1826 The Lancet  
April.] IN October, 1817, I was called to see a Mr. W——, a prisoner for debt in Castle Rxshen, who laboured under dropsy. He was between fifty and sixty years of age, one who is generally described as a broken down constitution, and a free liver, who had undergone a great deal of fatigue and various hardships in his time ; and even his countenance presented a bloated and sallow aspect. He was unable to lie down, from orthopnea. General anasarca had supervened to ascites, so that, from the toe
more » ... hat, from the toe to the axilla and epigastritim, the integuments pitted deeply on pressure; and, in the legs and scrotum, the swell. ing was so great as to render the skin tense and shining. The abdomen was as tense as a drum, but by no means protuberant in proportion. His spirits were good ; and, though his appetite admitted of little nourishment, he had supported himself, he said, by a plentiful allowance of liquor, which he could not do without, and which he could not be prevailed on to give up. Under these circumstances, tapping appeared to me to afford the best chance of relief; and it was accordingly performed, by puncturing midway between the ilium and umbiticus. The quantity of serum discharged did not amount to two gallons. The operation relieved the tension ot the abdomen, of course, but the general anasarca remained in statu qllo. As I resided ten miles distant from this patient, I left him to the care of Mr. Jones, resident practitioner of Castietown, and did not see him again for nearly a week, when I found that the wound made in the abdominal parietes had not only not closed, but looked angry and callous, and discharged water in large quantities. When I cut through the oedematous integuments, they discharged more water than blood, which caused me to suspect the puncture would be slow in healing; a circmmstance not to be wondered at, considering the man's mode of living. From the continue oozing of water from it, the belly became more and more flaccid, and the general dropsy had undergone a corresponding improvement ; from which circumstances, and the deep appearance of the wound, there was much reason to conclude the peritoneum remained divided ; but the patient complained only of slight pain or tenderness on pressure. However, suspecting that this accident might prove the cause of serious inflammation of the peritoneum, I refrained from probing it, and decided upon letting the case take its course. I therefore confined the practice to saline diuretics and purgatives, and prescribed venesection, if the pain in the abdomen on pressure should increase. He drank at this time a pint of gin daily, and denied the possibility of living without it; and, under the circum. stances, I did not consider it prudent to contend with him about it. 1 know this concession will expose me to the censure
doi:10.1016/s0140-6736(02)94720-3 fatcat:h2rxelmw7bcclckzfclzmj6vpm