The opium alone, and the opium with the rosin, seem much to have served this patient, and might probably have effected a cure, if the disease had been slighter, or the medicine had been exhibited, before it had been confirmed by habit during the seven months it had continued. The increase of the quantity of water on beginning the large doses of rosin was probably owing to his omitting the morning doses of opium.
[V]. The Phænomena of Dropsies explained.
[I]. Some inebriates have their paroxysms of inebriety terminated by much pale urine, or profuse sweats, or vomiting, or stools; others have their paroxysms terminated by stupor, or sleep, without the above evacuations.
The former kind of these inebriates have been observed to be more liable to diabetes and dropsy; and the latter to gout, gravel, and leprosy. Evoe! attend ye bacchanalians! start at this dark train of evils, and, amid your immodest jests, and idiot laughter, recollect,
Quem Deus vult perdere, prius dementat.
In those who are subject to diabetes and dropsy, the absorbent vessels are naturally more irritable than in the latter; and by being frequently disturbed or inverted by violent stimulus, and by their too great sympathy with each other, they become at length either entirely paralytic, or are only susceptible of motion from the stimulus of very acrid materials; as every part of the body, after having been used to great irritations, becomes less affected by smaller ones. Thus we cannot distinguish objects in the night, for some time after we come out of a strong light, though the iris is presently dilated; and the air of a summer evening appears cold, after we have been exposed to the heat of the day.
There are no cells in the body, where dropsy may not be produced, if the lymphatics cease to absorb that mucilaginous fluid, which is perpetually deposited in them, for the purpose of lubricating their surfaces.
If the lymphatic branch, which opens into the cellular membrane, either does its office imperfectly, or not at all; these cells become replete with a mucilaginous fluid, which, after it has stagnated some time in the cells, will coagulate over the fire; and is erroneously called water. Wherever the seat of this disease is, (unless in the lungs or other pendent viscera) the mucilaginous liquid above mentioned will subside to the most depending parts of the body, as the feet and legs, when those are lower than the head and trunk; for all these cells have communications with each other.
When the cellular absorbents are become insensible to their usual irritations, it most frequently happens, but not always, that the cutaneous branch of absorbents, which is strictly associated with them, suffers the like inability. And then, as no water is absorbed from the atmosphere, the urine is not only less diluted at the time of its secretion, and consequently in less quantity and higher coloured: but great thirst is at the same time induced, for as no water is absorbed from the atmosphere to dilute the chyle and blood, the lacteals and other absorbent vessels, which have not lost their powers, are excited into more constant or more violent action, to supply this deficiency; whence the urine becomes still less in quantity, and of a deeper colour, and turbid like the yolk of an egg, owing to a greater absorption of its thinner parts. From this stronger action of those absorbents, which still retain their irritability, the fat is also absorbed, and the whole body becomes emaciated. This increased exertion of some branches of the lymphatics, while others are totally or partially paralytic, is resembled by what constantly occurs in the hemiplagia; when the patient has lost the use of the limbs on one side, he is incessantly moving those of the other; for the moving power, not having access to the paralytic limbs, becomes redundant in those which are not diseased.
The paucity of urine and thirst cannot be explained from a greater quantity of mucilaginous fluid being deposited in the cellular membrane: for though these symptoms have continued many weeks, or even months, this collection frequently does not amount to more than very few pints. Hence also the difficulty of promoting copious sweats in anasarca is accounted for, as well as the great thirst, paucity of urine, and loss of fat; since, when the cutaneous branch of absorbents is paralytic, or nearly so, there is already too small a quantity of aqueous fluid in the blood: nor can these torpid cutaneous lymphatics be readily excited into retrograde motions.