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Show 230 or urrmc rue ABDOMEN. or Tarrinc- THE ABDOMEN. come a general leucophlegmatic swelling of the body, with paleness and sallowness in the countenance, it is needless to say how much less the probability of success, from operation, has become. If the habits, countenance, and present symptoms indicate disease of the liver, it is also unfavourable. There is a diifused inflammation on the surface of the in- testines, a consequence of ascites, which forbids the operation. We next enquire into the origin and progress of the swelling of the belly, to ascertain whether it be an incysted dropsy or not? If the tumefaction of the belly has been generally difi‘used from the beginning, and when there is a general hydropic tendency, with thirst, and scarcity of urine, it is ascites. If, on the contrary, a tumour rose at first circumscribed and distinct, and gradually extended upwards and across .2, it La dim" ' nor/nu («extends Wm M. '. 1- .t the belly, it is not ascites; especially if it has begun in the lower and lateral parts of the belly of afcmale. These symptoms indicate a dropsical swelling of the ovarium. Moreover, we shall find that the disease of the ovarium has been increasing slowly for many years. If there be no general 231 the system which originally produced the accumulation of the water. We have only to consider the connexions of the diaphragm; the relation which is established betwixt the abdomen and thorax; and the effect of the due degree of the tension on these cavities upon the state of the circulation, in order to see the usefulness of compressing the belly during the evacuation of any considerable quantity of flu~ id. This is never neglected in Scotland; but in London I have seen it very improperly omitted, and the consequence was anguish and fainting of the patient when the contraction of the abdominal muscles came to act feebly on the diminished cavity of the belly. The abdominal muscles acting feebly, the diaphragm must be also afl‘ected. The viscera of the abdomen, and their great veins, wanting their accustomed pressure and support, the blood accumulates in the vessels. The diaphragm acting feebly, the membranes around the heart are relaxed, the heart wants support, and the blood is accumulated in its sinuses. The blood is not carried with full stream to the brain. There is a fluttering of the pulse, and dropsical swelling of the limbsa‘s, and the strength, breathing, an immediate sensation of languor and faintness. and appetite, have been little affected, the skin not dry, 1101' any scarcity of urine, nor thirst, the absence of these symptoms confirm the supposition that it is not dropsy. In dropsy of the ovarium there is often a very viscid and somewhat gelatinous fluid, which requires a larger canula To prevent this, there is a bandage for the belly to be had in the shops; but the best support, I conceive to be a piece to draw it 011", than in the dropsy of the peritoneum. The occasion for drawing 011" the water of dropsical swellings of the belly, is either to give temporary relief from the burden, or to assist the operation of medicines in curing the disease ; for, certainly the oppressions of the heart and lungs, compressions of the viscera of the belly, and impeding of exercise of every kind, directly tend to continue the state 0f * In the dropsy of one of the ovaria, there is often a swelling 0f the thigh or leg of the same side. of flannel large enough to cover the distended belly complete- ly, and to go twice round the body. The ends of the cloth are then cut up like a bandage, into three or four slips, leaving the middle entire. The middle part of the cloth is put upon the fore part of the belly, and the cut slips go round to the back ; the surgeon's assistants take hold of these, and as the water flows, they tighten the bracing of the belly by pull« ing these ends. When the operation is finished, the ends of the cloths are put down over the belly, and pinned. When the puncture is to be made, the bandage is slit. At What part of the belly the puncture should be made, is a. matter of some moment. It has been the custom to tap at , ' vmm M09917 |