ever, comes rather in a questionable shape, I may be allowed to say, Non tali auxilio nec defensoribus istis, The text is in Virgil; Mr. Gibbon will probably know where to look for the commentary. Bedford, Nov. 9, 1813. I am, Sir, Your very obedient Servant, An Account of a singular Case of Ischuria in a young Woman, which continued for more than three years; during which time, if her Urine was not drawn off with the Catheter, she frequently voided it by Vomiting, and for the last twenty "Months, passed much Gravel by the Catheter, as well as by Vomiting, when the use of that Instrument was omitted, or unsuccessfully applied. By ISAAC SENTER, M.D. LUCY FOSTER, aged 15 years, a fleshy, healthy-looking, well-proportioned young woman, was taken, June 1st, 1785, with a pain in the left hypochondrium, accompanied with cough, fever, oppression at the chest, and difficulty of breathing. Being in very poor circumstances, her friends neglected asking advice till about a fortnight from her seizure, when I was called to her assistance. I was informed by her mother that she became a woman at thirteen, and continued pretty regular in her menses till within five weeks of her present illness; and that from her seeing nothing during that period, she supposed her to have taken a bad cold, as she was very inattentive to her health, and had been obliged to do the duty of a servant maid. Her pulse was upwards of 100 in a minute, her tongue coated with that sort of fur which often accompanies a bad kind of chronic inflammation of the thoracic viscera. I took ten ounces of blood from her arm, gave her an emetic, and directed a blister to the affected side. The blood, when cool, heaved up its coagulable lymph, as is common in pneumonic inflammation; but the buff was tender, and serum did not separate, as is usual in cases of acute inflammation of the breast. Expectorant febrifuge mixtures, &c. were given her, and another blister applied to her side within a few days. These medicines produced an abatement of the symptoms, and in the course of three weeks I ceased to visit her. I, however, looked upon her disease to have a strong tendency to a consumption; and about the fourth week from my first visiting her, she vomited up a quantity of bloody pus of a very disagreeable kind, which, with the preceding symptoms, symptoms, induced me to think a vomica had burst in her stomach; for during the whole of this illness, from my first seeing her, her stomach was so irritable that it was with difficulty food or medicine could be made to sit upon it; and she often vomited up the most simple barley drink. She had a suppression of urine for twenty-four hours, but did not get any aid from medicine, as nature relieved herself. She, however, became regular in her menses, and recovered so far in about two months as to return to her usual labor; and continued capable of doing her duty to the satisfaction of her employers till June following, 1786. On the 3d of this month I was desired to visit her again, when I found all her old complaints (except the suppression of her menses) returned with greater severity than they appeared last year. She was now let blood, and treated in other respects as before, her distress continuing so great that I found it necessary to repeat the operation (drawing small quantities) several times, as nothing else appeared to afford her any considerable relief. Her tongue was covered with a yellowish coat in the middle, and a muslin color at the edges. Her pulse beat 120 strokes in a minute. The irritability of her stomach was so great, that it had become extremely difficult to give any article either of medicine or nourishment but what she vomited up immediately. The effervescent draughts, infusions of Columbo with spirits of sweet nitre and sweet vitriol, liq. anod. min. &c.. were tried without any lasting effect. Opium gave the most permanent relief, and afforded her that refreshment from sleep which she could obtain by no other means. As I now looked upon her case to be of long continuance, and residing in a distant part of the town, I called but seldom, after the severity of her symptoms had subsided, which they did in about three weeks. On the 2d of July she was seized with a total suppression of urine, without any perceptible cause, which continued five days, not being able to void a single drop; and notwithstanding her pain and distress were very great, she did not let her circumstances be fully known to her friends, for fear of having it drawn off with an instrument. The beginning of the sixth day she was taken with a vomiting, which lasted till she brought up nothing but water, which, she said, tasted in every respect like urine. As her vomiting continued, she found relief in the bottom of her belly from the swelling and great soreness she had felt for several days. She now thought herself much better, but her vomiting recurred the next day, as I was informed, and continued more or less every day till I saw her, which was on the 14th of the month. As she had discharged from her stomach every thing she ate or drank from the time of her first vomiting till this, she did not suffer so much from the ischury which still continued, as she did before the first evacuation. I prevailed upon her to let me pass the catheter into the bladder, whence I drew about three pints of urine, clear, but high-colored. Her strength was very much exhausted, and she felt great heat and soreness throughout the abdominal viscera. A variety of medicines were prescribed, and every method pursued that could be thought of, to allay the extreme irritability of her stomach, and restore the natural action of her bladder. For ten weeks successively she was incapable of retaining on her stomach either food or medicines, except opium: this was her only solace by day as well as by night. From this time to December she continued with very little abatement of her distress, or alteration of her circumstances; and, as she could lie in no other position, she was constantly supported in an arm chair, in a reclined posture, with pil lows under her hips. Whenever I omitted to draw off her water once in thirty or thirty-six hours at farthest, she never failed to vomit it up. To ascertain so extraordinary a fact beyond the possibility of a mistake on my part, or a deception on hers, I often visited her about the time I knew she must vomit, if the catheter was not introduced; and I examined her bladder, found it full, hard, and tender, and sat by her till the vomiting