A bad use for good wine

claret

This promising headline appeared in an issue of the Philosophical Transactions published in 1755.  ‘Success’ is an interesting choice of word, since all the patients died, some within a matter of hours.  One wonders what ‘failure’ might have looked like.

Early medical writers made frequent reference to a condition they called dropsy.  By this they meant a swelling caused by excess fluid, which might occur in more or less any part of the body.  The word fell out of use in the nineteenth century, since it is vague and describes not one but many unrelated disorders.

The dropsy patients described in Mr Warrick’s letter to the Philosophical Transactions all appear to have been suffering from ascites, a condition in which the abdomen becomes distended with fluid.  For severe cases, the usual treatment was to remove the excess water by inserting a hollow probe known as a canula.   Mr Warrick’s idea was to inject another fluid at the same time, in order to reduce any inflammation and prevent further fluid building up:

The first case in which this experiment was tried, was that of the poor woman at Cubart, mentioned in the Transactions, N° 473, who was injected with claret and Bristol water, and about a week after the operation died suddenly.  She was upwards of 50 years of age.

Not an auspicious start.  Undaunted, Mr Warrick tried again with a young woman from St Kivern.  This time claret and tar-water was injected into her abdomen while the ‘dropsical lymph’ was being extracted:

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 12 o’clock 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.

Again, it is difficult to see much ‘success’ in this result.  The third opportunity for the new therapy came in March 1752, when Mr Warrick was called to see a middle-aged woman in Flushing, a small town opposite Falmouth.

She was a married woman, of a chearful 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.  

An operation was decided on, and Mr Warrick decided again to use his claret and mineral water injection.  His assistant proceeded:

Mr. Rice made the puncture; but on withdrawing the perforator, instead of lymph, nothing but a thick, ropy, gelatinous fluid came through the canula, in colour resembling red port wine, or rather grumous blood.  The singularity of this did not however alter their measures.  Two gallons of it were immediately drawn off, and half that quantity of claret and Bristol water injected in its stead.

They intended to repeat this procedure daily until the symptoms subsided:

But when they attended her again on the day following, not one drop of any fluid came through the canula; and a 2d and a 3d 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 12 hours, carried her off.

Confronted by the initial symptoms, I suspect many doctors would immediately suspect a late-stage malignant tumour (ascites being a characteristic symptom); and so it proved:

On 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 6 gallons, having completely filled the whole extent of it.  There were likewise attached to the coats of it 5 large bodies of fungus flesh, the least of them larger 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 fungus substances, and vagina, when taken out, entirely covered a middle sized pillar and claw tea-table.

A use for which the pillar and claw tea-table was certainly never intended, and from which it probably never recovered.

Whether these miscarriages are sufficient to discredit a method of practice, which has the appearance of being the most rational one yet found out for managing a dropsy, Mr. W. leaves to the determination of better judges.  

These ‘better judges’ probably included most of his readership.  Physicians were certainly desperate to find a successful treatment for dropsy: the same issue of Philosophical Transactions contains an article claiming that rubbing salad oil on the abdomen is an efficacious remedy.  Although scarcely a ‘rational’ practice, that does at least have the advantage of not immediately killing the patient.

Mr Warrick concludes by suggesting some refinements to his method: in particular, he requests that

brandy, or some such liquor, properly diluted, be made use of instead of claret, which, as he apprehends by the heat of the body, may be apt to turn sour.

A colleague having suggested tar-water as a further alternative, Mr Warrick decided to test it on an animal.

Mr. W. some time after the death of his 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 2 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 48 hours the dogs became well again, the injection being entirely absorbed.

Perhaps this is the ‘success’ alluded to in the headline.  Let us hope he was not given another opportunity to try it on a patient.

 

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