Ascetic

“ Does not cold occasion also ascites, which, in many cases, is regarded by every one as a local disease, sometimes terminating in anasarca? If so, why shall we regard anasarca, ending in ascites, as a general disease? The cases are analogous, and the action in both should not be explained differently. If the action of such a cause were really general, and extended to all parts of the body, then the effects should also be general, and the dropsy should be universal, which is very far from being always the case. ”

“ In tympanites, purgatives and every medicine which wastes the body must be rejected, and also the more drastic diuretics; and we must use both externally and internally such things as can attenuate and dissipate the flatus; and dry-cupping may be frequently applied over the whole belly. When those who have ascites are not benefited by any of the remedies already described, we must have recourse to paracentesis, which does not apply to any of the other varieties of dropsy. ”

“ It seldom succeeds in men of great natural strength, of tense fibre, of warm skin, of florid complexion, or in those with a tight and cordy pulse.
If the belly in ascites be tense, hard, and circumscribed, or the limbs in anasarca solid and resisting, we have but little to hope. ”

“ It is rare in ascites that the intestines do not float on the surface of the fluid, at least from the umbilicus upward, and there give a loud percussion sound, while toward the back, and often toward the pelvis, it is dull, or even flat; changing the position of the body, the resonance will be uppermost and the dulness in the most dependent part. Then the softness or impressibility of the abdomen till the tension becomes great is noticeable. The changed position of the fluid as the body is turned from side to side is important. ”

“ When in the latter mode, the ascites is usually combined with anasarca, and the disorder generally comes on suddenly, and has a rapid progress. The vascular system is excited, and there is more than usual thirst; the blood when drawn exhibits the buffy appearance; and the urine, when subjected to heat, is found to coagulate strongly, from the large quantity of serum contained in it. In some of the severer cases, the effusion into the abdomen takes place very suddenly, and yet, by a copious bleeding the disease may be at once arrested, and the water be afterwards absorbed. ”

“ Definition.—An accumulation of serous fluid in the peritoneal cavity.
Etiology.—Any obstruction of the portal circulation is a possible cause of ascites, the most frequent being cirrhosis of the liver. Pressure from tumors or neighboring organs may also give rise to it. Peritonitis and valvular diseases of the heart are also responsible for ascites, and chronic pulmonary affections may impair the portal circulation to the extent of producing it. ”

“ In ascites there is a gradual enlargement of the abdomen and when pressed upon, the fluid can be felt to flow from side to side and the part with the water gives a dull sound on being struck. Breathing is quicker and impeded and the appetite diminished, but there is no fever. ”

“ An elderly woman labouring with ascites I twice saw relieved for some weeks by insanity, the dropsy ceased for several weeks, and recurred again alternating with the insanity. A man afflicted with difficult respiration on lying down, with very irregular pulse, and œdematous legs, whom I saw this day, has for above a week been much relieved in respect to all those symptoms by the accession of insanity, which is shewn by inordinate suspicion, and great anger. ”

“ The urine seldom coagulates. This form of dropsy is usually seated in the abdomen or cellular tissue.
The treatment of ascites is seldom perfectly successful. The great extent of the peritoneum, the number and importance of the viscera with which it is connected, and of the absorbent glands which it encloses, the number and weakness of the veins which transmit their blood to the portal vessels, and the absence of valves, in some measure account for the frequent accumulation of fluid in this cavity. It appears in both sexes from the usual causes of inflammatory disease. ”

“ Dropsy of the ovary is another incysted dropsy, which seldom admits of cure. It is distinguished from ascites by the tumour and pain, especially at the beginning, occupying one side, and the fluctuation being less distinctly perceptible. When it happens to young subjects it is less liable to be mistaken for ascites. It affects women of all ages, either married or virgins; and is produced by cold, fear, hunger, bad food, and other debilitating causes. I saw an elegant young lady, who was shortly to have been married to a sensible man, with great prospect of happiness ”

“ The first of these openings establishes also a cellular correspondence between the abdomen and genital organs, particularly in man. We can easily prove these communications by injecting a fluid into the abdominal cellular texture of a dead body. This fluid goes spontaneously to the inferior extremities, whilst it requires a long continued force to drive it to the superior. All practitioners know, that there is hardly any case of ascites, in which the lower extremities are not swelled, while the superior are unaltered. ”

“ Gestation, which causes compression of certain digestive viscera, and of certain veins of the pelvic cavity.
Ascites was formerly regarded as always forming a complication either of anæmia or of hydræmia. We now know that the primary cause of these three collections of symptoms (ascites, anæmia, and 484hydræmia) is the development of certain chronic wasting diseases or chronic lesions of the heart, liver, and kidney, which act and react upon each other. ”

“ When the Ascidian is living and undisturbed, water is being constantly drawn in through the branchial aperture and passed out through the atrial. If coloured particles be placed in the water near the apertures, they are seen to be sucked into the body through the branchial aperture, and after a short time some of them are ejected with considerable force through the atrial aperture. The current of water passing in is for respiratory purposes, and it also conveys food into the animal. ”

“ The anus opens into the dorsal or cloacal part of the peribranchial cavity near the atrial aperture. The walls of the stomach are glandular, and most of the endoderm cells lining the tube are ciliated. A system of delicate, microscopic, branched tubules with dilated ends (the "refringent organ") , which ramifies over the outer wall of the intestine, and communicates with the cavity of the stomach at the pyloric end by means of a duct is probably a digestive gland. There is in Ascidia no separate large gland to which the name "liver" can be applied, as in some other Tunicata. ”

