cases of ascites, the child's prospects depend less upon the amount of fluid effused into the abdominal cavity than upon the cause of the phenomenon and the general symptoms by which the effusion is accompanied. Causes which affect the system generally, or impede the flow of blood through the portal vein as a consequence of obstruction to the general circulation, are especially to be feared. Thus, ascites from tubercular peritonitis, or from heart disease, is a symptom of serious import. In all cases, the prognosis depends chiefly upon the pathological condition which has occasioned the escape of serosity. If this cannot be discovered, we must judge of the prognosis by remarking the state of the child's strength, his temperature, and his pulse ; and by noting the degree of efficiency with which the skin and the other emunctories of the body are performing their functions. The skin in particular is an important guide. If the temperature is not elevated, the urine non-albuminous and of normal density, and the skin of natural tint, and neither dry nor harsh, we may speak favourably of the child's chances of recovery.
Treatment.—The treatment of ascites is dependent upon the illness in the course of which the symptom has arisen. If peritonitis (simple or tubercular) be present, the special measures recommended in the chapters relating to those diseases must be resorted to. If the ascites form a part of general dropsy dependent upon heart disease, it will be relieved by the diuretics, purgatives, and cardiac tonics and stimulants which are found efficacious in that serious condition.
In cases of ascites of obscure origin, or dependent upon disease of the liver, iron and other tonics have often a marked influence in reducing the amount of fluid in the peritoneum and improving the general condition of the patient. The exsiccated sulphate of iron is well borne by children, and may be given three times a day, in doses of five grains, to a child of three or four years of age. The tincture of the perchloride of iron with quinine is also useful ; but whatever form of chalybeate is used, the dose should be a large one. Violent purgatives are to be avoided, but consti patiorr must be treated by suitable doses of compound liquorice powder, compound jalap powder, or, if at the beginning of the treatment, by a grain of calomel followed by a saline. The action of the skin must be main tained by a daily tepid or warm bath ; and the child should be dressed in woollen underclothing from head to foot.
If the accumulation of fluid be copious, paracentesis should be per formed without hesitation ; and it is now generally held that promptness in the performance of this operation is to be preferred to delay. The diet of the child, as in all forms of chronic disease, should be arranged accord ing to the state of his digestion ; and a watch should be kept over his capacity for digesting starch, sugar, and all forms of fermentable food. An excess of such matters would encourage flatulence and colicky pains, and must therefore be avoided.