An Uncommon Dropsy from the Want of a Kidney; And a Description of a Large Saccus That Contain'd the Water, by Samuel Glass, Surgeon, at Oxford; Sent to Dr. Mead

II. An uncommon Dropsy from the Want of a Kidney; and a Description of a large Saccus that contain'd the Water, by Samuel Glas, Surgeon, at Oxford; sent to Dr. Mead. November 11, 1746. Read Jan. 8. MART Nix, who lived at Hampton-Poyle, a small Village in Oxfordshire, had been remarkable all her Life for the preternatural Size of her Belly. After her Death, I had the Curiosity, together with some learned Gentlemen of the University, to inspect her Body. Her Mother was then present, and inform'd us, that this her Daughter was born dropsical; that she herself had been ill of the same Disease for some time before, and during, her Pregnancy; but, on the Birth of this Child, she was freed from that Disorder. The Child, tho' born dropsical, prov'd otherwise healthy; and, notwithstanding the Disease continually increased as she grew up, liv'd to be near twenty-three Years of Age. She was a tall well-proportion'd Woman, except with Regard to the enormous Size of her Belly; and, for one of so unwieldy a Bulk, healthy, brisk, and active. Her Appetite was always good, and she was never more than ordinarily thirsty; had no remarkable Difficulty of Breathing, not even when she lay supine, nor did her Thighs or Legs ever swell. Her Menstrues, which appear'd at the usual Time of Life, continued regular, till within eight Months of her Death. The only Complaint was now-and then a Pain Pain in making Water; and the Quantity she made was commonly about four or five Ounces. Upon the Suppression of her Catamenia, there succeeded a Dyspnea, Loss of Appetite, Emaciation of the superior Parts, and a Tumescation of one of her Legs with Ulcerations. These Symptoms gradually increased till her Death. Upon taking the Dimensions of her Body before Dissection, we found the Circumference of her Abdomen to be just six Feet four Inches, and from the Xyphoid Cartilage to the Os Pubis it measur'd four Feet and half an Inch. The cutaneous Vessels, distributed upon the Abdomen, were remarkably large, and distended with Blood, and the spurious Ribs were press'd greatly outwards and upwards. After this general View of the external Parts, we began the Dissection, by dividing the Cartilages of the six superior Ribs, and raising the Sternum. The Thorax being laid open, we observ'd that the Diaphragm was forcibly protruded into that Cavity. The Base of the Heart lay under the right Clavicle, and its Apex upon the most convex Part of the Diaphragm; which Convexity advanced as high up as the third superior Rib. The Lungs were surprisingly small, scarce exceeding in Magnitude those of a new-born Child. The right Lobe slightly adher'd to the Pleura, the left was free, and both were in a sound State. Within the Pericardium was found, as usual, a small Quantity of Liquor, but none in the Cavity of the Thorax. We next perforated the Abdomen in the most convenient depending Part, and evacuated from thence a surprising Quantity of Water, which was lightly tinged tinged of a Coffee-Colour, limpid as Urine, and not in the least fetid. This Water was carefully measured, and found to be not above a Pint less than thirty Gallons Wine Measure; which must weigh, according to the common Calculation, near 240 l. We afterwards made an Incision into the Abdomen along the Linea alba. The Integuments upon the epigastric Region were very thin; the abdominal Muscles much extenuated; and above the Umbilicus the Tunica cellulosaf contain'd no Fat; but from the Navel to the Os Pubis, the Panniculus adiposus was half an Inch thick. Upon dilating the Incision, the large membranous Bag that contain'd the Water presented itself to View, adhering transversely about ten Inches to the anterior Part of the Peritoneum. This Adhesion being separated, we had a full View of this wonderful Reservoir, which was of an enormous Size, and had almost occupied the whole Cavity of the Abdomen: In Figure, Colour, Thickness, Number, Magnitude, and Distribution of Blood vessels, it very much resembled the Uterus of a Cow at the End of Gestation. The whole Inside was scabrous, and look'd as if parboil'd; and here and there was observ'd a small Quantity of a Coffee-colour'd Sediment. On the left inferior Part was discover'd the Orifice of a Duct, which open'd obliquely into the Cavity of the Saccus, and would easily admit of a large Goose-Quill. From this Opening the Tube advanc'd about twelve Inches between the Membranes of the Bag obliquely upwards, and towards the right, from whence it was inflected downwards, and pass'd between the Duplicature of the