ANALYTICAL REVIEWS.
Article VII.—Researches into the Nature and Treatment of Dropsy in the Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and consistent Pathology of these Diseases is attempted to be established, and a new and more successful method of treating them, recommended and explained. By Joseph Ayre, M. D. &. London, 1825.
We have read the present work with the liveliest pleasure, and we dare hope with considerable benefit, and hasten to lay a review of its contents before our readers. Dr. Ayre is already advantageously known in this country, where his Essay on Marasmus has had an extensive circulation; but we are disposed to think, that, however he might be esteemed for the talent he displayed in his former composition, he is entitled to much more credit for his able researches into the nature and treatment of dropsy. We confess that we enter upon our editorial duties on the present occasion, with the two-fold intention of offering to our readers what we regard, on the whole, as a very correct view of the pathology of dropsy, and of showing to some of our medical friends, who shudder at the mere mention of what they denominate hunch theories, that the English physicians, or at least some of the most intelligent among them, so far from considering these theories as dangerous and unphilosophical, are beginning to entertain similar views with their Gallic brethren, in respect to the inflammatory nature of many diseases too long regarded as resulting from a state of debility, and classed by nosologists among the Cachexiæ.
By most writers upon the subject, dropsy has too long been considered as a disease,—constituted into a separate class, and divided into many species. Dr. Ayre entertains, however, a very different and, we believe, a much more correct view of the pathology of this complaint; regarding it as only one in a series of effects of a disease, and not always the last of that series. He remarks, that the true disease is to be sought for in that particular condition of the solids by which the effusion is produced; and that to appreciate justly the nature and treatment of dropsy, it is necessary to understand the nature of that condition, which constitutes the disease, and of which the serous and watery effusion is merely the result.
Of all the hypotheses that have been advanced to account for the nature of the morbid state, which gives rise to general and local dropsy, there are only three which our author regards as entitled to our notice. According to these, all dropsical accumulations arise either, 1st, From a want of tone or energy in the absorbent vessels, giving rise to a deficient absorption. 2nd, From an increased exhalation of the natural fluid, through a similar want of tone in the exhalents; and 3d, From a mechanical obstruction to the free return of blood by the veins, produced by tumours of various kinds, &c., by which a greater portion of it is forced into the exhalents, and a greater effusion of their proper fluids thereby occasioned. With these hypotheses, however, Dr. Ayre is not satisfied, and he endeavours, in the following manner, to show their insufficiency.
"1st. The opinion of a want of tone in the absorbents, as a cause of dropsy, is contradicted by the fact, that in those cases, in which it is assumed to prevail, it is found, that the adipose matter, or fat of the body, is removed by the absorbents; or, in other words, that emaciation takes place to as great an extent, and as rapidly in this, as in other diseases; and emaciation can only be effected by means of absorption. Besides, in these cases of dropsy, mercury, when rubbed upon the surface, or received internally, is absorbed as readily, and affects the system as early as under other states of the body. There is also no accumulation of the fluids in the joints, or in the bursæ mucosæ in these cases, which, nevertheless would happen, if there was a general debility of the absorbent system; and ecchymoses or livid spots, though easily induced in anasarcous limbs, are likewise easily removed from them by the absorbents.
"2nd. The opinion of a want of tone or energy in the exhalants involves in it one of the following conditions: namely, either, 1st, that the fluid of dropsy may escape mechanically from them, and that the fluid thus mechanically separated may be identified in its sensible and chemical qualities with another fluid which is confessedly secreted; or 2nd, that if the fluid of dropsy be secreted, then that an increase in the quantity of a secretion may continue an indefinite period, under a decrease in the energy of its secreting vessels; conclusions to which experience and analogy are alike opposed."
In answer to the third hypothesis, Dr. A. remarks, that such an obstruction as contemplated, has never been shown to exist.