When medicine failed to remove the accumulation of liquid, it has been customary for a long time to endeavour to get rid of it by what is called tapping; that is, puncturing the abdomen, and letting the liquid out. This, however, can only be considered as a temporary mode of relief. A few instances have happened, where the liquid has been drawn off, and has not again collected; but such cases are very rare. Ordinarily the liquid accumulates, often with more rapidity than before; and again and again the pain and hazard of the operation must be repeated.

Dr. Mead relates the case of a lady, who, "for the information of posterity," ordered by her will that the following English inscription should be engraved on her monument in Bunhill Fields;

"Here lies Dame Mary Page,

Relict of Sir Gregory Page, Bart.

She departed this life, March 4, 1728,

In the 56th year of her age.

In 67 months she was tapped 66 times;

Had taken away 240 gallons of water,

Without ever repining at her case

Or ever fearing the operation."

Among authenticated instances of tapping, one of the most remarkable is detailed in the "Philosophical Transactions" for 1784, by Mr. Martineau, who was at that time Surgeon to the Norfolk and Norwich Hospital. An abstract of the case is given in the printed catalogue of the Hunterian Museum, where the cyst is preserved: it belonged to the left Ovary of Sarah Kippus, a widow, fifty-five years old. The complaint began after a miscarriage, at the age of twenty-seven. From the year 1757, to August, 1783, when she died, she had been tapped eighty times, and had, in all, had taken from her 6631 pints of fluid, or upwards of thirteen hogsheads. 108 pints was the largest quantity ever taken away at any one time. But after death, Mr. Martineau could not make the sac contain more than fifty pints. Mr. Spencer Wells has removed 115 pints of fluid at one tapping.

Upon the whole, it may be stated of this operation, as applied to Ovarian Dropsy, where the removal of the Ovary is impracticable:

First, that when it is essential to the comfort and continued existence of the patient, it brings sensible relief to her distress, and often materially prolongs her life: but, secondly, that when it is performed under less pressing circumstances, it tends to shorten the patient's days. Dr. Bright is of opinion that the number is small of those who survive the first tapping more than four years. Sir Thomas Watson adds: I question whether even that brief limit might not justly be abridged by one half. He adds: "A respectable woman, having a very large Ovarian Dropsy, entered the Middlesex Hospital, under my care, for the express purpose of being tapped. The tumour incommoded her by its bulk and weight, but in no other way; and as she had carried it for thirteen years I felt that I should not be justified in sanctioning the operation at such a case. The patient was made to understand that the performance of it would not be altogether free from immediate danger; and that if she went through it safely, the swelling would return, and the same kind of remedy again be equally necessary. She was instructed how to suspend the heavy over-hanging abdomen by a sling passing over her shoulders. There appeared no reason why she should not continue in good health for another period of thirteen years."

"I am aware of another instance, in which a woman, similarly burdened, but otherwise in comfortable health, has lived, not without enjoying life, between twenty and thirty years. Had she been tapped when the mere enlargement might have seemed to warrant the operation, she would probably have been for twenty years in her grave."

The parts concerned in this disorder are not essential to life, or to the enjoyment of health. On some of the lower animals (pigs, for instance), the operation of spaying is as common in the one sex, and is performed with as little risk, as that of gelding (in pigs, horses, bulls, and rams) in the other. Healthy Ovaries have in several instances been extracted from the living human body without any ill consequences. These facts, and the intractable character of the disease, naturally suggested the thought of extirpating the tumour in cases of Ovarian Dropsy.

But although the Ovary, when healthy, or when not greatly enlarged, might be removed without much difficulty or hazard, the operation becomos always perilous, and sometimes impracticable, when the altered gland has attained any considerable magnitude. Yet these are the very cases for which the remedy is needed. At first it was attempted to remove the enlarged Ovary entire, through a very large opening; and as, in some cases, an opening was made, and no disease was found to exist, the proposal did not meet with much encouragement, and some of the first surgeons of the day denounced the operation. The first successful case on record, was performed in America, in the year 1809, by Dr. McDowell, a Kentucky surgeon, who had been a student in Edinburgh under John Bell, in 1794. Various attempts were subsequently made, "but for the most part they were disastrous attempts." At length it was proposed to make such an opening as would allow of the introduction of two fingers: that the enlarged Ovary should be drawn to the side and tapped, and then being lessened in bulk, it could be easily removed.

Mr. Jeaffreson, a surgeon of Framlingham in Suffolk, was the first person in Great Britain who performed ovariotomy by the small incision. He removed a bilocular cyst through an opening only one inch and a half in length. The patient recovered, and bore several children afterwards.

This operation has since been performed with considerable success by various practitioners. Mr. Spencer Wells, up to February, 1871, had performed the operation 408 times. In his first hundred cases there were 66 recoveries, in the second 72, in the third 77, in the fourth 78, and eight patients who have since undergone the operation are all doing well. Dr. Keith has been, on a smaller scale, even more fortunate than this, counting nineteen deaths only in 100 cases.

Dr. W. L. Atlee, of Philadelphia, has (1872) performed the operation 262 times, with about 70 per cent. of recoveries.

Ovariotomy may be, and has been, performed during pregnancy, without leading to premature delivery.

According to Mr. Spencer Wells, one or more tappings beforehand do not considerably increase the mortality of ovariotomy. That tapping may often be a useful prelude to ovariotomy, either by giving time for the general health to improve, or by lessening the shock when the fluid is removed a few days before removing the more solid part of the tumour.

Formerly, the rapid evacuation of a large quantity of liquid from the belly was often attended with terrifying results; fainting, convulsions, almost instant death. This made the ancient physicians afraid of the operation: and when they could no longer avoid it, they let the accumulated fluid out at short intervals, and little by little.

The cause of these alarming symptoms is now well understood, and easily averted. They were owing to the sudden removal of the pressure to which the viscera and large blood-vessels had been for some time accustomed. For this explanation of the fact we are indebted to the sagacity of the celebrated Dr. Mead, who was the first to suggest that external compression should be substituted in place of the tension taken off by the operation. The complete success of that expedient fully justified his opinion. We now drain the cavity of its liquid contents without scruple or delay. Round the body of the patient, who sits on the edge of a chair, or of the bed, a sheet or broad roller is thrown, and tightened, as the fluid escapes, so as to maintain a regular pressure, which is continued for a while and at length gradually withdrawn. The risk, however, of exhaustion or fainting, and therefore the necessity for this artificial compression, may in most cases be avoided or diminished by keeping the patient, during the performance of the operation, in a horizontal posture, upon his or her side. Sir James Simpson has the credit of making this suggestion: and in some cases it may be of advantage to be able to resort to it; but when the Bandage secures absolute safety, it is best to trust to it.

Acupuncture of the dropsical belly has of late been recommended: the passage of a grooved needle, instead of a trocar, through the wall of the abdomen. This appears to be sometimes an advantageous mode of performing the operation. Dr. Robert Lee states that he has performed this operation many times; never with any bad result, generally with relief and benefit to the patient. In one case, ten gallons of liquid escaped from the little puncture. In another, where ordinary tapping was thought unsafe, acupuncture was performed, and fluid oozed freely away for two days and two nights. Great comfort was obtained from this process, and the woman's life was probably prolonged for two years, by several repetitions of it. In a third instance, four ounces only of liquid followed the puncture, but a larger portion, which was left behind, gradually disappeared.