A Letter from Daniel Peter Layard, M. D. and F. R. S. to the President, Containing an Account of the Case of a Young Lady Who Had an Extraordinary Impostume Formed in Her Stomach

II. A Letter from Daniel Peter Layard, M.D. and F.R.S. to the President, containing an Account of the Case of a young Lady who had an extraordinary Impostume formed in her Stomach. SIR, Read May 3. THE Communication of the following Case, which I have the Honour of laying before you, will not, I hope, be deemed an assuming Step in me: My only Design is, in Obedience to your Commands, to give you as exact an Account as I am able of this unexpected Cure; and I shall esteem it the highest Pleasure, should any Benefit accrue from this Observation. Give me leave to subscribe myself, with all possible Respect. SIR, Your most humble Dean-street, Feb. 17. and most obedient Servant, 1749 D. P. Layard. MISS—a young Lady of seventeen Years of Age, being at a Boarding-School about three Miles from this City, was, on the 28th of November 1745, taken with profuse Sweats, which, after some Continuance, and weakening her much, were stopped by means of saline Draughts, made with Elixir Vitiroli. On the Removal of those Sweats an Obstruction of the Menses, with all its Symptoms, ensued. A Shortness of Breath, a dry Cough, an acute Pain in the Left Hypochondrium, Rigors, &c. were taken for the Signs of a Peripneumonia; and, the Medicines usually prescribed having no Effect, a Blister was applied on the left Hypochondrium. The Faetids, and Musk, as in a nervous Case, were also administered in large Quantities, but with as little Success. It being thought advisable to bring the young Lady to Town, I first saw her on the 12th of Feb. 1745-6. when I observed a large prominent Tumor on the left Hypochondrium, which reached to Part of the Right, filling up the Epigastrium and Scrobiculum Cordis, where she complained of a constant acute Pain. The Muscles of the Larynx, Pharynx, and Neck, were much swelled, and the Glands indurated. The other Symptoms were a continual quick Pulse, Thirst, hoarse Cough, Difficulty of breathing, Cardialgia, and Obstruction in the Oesophagus, so that, as soon as any Liquid "fell down," as she expressed it, "to the Pit of her Stomach," she instantly threw it up with violent Pain, Borborigmi, Eructations, and Singultus. On the 14th, finding the Symptoms increase, especially the Obstruction in the Oesophagus, and apprehending that an Abscess was forming in the Stomach, I desired Dr. Mead should be called in, who confirmed me in my Opinion. In order to asswage the Inflammation, a cooling mucilaginous Mixture, and a Sperma Ceti one, were prescribed, as also a laxative Glyster. Next Day, being told, that not a Drop of the Mixtures could be admitted into into the Stomach, Dr. Mead took his Leave, advising the Repetition of the Glyster every three or four Days, as Necessity might require, and that Nature should be watched, in case of a favourable Turn, which He did not much expect, having observed, that those Abscesses more frequently terminate in a Gangrene than by Suppuration. On the 16th the Glyster brought away with the Faeces some Pieces of Membranes, about a Finger's Length, and two in Breadth; to lubricate the Intestines I directed ten Ounces of plain Mutton Broth to be injected, which, after the first time, was constantly absorbed and was repeated twice every Day, till the 3rd of May. In this State, with no other Sustenance than these Broth-Glysters, the laxative one repeated every third Day, and a warm carminative Plaister applied on the Tumor, did the Patient continue till the 17th of March, when, observing an Intermission in the Pulse, and hoping that a Decoction of the Cort. Peruv. might corroborate the Solids, if absorbed, as the Broth Glysters were, I directed eight Ounces of the Decoction to be injected, and repeated four Hours after: By Accident, the first was not half thrown up; the second, on the 18th of March, at Two o'Clock in the Morning, had a very extraordinary Effect; for being entirely absorbed, about two Hours after, the young Lady complained of a most acute Pain in her Stomach, which by its Violence brought on a profuse Sweat, and threw her into a Syncope, wherein she remained a full Quarter of an Hour; then, shrieking, made Signs to her Nurse to bring her the Basin; she