North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826

by Various

We now proceed to notice the mode of treatment, recommended by our author, for the different forms of dropsy. From what we have seen, it is natural to conclude, that as Dr. Ayre regards the proximate cause of the several forms of the effusion, or in other words, the disease, to be the same under all its conditions, he will be of opinion, that "the same general principles of treatment, are alike applicable to all—subject only to such modifications, as arise from differences in the nature and intensity of the remote cause, and those general or local relations of the parts implicated in the serous effusion, with the diseases of the organs, which incidentally produce it." Founding upon these views the indications of cure, he states them to be; 1st. To remove the visceral, or such other disease or state, which, when present, proves a remote cause of the effusion; 2nd. To remove the morbidly increased action in the serous membrane or tissue, which is its proximate cause. 3d. To promote the absorption of the effused fluid.

Agreeably to Dr. A. the treatment of hydrocephalus internus, is divisible into three general heads:

"The first, consisting of means to correct, with its causes, that turgescent state of the brain, which may produce the arterial re-action and effusion; the second, of those which shall subdue the excitement, when formed; the third, to correct or relieve, as far as it is practicable, the effects of the effusion, and procure, if possible, its absorption."

With respect to the general causes, tending to produce that congestive state of the brain, precursory to its inflammation, he remarks, that they are of three kinds; 1st. Those acting through the general system, and consisting of an irritation, from some obstructed or required evacuation; 2nd. A local disease, seated in the head, or a local injury inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically upon the brain. When the first of these causes appears to have been instrumental, in occasioning this condition of the brain, it is plain that it must be removed, and the obstructed emunctory corrected,—the suppressed evacuation promoted, or a new and artificial one substituted. When there exists any structural disease within the head, or a relic of a former state of excitement, a serous inflammation may be reasonably apprehended, and to avert it, the most rigid and undeviating attention must be paid to regimen, whilst cupping and leeching must be employed, and a seton fixed in the neck.

"For the object of the treatment, in these cases, is not to remove, but to avert the inflammation, and which, from the strong disposition to it, conferred by the organic disease, can only be effected by avoiding, not merely the causes of inflammation, but likewise, all those agents, which are calculated, in any way, to increase the momentum of the circulation." "Beyond those, the common precautions against morbid irritations, little else can be done."

When the turgescent state of the brain, arises from a disturbance in the digestive organs, it will be remedied, by means directed to this cause. Our author locates the primary seat of this disturbance, in most cases, in the liver; though he admits, it may occasionally be in the stomach and intestines. He places great reliance for correcting and increasing the secretion of bile, on small doses of calomel,—purging off the contents of the intestines by aperient medicines; and recommends, at the same time, the application of cups and leeches to the temples, as a measure of precaution. He very properly lays considerable stress on the necessity of combating this secondary affection of the head;

"For though the means applied, to correct the disorder in the digestive organs, may be sufficient to remove the turgescent state of the brain, which arose from it, yet, those means will have little or no control over the excitement, which that turgescent state has created; and still less can they avail in subduing an excitement, that may even survive its remote cause, and continue independently of it. By overlooking these facts, much distrust and disappointment have arisen with many, who confided in the opinion, delivered by some writers, of the uniform prevalency of chylopoietic disturbance, as a cause of this disease, and of the sufficiency of calomel to remove it."

When the inflammation exists, and is a sequel of some pre-existing structural disease in the brain or membranes, all that can be reasonably expected, is to palliate it by the antiphlogistic plan; but when it is idiopathic it may readily be cured, by the same remedies, graduated to the age and strength of the patient and to the violence of the attack. Dr. A. seems to rely principally on cups and leeches;—not excluding, in some cases, bleeding from the arm. Blisters to the summit of the head and afterwards a cold evaporating lotion to the temples, are also recommended. As soon as, by these means, an impression is made on the disease, mild diaphoretic medicines, assisted by the tepid bath, or the pediluvium, maybe prescribed;—the bowels are to be kept open by small doses of calomel, followed after two hours by a draught of some aperient medicine,—the antiphlogistic regimen should be rigidly enforced, and light and noise carefully excluded.

"Many practitioners give the mild preparations of mercury, and particularly calomel, freely in this disease, under a notion of its having some specific power in subduing it; but it never should be so used, excepting in cases where the disease is symptomatic of some functional disturbance in the liver and other chylopoietic organs, where it is calculated, in conjunction with the local bleeding, &c. to afford the most important service."

With a view of pointing out some characteristic sign, by which to distinguish those cases in which the affection of the bowels is primary from those in which it is secondary, he remarks—