(From uter, a mater bottle). So called from the protuberance of the belly resembling that of a bottle. It is the dropsy of the belly; termed also hydrocele peritonei. When water is accumulated in the cavity of the belly betwixt the peritonaeum and the viscera, or rather in the duplicature of the peritonaeum, it constitutes this disease. See Kirkland's Med. Surgery for an instance of an encysted ascites, vol. ii. p. 105.
Dr. Cullen ranks this genus of disease in the class cachexia, and order intumescentiae; and he defines it a tensive, slightly elastic, but fluctuating, intumescence of the abdomen, of which he enumerates two species.
1st, Ascites abdominalis, abdominal ascites: when there are a regular and equal intumescence of the abdomen, and a perceptible fluctuation; the varieties of which arise either from obstruction of the viscera, From Debility Or Thinness Of The Blood From the nature of the liquid effused, whether pus, urine, chyle, or oily fluid.
2d, Ascites saccatus. encysted ascites; when the ovaries, etc. are the seat of the disease, wherein the tumour of the abdomen, at least in the beginning, is partial, and the fluctuation less evident than in the former species.
Sauvages forms a different division, and by no means an useless one; he arranges the ascites into - 1st, The serous abdominal, of which he forms thirteen varieties; 2d, Serous not abdominal, of which are six varieties; 3d, Abdominal not serous, of which there are five; 4th, Neither serous nor abdominal, of which he forms six varieties. See Nosologia Methodica, vol. ii. p. 498.
We, however, in this place consider such species only where a preternatural accumulation of water is the cause, from which no age or sex is exempt, though it generally occurs in old men, and women after child bearing.
The causes are various; viz. jaundice, great evacuations of blood or serum, long continued intermittents, asthma, a rupture of some lymphatic vessel, obstructions in any of the viscera, most frequently a scirrhous liver, repelled eruptions, atonic gout, polypi of the heart, steatoms of the omentum, or any thing that obstructs the return of the venous blood, large quantities of diluting liquors, or, in general, whatever can lesson the quantity of crassamentum in the blood, and weaken the system. But the immediate causes are either a rupture of the lymphatics, in which case the fluid appears whitish when tapping is performed, increased exhalation, or diminished absorption.
This kind of dropsy is sometimes very rapid in its approach and advances, then continues many years without making any progress; at others its advances are very slow, and a number of years elapse before it manifests itself in a confirmed state. One of the first signs is a languor and an aversion to motion, with pitting of the ankles towards the evening, and a shortness of breath; though it should be observed that the pitting of the ankles is not conclusive, since it often attends pregnant women, as well as old men with gross habits, when suddenly freed from an asthma under which they have laboured many years. If, after the swelling of the feet, the legs and thighs swell also, the case is plain, and these anasarcous swellings usually precede ascites. The palms of the hands are dry and hard; perspiration is greatly diminished; the urine is less and less in quantity, appears turbid, high coloured, and deposits a large quantity of a lateritious sediment; the belly gradually swells; and, in proportion, the breathing becomes short, the appetite for solid food fails, and thirst increases; a slow fever sometimes attends; the face and arms are emaciated; a paleness at first, and afterwards a yellowish colour, is seen in the skin. These symptoms grow worse, and a dry cough comes on; the belly is greatly distended; and, except the water is contained in cysts, or hath rendered the integuments too tense, it may be felt to fluctuate by gently tapping one side of the belly with one hand, while the other is placed on the opposite side. At length little watery vesicles arise on the feet, which burst, and from them a quantity of water is discharged, which greatly relieves for a time, and has been known to remove the complaint. A mortification, however, frequently comes on; or, the strength gradually failing, the patient sinks from weakness, or is suffocated from accumulation of water.
If a scirrhus in any of the viscera is the cause, a cure is scarcely to be expected; since the swelling presses on the lymphatics and retards absorption. If an ascites succeeds other diseases, in which the viscera were injured, if the thirst is great, and other symptoms violent, there are but little hopes of recovery-. An haemorrhage, or an erysipelas coming on, with an increase of the fever, is highly dangerous. It is a bad sign when diuretics in every form, and of every different kind, fail. If the fluctuation, when the hand is laid on one side of the belly and struck with the other on the opposite side, can be felt only partially, tapping will afford a temporary relief; though, in such a case, we cannot expect to empty the belly totally; for this can only be the case when the fluctuation is felt by very distinctly striking on any point of the belly. But, on the other hand, if perspiration increases, or the discharge of urine becomes plentiful, these afford favourable prognostics. Indeed, without the urine continues to flow with tolerable freedom, or is compensated by other watery evacuations, there remains very little hope of a perfect recovery.
The distinction of ascites is of great importance, especially the distinction between the disease and the pregnant state. In an unmarried person, there is no disease which will so effectually conceal the real situac c 2 tion as dropsy; and, in a married woman, where there is no pretence or wish for concealment, dropsy will sometimes be considered as the cause, while the swelling arises from pregnancy, or is combined with it. Dreadful to relate! the trocar has, more than once, within our own observation, happily not by our direction, been plunged into a pregnant uterus.