Dropsy:
-RUDDOCK.E.H,
General and Local (In this Section are included most of the local forms of Dropsy, both for convenience of reference, and to present a more connected view of the subject.) (Anasarca, OEdema, etc.).
DEFINITION.- A serous or watery accumulation in the aerolar tissue, more or less general throughout the body, with or without effusion into the serous cavities.
Dropsy is of two different varieties, for besides it occurrence in the meshes of the loose tissue beneath the skin, it may take place as a local Dropsy in any of the natural cavities or sacs of the body, and is named according tot he parts involved. If the accumulation occur in the ventricles of the brain it is called Hydrocephalus; if in the membrane that lines the d surface of the lungs, Hydrothorax; if in the membrane of the heart, Hydropericardium if in the abdominal cavity Ascites; if in the serous sacs of the joints. Hydrops Articulorum; if in that of the testicles, Hydrocele.
Dropsy is course a symptom of diseases not a disease in itself According to Murchison, there are there forms of Dropsy-partial Dropsy, Dropsy at first partial but afterwards becoming general, and Dropsy which is general from the first. (1) Partial Dropsy is always due to excessive venous repletion; and this over- distension of the small veins is the result of some mechanical impediment to the venous circulation. Dropsy due to obstructed portal circulation may be recognized by the following clinical characters. It begins in the abdomen; dyspnoea follows, but does not precede the Ascites; there is a tendency to Vomiting, Diarrhoea, and Haemorrhoids, or to Haematemesis. Further, the spleen becomes enlarged, and there are Varicose veins on the right side of the abdomen. (2) Dropsy at first partial but afterwards becoming general, commences in the feet and extends upwards; and this is also due to excessive venous repletion from obstructed venous circulation. But here the obstruction is in the central organ of circulation, and is most frequently heart, consequent in Chronic Bronchitis and Emphysema. (3) Dropsy invading all parts of the body at once is almost invariably renal, and albumen is present in the urine. Here Dropsy results from diminished activity of the kidneys, and is consequently chiefly met with in those forms of kidney-disease in which the tubes are blocked up by diseased epithelium or inflammatory products, as in Acute. Nephritis and fatty kidney, and the latter stages of Nephritis.
CHARACTER OF THE SWELLINGS.- Dropsical swellings are soft, inelastic, diffused, and leave for some time the indentation made by the pressure of a finger. In chronic diseases, and when the oedema is very great, the skin becomes smooth, glassy, and of a dull red or purple colour, and where the skin is less elastic, as over the tibia, it becomes livid or blackish, and troublesome, even gangrenous sloughs may form.
EPITOME OF TREATMENT.-
1. General Dropsy.- Dig., Apis., Ars., Bry., Apoc.
2. Dropsy of the abdomen.- Apoc., Ars., China, Crot-Tig.
3. Dropsy of the ankles.- FErr., China., Ars.
4. Dropsy of the brain.- Hell., Merc., Bell., Apis.
5. Dropsy of the chest.- Bry., Dig., Ars., Hell., 6. Dropsy of the heart.- Dig., Spig., Ars.
7. Dropsy of the testicle.- Iod., Rhod., Puls., Graph.
8. Dropsy of the joints (knee, etc.).- Acon., Puls., Iod.,
LEADING INDICATIONS.-
Arsenicum.- It is a most useful remedy in oedema of the face, hands, and feet, and Anasarca from disease of the heart; also in Ascites with enlargement of the liver or spleen. It is especially indicated when there is much general debility, rapid emaciation, and anxious depression; constriction and oppression of the chest, and a sensation of suffocation on attempting to lie down; the skin is dry and pale, or burning and itching, and sometimes peels off in large flakes; and the tongue is red and parched, sometimes with excessive burning thirst; the pulse feeble and irregular, and the extremities cold.
Digitalis.- According to our experience in numerous cases this drug is most valuable in almost every variety of Dropsy, and often succeeds admirably in most desperate cases. It is especially indicated by a small, feeble, and irregular pulse, pale face, livid lips, distressing dyspnoea, inability to lie in the back. It benefits dropsical affections from heart or kidney disease by improving the action of these organs.
Apocynum Can.- The value of this remedy is due to its power of restoring the urinary secretion, which it often does rapidly, even after other remedies have proved ineffectual.
