Symptoms.—The belly is large, swollen, and bulging out at the sides, the blue veins show ing on the surface. The question whether the swelling is caused by fluid is settled by "per cussion." Percussion is practised by laying a finger of one hand flat on the belly and tap ping it sharply with the point of a finger of the other hand. If this be done over the healthy belly a clear sound is heard, like that given out by tapping a hollow vessel tilled with air. Now, if the patient lies on his back, the fluid will seek the lowest level, and on tapping on the middle of the belly, which is uppermost, the clear sound will be given out, but on tap ping low down at the sides the sound will be dull, like that produced by tapping a solid block of wood. In this way, by tapping all over the belly, the extent of the accumulation of fluid is determined. A solid tumour, how ever, would give forth as dull a sound as a collection of fluid. The determination of the presence of fluid is made by laying the one hand on one side of the belly and giving a sudden tap with the fingers on the other side. If there is fluid present, a is sent through it, and a thrill is communicated to the hand resting on the belly. In women there is a dropsy of the ovaries (see DISEASES all WOMEN), which requires skill to distinguish from dropsy of the cavity of the belly. The legs and genital organs tend to become drop sical from the pressure of the fluid in tlu belly on the veins there. Breathlessness is occasioned from the mere mechanical difficult) offered by the swelling, and the breathlessness is worse on lying down. Severe diarrhcez sometimes occurs.
The treatment depends on the cause of the dropsy. It consists usually in the administra• tion of medicines to cause sweating, a copious flow of urine, or a copious watery discharge from the bowels. On the whole, the two for mer are not risky, like the latter, for the ad ministration of strong purgatives may serious': weaken the patient when he needs strengthen ing. There can be no harm in administering spirit of nitrous ether or squill to encourag the flow of urine. Quinine and iron tonic often help by strengthening the patient. Thi disease, however, should be left to the treat ment of a physician. Tapping, that is, passing a fine tube through the walls of the belly to permit the fluid to escape, is practised when the swelling is great.
Other forms of dropsy are referred to on p. 339.
Tumours of the belly may be of a great variety of kinds. They may be connected with the liver, with the kidneys, with the spleen, with the glands of the bowel, and with the bladder: they may be formed by accumula tions of matter after peritonitis ; in women they may be connected with the womb or ovaries. It is useless to say anything of them here. They offer great difficulties often to skilled men in endeavouring to discover their nature, and the proper treatment for them.
Rupture (Hernia) is that condition in which there is a projection of part of the bowel or mesentery (p. 190) through some unusual open ing in the wall of the belly, the projection appearing as a tumour or swelling onr the out side. In males the tumour usually appears in the groin, and may pass down into the testicle. It is common here, because about the centre of the groin the spermatic cord passes out of the belly and down a canal to the testicle. Usually the rupture forces its way along this canal under cover of the skin, fat, and tendin ous layers. In women it may occur in a similar region, or towards the centre of the upper part of the thigh. In this position the rupture passes down a canal by which blood vessels pass to the thigh. The former is called
inguinal hernia, the latter femoral or crural. Hernia may occur in children at the navel (umbilicus), and is called umbilical. It occurs here before the opening is properly closed up which existed for the connection between mother and child by means of the cord.
It is at the parts naturally weaker than others that rupture tends to take place, and it is usually owing to extra pressure exerted on these weaker places that they yield and permit the rupture to occur. Thus sudden straining by lifting a weight, rowing, &c., or the great pressure exerted on the walls of the belly by frequent cough, as in bronchitis or whooping cough, &c., produces it. The rupture is called reducible if it can be returned the way it came into the cavity of the belly, and irreducible if it cannot be returned. Another form is called strangulated, where constriction occurs.
Symptoms.—There is the presence of a soft swelling. When the patient stands it increases in size, and when he coughs, the hand sur rounding it feels an impulse. If the swelling be formed by the bowel, wind may be felt passing through it. When the person lies down, gentle pressure upwards in the direction of the groin, along with a sort of kneading motion, diminishes its size, if it is reducible, and it passes up into the belly, gradually at first, but at last with a bolt and gurgling noise. If it is irreducible, for instance by adhesion having taken place between the bowel and the canal, it cannot be returned, but wind and feces still pass along the channel. A strangu lated hernia is a much more serious affair. Here the channel of the bowel is blocked, either because it has got twisted or caught at the neck because of the small opening through which it has passed, or for sonic other reason. Not only are the contents of the bowel pre vented passing along, but the circulation of the blood in the walls may be seriously hindered. The strangled bowel will, therefore, become congested and inflamed. The symptoms are thus those of stoppage of the bowels and of in flammation. Besides pain, vomiting soon occurs, first of the contents of the stomach and of bile, then of matter like that of stools—ster coraceous vomiting it is called. This kind of vomit should at once show the nature of the mischief, and should lead to the promptest action. The tumour becomes swollen and pain ful, the patient becomes very anxious, and, if not relieved, quickly begins to fail, the pulse grows small and wiry, the skin cold, and features pinched, and death speedily occurs, perhaps within a few hours after the strangulation.
Treatment.—The protrusion must be re turned, if possible, into the belly and kept there. In the case of a reducible hernia this is often easy. The patient lies on his back, with his hips supported and his knees bent, to relax the belly. The Wilmer is taken in one hand and gently compressed and urged upwards in the line of the groin, a kneading movement being practised till it returns into the belly; a pad is then to be fitted over the place to prevent its return. Pads are made for the purpose, called trusses. They are pads kept in place by a strong spring band that passes round the body. A truss should be of the proper size, and carefully fitted over the place out of which the rupture comes. They should be regularly taken off, and the part sponged, dried, and dusted to prevent fretting of the skin ; but the patient should be lying down when this is done, to prevent the coming down of the tumour.