ASCITES. 109 



inflammation of the pleura. Diuretics are more certainly beneficial 

 in this dropsy than in any other ; and of this class digitalis is the 

 most efficacious, particularly in the form of infusion. All authors 

 agree in admitting the power of digitalis in this affection. Where 

 there is much prostration of vital energy, we should combine tonics., 

 and antispasmodics^ with the diuretic medicines. Paracentesis 

 thoracis^ once so strenuously advised, is seldom or never resorted to, 

 excepting in empyema. The chief danger in this operation proceeds 

 from the introduction and action of the air ; but not so much from 

 its preventing dilatation of the lungs as from its action on the diseased 

 pleura and the fluid effused from it, which becomes putrid and 

 poisonous. 



ASCITES (^Drops^j of the Abdomen). 



Ascites, or dropsical effusion within the abdomen, may exist either 

 alone or complicated with hydrothorax and general anasarca. 



Causes. — The great extent of the peritoneum, the number and 

 importance of the viscera with which it is connected, and of the ab- 

 sorbent glands it encloses, the numerous sources of disorder to which 

 these organs are exposed, the great number and weakness of the 

 veins which transmit their blood to the portal vessels, and the ab- 

 sence of valves from them, in some measure account for the frequent 

 accumulation of fluid in this cavity. Ascites may arise at any age. 

 Camper, Lee, and others, have observed it in new-born infants ; but 

 it is most common in women and aged persons. It occurs more 

 frequently in married than in unmarried females ; and is often the 

 consequence of the distention and pressure attending pregnancy, of 

 difficult or instrumental labours, and of suppression of the puerperal 

 secretions, or of the perspiration, of catamenia, or of the disappearance 

 of this last evacuation. 



Pre-existe?it disease, particular!}^ diarrhoea or dysentery, and 

 sudden interruptions of these discharges ; intestinal worms ; organic 

 lesions of the liver and spleen, especially obstructions of their venous 

 circulation; inflammation of the vena portse, and obliteration of one 

 or more of its principal branches ; the suppression of chronic erup- 

 tions, or of the exanthemata, — as scarlet fever, erysipelas, &c. ; 

 acute or sub-acute peritonitis ; organic change of the structure of the 

 kidneys ; the rupture of cysts into the abdomen ; uterine or ovarian 

 disease ; intermittent or remittent fevers ; excessive evacuations and 

 hemorrhages; are all occasionally productive of ascites. 



Symptoms. — Idiopathic ascites generally assumes an acute, or 

 even inflamrnatorij form. ]t usually occurs either in the young, 

 the robust, or well fed, and presents all the-symptoms of the phlogistic 

 diathesis ; the pulse is hard, thirst increased, the urine scanty ; the 

 skin is warm, hot, or coloured, and resists more or less the pressure 

 of the finger. There are evidences of inflammatory pp excited action 



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