the *Ligamentum latum Uteri*, to be inserted into the Bladder of Urine. The *Saccus* was connected to the *Ligamentum suspensorium Hepatis*, to a considerable Part of the *Mesocolon*, to the *Peritoneum* on the right Side in two or three different Places, to the same Membrane the whole Length of the Spine, and to the *Ligamentum latum Uteri* on the right Side of the Body. The Liver was found, but less than in a natural State; and its convex Part adher'd closely to the Diaphragm. The Stomach, Spleen, *Omentum*, small Intestines, and the upper Part of the *Colon*, were thrust very high up into the left *Hypochondrium*. The Convolutions of the lower Part of the same Intestine were entirely obliterated; and that, together with the *Rectum*, formed one continued strait Tube, from the left *Hypochondrium* down to the *Anus*. The left Kidney, with its emulgent Vessels and *Ureter*, were in their natural State and Situation. The *Uterus*, *Tuba Fallopiana*, and *Ovarium*, on the same Side, had nothing preternatural; but, on the right Side, the *Fallopian* Tube and Ovary were dispos'd in a very extraordinary Manner. The Tube, by means of the Adhesion of the *Ligamentum latum Uteri* to the *Saccus*, was extended to three times its ordinary Length. The Ovary was likewise, by the same Cause, render'd very preternatural, being no less than five Inches three Quarters long, one Inch broad, two Tenths of an Inch thick, and two Inches and half distant from the *Uterus*. The Bladder of Urine was very small, but appear'd to be found. We then made an accurate Search for the right Kidney; but, to our great Surprize, found no such such Viscus, nor any thing analogous to it, unless the Saccus that contain'd the Water already describ'd, may be esteemed such: And what seem'd to favour this Opinion, was the Disposition of the emulgent Vessels on the right Side, which were propagated from the Aorta and Vena cava to this Saccus, in the same manner as to the Kidney on the opposite Side; and, after having ran twelve or fourteen Inches between the Membranes of the Bag without any Ramifications, were distributed all over it in the Manner before-mention'd. From the foregoing Account the following Queries are naturally suggested, which I leave to the Determination of the Learned: Query 1. Was not the Saccus originally a mis-shapen Kidney, and the Duct a Ureter? Query 2. Was not the Water contained in the Saccus prevented from growing putrid, by being continually drain'd off thro' the Duct into the Bladder of Urine, and by being afresh supplied by the emulgent Artery; and more being secrated than was evacuated, the Quantity thereby continually increased? Query 3. Was not this the Reason why the Patient had never any anasarcous Swellings of her Thighs or Legs, nor any Thirst, or other Signs of a confirm'd Dropsy? Query 4. Were not the Lungs prevented from growing by the great Diminution of the Cavity of the Thorax, and the Pressure they sustain'd from the distended Abdomen? And might not their never having occupied a larger Space than they did at Birth, be the Reason she never labour'd under any Difficulty of Breathing? Query 5. Was not the Bladder of Urine likewise by the superincumbent Weight, prevented from dilating itself; and that the Reason why the Water was often made, and always in so small a Quantity? In order to convey a more clear Idea of the several Parts already describ'd, to those who may not have an Opportunity of viewing them (they being properly preserved for that Purpose), and being sensible of the great Difficulty or clearly representing by Words such Things as are out of the ordinary Course of Nature, I must beg Leave to refer the Reader to the Figures hereto annex'd. See Tab. I. Fig. 1. aaaaa, The great Saccus that contain'd the Water. bb, The greater Diameter of the Saccus. cc, The lesser Diameter. d, A prick'd Line shews the Entrance of the emulgent Vessels. ef, Shews the Course of the Duct between the Membranes of the Saccus. f, The Orifice opening obliquely into the Cavity. eg, The inflected Part of the Duct, after its Egress from the Saccus, which passed between the Ligamentum latum Uteri to the Bladder of Urine. g, The Duct, divided near the Bladder, where its Cavity was so small as only to admit of a common-siz'd Probe. Fig. 2. Represents the posterior View of the Uterus, Fallopian Tubes, and Ovary. aa, The Uterus. A, The Os Tinea. bc, The Fallopian Tube in a natural State. c, The Morsus Diaboli. d, The left Ovary in a natural State. ee, The Ligamentum rotundum. fg, The right Fallopian Tube. g, The Morsus Diaboli. hh, The right Ovary. ii, The Ligamentum rotundum. kkkk, The Ligamentum latum Uteri. ll, Its Adhesion to the Saccus.