Apis.- The action of this remedy on the kidney is sufficient to make it most useful in acute febrile Dropsy from a chill, in post-scarlatinal Dropsy, in that of incipient Bright's disease, and in that which sometimes appears in the later months of pregnancy, laying the foundation of future puerperal Convulsions; sometimes also, for a time, it removes the oedema of the lower extremities symptomatic of disease of the thoracic organs (Hughes). Apis is particularly valuable in Dropsy complicated with Strangury, Suppression, or other urinary difficulties.
Bryonia.- OEdematous swellings of joints; Hydrothorax; Dropsy, or oedema from the retrocession of perspiration or an eruption, or associated with chest symptoms-Cough, dyspnoea-or with LIver- complaint Constipation, etc.
Helleborus.- Dropsical effusion in the ventricles of the brain (Hydrocephalus), in Hydrothorax and Anasarca, in which it often proves most valuable.
Ferrum.- Functional oedema, especially in anaemic or chlorotic females, with pale and cadaverous skin, feebleness, nausea after eating, Constipation, etc.
Sulphur.- OEdematous swellings following skin-affections or suppressed eruptions.
ACCESSORY TREATMENT.- A dry, soft, and moderately warm atmosphere is generally most suitable; and if the Dropsy be at all owing to climate influences, or to any endemic disease, a change of residence is necessary. A damp climate or soil is particularly unfavourable. In acute Dropsy the diet should be similar to that in acute fever; in chronic Dropsy patients require nourishing diet, but on account of the extreme feebleness commonly present, only easily digestible food should be taken. When there is albuminuria and disease of the kidneys the amount of meat and fish taken must be strictly regulated and much diminished if not forbidden. It is well also to cut off common salt in the dietary as much as possible. To allay the burning thirst often experience, cold water is the best beverage; but any other that the patient desires, if not positively injurious, may be taken. Water may be said to be a real restorative, for it increases the amount of fluids excreted to an extent greater than its down bulk; it also tends to improve the appetite and strengthen the pulse, while it diminishes the dropsical collections. It will thus be seen that the common notion that drinking water increases Dropsy is quite erroneous.
Warm baths for promoting perspiration, tapping, and other palliative measures of such means can only be decided by the circumstances of each individual case.
General and Local (In this Section are included most of the local forms of Dropsy, both for convenience of reference, and to present a more connected view of the subject.) (Anasarca, OEdema, etc.).
DEFINITION.- A serous or watery accumulation in the aerolar tissue, more or less general throughout the body, with or without effusion into the serous cavities.
Dropsy is of two different varieties, for besides it occurrence in the meshes of the loose tissue beneath the skin, it may take place as a local Dropsy in any of the natural cavities or sacs of the body, and is named according tot he parts involved. If the accumulation occur in the ventricles of the brain it is called Hydrocephalus; if in the membrane that lines the d surface of the lungs, Hydrothorax; if in the membrane of the heart, Hydropericardium if in the abdominal cavity Ascites; if in the serous sacs of the joints. Hydrops Articulorum; if in that of the testicles, Hydrocele.
Dropsy is course a symptom of diseases not a disease in itself According to Murchison, there are there forms of Dropsy-partial Dropsy, Dropsy at first partial but afterwards becoming general, and Dropsy which is general from the first. (1) Partial Dropsy is always due to excessive venous repletion; and this over- distension of the small veins is the result of some mechanical impediment to the venous circulation. Dropsy due to obstructed portal circulation may be recognized by the following clinical characters. It begins in the abdomen; dyspnoea follows, but does not precede the Ascites; there is a tendency to Vomiting, Diarrhoea, and Haemorrhoids, or to Haematemesis. Further, the spleen becomes enlarged, and there are Varicose veins on the right side of the abdomen. (2) Dropsy at first partial but afterwards becoming general, commences in the feet and extends upwards; and this is also due to excessive venous repletion from obstructed venous circulation. But here the obstruction is in the central organ of circulation, and is most frequently heart, consequent in Chronic Bronchitis and Emphysema. (3) Dropsy invading all parts of the body at once is almost invariably renal, and albumen is present in the urine. Here Dropsy results from diminished activity of the kidneys, and is consequently chiefly met with in those forms of kidney-disease in which the tubes are blocked up by diseased epithelium or inflammatory products, as in Acute. Nephritis and fatty kidney, and the latter stages of Nephritis.
