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DROPSY, HYDROPS. 



DROPSY, HYDROPS. 



673 



from the capillary arteries into the capillary veins, the blood accumu- 

 lates in the capillary arteries, which are the exhalant vessels. By this 

 accumulation of blood in the exhalents, either their action is increased, 

 the consequence of which is increased exhalation ; or their action is 

 diminished and their tone destroyed, the consequence of which is 

 equally increased exhalation. Various morbid conditions of many 

 organs oppose a free return of the circulating blood from the capillary 

 arteries into the capillary veins ; any disease of the right side of the 

 heart, for example, which prevents its receiving from the great venous 

 trunks of the body the quantity of blood in a given time, which is 

 necessary to maintain the balance of the circulation ; any disease of 

 the lungs, which prevents the lungs from receiving from the right 

 ventricle of the heart the full quantity of blood which the heart has 

 received from the great venous trunks ; any disease of the liver, which 

 prevents the liver from receiving by the great vein which ramifies 

 through it, the vena porte, the full quantity of blood which it ought to 

 receive from the different abdominal viscera ; any disease of the great 

 blood-vessels themselves, by which the current of the circulating blood 

 is prevented from passing freely through them. Such a disease of the 

 heart may be occasioned by an ossification of its valves ; of the lungs, 

 by an obliteration or compression of its air vesicles, upon the walls of 

 which the capillary terminations of the pulmonary artery are dis- 

 tributed ; of the liver, by an induration of its substance and a con- 

 sequent mechanical compression of the minute branches of the vena 

 portse ; of the great blood-vessels, by diseases of their coats giving rise 

 to the tumours called aneurisms, or by the compression of tumours 

 existing in neighbouring parts, scirrhous, fatty, or watery tumours, 

 which may have their seat in any organ, or by the compression of the 

 great venous trunks of the system by the bulk of the distended uterus 

 in pregnant women. 



When dropsy is the result of an increased action of the capillary 

 blood-vessels, it is considered a primary or idiopathic disease, and con- 

 stitutes the sthenic, tonic, active, or acute dropsy of authors. In this 

 case the capillaries are conceived to be in that state, whatever it may 

 be, which constitute acute inflammation. The increased effusion, which 

 itutes the dropsy, is the result of that increased action, and by the 

 effusion the inflamed state of the vessels is often removed. 



This form of dropsy occurs most frequently in the young, the ple- 

 thoric, and the robust. It is induced by all the causes of inflammation, 

 such as cold, suddenly checked perspiration, suppression of any of the 

 natural secretions and discharges, a plethoric condition of the system, 

 a repulsion of acute diseases of the skin, &c. It has its seat most fre- 

 quently in the serous membranes of the great cavities of the body, the 

 walls of which are lined by those membranes, as those of the chest and 

 abdomen, or of the viscera to which these membranes afford an external 

 covering, as the brain, the lungs, the heart, the liver, and all the 

 abdominal and pelvic viscera. 



The third form of dropsy is that termed asthenic, or passive. It is 

 so generally the consequence of some other morbid condition of the 

 system that it is not usually considered a primary or idiopathic disease, 

 but merely a sequent or ultimate result of some other pathological 

 state. Its proximate cause is conceived to consist partly of a laxity of 

 the tissues of the exhalant vessels, in consequence of which they are 

 incapable of retaining the fluid part of the blood ; and partly of an 

 altered condition of the blood itself, in which its solid portions, namely, 

 iU albumen, fibrin, and red particles [BLOOD, NAT. HIST. Div.] are 

 pretematurally diminished, and its serum proportionally increased. 

 The state of the system in which this form of dropsy usually comes 

 on, and the causes which most frequently and obviously induco it, are 

 supposed to conduce equally to this morbid state of the containing 

 vessels and the contained blood. The state of the system in which it 

 comes on is that of extreme debility, however induced ; but its ordi- 

 nary exciting causes have so obvious and great a tendency to exhaust 

 the vital power, that they are usually denominated debilitating causes ; 

 ouch are fever, whether intermittent or continued, exanthematous or 

 typhus, long continued and excessive evacuations, whether of natural 

 discharges, or of preternatural effusions of blood, deficient or unwhole- 

 ftome diet, diseases of the digestive organs, by which the due assimila- 

 tion of the food is prevented, intemperance in the use of intoxicating 

 liquors, whence drunkards of all kinds, and especially dram-drinkers, 

 o commonly, nay, almost invariably, die of dropsy. 



All the acute inflammatory and febrile symptoms so characteristic 

 of the other forms of dropsy are of course absent in this. The skin, 

 instead of being hot, is often unusually cold ; the pulse, instead of 

 being full and hard, is weak, small, unequal, and rapid ; the contraction 

 of the heart is so feeble that slight causes often completely arrest its 

 action, and render it incapable of carrying on the circulation, whence 

 the patient drops down dead instantaneously, perhaps on endeavouring 

 to walk down stair*, or to move from one chair to another ; the muscles 

 in general are flaccid, all the movements are weak, irregular, and 

 uncertain, and all the actions of the system exceedingly feeble. 



