Clinical lectures on the diseases of women / delivered in Saint Bartholomew's Hospital by J. Matthews Duncan.

  • Duncan, J. Matthews (James Matthews), 1826-1890.
Date:
1889
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Licence: Public Domain Mark

Credit: Clinical lectures on the diseases of women / delivered in Saint Bartholomew's Hospital by J. Matthews Duncan. Source: Wellcome Collection.

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    case of a very delicate pregnant woman who has hydrothorax—a collection of fluid in one side of the chest which is evidently not of pleuritic origin, and is connected, as far as I can tell, merely with the delicate condition of her health. I have also seen large hydroperitoneum in pregnancy. This collection of serum in the peritoneal cavity has been the subject of very interesting illustration experimentally. I do not know of experiments which can illustrate tlie production of effusion of watery fluid from the peritoneum, but we see plenty of examples, in disease, of the extremely rapid accumulation of thin watery fluid in the peritoneal cavity. On the other hand, very interesting exxDeriments can easily be made to show the rapidity of the absorption of fluid by the peritoneum ; and to such I merely refer, saying that injection of large quantities of water into the peritoneal cavities of some of the lower animals—as of the dog—luis often been done, and the water has been found to be absorbed in a very remarkably short time. Similar observations have been made in women in peritoneal injections with therapeutical objects. These two facts are necessary for you to remember in order to u.nderstand the rapid variations in cases of hydroperitoneum, especially in the simple hydroperi- toneum that I shall presently describe to you at length. The rapid absorption of large turbid hydroperitoneal collections, even in cases complicated with uterine tumour and depraved health, is one of the most remarkable observations you can make. I have lately seen a case in which this has twice occurred, to my extreme astonishment. In this case the fluid was twice drawn off by tapping, and thus its characters of turbidity and slight viscidity, and its containing much albumen, were ascertained. What is the nature of the fluid that is effused ? When the case is simple, without any inflammation, it is a clear albuminous fluid, the albumen being of moderate amount. It is of a low specific gravity, which may be stated generally about 1008 to I o 15 ; it forms no clot on standing; and under the microscope the sediment shows no pus nor blood, but merely endothelial products. This is a very vague statement, and it is supplemented by this—that in these cases there may be healthy peritoneum or any degree of irritation of it, on to the condition called chronic peritonitis; and, as you have the irritation of the peritoneum increasing, you have the fluid becoming more dense, more albuminous, and generally then presenting at the bottom of the