110 PRACTICE OF MEDICINE. 



oi* the peritoneum, with pain, tenderness, and sometimes tension of 

 the abdomen ; a quick, small, hard or wiry pulse, and suppression 

 or diminution of all the secretions or excretions. Either consecu- 

 tively on, or concomitantly with, these symptoms, fulness of the ab- 

 domen is observed, Avhich usually augments rapidly. At first, the 

 increase is most remarkable in the lower part of the abdomen and 

 iliac regions when the patient is sitting up, and the liver is not 

 enlarged ; but it is always diffused when the patient is in the supine 

 posture, and without any limitation or tumour. Upon examining the 

 abdomen, a dull sound is emitted by percussion, and fluctuation is 

 easily perceived. As the effusion augments, all the abdominal func- 

 tions are more and more disturbed, and at last respiration becomes 

 difficult from the pressure of the fluid impeding the descent of the 

 diaphragm, and the patient is unable to lie down. The abdomen is 

 now large and prominent in its upper regions, and pushes, particu- 

 larly in young subjects, the ribs and cartilages upwards. Irrita- 

 bility of the stomach, anxiety, restlessness, want of sleep, great 

 quickness of pulse, sometimes delirium, and ultimately coma and 

 death, supervene, if temporary or more prolonged relief be not 

 obtained from treatment. 



Ascites may be mistaken for tympanitis, ovarian dropsy, and for 

 pregnancy. Tympanitis is readily recognised by the clear reso- 

 nance iurnished on percussion, by the absence of fluctuation, and of 

 the oedema of the lower extremities, and by the history of the case. 

 Ovarian dropsy is never general or uniform in its earlier stages, 

 like ascites ; and fluctuation is usually very obscure, and to be de- 

 tected only in the situation of the tumours, the circumscribed form 

 of which may be determined until a very advanced period of the dis- 

 ease. Pregnancy is distinguished from ascites by the state of the 

 OS uteri upon examination, by the progress of the enlargement, and 

 the detined form of the uterus when the patient is supine, and the 

 abdominal muscles relaxed ; by her unbroken health and clear com- 

 plexion, — the countenance of dropsical persons being pale, sickly, 

 and cachectic ; by the enlargement and firmness of the breasts, and 

 the deep colour of the areolae, — these organs being soft and flabby in 

 ascites. 



Let the patient lie on his or her back, and percuss the abdominal 

 parietes. In ascites, they generally yield a dull sound towards the 

 back, where the fluid settles, and clear in front, because the bowels 

 float upwards through the serum. It is the reverse in pregnancy 

 and ovarian dropsy. 



Treai'rnent. — This must depend, as in other dropsies, upon the 

 organ affected, and upon the extent and nature of the disease. The 

 acute forms require vascular depletions, general or local, or both, to 

 an extent which the pulse and symptoms indicate. Mercurials and 

 antimonials, at first so as to act on the bowels, and subsequently as 