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| Abdomen swelling. |
CHARACTER OF THE SWELLINGS.- Dropsical swellings are soft, inelastic, diffused, and leave for some time the indentation made by the pressure of a finger. In chronic diseases, and when the oedema is very great, the skin becomes smooth, glassy, and of a dull red or purple colour, and where the skin is less elastic, as over the tibia, it becomes livid or blackish, and troublesome, even gangrenous sloughs may form.
EPITOME OF TREATMENT.-
1. General Dropsy.- Dig., Apis., Ars., Bry., Apoc.
2. Dropsy of the abdomen.- Apoc., Ars., China, Crot-Tig.
3. Dropsy of the ankles.- FErr., China., Ars.
4. Dropsy of the brain.- Hell., Merc., Bell., Apis.
5. Dropsy of the chest.- Bry., Dig., Ars., Hell., 6. Dropsy of the heart.- Dig., Spig., Ars.
7. Dropsy of the testicle.- Iod., Rhod., Puls., Graph.
8. Dropsy of the joints (knee, etc.).- Acon., Puls., Iod.,
LEADING INDICATIONS.-
Arsenicum.- It is a most useful remedy in oedema of the face, hands, and feet, and Anasarca from disease of the heart; also in Ascites with enlargement of the liver or spleen. It is especially indicated when there is much general debility, rapid emaciation, and anxious depression; constriction and oppression of the chest, and a sensation of suffocation on attempting to lie down; the skin is dry and pale, or burning and itching, and sometimes peels off in large flakes; and the tongue is red and parched, sometimes with excessive burning thirst; the pulse feeble and irregular, and the extremities cold.
Digitalis.- According to our experience in numerous cases this drug is most valuable in almost every variety of Dropsy, and often succeeds admirably in most desperate cases. It is especially indicated by a small, feeble, and irregular pulse, pale face, livid lips, distressing dyspnoea, inability to lie in the back. It benefits dropsical affections from heart or kidney disease by improving the action of these organs.
Apocynum Can.- The value of this remedy is due to its power of restoring the urinary secretion, which it often does rapidly, even after other remedies have proved ineffectual.
Apis.- The action of this remedy on the kidney is sufficient to make it most useful in acute febrile Dropsy from a chill, in post-scarlatinal Dropsy, in that of incipient Bright's disease, and in that which sometimes appears in the later months of pregnancy, laying the foundation of future puerperal Convulsions; sometimes also, for a time, it removes the oedema of the lower extremities symptomatic of disease of the thoracic organs (Hughes). Apis is particularly valuable in Dropsy complicated with Strangury, Suppression, or other urinary difficulties.
Bryonia.- OEdematous swellings of joints; Hydrothorax; Dropsy, or oedema from the retrocession of perspiration or an eruption, or associated with chest symptoms-Cough, dyspnoea-or with LIver- complaint Constipation, etc.
Helleborus.- Dropsical effusion in the ventricles of the brain (Hydrocephalus), in Hydrothorax and Anasarca, in which it often proves most valuable.
Ferrum.- Functional oedema, especially in anaemic or chlorotic females, with pale and cadaverous skin, feebleness, nausea after eating, Constipation, etc.
Sulphur.- OEdematous swellings following skin-affections or suppressed eruptions.
ACCESSORY TREATMENT.- A dry, soft, and moderately warm atmosphere is generally most suitable; and if the Dropsy be at all owing to climate influences, or to any endemic disease, a change of residence is necessary. A damp climate or soil is particularly unfavourable. In acute Dropsy the diet should be similar to that in acute fever; in chronic Dropsy patients require nourishing diet, but on account of the extreme feebleness commonly present, only easily digestible food should be taken. When there is albuminuria and disease of the kidneys the amount of meat and fish taken must be strictly regulated and much diminished if not forbidden. It is well also to cut off common salt in the dietary as much as possible. To allay the burning thirst often experience, cold water is the best beverage; but any other that the patient desires, if not positively injurious, may be taken. Water may be said to be a real restorative, for it increases the amount of fluids excreted to an extent greater than its down bulk; it also tends to improve the appetite and strengthen the pulse, while it diminishes the dropsical collections. It will thus be seen that the common notion that drinking water increases Dropsy is quite erroneous.
Warm baths for promoting perspiration, tapping, and other palliative measures of such means can only be decided by the circumstances of each individual case.
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