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

by Various

In the idiopathic form of hydropic inflammation, attacking the serous membranes of the chest and abdomen, and which, agreeably to our author, may be strictly local, or consist in a general specific excitement of the system, leading to a general watery effusion, the lancet is particularly advantageous, and should be had recourse to. The pulse is generally hard, the blood exhibits a buffy appearance, and the urine coagulates when subjected to heat. Leeches, in pretty large numbers, must also be used, as well as all the remedies already enumerated. But as in these cases, which according to Dr. Ayre are more common among females than males, and among the younger than those of middle and advanced age, the disease is of a more acute nature, a greater reliance is to be placed on an active antiphlogistic plan; and if this be steadfastly persevered in, comparatively little difficulty will be experienced in effecting a discharge of the water.

When hydrothorax occurs after scarlatina, and is combined with anasarca, its course is generally rapid, and the cure difficult; partaking, as it often does, of the two-fold state of debility and excitement. When detected early, the lancet must be promptly used. Cups and leaches, followed by the warm bath, blisters, and cathartics, must also be resorted to.

"Diuretics, which are so beneficial in the less acute forms of dropsy, are commonly too inert and slow in this, unless given in doses to act immediately upon the vascular system, when the infusion of digitalis, as given by many practitioners in all the other states of the disease, may be resorted to; since the treatment here is not so much to remove the water, as to prevent, if possible, its farther effusion; for when a discharge suddenly takes place into the chest after scarlet fever, it will generally prove fatal, even though the quantity collected be inconsiderable, and only such as would occasion, if gradually effused, a moderate degree of inconvenience to the lungs."

In respect to tapping, our author remarks, that the circumstances calling for this operation are, where, from the very considerable accumulation of water, and the consequent distension it occasions, a permanent and morbid stimulus is given to the peritoneal membrane, by which its serous inflammation is perpetuated or increased; or where so much pain and irritation are produced, as to risk inducing a similar disease in the chest, and of bringing on likewise an ulcerative form of inflammation in the peritoneal lining of the abdomen.

"Whilst the objections to its employment consist in the danger which is incurred, where there is much visceral disease, of its causing a destructive form of inflammation in the peritoneum; and the probability of its occasioning, under the most favourable condition of the disease, a more rapid renewal of the serous accumulation."

Our limits not allowing us to enter on the treatment of ovarian dropsy, we proceed to offer a few remarks on the means recommended by Dr. A. for the cure of anasarca. As in the treatment of every other form of dropsy, it is necessary, in attempting the cure of anasarca, to advert to the nature and causes of the disease.

"If it be idiopathic, and unconnected with any dropsy of a circumscribed cavity, and the pulse at the same time be soft, and the urine free from serum, it may be treated solely with the view of procuring the absorption of the effused fluid, as in such cases, the watery discharge in all probability will have removed, in a considerable degree, the excitement which caused it."

It is in such cases that recoveries take place under almost any plan of treatment, and that bark and other tonics have been found beneficial. Their utility, however, in these cases is very limited, consisting only in aiding the removal of the effects of the disease, and keeping up the strength of the system, whilst the absorbents perform their function, and remove the fluid. Dr. A. recommends, in these cases, puncturing and bandages; but he very justly adds, that they must not be employed, whenever there remains any inflammation in the parts, as they would then tend to aggravate it.

"To œdematous swellings, in which the serous local inflammation, whether symptomatic or idiopathic, still subsists, I am accustomed to direct the application of leeches and cold evaporating lotions, observing not to commence the use of the latter, until twelve hours after the leeches have been used, that inflammation may not be produced in the wound." "When anasarca arises from a general excited state of the system, as denoted by the pulse, and by the serous quality of the urine, venesection becomes necessary, combined with the use of leeches, applied to the extremities, or to those parts of the body, in which the serous tissues are most affected, along with the active use of the general means already alluded to."

In anasarca, an error is sometimes committed, especially by young practitioners, of estimating the degree of danger, and the necessity for active treatment, by the single consideration of the extent of the œdematous swelling. This, however, should be guarded against, as the swelling may be very considerable, and the disease subsided, or of little consequence; whilst, in other instances, the reverse may be the case. In the first instance, where the disease is not seen early, the treatment must sometimes be limited to those means which promote the absorption of the water, and neither venesection nor leeches will be required. In such cases, the practitioner must be guided by the state of the pulse and urine; the presence or absence of vascular excitement; the history given of the case up to the period when visited, and particularly by the progress of the swelling.