Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

II. Of an ASCITES.

XXX. Definition. An Asci∣tes is a preternatural Tumor of the Belly, caused by a Collection of Watery Humors into the capa∣city of the Abdomen.

XXXI. The Causes. The Pro∣catartick Causes are the same with the former. The Antecedent Cause is the weakning of the Blood, or a discrasy, whereby it cannot convey its Serum to the Reins: so that the sanguiferous Vessels swelling, they are not able to receive their continual and daily proportions of Lym∣pha; from which cause, the Lymphaducts being overcharged, are extended, and swell; and at length where they are most tumified, and weakest, break.

XXXII. This breach of the Lymphaducts, if it happens in the internal Parts, as the Viscera, they let fall their Juices, (now depauperated, altered, and changed, thro' their stagnation) into the cavity of the Abdomen; which at beginning is but small, but being continual (tho' gra∣dual) at length comes to pro∣duce a mighty Tumor of the Belly; from whence, the Cods,

Thighs, Legs, and Feet, many times are caused to swell, thro' the dispersion of the same Humor.

XXXIII. The conjoined Cause is a serous Lympha, but in a recent Ascites it seems to be wholly Lymphatick; in an inveterate Ascites, it is most like to Serum, with a thicker part like Curds, or some such like thing; as Barbett in a dissection after death observed.

XXXIV. A Woman fifty years old died of an Ascites, she was opened by Barbett, the famous Franciscus Sylvius, and Ver∣schagen being by, they found, 1. A thin and fluid Lympha: 2. Then a Matter, which was congealed: 3. That which was thicker, or like the Matter of an Apostem. From this and several other like Examples, Bar∣bett was of opinion, that this thicker part of the Matter re∣maining in the Belly, after Tapping, is the cause of many a Patient's death.

XXXV. And that if the Pa∣tient would sooner yield to ••e tapp'd, they might, with much greater probability, recover: whereas being grown invete∣rate, it is for the most part mortal.

XXXVI. The Signs. There is a manifest Tumor or Swelling of the whole Belly, and when it grows great, it is very heavy with the Water: and there is a sound of Water rumbling, as it were falling or squashing, when the Sick turns from one side to the other.

XXXVII. The Thighs, Legs, and Feet many times swell; and generally there is a tumor of the Scrotum, which by degrees, grows many times as big as a Man's head.

XXXVIII. There is an internal Fever, very great Thirst, a dry Cough, and at length a difficulty of Breathing; whereby the Patient cares not for stirring or moving up and down, but rather de∣lights in sloth and idleness.

XXXIX. There is also an Exte∣nuation, or kind of Consumption of the upper parts of the Body; and the Urine is very little, and thick, and sometimes of a red∣dish colour.

XL. The Prognosticks. This is the most difficult of all Dropsies to cure; yet while it is recent, and newly begun, may be at∣tempted by Purging: but if it is inveterate, then Purging rather adds to it, and in∣creases it.

XLI. Hippocrates, Sect. 7. Aph. 55. Those who have their Liver fill'd with Water, if (says he) it falls upon the Caul (that is, into the cavity of the Abdo∣men) it fills the Belly with Water, and then the Patient dies.

XLII. If it has been of long continuance, there is great dan∣ger of the Bowels being corrupted or putrified; and then, (tho' the Sick admits of being Tapt) no∣thing but Death can put a period to the Disease.

XLIII. But if Tapping be at∣tempted while the Disease is recent, and the Patient has strength and courage, the Operation may be very successful; and many times the Patient returns to perfect

health again, and that in a short time.

XLIV. The Cure. The Diet in this ought to be as in the former, with observation of all other things relating to the seven Non-naturals: and while the Disease is recent, Purging may be made use of for some time, with such things as restore and strengthen the Tone of the Parts in the intervals of Purging; as Opiates, and all sorts of hot and dry Antiscorbuticks, which abound with a volatil Salt.

XLV. But if after some trials by Purging and Diureticks, you find no benefit; but that the Dis∣ease does get ground of the Pa∣tient; it is then totally to be forborn, and the sooner the better, to make way for a more effectual Remedy; since delays in this case always breed danger.

XLVI. How the Paracentesis or Opening is to be made for letting out of the Water, we have at large declared in Lib. 1. cap. 16. aforegoing of this Work: so that what we have there said, need not be here again repeated. See more of the Cure of this Dis∣ease, in the third Edition of Our Synopsis Medicinae, lib. 5. cap. 19. and lib. 6. cap. 4. sect. 131, ad 140. of the same Book.

XLVII. Tho' Barbett's way of making the Paracentesis, is by many approved of, yea by the most Excellent Sylvius; yet some great Artists have a few Exceptions against it. Wiseman says, that while the Belly is distended with abundance of Water, it may succeed well: but that it is not to be pretended to, farther than the evacuation of half the Hu∣mor; for then (says he) you will be in danger of wounding the In∣testines: and therefore he con∣cludes it an unfit Instrument to discharge a Dropsy: nor will our Patients admit of so many openings, as will be necessary to empty an Hydropical Belly.

XLVIII. He therefore concludes, that a Pipe, made taperwise, with holes in the side, (whose Descri∣ption is in Paraeus) according to the old method, to be best: this is to be conveyed in thro' a hole made by puncture.

XLIX. The Cannula or Pipe is to be stopt with a Screw or Plug, which may be put in or pulled out at pleasure; and the Pipe is to be kept in the Hole by Bandage, till all the Water is evacuated, by degrees, and at fit times, as you see convenient. You may consider all the ways which Authors have taught, and chuse that which in reason you find to be most convenient and safe.