An Extraordinary Case of a Dropsy of the Ovarium, with Some Remarks. By Mr. Philip Meadows Martineau, Surgeon to the Norfolk and Norwich Hospital; Communicated by John Hunter, Esq. F. R. S.

XXXIX. An extraordinary Case of a Dropsy of the Ovarium, with some Remarks. By Mr. Philip Meadows Martineau, Surgeon to the Norfolk and Norwich Hospital; communicated by John Hunter, Esq. F. R. S. Read July 1, 1784. SARAH KIPPUS, a pauper in the city of Norwich, was, for many years, a patient of my father's, and, at his decease, was under the care of Mr. Scott, as city surgeon, who obliged me many times by taking me to the poor woman, from whom I received the account of the early part of her disease. Her complaints came on first after a miscarriage at the age of 27. She had never been pregnant before; and her discharges at that time were so great as to bring her into a very weak condition. She soon perceived some uneasiness, attended with a swelling, on one side, which, after a few months, became too large to distinguish whether it was greater on one side or the other. As the swelling was found to arise from water, it was drawn off, which was in the year 1757. She was never afterwards pregnant; but the catamenia continued regularly till the usual period of their cessation. When I first saw her, which was in the year 1780, she had been many times tapped, and she was then full of water. Her appearance was truly deplorable, not to say shocking. She was rather a low woman, and her body so large as almost wholly to obscure her face, as well as every other part of her: with all she was tolerably. rably cheerful, and seldom regarded the operation. I saw her just before we took away 106 pints of water, and I begged leave to take a measure of her. She was sixty-seven inches and a half in circumference, and from the cartilago ensiformis to the os pubis thirty-four inches. Her legs were now greatly swelled; but this, and every other symptom of which she complained, evidently arose from the quantity and weight of water. She neither ate nor drank much, and made but a small quantity of urine. The operation of drawing off the water was generally performed on a Sunday, as the most convenient day for her neighbours to assist her, and before the latter end of the week she was able to walk very well. She was first tapped in the year 1757, and died in August 1783. Thus she lived full twenty-five years with some intervals of ease, having eighty times undergone the operation, and in all had taken from her 6631 pints of water, or upwards of thirteen hogsheads. I will subjoin the account of the dates, and the quantity drawn off at each time, as given me by Mr. Scott, observing that till 1769 no exact memorandum was kept, except of the number of times, although the quantity of water drawn off was always measured. By my father she was tapped twenty-six times, averaged at 70 pints each time: by Mr. Donne once, 73 pints, which makes 1683 pints from some part of the year 1757 to 1769. By Mr. Scott as follows: 1769. | Year | Month | Day | Pints | |------|-------|-----|-------| | 1769 | Mar. 16 | 70 | | | July 17 | 72 | | | Nov. 20 | 78 | | | Dec. 31 | 70 | | | | | 290 | | 1770 | April 15 | 70 | | | Aug. 11 | 73 | | | Dec. 4 | 76 | | | | | 219 | | 1771 | Mar. 22 | 74 | | | July 14 | 78 | | | Nov. 3 | 79 | | | | | 231 | | 1772 | Feb. 22 | 79 | | | June 6 | 73 | | | Sept. 12 | 74 | | | Dec. 12 | 82 | | | | | 308 | | 1773 | March 7 | 78 | | | May 29 | 71 | | | Aug. 29 | 79 | | | Dec. 5 | 81 | | | | | 309 | | 1774 | Mar. 13 | 77 | | | June 26 | 89 | | | Oct. 23 | 92 | | | | | 258 | | 1775 | Jan. 24 | 94 | | | May 28 | 91 | | | Sept. 13 | 72 | | | Dec. 16 | 80 | | | | | 337 | | 1776 | April 9 | 84 | | | July 28 | 82 | | | Nov. 27 | 85 | | | | | 251 | | 1777 | Mar. 16 | 89 | | | July 27 | 90 | | | Nov. 9 | 98 | | | | | 277 | | 1778 | March 8 | 96 | | | July 5 | 99 | | | Nov. 5 | 105 | | | | | 300 | | 1779 | Feb. 28 | 106 | | | June 13 | 108 | | | Aug. 17 | 92 | | | Oct. 24 | 99 | | | Dec. 10 | 90 | | | | | 495 | | 1780 | Feb. 6 | 73 | | | Apr. 23 | 102 | | | July 24 | 106 | | | Sept. 10 | 95 | | | Nov. 12 | 98 | | | | | 474 | | 1781 | Jan. 1 | 100 | | | Mar. 11 | 94 | | | June 25 | 100 | | | Oct. 14 | 100 | | | | | 394 | | 1782 | Jan. 13 | 99 | | | Mar. 18 | 64 | | | June 2 | 74 | | | Aug. 25 | 98 | | | Nov. 17 | 90 | | | | | 425 | | 1783 | | | | 1783. Pints. Feb. 14. 104 May 11. 100 July 20. 