In recommending the antiphlogistic treatment of certain dropsies, I must here confine myself to the dropsies of such climates as dispose to diseases of great morbid action in the system. I am satisfied that it will often be proper in the middle and eastern states of America; and I have lately met with two observations, which show that it has been used with success at Vienna, in Germany. Dr. Stoll tells us, that, in the month of January, 1780, “Hydropic and asthmatic patients discovered more or less marks of inflammatory diathesis, and that blood was drawn from them with a sparing hand with advantage;” and in the month of November, of the same year, he says, “The stronger diuretics injured dropsical patients in this season; but an antiphlogistic drink, composed of a quart of the decoction of grass, with two ounces of simple oxymel, and nitre and cream of tartar, of each a drachm, did service[43].” It is probable that the same difference should be observed between the treatment of dropsies in warm and cold climates that is observed in the treatment of fevers. The tonic action probably exists in the system in both countries. In the former it resembles the tides which are suddenly produced by a shower of rain, and as suddenly disappear; whereas, in the latter, it may be compared to those tides which are produced by the flow and gradual addition of water from numerous streams, and which continue for days and weeks together to exhibit marks of violence in every part of their course.
I come now to say a few words upon atonic dropsies, or such as are accompanied with a feeble morbid action in the blood-vessels. This morbid action is essential to the nature of dropsies, for we never see them take place without it. This is obvious from the absence of swellings after famine, marasmus, and in extreme old age, in each of which there exists the lowest degree of debility, but no morbid action in the blood-vessels. These atonic or typhus dropsies may easily be distinguished from those which have been described, by occurring in habits naturally weak; by being produced by the operation of chronic causes; by a weak and quick pulse; and by little or no preternatural heat or thirst.
The remedies for atonic dropsies are all such stimulating substances as increase the action of the arterial system, or determine the fluids to the urinary organs. These are,
I. Bitter and aromatic substances of all kinds, exhibited in substance or in infusions of wine, spirit, beer, or water.
II. Certain acrid vegetables, such as scurvy-grass, horse-radish, mustard, water-cresses, and garlic. I knew an old man who was perfectly cured of an anasarca, by eating water-cresses, on bread and butter.
III. Opium. The efficacy of this medicine in dropsies has been attested by Dr. Willis, and several other practical writers. It seems to possess almost an exclusive power of acting alike upon the arterial, the lymphatic, the glandular, and the nervous systems.
IV. Metallic tonics, such as chalybeate medicines of all kinds, and the mild preparations of copper and mercury. I once cured an incipient ascites and anasarca by large doses of the rust of iron; and I have cured many dropsies by giving mercury in such quantities as to excite a plentiful salivation. I have, it is true, often given it without effect, probably from my former ignorance of the violent action of the arteries, which so frequently occurs in dropsies, and in which cases mercury must necessarily have done harm.
V. Diuretics, consisting of alkaline salts, nitre, and the oxymels of squills and colchicum. It is difficult to determine how far these medicines produce their salutary effects by acting directly upon the kidneys. It is remarkable that these organs are seldom affected in dropsies, and that their diseases are rarely followed by dropsical effusions in any part of the body.
VI. Generous diet, consisting of animal food, rendered cordial by spices; also sound old wine.