. A practical treatise on medical diagnosis for students and physicians . n tuberculosis, although in both of these diseases the fluidmay consist of pure serum ; in ruptured tubal pregnancy the fluid isalways hemorrhagic. Disease of the lymphatics and of the thoracic ductwith perforation in rare instances leads to the production of a chylous,milky ascitic transudate. Chylous ascites may also be due to the presenceof filaria. It should be remembered that Upcemia, which sometimesdevelops as the result of excessive or long-continued ingestion of milk,may be responsible for the turbidity of an eif
. A practical treatise on medical diagnosis for students and physicians . n tuberculosis, although in both of these diseases the fluidmay consist of pure serum ; in ruptured tubal pregnancy the fluid isalways hemorrhagic. Disease of the lymphatics and of the thoracic ductwith perforation in rare instances leads to the production of a chylous,milky ascitic transudate. Chylous ascites may also be due to the presenceof filaria. It should be remembered that Upcemia, which sometimesdevelops as the result of excessive or long-continued ingestion of milk,may be responsible for the turbidity of an eifusion into a serous cavity. The subjective symptoms are those due to the jirimary disease and tomechanical pressure. Differential Diagnosis. Ascites must be distinguished from enlarge-ment of the abdomen due to pregnancy, enlargement due to ovarian tumor,and enlargement due to an over-distended bladder. During the last monthor two of gestation, especially when the woman has previously bornechildren, the enlargement is general. In ovarian tumor the swelling at Fig. Ascites from sarcoma of ovary. Dislocation of liver and spleen. X is apex-beat, not liftedbecause of fallen abdominal organs. (Original.) first takes place to the right or left of the median line; when the tumoris very large, the signs may be in the central portion of the abdomen, butthe flanks are always tympanitic on percussion. A vaginal examinationusually reveals the local disease. A distended bladder should always bethought of, and catheterization performed in doubtful cases. Pancreaticcysts may be mistaken for ascites, and large hydatid cysts connected withthe liver may simulate an accumulation of fluid in the peritoneal history and the appearance of the fluid obtained by aspiration pointto the correct diagnosis. SYMPTOMS OF PERITONITIS. 999 Peritonitis. Acute General Peritonitis, Infianmiation of the peritoneum may beiioute or chronic, general or localized, primary or secondary. Acutegeneral pe
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