recurred, saved the water that she brought up this way, compared it with what I drew off, and found it the same in every respect. During the time her urine came off by vomiting, she suffered extreme anxiety, and always complained of great heat, smarting, and extreme thirst, and a sensation of inversion or turning up of something, (running, as she expressed it,) that appeared to tear her bowels. As the affair had become so lengthy, and my business was such that it was not in my power to attend upon her as often as her case required, I instructed the young gentlemen who lived with me in the use of the catheter, and they waited on her in my absence as often as they could conveniently. In the month of January, 1787, from some cause unknown, she could not be relieved by the instrument, nor could she vomit up her urine for several days, when it passed off by the navel for three days successively; after which the catheter was used with the same effect as before. From this time to August following, there was so great a sameness in her complaints, that nothing occurred worth noticing. About the beginning of this month, a brick-colored gravel began to pass off through the catheter, and soon became so large and and plentiful, that neither urine or gravel could be completely evacuated by the instrument in its usual form. I had one made of a different construction, open at two of the sides for about half an inch, which answered my wishes. She continued to discharge gravel this way whenever her urine was drawn off, till the beginning of November, at which time she felt more,distress than usual, whenever her urine came off by vomiting, and she soon observed a gritty substance in her mouth. When I was informed of this new phenomenon, I requested her to save the urine for my inspection the next time she vomited. I compared this with what I drew off, and found it contained the same kind of gravel as that which past the catheter. I procured and saved several drachms of this gravel that came from her both by the instrument and by vomiting, and could observe no difference in the color or consistence of them. From this period to the summer 1788, her complaints continued much the same. When her water was not drawn off, she always brought it up by vomiting, commonly attended with great pain in the head. During this summer, she twice past a small quantity of urine through the urethra, in consequence of being frightened, once by thunder, and the second time by the falling of a window in her room. This served only to raise her spirits for a few days, with the expectation of her urine returning through its natural channel. Her case, however, continued the same in that respect, and grew every day more complicated in others. The hypogastrium became more tumid and tender, and her bladder appeared very much thickened and extremely sore even after it was evacuated; add to this, the apparent inequality of the surface of the bladder was so great, and the tumor shifting sometimes towards the right and at others to the left inguen, according as her body was moved, that I began strongly to suspect a stone. Through the month of September, her urine could very rarely be drawn off; for, upon the introduction of the catheter, a spasm seized the urethra and neck of the bladder; and, though the instrument appeared to pass high up into the fundus of the bladder, not more than a gill could be drawn before it stopped entirely, with a sensation of something falling down against its cervix, which she was very confident was a stone. In the course of this month she vomited more sand than she had at any time before, and failed in strength and spirits so fast, that I was apprehensive she would not live the month out. Her urethra, bladder, and external genital parts, were so extremely sore, that, for some time, it prevented prevented my searching her for the stone in the manner I intended. About the beginning of October, I was able to introduce the sound, when I readily met with a stone which appeared of a small size, and rather softer than urinary calculi commonly are. I repeated the examination a number of times, till I was perfectly satisfied that this was the case. She would readily have undergone the operation of lithotomy, but I told her no lasting advantage could be expected from it while her viscera continued in such a diseased state. During this month her urine could be drawn off but part of the time, and she vomited it up for more than a week, without the possibility of any relief from the instrument, notwithstanding it was kept in the bladder sometimes during the whole night. She had, at different seasons of the year, several ill-condi tioned small abscesses on her arm-pits, and on other parts of her body, but they did not appear to benefit her general complaints. She also voided at different times, by vomiting, (after she had thrown up all her urine,) a bloody pus, of a very disagreeable appearance and coppery taste. As her case was so very uncommon, I at different periods of it requested the advice of most of the faculty of this town. She was visited by the late Dr. Fletcher, Drs. Olyphant and Mason; the last of these gentlemen frequently attended her, both with me and in my absence, repeatedly relieved her by the catheter, and saw her vomit up both urine and gravel. She was also visited transiently by Dr. Waterhouse of Cambridge, and several other physicians of eminence, who belonged out f the State. During the remainder of the fall, and principal part of the winter ensuing, the same troublesome sensation of the falling down of a stone in the bladder upon the use of the catheter continued, and induced the most excruciating pain and misery imaginable. She was put into different positions when the catheter was introduced, and I gave the instrument various directions in the bladder, sometimes with success, at others without. Her bowels for the most part were much less constipated than could have been expected, considering the frequency of vomiting, her supine situation, and the little nourishment she was able to retain upon her stomach; and during the whole of her disease, till within three months. of her death, the catamenia were irregular. Sometimes they appeared every fortnight, and at others she past the regular period for that evacuation two or three months without having any; but it did not appear to me that her disease was much influenced by either. She had by times a dry cough, with the return of the old pain in the side; but NO. 178. 3 $ she |