Ascites Prolonged for Forty Years.
GEO. E. MILLER, M. D.
I obtain much benefit from the reports of interesting cases, and am confident other physicians do also. The following I am sure is an unusual one.
Mrs. P., married, aged about 52, Three children, all living, the oldest about thirty. Family history indicates a scrofulous constitution. At about the age of fourteen or fifteen she had typhoid fever with ascites as a sequel. Until she was 46 years of age she had to be tapped every two or three years, since then she has been aspirated every two months.
The amount of fluid taken away each time amounted to seven or eight gallons. The last day I aspirated her was the 8th day of September, that being the 28th time I had relieved her. I examined her urine years ago and her kidneys then appeared to be in fair condition, and all her other organs with the exception of the rectum and possibly the liver which ten years ago appeared to be smaller than normal.
I have found the trocar in Potain's aspirator the best instrument to use in this case. With this it requires about two and one-half hours to complete the operation, yet the patient does well. The last time I aspirated her, I proposed to shorten the time to one and one-half hours by using two trocars or a larger trocar. But the patient decided to continue as we had done. I see to it that the bladder is not distended before inserting trocar. Lately the patient assumes this responsibility herself.
I cleanse the abdomen with soap I make myself. I mark the line alba midway between the umbilicus and the pubic bone with a drop of carbolic acid, inject a local anesthetic, incise the skin with the point of a knife, insert the trocar, put on the binder, and as the fluid gets low I draw the binder tightly. When I get through, I cleanse the puncture and seal it with a piece of adhesive plaster about two inches square. In about three days she does her work again. If anyone has any suggestion to give in this rather remarkable case which will cure the patient, I would be pleased to get it.