We are accustomed to call the commencement of dropsical affections cachexia. Wherefore we must cure it by bleeding, if nothing prevent, at intervals, and continuing the abstraction until the third or fourth day. But, in an especial manner, we must evacuate those who have fallen into this affection from retention of the hemorrhoidal or menstrual discharge; as in those cases which arise from a copious evacuation, we must abstain from venesection, and by all means purge with the hiera from colocynth. The diet should be light and desiccative; and recourse must be had to natural baths, namely the aluminous, and more especially the nitrous, and then the sulphureous; but the other kind of baths may be taken at greater intervals. Let them be exercised in every way, more especially by those who are called jatraliptæ. At last they must be put under a course of hellebore. They are wonderfully remedied by a propoma of wormwood, and by sinapisms and dropaces. If the affection is converted into dropsy, we must have recourse to the treatment applicable for dropsical cases in the manner about to be explained.
Commentary. Almost all the authors referred to in [the preceding Section] may be consulted on cachexia and dropsy.
Aretæus gives an accurate account of this affection, which, he says, usually terminates in dropsy, phthisis, or wasting. He mentions many symptoms of it, such as œdema, difficulty of breathing, and so forth; and he correctly remarks that the alvine discharges are dry, white, crude, and without bile. His chapter on the treatment unfortunately is lost.
Cælius Aurelianus says that Themison was the first who explained the treatment of cachexia. He mentions as causes of the disease intemperance, the improper use of medicines, hardness of the liver or spleen, long-continued hemorrhoidal discharge, vomiting, protracted fevers, &c. His treatment is judiciously varied according to the cause of the disease, and is given at great length.
Aëtius gives a very interesting account of the views and practice of Archigenes. He says the disease is generally occasioned by scirrhus of the liver or spleen. Like our author, he recommends bleeding if not contra-indicated, and purging with drastic cathartics, such as the hiera from colocynth, friction, rubefacients, exercise, the bath, and thin white wines. Celsus admits of bleeding, but not until after purging, friction, unction, and exercise have failed to restore the health.
Serapion expresses himself in much the same terms as our author and Aëtius respecting venesection; but Avicenna recommends not to have recourse to it unless there be a sanguineous plethora. He also forbids baths of sweet water, but otherwise he adopts the treatment recommended by the Greeks.
SECT. XLVIII.—ON DROPSY.
When the liver is greatly congealed, sometimes primarily, as when it has been inflamed, indurated, or otherwise affected, or when from sympathy with other parts, the process of sanguification ceases, and the affection is called dropsy. When a great quantity of air is collected with a small quantity of fluid between the peritoneum and intestines, so that the abdomen when struck sounds like a drum, the dropsy in this case gets the name of tympanites, being formed by flatulence about the stomach, belly, and colon, and by chronic fevers. But sometimes from hardness of the peritoneum and of the uterus in women, or from scirrhus, on the contrary, a great collection of fluid with a very small proportion of air is formed in the same parts, being confined as it were in a bladder, when the dropsy is named ascites, and is occasioned by the afore-mentioned causes; but, for the most part, it arises from hardness and scirrhus about the spleen and liver, and from chronic defluxions about the intestines; whereby it happens that the belly is swelled, while the rest of the body is melted owing to its not being nourished. Sometimes throughout the whole body a colder and more pituitous blood is collected, either coming from the liver, or deriving its origin from a melting down of the flesh of the whole body, which is as it were converted into water, so that the whole body appears white and pituitous like a corpse, and then the affection is called leucophlegmatia, dropsy of the flesh, or anasarca, being occasioned by protracted fevers, cachexia of the stomach, suppression of long-continued hemorrhoidal discharges, the female flux, dyspnœa, inordinate insomnolency, and similar causes. In treating these complaints, we commence generally with evacuation; but in ascites and tympanites it is by administering hydrogogue medicines; and in anasarca by bloodletting, more especially when the affection is formed by retention of the hemorrhoidal or menstrual discharges, unless the patients had been previously bled for cachexia; and in this case, as in cachexia, the evacuation must be made at intervals. Then, having carefully triturated the dried dung of an ox of the herd, boil it in oxycrate or oxymel, and sprinkling on it a fourth part of sulphur, apply it over the whole belly; or, apply a cataplasm of goat’s dung with the urine of a child, made of the thickness of bath-sordes. These things purge strongly by the belly; and we may use cataplasms made of leaven, dried figs, calcined lime, nitre, iris, cardamom, native sulphur, ammoniac, bay-berries, stavesacre, the dung of wild pigeons, all or some of these may be used with oxymel. After which