616 PRACTICE OF PHYSIC. 



hydrops saccatus. Their precise seat, and even their existence, 

 is very often difficult to be ascertained. They are generally 

 formed by collections of hydatides. 



MDCCXII. In the most ordinary case, that of abdominal 

 dropsy, the swelling at first is in some measure over the whole 

 belly, but generally appears most considerable in the epigas- 

 trium. As the disease, however, advances, the swelling be- 

 comes more uniform over the whole. The distention and sense 

 of weight, though considerable, vary a little, according as the 

 posture of the body is changed ; the weight being felt the most 

 upon the side on which the patient lies, while at the same time 

 on the opposite side the distention becomes somewhat less. In 

 almost all the instances of ascites, the fluctuation of the water 

 within may be perceived by the practitioner's feeling, and some- 

 times by his hearing. This perception of fluctuation does not 

 certainly distinguish the different states of dropsy ; but serves 

 very well to distinguish dropsy from tympanites, from cases of 

 physconia, and from the state of pregnancy in women. 



MDCCXIII. An ascites frequently occurs when no other 

 species of dropsy does at the same time appear ; but sometimes 

 the ascites is a part only of universal dropsy. In this case, it 

 usually comes on in consequence of an anasarca, gradually in- 

 creasing ; but its being joined with anasarca, does not always 

 denote [any general diathesis, as for the most part an ascites 

 sooner or later occasions cedematous swellings of the lower ex- 

 tremities. When the collection of water in the abdomen, from 

 whatever cause, becomes considerable, it is always attended with 

 a difficulty of breathing : but this symptom occurs often when, 

 at the same time, there is no water in the thorax. The ascites 

 is sometimes unaccompanied with any fever; but frequently 

 there is more or less of fever present with it. The disease is 

 never considerable without being attended with thirst and a 

 scarcity of urine. 



MDCCXIV. In the diagnosis of ascites, the greatest diffi- 

 culty that occurs is in discerning when the water is in the 

 cavity of the abdomen, or when it is in the different states of 

 encysted dropsy above mentioned. There is, perhaps, no cer- 

 tain means of ascertaining this in all cases ; but in many we 

 may attempt to form some judgment with regard to it. 



