Ascites
Collier's New Encyclopedia (1921)
an effusion of fluid of any kind into the abdomen; especially effusion of fluid within the ca cavity of the peritoneum, as distinguished from ovarian dropsy and dropsy of the uterus. There is an idiopathic ascites, which may be of a chronic or acute form, or of an asthenic type; and a sympathetic or consequential ascites. Another division is into active ascites, that in which there is a large effusion of serum into the cavity of the peritoneum, after undue exposure to cold and wet; and passive ascites, that produced by disease of the heart or liver, 20-Vol. I-Cyc ASCLEPIADACEE (as-klep-e-a-dasē-i), an order of plants closely allied to the apocynaceæ, or dogbanes. Shrubs, or more rarely herbs, almost always tly twining. Leaves milky, and frequently entire, opposite; flowers umbellate, fascicled, or racemose. Their favorite habitat is Africa. They occur also in India and the tropics generally. Fully 1,000 are known. The milk, which in some species furnishes caoutchouc, is usually acrid and bitter, though apparently not so deleterious as that of apocy- That of calotropis gigantea, the nacea. akund, yercum, or mudar plant of India, has been used with effect in leprosy, elephantiasis, and some other diseases. The roots of cynanchum tomentosum, and periploca emetica are emetic. Gymnema lactiferum is the cow-plant of Ceylon. Pergularia edulis and periploca esculenta are eatable. Diplopepis vomitoria is expectorant and diaphoretic, and is used like ipecacuanha in dysentery. Hemidesmus indica is the Indian sarsaparilla. The leaves of cymanchum argel are used in Egypt for adulterating senna. Mardenia tenacissima is employed for bowstrings by the mountaineers of Rajmahal, while M. tinctoria and gymnema tingens yield an indigo of excellent quality.
What Has Changed in the Last Century
Collier's in 1921 still divided ascites into "idiopathic" and "sympathetic" types, and blamed "active" ascites on "undue exposure to cold and wet" — a cause no longer recognised. Today ascites is understood as a sign, not a disease, and in developed countries roughly four cases in five arise from cirrhosis of the liver with portal hypertension; the rest come mainly from cancer, heart failure, tuberculosis or kidney disease. Diagnosis now rests on ultrasound, which detects fluid volumes far too small to feel, and on tapping the fluid and calculating the serum-ascites albumin gradient, introduced in the 1980s, which distinguishes portal-hypertensive from other causes with about 97 per cent accuracy. Treatment has moved from tapping alone to salt restriction and diuretics such as spironolactone, large-volume paracentesis with albumin replacement, the TIPS shunt, and ultimately liver transplantation; the once-fatal complication of spontaneous bacterial peritonitis, only described in the 1960s, is now routinely treated with antibiotics.
Written for this edition, 2026.