the epitheme, called spongium, made of goat’s dung, evacuates the fluids in a wonderful manner, both by the insensible pores and by the belly. Afterwards we must apply desiccative plasters, that from willows, the Icesian, the barber’s, that from bay-berries, the Polyarchium, and that from seeds. And the following one is wonderfully efficacious, for it fetches, as it were, the fluids from the deep-seated parts: Of the stone pyrites, dr. xij; of native sulphur, dr. xij; of ammoniac perfume, dr. xij; of cumin, dr. xvj; of nitre, dr. xij; add to a little wax and turpentine, and spreading it upon a piece of skin, apply to the whole belly. Let them take the propoma (liqueur) made by boiling the root of vervain-mallow in wine, or macerate the wild cucumber in austere wine, and give every three days, adding a cupful every day, until the dose amount to three cupfuls. The following is a very compound mixture: Of balsam, of nard, of cassia, of cumin, of liquorice, of St. John’s-wort, of bog-rush, of asarabacca, of carrot, of amomum, of myrrh, of Macedonian parsley, of sweet hay, of pepper, of hartwort, of cow-parsnip, equal parts. Each of these produces a good effect by itself, and in like manner all the diuretics. Squill baked and triturated with honey, and given as a linctus, provokes urine without trouble; or it may be boiled in the water which is drunk. And the following is an excellent remedy: Boil lb. ij of the inner part of squills in iij sextarii of austere wine until it be reduced to one third; give every day of this wine, beginning with a mystrum, until the dose amount to an ounce. The following is an excellent diuretic: Of moist alum, the size of a bean; dissolve in water; strain through a linen cloth; and give to drink every third day, or every alternate day. Picra given in oxymel, the theodoret, and the trochisk from bitter almonds also suit with them. There are many hydragogues, but the following are of approved efficacy: The seeds of the thymelæa (grana cnidia), xl or l; or lathyrides, xx or xxx; or of euphorbium, v or vj siliquæ; or of flakes of copper, dr. ij or iij; being mixed with crumbs of bread and formed into pills; or the juice of the rind of elder-root, drunk with prepared wine; or of the leaves of mezeron, of burnt copper, and of anise, equal parts; give in water at first to the amount of dr. j; and afterwards of dr. ij, or more. And the following are admirable pills: Of aloes, of euphorbium, of grana cnidia, of each, oz. j; of rhubarb, oz. ss; mix together with the juice of cabbage, and form into pills, and give to the amount of viij or ix siliquæ. And the antidote from cloves evacuates water in a wonderful manner. And we must try the effect of a hydragogue wine. The following makes an excellent one: Of squills, oz. iij; of parsley-seed, of the rind of the root of capers, of pepper, of each, dr. iv; of peeled grana cnidia, dr. j; of the Indian leaf, two balls; of best wine, xij heminæ; of raw honey, dr. xvj; beat together, sift, and macerate in the wine, but triturate the squill. The dose is three cyathi. After the evacuation of the water, we must use the theriac. And ox-dung dried and drunk to the amount of a spoonful every day is of mighty use. We must use the most stimulant clysters, unless the belly be spontaneously very loose, in which case we must rather use things for drying it up. When women are affected with dropsy we must use this pessary: Of anise, of cardamom, of cumin, of nitre, of birthwort, of fenugreek, of pennyroyal, of the inner part of figs, equal parts; mix together in the oil called Susinum, and apply per vaginam. Afterwards we may use the natural baths perseveringly, and the sand-bath, but we must abstain from the others; but if they do ever go into a bath, let them sprinkle the body with powders from nitre, salts, mustard, lime, and the like. These things even without bathing are useful, when rubbed into the belly in a dry state, or with oil. In anasarca they must exercise the other parts as much as possible, and use dry friction in the sun. And a desiccative diet should be taken. Let them, therefore, eat pickle, mustard, garlic, wild and dry fowls, asparagus, picktooth fennel, leeks, wild carrot, and the other wild pot-herbs; and the theriac salts, or those of Iamblichus may be mixed with condiments; and old light diuretic wine may be used, or if it is at hand, the wine prepared with salt water. But the patients must abstain from much drink of any kind, and from water altogether.
When the dropsy is attended with fever, the patient must abstain from the more heating and acrid food or remedies; but we may give them intermixed with other things in case of urgent necessity. In tympanites, purgatives and every medicine which wastes the body must be rejected, and also the more drastic diuretics; and we must use both externally and internally such things as can attenuate and dissipate the flatus; and dry-cupping may be frequently applied over the whole belly. When those who have ascites are not benefited by any of the remedies already described, we must have recourse to paracentesis, which does not apply to any of the other varieties of dropsy.
Commentary. See Hippocrates (de Intern. Affect. 25; de Ratione Victus in Morb. Acut.), and Galen’s Commentary on the same (Prognost.), with the Commentary of Stephanus (ed. Dietz), and almost all the authors who treat of hepatic diseases may be consulted.