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Her appetite is orse, and the wellinios her bellyris nothin dimini med. Pulsea oo thirst rather more moderate. Captat risin si, eris cremoris tartari omni mane, et sibilum scilliticam omni nocte. November O. Her oose ool have been es frequent since the last repori; and she has in generat discliarge nearive pound of urine during the space of twenty- seu hours. The wellinios her belly is somewhat diministied every orning, butit again increasse tomard night. It wasthi morniniles than it has been or omeyears besore Her thirst is more moderate, her appetite mended. Pulse 96. Continue
ops ERVATION delibered December . Tu dis eas of this patient, in my opinion, is no altogether ithout ambiguity. There are, indeed, an symptom here, whicli are considere a the characterigingmark of a dropsical affection. Fro the
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breathing the thirst, and carcit os urine, we might conclude that be is subjecte lio scites am inclined to thin that this is reatly the case But here a very
essentia circumstanc is anting. Withthis welling of the belly there is no evident fluctuation a circumstance hicli salmos constanti observe where an en- largement of the abdomen depend uponwater Or even here an other liquid, such, for example, as lood, pus, o the like is deposited in the cavlty of the abdomen. The want of fluctuation then, would naturali lea uso inquire, o far here is reason to suspect that the wellin here depend on an other cause. And there is the rathe room for suchan inquiry, a there is no appearance of effused water in any other par of the system. Pure ascites, indeed, may an frequently does exist; et for the mos pari, i is conjoined illi ther dropsica affec
There are two other supposition respect-ing the cause of this fwelling, hicli here
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naturali present themselves It omelimes happens that wellings, in appearance, simila to the present, depend pon a soli matter. But o his supposition hereare here two iansurinountable objections.
The firs may be rawn rom the progressos the dis eas . here the enlargement of the abdomen depend upon a solid matter,it very generalty egins at a particulars pol, and Dona hencerit is graduali extended to the paris of the abdomen But, in the present case, although the increasse has been gradual, et it has been uniformi extended ver the whole, and noparticula locat hardnes has eve been dis covered Besides his, wellings depend-inion a soli matte are noctiablesto sud-den changes With Ur patient, hOWeVer,such changes manifesti occur HenCe,
for the supposition of the welli nidepend-inion solid there is litile foundation. Another supposition is that theswellinghere occurring may depend pon ir; that is that ou patient a be subjectedio tympanites. But of this affection also
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some of the lites sympionis are Wanting. Nolound is observe estote emitte ora per cussion of the abdomen, nor is an relies afforde on the disicharge of ind. The first of these particulars, however, is thealmost constant attendant of abdominat, and the lastis intestinat, tympanites. Ponthe whole, then, I rechon it a least themost probabie supposition, that this fwellingdepend on ater. The want of nuctuation ma aris fron disserent circumstan ces. I may depend pon the state of the integuments it ma aris fron the condi tion of the viscera o it ma proceed romthe water ein containe in hydatides.
out os a complicated nature, netther entiret dependinion ater no air, ut parilyon both. With his uncertainty I am not here disposexto ive a very favo urabie rognostic. The outh of this patient is indeed
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more so that me has received, at east, temporar relies, froni the quantit of herurine being increasse l. iut these circum stances excepted inest ther are against ou patient While, have much uncertaint respecting the nature of the dis eas , we have a least sonae reason to read a loca affection and froin the ain of thebeti of whicli sile complains, weman Prog- , nosticate nothin favoui able. 4roin the continuarice of her diseasse also, e may conclude it to e sis stubborn nature.
