3. Alternation of dropsies with certain diseases which were evidently accompanied by excess of action in the arterial system. I have seen anasarca alternate with vertigo, and both ascites and anasarca alternate with tonic madness. A case of nearly the same kind is related by Dr. Mead. Dr. Grimes, of Georgia, informed me that he had seen a tertian fever, in which the intermissions were attended with dropsical swellings all over the body, which suddenly disappeared in every accession of a paroxysm of the fever.
4. The occasional connection of certain dropsies with diseases evidently of an inflammatory nature, particularly pneumony, rheumatism, and gout.
5. Spontaneous hæmorrhages from the lungs, hæmorrhodial vessels, and nose, cases of which shall be mentioned hereafter, when we come to treat of the cure of dropsies.
6. The appearance of dropsies in the winter and spring, in habits previously affected by the intermitting fever. The debility produced by this state of fever, frequently disposes to inflammatory diathesis, as soon as the body is exposed to the alternate action of heat and cold, nor is this inflammatory diathesis always laid aside, by the transition of the intermitting fever into a dropsy, in the succeeding cold weather.
7. The injurious effects of stimulating medicines in certain dropsies, prove that there exists in them, at times, too much action in the blood-vessels. Dr. Tissot, in a letter to Dr. Haller, “De Variolis, apoplexia, et hydrope,” condemns, in strong terms, the use of opium in the dropsy. Now the bad effects of this medicine in dropsies, must have arisen from its having been given in cases of too much action in the arterial system; for opium, we know, increases, by its stimulating qualities, the action and tone of the blood-vessels, and hence we find, it has been prescribed with success in dropsies of too little action in the system.
8. The termination of certain fevers in dropsies in which blood-letting was not used. This has been ascertained by many observations. Dr. Wilkes relates[36], that after “an epidemical fever, which began in Kidderminster, in 1728, and soon afterwards spread, not only over Great Britain, but all Europe, more people died dropsical in three years, than did perhaps in twenty or thirty years before,” probably from the neglect of bleeding in the fever.
But the existence of too much action in the arterial system in certain dropsies, will appear more fully from the history of the effects of the remedies which have been employed either by design or accident in the cure of these diseases. I shall first mention the remedies which have been used with success in tonic or inflammatory dropsies; and afterwards mention those which have been given with success in dropsies of a weak action in the arteries. I have constantly proposed to treat only of the theory and cure of dropsies in general, without specifying any of the numerous names it derives from the different parts of the body in which they may be seated; but in speaking of the remedies which have been used with advantage in both the tonic and atonic states, I shall occasionally mention the name or seat of the dropsy in which the remedy has done service.
The first remedy that I shall mention for dropsies is blood-letting. Dr. Hoffman and Dr. Home both cured dropsies accompanied by pulmonic congestion by means of this remedy. Dr. Monroe quotes a case of dropsy from Sponius, in which bleeding succeeded, but not till after it had been used twenty times[37]. Mr. Cruikshank relates a case[38] of accidental bleeding, which confirms the efficacy of blood-letting in these diseases. He tells us that he attended a patient with dropsical swellings in his legs, who had had a hoarseness for two years. One morning, in stooping to buckle his shoes, he bursted a blood-vessel in his lungs, from which he lost a quart of blood; in consequence of which, both the swellings and the hoarseness went off gradually, and he continued well two years afterwards. I have known one case in which spontaneous hæmorrhages from the hæmorrhodial vessels, and from the nose, suddenly reduced universal dropsical swellings. In this patient there had been an uncommon tension and fulness in the pulse.
I could add the histories of many cures of anasarca and ascites, performed by means of blood-letting, not only by myself, but by a number of respectable physicians in the United States. Indeed I conceive this remedy to be as much indicated by a tense and full pulse in those forms of dropsy, as it is in a pleurisy, or in any other common inflammatory disease.