vomited near two Pounds of of grumous Blood, and then some purulent Matter; thereupon she discharged by stool above four Quarts of well digested Pus, with several Pieces of Membranes, like those before-mentioned. The purulent Discharge continued gradually decreasing till the 23rd of April. Balsamics, and small Quantities of thin Veal and Mutton-broths, were daily given. April the 29th the Patient was purged with Pulp of Cassia. On May the 3d the Mutton-broth Glysters were omitted, the Stomach now performing its Office. The 7th ten Ounces of Blood were taken from the Foot, which brought down the Menses. The Tumefaction and Induration of the Muscles and Glands of the Neck were removed by the continual Application of the Emplastr. Saponac. And after the Use of Stomachics, and mineral Waters, the young Lady was perfectly cured on the 17th of June 1746, and has continued well ever since. It may not be improper to observe, that the Stomach, on account of the Number of Blood-vessels it is furnished with, is as liable (1) to Inflammations, and Abscesses, in any Part of the human Body. These are occasioned by a Stagnation of the Blood, which, if not speedily removed, must greatly endanger the Patient's Life, by obstructing the necessary vital Functions of that Viscus. The speedy Progress of this Disease, and the Remoteness of the Part from proper Applications, render its Termination mostly fatal; and, as Dr. Mead judiciously observed, these Abscesses more frequently terminate by a Gangrene, than (1) Boerhave in Aphorism. de ventricul. inflam. p. 228. Articul. 951. 952. 955. than come to Suppuration. Those that do suppurate, generally form Ulcers, penetrating into the Cavity of the Abdomen, and sometimes also perforate the Integuments, as the following recorded Observations testify. (1) "Monsieur Petit has found a carcinomatous and fistulous Ulcer, which eat through the Fundus Ventriculi, and the Integuments of the umbilical Region. (2) "Monsieur Duverney also found a Hole in a Stomach, which he could pass his Thumb through: This Hole was near the Pylorus, which was extraordinarily dilated. (3) "Monsieur Littre observed an Ulcer of five Lines Diameter, about one Inch and a half from the Pylorus; and found three Pints of grumous and serous Blood in the Stomach of a young Man who had voided large Quantities of Blood. (4) "The same Gentleman gives an Account of a Tumor on the right Side, which being opened between the last of the true Ribs, and the first of the false ones, there issued out Pus, Stones, and the Succus Gastricus, with Pieces of digested Food. (5) "And Mr. Atkinson tells us in the Philosophical Transactions, that he opened a Tumor on the upper Part of the Belly, out of which Opening part of the Omentum came, and whatever the Patient eat or drank for eight or ten Days: Yet (1) Mem. de l'Academ. des Sciences, Ann. 1716. p. 312. (2) Hist. de l'Academ. des Sciences, Ann. 1704. p. 27. (3) Ibid. p. 30. (4) Ibid. p. 28. (5) Philos. Trans. No. 371. the Patient, contrary to his Expectations, was cured in six Weeks." But the following Observation from Forestus comes the nearest to our Case "Puella quindecim annorum, per biennium fere cum de dolore ventriculi conquereretur, anno tertio tumorem manifeste videbunt parentes, in eo loco; necque tunc quicquam consilii aut remediis tentatum. Hinc rupturam animadverterunt, excrevitique puella materiam, biliosam, pituitosam, ac saniosam, per alvum: ex his apostema apparuit," &c. (6). "Luetus (7) relates several Instances of Persons who have lived a long while without Food, but then they could admit of Liquids; and the young Lady which Monsieur Littré (8) nourished with Broth-glysters, in which a Yolk or two of Eggs, and sometimes a Glass of Wine, were mixt, could also keep Water in her Stomach, tho' no other Fluid." An Advantage which our Patient was deprived of. From what I have related it appears, that our young Lady had an Abscess in her Stomach, which gradually ripened, and then broke, suppurated, digested, and cicatrized, as all other Abscesses do; and that during this time, which was near three Months, she was almost all the while nourished solely by the Mutton-Broth Glysters. III. Ac- (6) Forestus Observ. 33. de ventricul. ulcer. (7) Luetus de his qui diu vivunt sine alimento. (8) Mem. de l'Academ. des Sciences. Ann. 1715. p. 183.