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History: Liver & Ascites
Fluid accumulation in the abdomen was recognized in ancient times. Celsus is credited with first describing in ~20 B.C. the technique of paracentesis for aspirating fluid from the peritoneal cavity, using a bronze tube with a flanged collar to drain fluid.
One of the famous patients to receive large volume paracenteses was Ludwig van Beethoven in 1827, whose physician wrote about his deathbed with the following description:
"'the tremendous volume of the water accumulated called for immediate relief; and I found myself compelled to advocate the abdominal puncture in order to preclude the danger of sudden bursting.' Beethoven had almost immediate relief, and when he saw the stream of water, cried out that the operation made him think of Moses, who struck the rock with his staff and made the water gush forth. "
Two days later Beethoven died. At autopsy his liver was described as "shrunken to half its normal volume…it was beset with knots the size of a bean…the spleen was double its proper size and dark coloured and firm." (Adams)
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