bleeding, he soon recovered his Strength, so as to do his Business in the Gardens; and continued very well till the Month of March 1730. About the Middle of this Month, he complained of Sleepiness, and a particular Heaviness all over his Body; which was followed, in Three Days time, by a violent Hemorrhage from the Nose. This Flux, in spite of all Means being tried, except Venesection, continued Seven Days, and could never be totally stopped, all this time, for one Hour together. He recovered again in a very short time, and was able to work in the Summer-season, without any Complaints, till October following. Then the Hemorrhage returned again at the Nose, as before, with all the same Circumstances, and in Defiance of all Endeavours, continued the Period of Seven Days. Thus it returned in like manner of Bleeding, by Stools, in the Middle of March 1731, and continued to discharge this Way great Quantities of Blood, in one Motion, and sometimes two Motions every Day for Seven Days together, in Opposition to the most efficacious Restrings. Also it made its regular Return by vast Profusions of Blood from the Intestines, in the Beginning of October following, to the End of the first Period of Seven Days, without Gripings, or any such uneasy Sensations. Thus, again, it kept as orderly Returns about the Vernal and Autumnal Equinoxes of the Years 1732, 1733, with vast Profusion of Blood by Stool, for the usual Term of Seven Days, agreeing in all Circumstances with the preceding Years. Likewise at, or very near these two grand Seasons, in the Years 1734, 1735, this habitual Hemorrhage broke away by the Kidneys and urinary Passage; and still constantly, for these Two Years, kept its old stated Time of Seven Days, without any other Variation. This young Man was seized in Dec. 1735, with the Small-pox, of the Distinct Kind, which produced such a Change in his Constitution, that he escaped those periodical Hemorrhages, or any other spontaneous Evacuations equivalent thereto, for the Two Seasons of the Year 1736; and remained in very good Health till Christmas following, being above Thirteen Months free from any Symptoms of his old Eruption. But, upon December the 27th, without any previous Notice of Heaviness and Sleepiness, the Hemorrhage returned by the urinary Passages; but much more favourably, and continued only Three Days. Again, on May the 13th following, 1737, he then felt the previous Warnings, and bled again by Urine to the 20th of the same Month; with this Difference, that for Three Days the Urine was only Coffee-coloured, but afterwards, for Four Days longer, every Discharge resembled an Effusion of Blood from a Vein just opened. He presently recovered his Strength, even although the Air was exceeding warm at this Time; and I saw him Five Months after, very robust and healthy, and, as he told me himself, was free from all kinds of Tendency towards his old Complaint. But he had always the Appearance of too much Fulness, though I am of Opinion, that his Constitution did not suffer so much as might reasonably be imagined, from such prodigious Hæmorhages. Of my own Knowledge, he had no Return of his Bleeding, or any thing like it, the ensuing Autumn; but remained perfectly well all the following Winter Season. Afterwards I had no Opportunity of making further personal Inquiries, but was informed by an intelligent Man, that in March 1738 this unfortunate Person got a slight Wound again, somewhere upon one of his Legs, which proved equally as difficult, with respect to the Flux of Blood, as the first Puncture in his Foot. And, whether from too strict a Restraint of the Hemorrhage, or for want of Venesection, he fell into very violent Convulsions for Four or Five Days, and died in a manner like Suffocation, from too much Redundancy of Blood. As this Hæmorrhage never once depended upon any other Distemper, or observed any regular Concurrence with the Revolutions of the Moon, it appears to be a very extraordinary simple Plethora. During the Four Years that this Flux of Blood came from the Nose and Intestines, the Urine was never of a higher Colour than Amber; nor was there any Symptom of a Fever by the Pulse, or otherwise, for the whole Term of the Disorder. January the 6th, 1743. On March the 26th, 1739, the Wife of Mr. Matth. Wilkinson, of Long-Sutton, in Lincolnshire, was tapped for an Ascites, proceeding from frequent Hemorrhages, and a too liberal Use of small Liquors. She was between 30 and 40 Years old, of a very low Stature, and always of a weak Constitution. The Water was all taken away at one Time, and measured Five Gallons. She was very faint immediately after the Operation, and remained so for near Three Weeks after. But, by great Abstinence from Liquids, excepting Lower's bitter Infusion, and sometimes a Spoonful or Two of Cordial Julap, she perfectly recovered her Health again; and to a much better Degree of it, than she had enjoyed for many Years before; without any Appearance at all of a Return of the abdominal Tumour to this Day. The Water was clear, and readily turned to a strong Jelly upon heating it; and I am very certain, there was unavoidably left in the Abdomen a Quantity sufficient to prove the Existence of absorbent Vessels. Perhaps those Patients, in this Distemper, whose Water turns to a Jelly, have a better Chance to be cured by Paracentesis, than others, whose Discharge is more like Urine, and will never curdle by Heat. But Time, and repeated Observation, must confirm this Opinion. Postscript against Empiricism. Notwithstanding the great Usefulness and Tendency of successful Observations in Physic and Surgery, to encourage Practitioners in a Perseverance in their Duty, even where the regular Prognostics stand against them; yet I cannot forbear taking this Opportunity to assert the Impossibility of any Person's obtaining a competent Knowledge of the Art of Healing, by Practice only; without a previous Knowledge of Anatomy, and the Animal Oeconomy. Hence have I met with an old Practitioner, of very extensive Business, who had never been educated in this fundamental Qualification, and who, for want of it, was treating his Patient with Cataplasms and Fomentations, to cure that Numbness in the Thigh which is a certain Diagnostic of a Nephritic Case. And I have more than once seen a Dysuria under the Treatment of a gravelly Case, when it has plainly arisen from the Vena Hæmorrhoidales having been too much swelled towards the urinary Passages. Thus, where Men are not qualified to distinguish at all upon the Symptoms of a Distemper, from some true Knowledge of the Parts concerned, they must necessarily be often mistaking the Symptoms for Distempers, and so vice versa, after this Manner; insomuch that their longest Practice will be little better than a Multiplication of Blunders, without much Chance to be wiser by Time and Experience.—Huic Ratiocinationi adstipulatur Experientia, qua sine vana omnis Theoria, bella sit utcunque.