Dr. Hall, of York-town, in Pennsylvania, informed me, that he had been called to visit a young woman of 19 years of age, who had taken all the usual remedies for ascites without effect. He at once proposed to her the operation of tapping. To this she objected, but so great was the fear of this operation, which the proposal of it suddenly excited in her mind, that it brought on a plentiful discharge of urine, which in a few days perfectly removed her disease.
On the 27th of August, 1790, I visited a gentlewoman in this city with the late Dr. Jones, in an ascites. We told her for the first time, that she could not be relieved without being tapped. She appeared to be much terrified upon hearing our opinion, and said that she would consider of it. I saw her two days afterwards, when she told me, with a smile on her countenance, that she hoped she should get well without tapping, for that she had discharged two quarts of water in the course of the day after we had advised her to submit to that operation. For many days before, she had not discharged more than two or three gills in twenty-four hours. The operation, notwithstanding, was still indicated, and she submitted to be tapped a few days afterwards.
I tapped the same gentlewoman a second time, in January, 1791. She was much terrified while I was preparing for the operation, and fainted immediately after the puncture was made. The second time that I visited her after the operation was performed, she told me (without being interrogated on that subject), that she had discharged a pint and a half of urine, within twenty minutes after I left the room on the day I tapped her. What made this discharge the more remarkable was, she had not made more than a table spoonful of water in a day, for several days before she was tapped.
I have seen similar discharges of urine in two other cases of tapping which have come under my notice, but they resembled so nearly those which have been mentioned, that it will be unnecessary to record them.
But the influence of fear upon the system, in the dropsy, extends far beyond the effects which I have ascribed to it. Dr. Currie, of this city, informed me that he called, some years ago, by appointment, to tap a woman. He no sooner entered the room than he observed her, as he thought, to faint away. He attempted to recover her, but to no purpose. She died of a sudden paroxysm of fear.
It is a matter of surprise, that we should have remained so long ignorant of the influence of fear upon the urinary organs in dropsies, after having been so long familiar with the same effect of that passion in the hysteria.
X. A recumbent posture of the body. It is most useful when the dropsy is seated in the lower limbs. I have often seen, with great pleasure, the happiest effects from this prescription in a few days.
XI. Punctures. These, when made in the legs and feet, often discharge in eight and forty hours the water of the whole body. I have never seen a mortification produced by them. As they are not followed by inflammation, they should be preferred to blisters, which are sometimes used for the same purpose.
I cannot dismiss the remedies which discharge water from the body through the urinary passages, without taking notice, that they furnish an additional argument in favour of blood-letting in dropsies, for they act, not by discharging the stagnating water, but by creating such a plentiful secretion in the kidneys from the serum of the circulating blood, as to make room for the absorption and conveyance of the stagnating water into the blood-vessels.
Now the same effect may be produced in all tonic or inflammatory dropsies, with more certainty and safety, by means of blood-letting.