DROPSIES.
Transudation is the passage of fluid through the tissue of any part of the body without changing its liquid state, while exudation means, medically, the passage of matter which coagulates and gives rise to solid deposits. When transudations are unhealthy, they may accumulate in serous cavities or in cellular structures, and constitute dropsy. Exudation is the result of inflammation, and the product effused coagulates and becomes the seat of a new growth of tissue. Exosmosis means the passage of fluid from within outward, and is a process constantly taking place in health; while transudation takes place because the blood is watery and the tissues are feeble and permeable, permitting the serum and watery elements of the blood to pass into certain cavities, where they accumulate.
The cause of dropsies may be low diet, insufficient exercise, indigestion, hemorrhages, wasting diseases, in fact, any thing which impoverishes the blood and increases the relative amount of serum. The tardy circulation of blood in the veins, or its obstruction in any way, is a condition highly favorable to the development of dropsy.
General dropsy is called anasarca, and is readily distinguished by bloating or puffiness of the skin all over the body. This condition is also called oedema. The skin is pale, yields under the finger without pain, and preserves the impression for some time. The oedema usually appears first in the lower extremities, next in the face, and from thence extends over the body.
General dropsy is commonly due to an impoverished condition of the blood, and this may be the result of albuminuria, a disease of the kidneys. Albuminuria is frequently the sequel of scarlatina. Hence, the utmost care should be taken against exposure of a patient recovering from scarlatina, and the same caution should be exercised during convalescence from measles, erysipelas, and rheumatism. Dropsies may be general, as in anasarca, or local, as dropsy of the heart, called cardiac dropsy: dropsy of the peritoneum, the serous membrane which lines the abdominal cavity, called ascites; dropsy of the chest, called hydrothorax; dropsy of the head, called hydrocephalus; dropsy of the scrotum, called hydrocele.
Dropsy is not, therefore, of itself a disease, but only the symptom of a morbid condition of the blood, kidneys, liver, or heart. Thus disease of the valves of the heart, may obstruct the free flow of blood and thus retard its circulution. In consequence the pulse grows small and weak, and the patient cannot exercise or labor as usual, and finally the lower limbs begin to swell, then the face and body, the skin looks dusky, the appetite is impaired, the kidneys become diseased, there is difficulty in breathing, and the patient, it is said, dies of dropsy, yet dropsy was the result of a disease of the heart, which retarded the circulation and enfeebled the system, and which was actually the primary cause of death.
Treatment. Dropsy being only a symptom of various morbid conditions existing in the system, any treatment to be radically beneficial must, therefore, have reference to the diseased conditions upon which the dropsical effusion, in each individual case, depends. These are so various, and frequently so obscure, as to require the best diagnostic skill possessed by the experienced specialist, to detect them. There are, however, a few general principles which are applicable to the treatment of nearly all cases of dropsy. Nutritious diet, frequent alkaline baths to keep the skin in good condition and favor excretion through its pores, and a general hygienic regulation of the daily habits, are of the greatest importance. There are also a few general remedies which may prove more or less beneficial in nearly all cases. We refer to diuretics and hydragogue cathartics. The object sought in the administration of these is the evacuation of the accumulated fluids through the kidneys and bowels, thus giving relief. Of the diuretics, queen of the meadow, buchu, and digitalis generally operate well. As a cathartic, the Purgative Pellets accompanied with a teaspoonful or two of cream of tartar, will prove serviceable. Beyond these general principles of treatment it would be useless for us to attempt to advise the invalid suffering from any one of the many forms of dropsy. The specialist skilled by large experience in detecting the exact morbid condition which causes the watery effusion and accumulation, can select his remedies to meet the peculiar indications presented by each individual case. Sometimes the removal of the watery accumulation by tapping becomes necessary, in order to afford relief and give time for remedies to act. We have found it necessary to perform this operation very frequently in cases of hydrocele, and also quite often in cases of abdominal dropsy. The chest has also been tapped and considerable quantities of fluids drawn off, and this has been followed by prompt improvement and a final cure.
CASES TREATED.
Case I. A Canadian gentleman, aged 68, applied at the Invalids Hotel and Surgical Institute, for examination and treatment. He had been dropsical for over two years, and had become so badly affected as to be unable to lie down at night. His legs were so filled with water and enlarged as to render it almost impossible for him to walk, and there was a general anasarca. The least exertion was attended with the greatest difficulty of breathing. He had been under the treatment of several eminent general practitioners of medicine in Canada but found no relief. They were unable to discover the real cause of his ailment, but to the specialist who has charge of this class of diseases at our institution, and who annually examines and treats hundreds of such cases, it was at once apparent that the dropsy was caused from a weakened condition of the heart, which rendered it unable to perform its functions. He was put upon a tonic and alterative course of treatment, which also embraced the use of such medicines as have been found to exert a specific, tonic action upon the muscular tissues of the heart. He improved so rapidly that in less than two months he was able to lie down and sleep soundly all night. The bloating disappeared, his strength improved, and in three month's more he was discharged perfectly cured.
Case II. A man aged 42, consulted us by letter, stating that he was troubled with general bloating which had made its appearance gradually and was attended by general debility and other symptoms which have been enumerated as common to general dropsy. He had been under the treatment of several home physicians without receiving any benefit; he had steadily grown worse until he felt satisfied that if he did not soon get relief he could not live very long. He was requested to send a sample of his urine for examination, as we had suspicions, from the symptoms which he gave, that the cause of his dropsy was albuminuria, or Bright's disease of the kidneys. On examination of the urine, albumen in very perceptible quantities was found to be present. We had, about this time, come into possession of a remedy said by very good authority, to be a specific in degeneration of the kidneys when not too far advanced, and we determined to test it upon this well-marked case. We accordingly prescribed it, together with other proper tonics and alteratives, at the same time giving the patient important hygienic advice, which must be complied with if success is attained in the management of this very fatal malady. Our patient gradually improved, and in a few months' time was restored to perfect health, which he has continued to enjoy ever since. From our subsequent experience, embracing the treatment of quite a large number of cases of Bright's disease of the kidneys, we are satisfied that it is, in its early stage, quite amenable to treatment.
Case III. A man aged 35, single, consulted us for what he supposed to be enlargement of the testicles. The scrotum was as large as his head, and it was with difficulty that he could conceal the deformity from general observation. The disease was immediately recognized by the attending surgeon as hydrocele. The liquid was promptly drawn oft by tapping, and a stimulating injection was made into the scrotum to prevent re-accumulation. We mention this case only because it is one among a very large number who have consulted us supposing that they were suffering from enlargement of the testicles, cancer, or some other morbid growth within the scrotum, when a slight examination has shown the affection to be hydrocele, a disease which is speedily cured by tapping, with a little after treatment. The operation is perfectly safe and almost entirely painless.
Case IV. A lady, aged 24, consulted us by letter enumerating a long list of symptoms which clearly indicated abdominal dropsy, resulting from suppression of the menses. A well-regulated, hygienic treatment was advised, and medicines to restore the menstrual function by gradually toning up and regulating the whole system, were forwarded to her by express. After four months' treatment, perfect recovery resulted. Cases like this latter are very common and generally yield quite readily to proper management. No harsh or forcing treatment for restoring the menstrual function should be employed, as it will not only fail to accomplish the object sought, but it is also sure to seriously and irreparably injure the system. The most difficult cases which we have had to deal with, have been those which had been subjected by other physicians to the administration of strong emmenagogues in the vain effort to bring on the menses.