“ I use it in the Ascites, Anasarca, and Hydrops Pectoris; and so far as the removal of the water will contribute to cure the patient, so far may be expected from this medicine: but I wish it not to be tried in ascites of female patients, believing that many of these cases are dropsies of the ovaria; and no sensible man will ever expect to see these encysted fluids removed by any medicine. ”

“ But sometimes from hardness of the peritoneum and of the uterus in women, or from scirrhus, on the contrary, a great collection of fluid with a very small proportion of air is formed in the same parts, being confined as it were in a bladder, when the dropsy is named ascites, and is occasioned by the afore-mentioned causes; but, for the most part, it arises from hardness and scirrhus about the spleen and liver, and from chronic defluxions about the intestines; whereby it happens that the belly is swelled, while the rest [570] of the body is melted owing to its not being nourished. ”

“ This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence. ”

“ The pyogenic membrane, like the granulations of a sore, which it resembles in nature, forms pus, not from any inherent disposition to do so, but only because it is subjected to some preternatural stimulation. In an ordinary abscess, whether acute or chronic, before it is opened, the stimulus which maintains the suppuration is derived from the presence of the pus pent up within the cavity. When a free opening is made in the ordinary way, this stimulus is got rid of ”

“ Formation of ascidia or pitchers.—In the preceding paragraphs, the formation of tubular or horn-like structures, from the union of the margins of one organ, or from the coalescence, or it may be from the want of separation of various organs, has been alluded to, so that it seems only necessary now, by way of summary, to mention the classification of ascidia proposed by Professor Charles Morren [29] , who divides the structures in question into two heads, according as they are formed from one or more leaves. ”

“ SYMPTOMS.—In general, ascites is easily recognized by the swollen state of the bowels: a well-rounded swelling when the patient stands or sits, but spread out in the flanks when he lies on his back; the fulness of the side on which the patient may be lying, and the flattened condition of the opposite side,—belong to this disease, and as a group to no other. ”

“ The muscles are all formed of very long fusiform non-striped fibres. The mantle in some Ascidians is often brilliantly pigmented—red, yellow and opaque white, the coloured cells being exactly like those found in the blood.
Fig. 18.—Dissection of Ascidia, from right side, to show anatomy. a, Anus; At, atrial aperture; Br, branchial aperture; br.s, br.s′, branchial sac; end, endostyle; g.d, genital ducts; gon, ovary; hyp, neural gland; hyp.d, the duct leading to dorsal tubercle; m, mantle; n.g, ganglion; oes, oesophagus; p.br.c, peribranchial cavity; ren, renal vesicles; st, stomach; t, test ”

“ PHYSICIANS' TREATMENT for Ascites.—First treat the disease causing it. Sometimes it is necessary in order to prolong life to repeatedly tap the patient as in cirrhosis of the liver. When it is caused by the heart or kidneys, give cathartics that carry away much liquid, hydragogue cathartics. One dram of jalap at night followed by a big dose of salts before breakfast. Cream of tartar and salts are good, equal parts. Or cream of tartar alone, one to two drams, with lemon juice in water in repeated doses. Digitalis and squill, of each one grain to cause great flow of urine. ”

“ Ascites and general anasarca. A large corpulent man, and a hard drinker: he had repeatedly suffered under complaints of this kind, but had been always relieved by the judicious assistance of Dr. Ash. In the present instance, however, not finding relief as usual from the prescriptions of my worthy friend, he sent for me; after examining into his situation, and informing myself what had been done to relieve him, I was satisfied that the Digitalis was the only medicine from which I had any thing to hope. ”

“ Throughout her fast she had periodic convulsions, and voided no urine or feces for twelve months before her death. There was a middle-aged woman in England in 1860 who for two years lived on opium, gin, and water. Her chief symptoms were almost daily sickness and epileptic fits three times a week. She was absolutely constipated, and at her death her abdomen was so distended as to present the appearance of ascites. After death, the distention of the abdomen was found to be due to a coating of fat, four inches thick, in the parietes. ”

“ The primitively double atrial aperture has its parallel in the peritoneal openings which persist in many Vertebrata.
Thus the ascidian has no " perivisceral cavity" formed by splitting of the mesoblast, nor has it any "perivisceral cavity " formed by diverticula from the alimentary canal. It is neither enterocoelous nor schizocoelous, but what, at first sight, resembles a perivisceral cavity is formed within the body by involution, and the ascidian may therefore be said to be epiccelous. ”

“ In Aetius (IV. iv. 23) and Paulus Aegineta (VI. lxxiv) it is used for opening not only the foetal cranium but also the thorax and abdomen of the foetus in transverse presentations. Paul refers to it for opening the thorax in empyema (VI. xliv) and the abdomen in ascites (VI. l) . In both cases the outer integument was incised with a scalpel and the deeper layer punctured with the bistoury. In opening the abdomen for ascites, by sliding the outer skin upwards before the peritoneal cut was made, a valvular opening was secured. ”

“ For several years, I have given the infusion in a variety of cases, where there was a deficiency in the secretion of the urine, with the greatest success. In recent obstructions, I do not recollect many failures. In anasarcous diseases, and in the anasarca, when combined with the ascites; in swellings of the limbs, and in diseases of the chest, when there was the greatest reason to believe an accumulation of serum, the most beneficial consequences have followed from its use. ”

“ In my different experiments with regard to asphyxia, I have remarked, that if after shutting the cock of the syringe, the animal agitate the chest by similar movements to those of inspiration and expiration, the blood is a longer time in losing its red colour, than in the case where the breast remains at rest. Such motion and agitation must cause a circulation of air in the cells, in consequence of which, a greater number of its points must be presented to the circulating fluid. ”