TREATMENT OF BOWEL FISTULA. 
261 
Dammann used sutures in one case, but attacks of colic occurred and 
caused the ligatures to tear out, and as the animal was no better after 
five months’ treatment, it was killed as incurable. Where the opening is 
small, dressing with irritants, or the use of the actual cautery, may cause 
swelling of the edges and union ; but should this fail, a strong thread may 
be passed through the muscular walls of the abdomen. Dammann cured 
the second case in two months by using liquor Villati, applied on a mass 
of tow and kept in position with a bandage. Should the injured portion 
of bowel have become adherent to the abdominal wall, a section may be 
excised and the divided ends united by sutures, or in the case of small 
animals by using Murphy’s button or tubes of decalcified bone. 
IV.—PARACENTESIS ABDOMINIS (PUNCTURE OF 
THE ABDOMEN). 
Serous fluid collects in the peritoneal sac in consequence of chronic 
inflammation of the peritoneum, or more frequently of disease of the 
kidneys, liver, or disturbance of circulation, and may require to be removed 
by tapping. The peritoneum certainly possesses the power of rapidly 
taking up large quantities of fluid and returning them to the circulation, 
as clinical and experimental observations have shown ; and these facts 
accord with our conception of the peritoneal cavity as a great lymph- 
sac. When, therefore, fluids remain for long unabsorbed, some special 
cause must be at work, and as that cause is not removed by draining 
away the fluid, the latter usually returns after a short time. For this 
reason the operation has, at the most, only a symptomatic importance. 
It may, by relieving pressure on the diaphragm, lessen the danger of 
suffocation, and mitigate difficulty in breathing, but it seldom produces 
lasting improvement. In ascites the operation must generally be 
repeated after a short time, and as the already weakened constitu¬ 
tion loses more albumen on each occasion, it often only hastens a fatal 
termination. 
Diagnosis of ascites is seldom difficult where so much fluid is present 
as to call for puncture. The disease is commonest in dogs, whose soft 
abdominal walls allow the internal organs to be readily examined. 
Such an examination gives valuable information as to the causes of 
dropsy. One often finds chronic changes (tumours, &c.) in the liver, 
which render exceedingly improbable any lasting favourable results from 
operation. The same is true where the dog suffers from heart mischief. 
In such cases the abdomen often shows unmistakable distension, which 
is sometimes attended with dyspnoea. When the animal is standing, 
the wave-like movement of the fluid may be felt by placing the left hand 
on one side of the abdomen and tapping the other side with the right. 
