DKOPSY OF THE PERITONAEUM ASCITES. 653 



dropsy, and depends on obstructed evacuation of the vena cava, the 

 causal indications require a treatment of the often-mentioned heart 

 and lung diseases ; and when it is the result of excessive hydraemia, a 

 suitable treatment of the exhausting original disease and an improve- 

 ment of the quality of blood. In the former case we are generally 

 unable to fulfil the indications. In dropsy resulting from intermittent, 

 morbus Brightii, and the convalescence from severe disease, the fulfil- 

 ment of the latter indications usually has the best result and does much 

 more good than the old-fashioned routine administration of hydra- 

 gogues. When the portal or hepatic veins are compressed or obliter- 

 ated, we cannot render them pervious again, nor can we cause an ex- 

 pansion of the contracting parenchyma of the liver which constricts 

 the vessels in cirrhosis of the liver. In regard to the causal indica- 

 tions in ascices resulting from tuberculosis or carcinoma, we are just 

 as powerless. 



The indications from the disease demand the removal of the fluid 

 in the abdomen. Almost all patients with ascites have diuretics pre- 

 scribed them, but the number cured by these is hardly worth mention- 

 ing. If the ascites be one symptom of general dropsy, diuretics may 

 very properly be given, but, if the result of portal obstruction, they do 

 no more good than they would in oedema of the leg from obstruction 

 of the crural vein by a thrombus. The case is different with drastics. 

 Practitioners have long preferred these to diuretics in the treatment of 

 ascites ; and, in obstruction of the portal vein, we can readily see why 

 they should be more efficient, as they cause a depletion of the branches 

 of the portal vein, and hence diminish the increased lateral pressure, 

 which is the cause of the ascites. In ascites, the most active among 

 the drastics are usually chosen, and of the various compositions that 

 have gained a reputation as hydragogues, we may mention Helm's 

 pill, which, besides squills and golden sulphuret of antimony, contains 

 chiefly gamboge. As long as the strength of the patient and the con- 

 dition of his abdominal canal permit the use of drastics, they are bene- 

 ficial, but if the strength fail decidedly, or the bowels become irritated, 

 they must be given up. The operation of tapping is almost always 

 free from danger, and it removes the fluid from the abdomen more cer- 

 tainly than any other method of treatment. But the more the slight 

 danger and certain effect of tapping speak in its favor, the more neces- 

 sary it becomes to enumerate its bad subsequent results. We should 

 never forget that we do not remove water, but an albuminous fluid, 

 from the abdomen, and that the fluid evacuated is almost always soon 

 replaced by a new effusion. This is a severe tax on the patient's 

 strength and supply of blood. Daily experience teaches that, after 

 the first tapping, emaciation progresses much more rapidly than previ- 



