INTUMESCENTI^. 



When the antecedent circumstances give suspicion of a gen- 

 eral hydropic diathesis ; when at the same time some degree of 

 dropsy appears in other parts of the body ; and when, from its 

 first appearance, the swelling has been equally over the whole 

 belly, we may generally presume that the water is in the cavity 

 of the abdomen. But when an ascites has not been preceded 

 by any remarkable cachectic state of the system, and when at 

 its beginning the tumour and tension had appeared in one part 

 of the belly more than another, there is reason to suspect an en- 

 cysted dropsy. Even when the tension and tumour of the 

 belly have become general and uniform over the whole ; yet if 

 the system of the body in general appear to be little affected ; 

 if the patient's strength be little impaired; if the appetite 

 continue pretty entire, and the natural sleep be little inter- 

 rupted ; if the menses in females continue to flow as usual ; 

 if there be yet no anasarca ; or, though it may have already 

 taken place, if it be still confined to the lower extremi- 

 ties, and there be no leucophlegmatic paleness or sallow colour 

 in the countenance ; if there be no fever, nor so much thirst, 

 or scarcity of urine, as occurs in a more general affection ; then, 

 according as more of these different circumstances take place, 

 there will be the stronger ground for supposing the ascites to be 

 of the encysted kind. 



The chief exception to be made from this as a general rule, 

 will, in my opinion, be when the ascites may, with much prob- 

 ability, be presumed to have come on in consequence of a 

 scirrhous liver ; which, I apprehend, may occasion a collec- 

 tion of water in the cavity of the abdomen, while the general 

 system of the body may not be otherwise much affected. 



MDCCXV. With respect to the cure of ascites when of the 

 encysted kind, it does not, so far as I know, admit of any. 

 When the collection of water is in the abdominal cavity alone, 

 without any other species of dropsy present at the same time, 

 I apprehend the ascites will always be of difficult cure ; for it 

 may be presumed to depend upon a scirrhosity of the liver, or 

 other considerable affection of the abdominal viscera, which -I 

 conceive to be of very difficult cure, and therefore the ascites 

 depending upon them. At the same time, such cases may often 

 admit of a temporary relief by the paracentesis. 



