654 DISEASES OF THE PERITONAEUM. 



ously. From what has been said, it follows that, in ascites, the ab- 

 domen should only be tapped where life is immediately endangered 

 by obstruction of the respiration, or by threatened gangrene of the 

 skin. 



[Where the ascites is not due to portal obstruction, diuretics 

 are indicated ; if the dropsy be due to diminished heart-power, 

 chronic bronchitis, or emphysema of the lungs, with secondary af- 

 fection of the heart, good results may be obtained from digitalis. 

 In place of this 'drug, or with it, we may give other diuretics, as 

 acetate of potash, cream of tartar, lemon-juice with sugar- water, 

 Selters and other soda-waters, and irritating diuretics like squills 

 or juniper-berries ; but these should be avoided in inflammatory 

 diseases of the kidneys. (I. fol. digitalis gr. xv-xxx ; rad. scillaB 

 gr. xv ; infus. columb. vij ; potass, acet. RS > succ. junip. in- 

 spis. ? j. M. S. tablespoonful every two hours.) These remedies 

 should be carefully watched and occasionally interrupted. Regard- 

 ing the diaphoretic treatment of dropsy, we refer to the treatment of 

 morbus Brightii. Here also pilocarpin may sometimes prove very 

 beneficial, -J- to % grain of one of its salts being injected hypoder- 

 mically, or half a drachm to one drachm of fluid extract of jaborandi 

 being given by the stomach or rectum. When dropsy is increasing, 

 we may lessen the quantity of fluids in the cavities of the body and 

 relieve the patient by puncturing the swollen limbs with a needle 

 or knife ; but this is not free from danger : it may start an inflam- 

 mation of the skin, which may spread over the entire limb and cause 

 death by gangrene ; even spontaneous ruptures of the skin may re- 

 sult thus. After the punctures the skin may be kept well greased 

 with vaseline to protect it from the escaping fluid ; if inflammation 

 occur, it should be treated with lead-water compresses. In some 

 cases we may try to prevent increase of the fluid by limiting the 

 amount the patient drinks.] 



CHAPTER III. 



TUBERCULOSIS AND CANCER OF THE PERITONAEUM. 



TUBERCULOSIS of the peritonaeum hardly ever occurs primarily, 

 but accompanies tuberculosis of either the lungs, intestines, urinary 

 or sexual organs. In other cases it is one symptom of acute miliary 

 tuberculosis. The latter form has no clinical interest ; for the de- 

 posit of the small, translucent nodules in the peritonaeum causes no 

 symptoms, and has no perceptible influence on the course of acute 



