Ascites hi Solipeds. 401 



table (sometimes palpitating), and respiration labored and with 

 lifting of the flank. From first to last there is no hyperthermia. 



If the cause is irremediable the i.ssue is necessarily fatal sooner 

 or later. 



Diagnosis from peritonitis depends largely on the absence of 

 hyperthermia, and of abdominal tenderness, and on the nature of 

 the ascitic fluid which is incoagulable, and comparatively desti- 

 tute of leucocytes cells and granules. 



Lesions. The quantity of effused liquid is often enormous 

 (50 qts. Reynal, 80 qts. Woodger, 150 qts. Friedberger and 

 Frohner). It is very watery and poor in salts and albuminoids, 

 of a density near 1012, neutral or slightly alkaline, does not 

 coagulate spontaneously, and is not associated with false mem- 

 branes. The peritoneum shows no congestion, but is pale, and, 

 like the abdominal walls, infiltrated. Tumors, cysts and venous 

 obstructions referred to under causes may be found. 



Treatment. When ascites depends on actinomycosis or glandu- 

 lar enlargement a course of iodide of potassium may remove the 

 cause. In other cases an operation may remove the offending 

 tumor or ovary. Too often, however, the cause is beyond 

 remedy and palliative treatment only is available. The most 

 urgent indication is the removal of the accumulated fluid, and 

 paracentesis under proper antiseptic precautions is the readiest 

 means to this end. Compression by a tight bandage is neces.sary 

 to prevent the sensation of vacuity and tendency to fainting which 

 come from the removal of the fluid and to counteract the disposi- 

 tion to the instant effusion of more. Even with the compress it is 

 judicious not to draw off all of the fluid at once in bad cases, but 

 to make two or three operations and allow the patient to become 

 accustomed to the change in the intervals. These may be 

 repeated as circumstances demand. Saline purgatives, or diuret- 

 ics (saltpetre i oz., digitalis 25 grs., squill 3 ozs., iodide of 

 potassium 2 drs. ), are useful, and pilocarpin is the most efficient 

 agent of this kind, but' also dangerous by reason of the extreme 

 depletion which it causes. Electricity has been employed with 

 alleged advantage, also poultices of digitalis applied over the loins. 



Cholagogues are also recommended especially in cases of liver 

 disease. Bitters may prove useful. 



26 