98 Aug. 11 on opening 78 Total 6631 pints. In looking over this account it appears, that 108 pints was the greatest quantity ever taken away at any one time; that she was never tapped more than five times in any one year; and the largest quantity in a year was 495 pints. The most collected in the shortest space of time was 95 pints in seven weeks, from July 24th to September 10th in 1780, which is very nearly two pints a day. It appears also, that in the last 14 years of her life, when a regular account was kept, she increased faster in the winter than in the summer months. If the six summer months from April to September inclusive are reckoned, she lost in the 14 years in 23 operations 1972 pints, and in the winter months from October to March inclusive, by 30 tappings, 2596 pints; and it will be found, that 30 is to 2596 rather more than 23 to 1972, so that seven more tappings were at least necessary in the winter than in the summer. In the months of March and November she oftener underwent the operation than in any other. In these calculations the three months in 1783 are not included, as the year was not finished. If we compare the famous case of Lady Page, related by Dr. Mead, the quantity of water taken from her ladyship appears small when opposed to the number of pints drawn from from Sarah Kippus. The one lost 1920, the other 6631. It must be confessed, however, that Lady Page collected faster than the poor woman whose case I have related. I come now to speak of the dissection, and to make some observations on the whole. On the 10th of August 1783, the poor woman died; and the following day Dr. Dack, an eminent physician of this place, accompanied me to open the body. I first drew off 78 pints of clear water: supposing, therefore, all the water to have been taken away at the last operation, then in three weeks she had collected 78 pints, which is more than three pints and a half in each day: a quantity far exceeding what she had taken. I then opened into the cavity from which the water came, and separated the sac from the peritoneum, and found the sac had arisen in the ovarium of the left side. After this, I dissected out the uterus, with the right ovarium in a natural state, and thus obtained every part necessary to show the disease, viz. the uterus, the right ovarium found, and the left enlarged into an immense pouch. The cyst itself was not very thick, but lined in almost every part of it, but more especially in the fore part, with small ossifications. The peritoneum was prodigiously thickened, and thus, by its additional strength, became the chief support of the water. There was something singular in the sac itself, for it was rather two than one, from there being an opening in the side of what appeared at first the only cavity, which led to another cavity, almost equally large with the first, so that if all the water in any operation had not been evacuated, it must probably have been owing to a difficulty in its passage from the second into the first or more external cyst. From the size, however, of the poor woman after each operation, it is evident, that in her there being two sacs did not prevent the total drawing off of the water. The other viscera appeared all in a natural state. The intestines were quite empty, and pushed up under the ribs, so as to have left but very little room for the expansion of the lungs within the thorax. The bladder was contracted, or rather I should say appeared lessened. The kidneys were healthy, and both ureters in a natural state. The sac is in the collection of John Hunter, esq. In reflecting upon this case, an obvious question arises; from whence proceeded this immense collection of water? At different periods of this poor woman's life the quantity drawn off, without considering the urine she made, was much greater than the fluids she drank, which appeared from measuring whatever she took. It appears then pretty certain, that this superabundant quantity must have been taken into the body by absorption; and if we allow the bodies of animals to have this power of absorbing, which we very well know vegetables are possessed of, it will account for many appearances in the animal economy. This poor woman collected faster in the wet moist months of winter, than in summer. From all, this happy conclusion may be drawn, that although human art is at present insufficient to the perfect cure of diseases similar to the poor woman's case I have related, yet nature is continually defending herself from sudden death; and such relief may be granted as to protract life a long time without much pain, and often with intervals of great ease and comfort.