Hence likewise we understand, why in the ascites, and some other dropsies, there is often no thirst, and no paucity of urine; in these cases the cutaneous absorbents continue to do their office.
Some have believed, that dropsies were occasioned by the inability of the kidneys, from having only observed the paucity of urine; and have thence laboured much to obtain diuretic medicines; but it is daily observable, that those who die of a total inability to make water, do not become dropsical in consequence of it: Fernelius mentions one, who laboured under a perfect suppression of urine during twenty days before his death, and yet had no symptoms of dropsy. Pathol. 1. vi. c. 8. From the same idea many physicians have restrained their patients from drinking, though their thirst has been very urgent; and some cases have been published, where this cruel regimen has been thought advantageous: but others of nicer observation are of opinion, that it has always aggravated the distresses of the patient; and though it has abated his swellings, yet by inducing a fever it has hastened his dissolution. See Transactions of the College, London, vol. ii. p. 235. Cases of Dropsy by Dr. G. Baker.
The cure of anasarca, so far as respects the evacuation of the accumulated fluid, coincides with the idea of the retrograde action of the lymphatic system. It is well known that vomits, and other drugs, which induce sickness or nausea; at the same time that they evacuate the stomach, produce a great absorption of the lymph accumulated in the cellular membrane. In the operation of a vomit, not only the motions of the stomach and duodenum become inverted, but also those of the lymphatics and lacteals, which belong to them; whence a great quantity of chyle and lymph is perpetually poured into the stomach and intestines, during the operation, and evacuated by the mouth. Now at the same time, other branches of the lymphatic system, viz. those which open on the cellular membrane, are brought into more energetic action, by the sympathy above mentioned, and an increase of their absorption is produced.
Hence repeated vomits, and cupreous salts, and small doses of squill or foxglove, are so efficacious in this disease. And as drastic purges act also by inverting the motions of the lacteals; and thence the other branches of lymphatics are induced into more powerful natural action, by sympathy, and drink up the fluids from all the cells of the body; and by their anastomoses, pour them into the lacteal branches; which, by their inverted actions, return them into the intestines; and they are thus evacuated from the body:—these purges also are used with success in discharging the accumulated fluid in anasarca.
[II]. The following cases are related with design to ascertain the particular kinds of dropsy in which the digitalis purpurea, or common foxglove, is preferable to squill, or other evacuants, and were first published in 1780, in a pamphlet entitled Experiments on mucilaginous and purulent Matter, &c. Cadell. London. Other cases of dropsy, treated with digitalis, were afterwards published by Dr. Darwin in the Medical Transactions, vol. iii. in which there is a mistake in respect to the dose of the powder of foxglove, which should have been from five grains to one, instead of from five grains to ten.
Anasarca of the Lungs.
1. A lady, between forty and fifty years of age, had been indisposed some time, was then seized with cough and fever, and afterwards expectorated much digested mucus. This expectoration suddenly ceased, and a considerable difficulty of breathing supervened, with a pulse very irregular both in velocity and strength; she was much distressed at first lying down, and at first rising; but after a minute or two bore either of those attitudes with ease. She had no pain or numbness in her arms; she had no hectic fever, nor any cold shiverings, and the urine was in due quantity, and of the natural colour.
The difficulty of breathing was twice considerably relieved by small doses of ipecacuanha, which operated upwards and downwards, but recurred in a few days: she was then directed a decoction of foxglove, (digitalis purpurea) prepared by boiling four ounces of the fresh leaves from two pints of water to one pint; to which was added two ounces of vinous spirit: she took three large spoonfuls of this mixture every two hours, till she had taken it four times; a continued sickness supervened, with frequent vomiting, and a copious flow of urine: these evacuations continued at intervals for two or three days, and relieved the difficulty of breathing—She had some relapses afterwards, which were again relieved by the repetition of the decoction of foxglove.
2. A gentleman, about sixty years of age, who had been addicted to an immoderate use of fermented liquors, and had been very corpulent, gradually lost his strength and flesh, had great difficulty of breathing, with legs somewhat swelled, and a very irregular pulse. He was very much distressed at first lying down, and at first rising from his bed, yet in a minute or two was easy in both those attitudes. He made straw-coloured urine in due quantity, and had no pain or numbness of his arms.
He took a large spoonful of the decoction of foxglove, as above, every hour, for ten or twelve successive hours, had incessant sickness for about two days, and passed a large quantity of urine; upon which his breath became quite easy, and the swelling of his legs subsided; but as his whole constitution was already sinking from the previous intemperance of his life, he did not survive more than three or four months.