For, although iue eiu eight years id,
her affection has been observed for no essthanive of these And there are even sonae indications oscit bellatos a much earlier date for, ina confider, as a symptomos it the hirst,ith hicli iste has been affected rom the time that e wasin thebi east. To at these circumstances, it is far ther tot added that he complaint haveaiready resisted the power of severat medi cines. f, heres ore heriiseas,admits of a
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speedy and fortunate termination, it is, Iown much more than I ex pec . I may seem strange that hitherio lavetalienis notice of a circumstance particularly mentioned in his case, that is, theworms,hicli siue has, at different times, heen observello dis charge by tool. Thereare sonte pracstitioners, ho, illi sach circumstances as occur here, ould ookopon orm in the intestinat canal ob the cause of the greates pari, is notissali, the symptoms. I must homeVer, Wn, that I do no suspecit them to have any connection illi the present complaint. Wornis, indeed, in the intestines, re by
as m inquiri es o, Pthini ma venturet assteri, that in his country the aretes frequent than in ome thers and ar-ther, that no the are es frequent herethan they were formerly whicli I am inclined to ascribe to changes hicli avetaken place illi respecto diei. Cases are osten tote et illi, in hicli thegare unquestionabi productive of the ost
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threatening and most anomalous symptonas; yet there ante no dolabi that the are frequently present in the alimentary canalwhen the are productive ostio inconvenience This sufficiently appears froni theirhein observed to e dis charged wherethere has been no prece lingineasiness.
In the case ei ore us, the appeared chieny during the oui se of a ever. Itis to e remarhed that, urin febrile
assiections, orios frequently appear and when his is the case, there are man whoare disposed to conside them a the cause of the ever his conclusion, OweVer,
is, imagine, osten rawn ithou goodreason and I cannot hel thinhing that the are frequently disicharged mei ely ii, consequent of the e ver It would seem, that frona the morbid affection hicli ex ists, probably rom the increased heat of the body their situ attoniecomes dis agree- able in them. And I reclion it probabie, that his may have been the case in the instanc bes ore us ur patient has evenos late incleed, discli arge one, hich
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giVes a presumption that there a b stillother present. And the actio of theseon the alimentar canal, may ither belli cause of so me symptoms, o may aggravate them: et admittinithis I mustown Ddo no conlade them a formingany angerous par of the assection and I do no thin that our attempis O Ureare tot directed illi a vie to these. Respecting the genera plan os cure,from,hat has been aid it a b conclude thates in omewhat at Moss. have, however, egun the reaiment of this case, on halci rechon the most pro-hable supposition that is, theside os iis hein a ropsica assection. Supposingi ha there is a collection o water in thecavit of the abdomen, it is, intentionto attempta dis charge iti natura out-leis of these the clites are evacuation bynoo and urine. 4ro the rs of these, we an obtain the most immediate and most sadden dis charges froin the tali, theevacuation hicli akes place has the east influenc a debilitatin the patient; and,
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on his account, iuretic can e sed in more regulari ty, and foris greater tengilii time, than purgatives To these, theres ore, Lam clites ly disposed to trus in the present case; et I isti, in s me de gree, to corioin the advantage both from diuretic and purgatives est is froni theseconLiderations that I have put his patienton the use of two different remedies cream os tartar and squilis. 'hile thetars ope rates most immediatet as a purgative, it is, at theriam time, powerfuli diure lic. The last is intended solely with a vie of increasing the quantity of urine. ffro these medicines, can obtain a copious disicharge of urine, illi a diminution of the wellings, an aesthe sanae timewithout debili ty, it may go farcio ardsthe recovery of the patient. In dropsica affections, however,et considerili evacuationis the water a the east in portant par of the cure and in almost ever case, it is a more dissicut matter toprevent the returnis effusion than to produc evacuation. t may thereforet ne-
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cessary, in orde to secure the good effecta whichisa be derived froni these evacuant8,to have recoui se to Peruvianiarii, and therioni cs. utri ould by no meansie un- dei stood to promis that me mali eve comethis tength in the cure; and we ma eventie oon satisfied that the present plan is notos e persisted in The evacuationmay be reater tha ou patient is able obear, or it ma tali place ithout a diminutionis the wellings. In either casse, twould e prejudiciat. Supposing this to
bly however, tr some of thos medicines whicli more immediatet tend to increasse the tone of the alimentar canal particu Jarly those whicli passe under the generat tities of stomachi and carminative medicines. It is in ome meas ure, illi an intentiono filiis kind thatri mean o conjoin, illithe present course, friction of the abdo