A Farther Account of the Success of Some Experiments of Injecting Claret, &c. into the Abdomen, after Cupping. By Mr. Christopher Warrick

LXV. A farther Account of the Success of some Experiments of injecting Claret, &c. into the Abdomen, after Cupping. By Mr. Christopher Warrick. Read Feb. 12, 1756. Some time since did myself the honour to lay before the Society an account of an improvement I had attempted on the operation of tapping, by injecting the abdomen, after the lymph was drawn off, with astringents. This method proving successful in the case of Jane Roman, (as mentioned in the Transactions, No. 472) I was in hopes some gentleman of better abilities, and larger experience, would have made further tryals; but having not heard, that any attempt this way hath been made by others, and having lately met with three instances, wherein my own endeavours have failed, I am under some doubt, whether, upon the authority of a single instance, I have not been too sanguine in my hopes concerning it; tho' the seeming reasonableness of such a scheme, and the good event of it, under the very particular circumstances of that woman, still plead strongly with me in its favour. The first is that of the poor woman at Cubert, mentioned in the Transactions, No. 473, who was injected with claret and Bristol water, and about a week after the operation died suddenly. She was upwards of fifty years of age. The second instance is that of a young woman of St. Kivern, who was about twenty-five, and had been three times tapped in the common way. Here we made use of two punctures, according to Dr. Hales's method, as recommended in the Transactions, No. 478, and claret and tar-water for the injection; which was conveyed into the abdomen thro' one canula, whilst the dropsical lymph passed off thro' the other. A few hours after, she complained of much pain in her bowels, and on drawing off the whole contents at once, she fell into a syncope, in which she remained till about twelve o'clock of the next day, when she died. It may not be amiss to mention, that her breath was immediately affected by the tar-water, and the smell of it continued to her death. The third instance being somewhat singular, I beg leave to relate it in all its particulars. In March, 1752, I was called to Flushing (a small town opposite Falmouth) to attend the tapping a poor woman, who was about forty years of age, and laboured, as was imagined, under an ascitical dropsy, occasioned by a suppression of her menses, that happened about twelve months before. She had been told of my success with Jane Roman, and desired my assistance, together with Mr. Rice, Mr. Cudlip, and Mr. Lillicrap, of the same profession. She was a married woman, of a cheerful temper, had never had a child, and, to all appearance, was a proper subject for the operation, she being never thirsty, and her extreme parts being of the natural size: the abdomen was likewise evenly and equally distended, and of a great magnitude; but the fluctuation was not altogether so manifest as might have been expected. From these circumstances we made no difficulty to resolve on the operation, and determined to try, at the same time, the efficacy of a subastringent injection. A suffi- sufficient quantity therefore of claret and Bristol water being got ready, Mr. Rice, whose patient she was, made the puncture; but on withdrawing the perforator, instead of lymph, nothing but a thick, ropy, gelatinous fluid came thro' the canula, in colour resembling red port wine, or rather grumous blood. The singularity of this did not however alter our measures. Two gallons of it were immediately drawn off, and half that quantity of claret and Bristol water injected in its stead. This we purposed to have repeated the next day, and as the circumstances of the patient would admit; and to continue daily, till the whole contents should be gradually discharged; fearing that a total discharge in the ordinary way would have brought on a syncope. But when we attended her again on the day following, not one drop of any fluid came thro' the canula; and a second and a third puncture was attended with no better success. Soon after this, the whole abdomen became painful and distended, frequent rigors came on, and a delirium, in about twelve hours, carried her off. Upon opening the body the day following, not one drop of any fluid was found in the cavity of the abdomen; an enormous cystis, which might have contained, when full, about six gallons, having completely filled the whole extent of it. There were likewise attached to the coats of it five large bodies of fungous flesh, the least of them bigger than a man's fist. Each of these, when cut open, appeared to be divided into cells, full of white glutinous pus. This extraordinary mass adhered only to the fund of the uterus, and together with it, the fungous substances, and vagina, when taken out, intirely covered a middle sized pillar and claw tea-table. We now found, that in the night the canula had accidentally fliped out of the cystis; and that the operator, in making the second or third puncture, had fallen upon one of these fungous bodies, which gave occasion to the above-mentioned disappointment. On proceeding to a farther examination of the abdomen and thorax, we found every thing found, and in its proper state, excepting the posterior part of the right lobe of the lungs, which was full of purulent matter, and adhered to the pleura. I should add, that the ovaria did not distinctly shew themselves, so as to satisfy any enquiry about them; but this perhaps might be owing to the hurry or inaccuracy of the disfector. Whether these miscarriages are sufficient to discredit a method of practice, which hath the appearance of being the most rational one yet found out for handling a dropsy, I leave to the determination of better judges. The frequent miscarriages, that happen in the ordinary way, seem sufficient to justify every attempt to render the success of it less precarious. If any further tryals of it be made, I would beg leave to recommend its being done before the viscera are too much injured by the dropsical lymph; and if the evacuation be made at different times, with a view of preventing a syncope, (as was proposed in the last instance) that brandy, or some such liquor, properly diluted, be made use of instead of claret, which, as I apprehend, by the heat of the body, may be apt to turn sour. It may be likewise proper, that the head of the patient, during the evacuation, lies lower than any other part of the body. As in the second instance above-mentioned, tar-water had been recommended by some gentlemen of the profession, then present, instead of Bristol-water, I, some time after the death of the patient, injected a pint of it warm into the belly of a small cur, to see how far the effect of it differed from that of claret and Bristol water. The dog immediately fell into great agonies, and in about two hours died. The abdomen being opened, all the intestines were found greatly inflamed. I then tried claret and Bristol water, also port wine and fountain water, on other dogs, after the same manner. Each of these injections was retained with little or no inconvenience, except intoxications: and in forty-eight hours the dogs became well again, the injection being entirely absorbed. It occurred to me, in making these experiments (wherein the power of absorption seemed very considerable) how far it might answer in preventing a syncope, or for other purposes, that a fit quantity of a properly adapted injection be left undischarged, after tapping, which might be either absorbed, or drawn off at proper intervals, as the strength of the patient may admit. I am, with great respect, SIR, Truro, Jan. 21, 1744. Your most humble Servant, Chr. Warrick. LXVII.