The Case of Ann Davenport. By Mr. Fielding Best Fynney, Surgeon at Leek, in Staffordshire; Communicated to Thomas Percival, M. D. F. R. S. and by Him to Sir John Pringle, Bart. P. R. S.

XXIV. The Case of Ann Davenport. By Mr. Fielding Best Fynney, Surgeon at Leek, in Staffordshire; communicated to Thomas Percival, M.D. F.R.S. and by him to Sir John Pringle, Bart. P.R.S. TO SIR JOHN PRINGLE, BART. P. R. S. SIR, Read April 10, 1777. I TOOK the liberty, a few days ago, of transmitting to you, by a private hand, a singular case, sent me by Mr. F.B. FYNNEY, an ingenious surgeon, who is settled at Leek in Staffordshire. He desires that it may be laid before the Royal Society; and I shall think myself much obliged by your compliance with his request. TO DR. PERCIVAL. SIR, Leek; March 16, 1777. UPON May 16, 1775, being desired to visit ANN DAVENPORT, a native of this town, I beheld a truly miserable object, with the most cadaverous countenance I had ever seen, emaciated to the last degree by a hectic fever, and profuse colliquative sweats. She had a continual thirst, her appetite was totally gone, and she was always in the extremes of being too loose or too bound. Her mother informed me, that she was then in her twenty-first year; and that she had been a strong and sprightly child from her birth, until she was about five years of age, from which time she had been a stranger to health, and every now and then had been seized with excruciating fits of the colic, especially whenever she ate or drank any thing the least acid. The young woman told me, that about a year ago she had first perceived a swelling on the right side of her belly, just above the groin; which, if at any time she attempted to stretch out her thigh, gave her inexpressible pain, as if something stabbed her in that part: that therefore she was always obliged to keep up her knees, more or less, towards her breast, by which means she had, in some degree, lost the power of extending her limbs. I ordered her to take half a drachm of powdered bark in a little red port wine every four hours; and, as matter had already formed within the tumor, I desired that a maturating poultice might be applied every night and morning; for I imagined that nature, without such assistance, could never bring the abscess to a head in her weak condition. July 10th, the matter pointing at the upper end of the tumour very near the os ilium, I made a large opening, from which was discharged an amazing quantity of pus; but, as the tension was still great, I applied a linseed poultice over the common dressings: nevertheless, in a few days a second abscess began to form towards the vertebrae of the loins, between the false ribs and the os ilium, which was rapid in its progress, for it was brought to maturation, and opened on the 26th. On the 31st I was alarmed with a gangrenous appearance of the whole integuments of the abdomen: for this she took one drachm of powdered bark in red-port every three hours; but, as vesications and every sym- ptom of a *spbacelus* continued to increase, I likewise used the bark externally, in the two following forms, every morning and evening: \[ \begin{align*} & \text{℞ Tinct. Cort. Peruv. Simp. } \frac{3}{ij} \\ & \quad \text{Myrrh. Comp. } \frac{3}{j} \\ & \quad \text{Sp. Sal. Ammon.} \\ & \quad \text{Mell. Ægypt. aa. } \frac{3}{fl. m. fiat embrocat.} \end{align*} \] \[ \begin{align*} & \text{℞ Faec. Cerevis. acid. } \frac{1b}{j} \\ & \quad \text{Farin. Avenac. q. s. coque ad consistentiam Cata-} \\ & \quad \text{plasmatis, et adde Pulv. Cort. Peruv. } \frac{3}{j} \\ & \quad \text{Ol. Olivar. rec. } \frac{3}{iv m. fiat Cataplasm.} \end{align*} \] This treatment soon put the mortification to a stand, and the parts floughing off largely left three holes, at nearly equal distances one from another, betwixt the first opening and the left *os ilium*, besides several ones in different parts of the belly; but as the discharge was immoderate, I looked upon the patient to be in the utmost danger. However, the same course was persevered in, and at the latter end of August another abscess appeared lower down, towards the right groin; I ordered it to be poulticed, and left it to open of itself, which it did on the 21st of September. I was immediately called to her; and, upon carefully examining the part, I found a hard substance deeply seated, which I directly extracted\(^{(a)}\). It was making its way towards the integuments from the extremity of the appendix vermiformis of the cæcum, which probably, and fortunately, by former inflammations had adhered to the peritoneum. The large end came first, and the small end was within the appendix vermiformis of the cæcum at the time I took it out; for, immediately upon the extraction, some excrements followed, and among them some dark brown particles which I discovered to be filings of iron, which the patient had formerly taken in a large quantity, as she had never been regular like other women. On a careful examination I found some of these filings quite reduced to rust, \(^{(a)}\) See plate IX. the figures 1. and 2. are different views of the external surface of this irregular substance, and of so much of its nucleus as projects out of the round part, exactly as both appeared on being taken out of the body. The whole was of a dusky brown colour, and had a great resemblance to a small shrivelled pear. Fig. 3. is a section of the round part, which seemed to be formed of fine fibrous substances, closely cemented together by an earthy matter, and of the peg of crab-tree wood, its nucleus. This figure likewise shews how far the peg went in, and also an incrustation of stony matter upon it. The nucleus, I believe, is the smaller end of that part of a silk engine called a star, at which machine the patient had been employed before she was five years of age, therefore it must have been lodged at least sixteen years within the appendix vermiformis of the cæcum, as she remembers nothing of swallowing it, and as during that course of years she had frequently been afflicted with the severe colics before-mentioned. but still retaining their form as they came from under the file. Some *faeces* came through this last wound daily, frequently most copiously; and sometimes (though the external orifice was large) by being confined with the dressings, they insinuated themselves between the integuments of the *abdomen*, and came through the other openings. About the middle of February 1776, the discharge of the excrements by these openings was sensibly diminished; and the wounds were all healed, except one, by the latter end of the year, through which a small quantity of excrements still continue to pass now and then. Her health is, within this short time, surprizingly improved; she is now very fleshy and strong, has had the *catamenia*, and I have the greatest reason to expect that she will be perfectly cured. Strict regard was all along paid to the non-naturals. As the case above is a very uncommon one, I prevailed on the reverend Mr. Rogers, minister of this place, to visit the patient along with me; and he was so fully satisfied of the truth of the account, as to give me the following certificate. I hereby I hereby certify, that I saw, this 27th day of December, 1775, Mr. FIELDING BEST FYNNEY dress his patient ANN DAVENPORT, and was an eye-witness to pure faeces coming out of the wound from which he had extracted an irregular substance on the 21st of September last. As witness my hand, J. ROGERS, Minister of Leek.