IV. ASCITES.
Frequency.—Congenital ascites is very rare. The number of recorded cases amounts to about 50. Van Gelder ranges them under the following heads: Usually, hence, ascites is complicated by inflammatory lesions of the peritoneum, or by multiple lesions of the abdominal organs. The quan tity of fluid varies from one-third of a pound to pints and over, and is ordinarily a yellow serum, sometimes clear and limpid, again greenish yellow, red, probably due to admixture with blood. The peritoneum has been found inflamed, thickened, covered with reddish granulations. The intestines are bound together; the spleen occasionally hypertrophied; the liver frequently altered. Porak found an abscess in the liver. Retention of urine is a frequent complication. The bladder congested, thickened, with or without imperforate urethra. Sometimes hydronephrosis, de generation of the kidneys by hydramnion, exaggerated development of the placenta, are found. Anomalies elsewhere in the body, imper forate anus, absence of the scrotum, persistent urachus, absence of the csecum or colon, accompany the ascites. Syphilis is a frequent causal
factor.
During pregnancy the symptoms are about nil. The development of the abdomen, and the rapidity of this growth, edema, respiratory troubles, diminution in foetal movements, absence of ballottement, etc., :which have been mentioned as signs, are met with in many other conditions, and we cannot, hence, establish a diagnosis by them. It is only during labor that we may suspect ascites. When, after delivery of the head or the breech, the trunk is arrested, we should introduce the hand along the ven tral surface of the foetus. The exaggerated development of the abdomen and fluctuation may thus be determined. But the question will still re main, are we dealing with simple ascites, or with retention of urine? The answer to this question can usually only be made after birth.
The prognosis is always fatal for the infant and for the mothers; it de pends on the method of intervention.
The only way of ending labor is by puncture, by means of a trocar. In many cases the finger has served as perforator.