A PLEA FOR THE OPERATION OF PARA CENTESIS ABDOMINIS IN THE TREATMENT OF ASCITES
THE presence of ascitic fluid exists in the majority of cases as a symptom of some form of chronic disease and is especially prevalent amongst the ill-nourished and emaciated. Very rarely, indeed, do we see it constituting an actual, uncomplicated affection of the peritoneum. It is not my intention to refer to the etiology of ascites ; its causes are numerous. My object is to draw attention to the incontestable fact that large numbers of these cases are treated as if the presence of the ascitic
... fluid constituted an actual disease, instead of being treated directly as a localised symptom of some recognised malady. I should like to add my experi-in which I tapped the abdomen during 1891, when in India. The majority of these, it will be seen, were cases of splenic ascites, an extremely corimon symptom of a disease characterised by a hypertrdphied spleen and which is essentially prevalent amongst those who are ill-nourished and have been subjected for years to malarial influences in a tropical climate. Of these cases, one man was tapped four times, another three times and two others twice each, and on several the operation was only resorted to once. The remaining cases were of hepatic origin and in one instance a patient was tapped three times with satisfactory results. The indications for the removal of ascitic fluid are usually referable to the additional symptoms caused by the mechanical pressure of the fluid on the thoracic and abdominal viscera. The operation itself being so simple, it is not worthy of a detailed description. There are, however, one or two important practical points to be noted in its performance. Of these, the complete evacuation of the bladder immediately before the operation is, perhaps, the most important. It sometimes happens during an operation that the fluid suddenly ceases to flow through the cannula ; the cause of this is that the internal aperture of the cannula gets blocked by the entrance of a portion of EPITOME OF CASES TREATED BY PARACENTESIS ABDOMINIS IN 1891. * In each case all fluid was removed at one sitting. ence of the treatment of ascites by the direct method of removing all the fluid at one sitting from the peritoneum, and to this I will confine my remarks without reference to the constitutional treatment of the several diseases of which it forms a symptom. Before submitting an epitome of cases I will state the reasons on which I based my decision to adopt this method of treatment. 1. Because ascites, no matter from what cause its presence may be excited, is a symptom of a grave and urgent nature and is usually developed in the more advanced stages of the disease with which it is complicated. 2. Because its presence causes pain and much unnecessary discomfort to the patients. 3. Because any other modes of treatment, such as the administration of purgatives, diaphoretics, diuretics, absorbents &c., are utterly untrustworthy and greatly add to the exhausted and debilitated condition of the patient. 4. Because the operation of paracentesis abdominis is practically devoid of danger and it can be repeated several times on the same subject with advantage. 5. Because the result of the operation benefits the patient and improves his general condition and thereby tends to augment the chances of curing his actual constitutional disease by subsequent treatment. The following tabular statement gives the details of cases the omentum. In such cases a blunt-pointed probe ought to be introduced through the cannula and the protruding omentum pushed gently inside ; at the same time, by a slight movement, the cannula should be directed in a slightly oblique line, so as to obviate a recurrence of the accident. If ascites is complicated with general anasarca (affecting usually the lower extremities and the scrotal sac) it is my routine method of treatment to extend the principle of direct removal of fluid to these regions by making innumerable surface-pricks all over the lower extremities and scrotum. This simple procedure, combined with the elevation of the feet, a suspensory bandange to the scrotum and complete rest in bed in the recumbent position, gives most satisfactory results and in a very short time the patient is in a better condition for the performance of the major operation. I have been indnced to offer the above observations. by a perusal of Dr. W. B. Cheadle's remarks on the treatment of ascites ;1 and as a result of my own experience I am able to endorse his opinions and advocate early paracentesis abdominis in the treatment of ascites. 1 Brit. Med. Jour., Nov. 19th, 1892.