A S C- 199 A S C violent to be repeated; and, in a less degree, the abstaining from drink would probably be useless. In fact, the prohibition is of a modern date: it was not the practice of the ancients; it is not of the most experienced physicians of the present day. If a regular course of evacuants is pursued, the fluid taken in will not at least be injurious: it may be beneficial; for watery liquors verging to the kidneys may. excite their action, and thus contribute to the absorption. It generally happens, that, during a course of purgatives and diuretics in dropsy, occasionally refusing or supplying drinks, occasions little alteration in the progress of the complaint: if there is any change, the cure is accelerated; and we think we have seen, that cathartics and diuretics have not had their proper and appropriate effects till diluent drinks have been allowed. The prejudices of patients have sometimes occasioned their rigorously abstaining from drink, but we have never found the cure advance more rapidly. Dr. Milman has considered the subject at length, and is of this opinion; and we formerly examined in a chronological series the opinions of the ancient physicians on this subject, and found them speaking the same language; but this historical research would be too extensive for the present work.

The operation of the paracentesis has been in general too long delayed. If there is a considerable accumulation of fluid in the abdomen, and the different evacuants have no decided or powerful effects, it should be attempted early. When the load is removed, medicines, which were unequal to the discharge of so large a quantity, may prevent its again accumulating; and, at all events, the removing the pressure from the kidneys appears to facilitate the action of their vessels: even a spontaneous discharge of urine has been the result; and diuretics certainly answer with greater certainty and effect after the former burden is taken off. Dr. Fother-gill recommends the operation so soon as the degree of distention removes all fear of wounding the intestines. Dr. Hunter leans to the same opinion; and Dr. Baker urges it more confidently.

Yet, in directing the operation, we should examine several questions with great care; and the neglect of this enquiry has contributed to its disrepute. The general contents of dropsical swellings are serum, not essentially different from the serum of the blood; but we sometimes find it lymph from a rupture of a lacteal; sometimes purulent matter from a supposed previous inflammation; sometimes the peculiar serosity of hydatids. The two former may perhaps be distinguished by a want of freedom in the fluctuation; yet this criterion is necessarily uncertain; and, in some of the less sensible viscera, suppuration proceeds with so little fever, that we have no reason for suspecting the existence of purulent matter. Added to this, it is by no means certain that this peculiar fluid may not be secreted from a surface not previously inflamed. Dehaen was of this opinion; and we have, we think, seen two instances of purulent matter in the abdomen, apparently secreted from its parietes without previous fever. When the fluid is the lymph effused, in consequence of a rupture of a lymphatic, there is no particular danger from the operation; but should the accumulation recur, perhaps some delay may be necessary, as the pressure of the effused fluid may contribute to prevent further effusion, and heal the wound. Where the fluid is purulent, the worst consequences result from the operation, as the access of air soon occasions putrefaction; and, though some present relief is obtained, we have seldom seen such patients long survive the operation. It would be an object of importance, therefore, to be able to ascertain its existence; but there are no discriminating symptoms, except the fluctuation and the apparent causes when the accumulation is from hydatids, there is no peculiarity in the symptoms, and indeed no danger from the operation. These may be suspected in dropsies which attack the young, whose viscera are sound; and these are cases which often recur for a time, then the disease disappears for long intervals, perhaps wholly. The cause is ascertained by some small pieces of apparent membrane passing through the trocar. See Hydatids.

One other kind of dropsy, the encysted, requires peculiar attention with respect to the propriety of performing the operation. It is distinguished by the tumour appearing first locally; by the fluctuation feeling distinct only in some particular directions, or parts of the abdomen; and in the early stages, by some irregular hardness on deep pressure. These accumulations of water generally begin in the ovaria, and we suspect are always occasioned by hydatids. We know not, however, that if the sac is pierced by the trocar that there is any peculiar danger; but in all these instances the relief is temporary only: a dropsy originating in the ovarium is seldom cured. After the operation, the existence of a cyst is ascertained by the abdomen not being completely emptied; for some water is always at; the same time accumulated in the abdomen; and if the instrument has penetrated the cyst, the other water remains; if not, the cyst is still unemptied. In either case it may be felt on pressing the abdomen. In passing the trocar, if there is a cyst, the resistance is unusual, and the pain violent; but we have known a cyst penetrated, in repeated operations, without danger. Paracentesis.

When the duplicature of the peritonaeum is the seat of the ascites, tapping is alone the remedy. For the relief of occasional symptoms see Hydrops. See Mil-man on the Dropsy. Leake's Medical Instructions, edit 5. Cullen's First Lines, vol iv. and White's Surgery, 304.

Ascites Uterinus. See Hydrops uteri.