ASCITES 79 



lured Bladder. — Urine in the abdominal cavity from 

 ruptured bladder is a condition in which there are 

 always symptoms of collapse, absent in ascites. As- 

 piration reveals urine instead of ascitic fluid. 



Treatment. — Alleviation and sometimes permanent 

 relief may be obtained for this condition by (1) 

 purgatives ; (2) diuretics ; or (3) paracentesis ab- 

 dominis. In addition treatment against the primary 

 cause must, however, be instituted, and even then in 

 many cases recurrences occur. It is usual, however, 

 in addition to treating the primary cause to make 

 use of all three of the above-named methods of 

 treatment for relieving the ascitic symptoms. 



1. Drastic purgatives are here indicated: Elaterin 

 in doses of 1-20 to 1-12 grain or one to three grains 

 of colocynth are the most useful. These cathartics 

 cause copious fluid evacuations. 



2. Digitalis, potassium iodid, potassium asetate, or 

 spirits of juniper are the usual diuretics employed. 



The following is a useful formula for a diuretic 

 pill: 



Scillee, 

 Digitalis follae, 



Ext. hyoscyami, aa gr. 1 



Calomel gr. 1-4 



Misce et fiat pilula mltte No. XII 

 Sig. — Give one pill three times a day to free elimination. 



3. The evacuation of th-e fluid by means of the 

 trocar and cannula — paracentesis abdominis. (The 

 technic for this operation will be found on p. 204.) 

 This operation should hot be delayed if there is 

 excessive dyspnea, and it may repeated as often as 

 required. The diet should consist of meat extracts, 

 milk, and finely minced meat. Water should be 

 allowed only in small quantities. The patient should 