It is more especially this last form of dropsy which is induced by a 

 mnrbid change in the constitution of the blood, namely, an increase in 

 the prqjMrtion of iU serum. An unusual quantity of water taken into 

 the body, and not carried off by the excretory organs, may possibly 

 give rise to such a condition of the blood, and accordingly it is said 

 that suddenly drinking large draughts of very cold water has been 

 immediately followed by dropsy, probably from the cold producing a 



constriction of the exeretories ; in consequence of which they are 

 unable to carry off the water as it flows into the mass of blood and 

 thus to maintain its proper constitution. A preternatural abundance 

 of the more fluid parts of the blood may also accumulate in the circu- 

 lating mass by a suppression or diminution of the ordinary aqueous 

 excretions. Hence the influence of a cold and moist atmosphere in 

 inducing dropsy ; and the highly important influence of diseases of the 

 kidneys in producing the disease. It is found that there are several 

 different diseases of the kidneys of which dropsy is the ordinary result. 

 It is the office of the kidney to remove from the blood a large propor- 

 tion of its fluid parts ; it is an excreting and depurating organ of the 

 greatest importance. Any disorder of it which interferes with the 

 performance of its function may therefore occasion an accumulation of 

 the watery particles of the blood, and thus give rise to dropsy ; and it 

 is actually found that when the secretion of the urine is suppressed, 

 the watery portion of the blood is often poured into some of the in- 

 ternal cavities. [KIDNEYS, DISEASES OF.] Moreover, large abstractions 

 of blood are frequently followed by dropsy, because the albumen, the 

 fibrin, and the red particles which constitute the solid parts of the 

 blood, are not so easily renewed as the serum, and the superabundant 

 serum readily passes off by the exhalants pretematurally relaxed by 

 the debilitated state of the system induced by the bleeding. 



The parts of the body in which the dropsical effusions usually collect 

 are the cavities of the cranium, chest and abdomen, and the interstices 

 of the cellular tissue diffused over the whole body, and forming a con- 

 stituent element of every organ. 



The dropsical fluid itself consists for the most part of the serum of 

 the blood ; but its sensible properties and its chemical constitution 

 vary exceedingly according to the form of the disease and the condition 

 of the capillary vessels at the moment the effusion takes place. If the 

 vascular action have been great, the fluid is yellow or straw coloured 

 like whey, and is more or less turbid, and contains minute particles of 

 albumen and fibrin. If, instead of excited vascular action, the effusion 

 have been the consequence of an altered condition of the blood, the 

 fluid is dark-coloured and turbid, probably from the admixture of the 

 red particles of the blood. If the effusion have taken place very slowly 

 in consequence of the operation of some cause progressively but not 

 rapidly impeding the circulation more and more, the fluid is almost 

 colourless and nearly destitute of animal matter. If the fluid have 

 been long retained in the cavity containing it, it may be of all colours 

 and consistence, and its sensible properties may be infinitely diversified 

 and these diversities are apparently increased by the admission of the 

 external air to the cavity in consequence of the artificial removal of 

 the fluid by the operation called tapping. 



There are many diseases of which dropsy is the sequent, and the 

 dropsy induced in this indirect mode is called secondary, consecutive, 

 symptomatic, or passive, in contradistinction to its primary acute and 

 active forms. The diseases which precede dropsy as their ordinary 

 consequent have then- principal seat in the heart, and its great vessels, 

 in the lungs, the liver, the spleen, the kidneys, the uterus, and the 

 ovaria. When dropsy is the consequence of disease of the heart, the 

 signs of disease of the heart commonly long precede the appearance of 

 the dropsy. The diseases of the heart which most commonly give rise 

 to dropsy are passive dilatation of its muscular parietes and ossifica- 

 tion of its valves, the existence of which may be ascertained with 

 tolerable certainty both by certain signs which are pathognomonic of 

 these organic changes, and by auscultation. When dropsy is the con- 

 sequence of disease of the heart, the effusion is commonly indicated 

 first by swelling of the face, especially beneath the eyelids, and next 

 by swelling of the feet and ankles, and of the hands and arms, particu- 

 larly of the left. As in the progress of the disease the effusion collects 

 and accumulates in the cavity of the thorax, or in that of the peri- 

 cardium, it is denoted by a peculiar train of symptoms. [HYDRO- 

 THORAX ; HEART, DISEASES OF.] The respiration is always more or 

 less embarrassed ; the horizontal position uneasy, and often impossible ; 

 the pulse, which is seldom or never natural, is very variously affected. 

 Whenever there is a watery swelling of the face, hands, arms, or 

 ankles, with an impaired state of the constitution, the consequence of 

 protracted ill health, and without manifest disease of the lungs, it may 

 be certainly inferred that there is a disease of the heart. The dropsy 

 which results from disease of the heart is very often completely re- 

 moved by appropriate remedies. The effusion often recurs indeed, 

 and is again removed, and this successive recurrence and removal of 

 the affection takes place indefinitely until the cardiac disease, on which 

 the effusion depends, reaches a point which is no longer compatible 

 with life. 



Diseases of the coats of the great blood-vessels constituting aneurism, 

 concretions within their cavities, or tumours of neighbouring parts, 

 pressing upon their trunks, and obstructing the passage of the blood 

 through their canal, are frequent causes of consecutive dropsy. Inflam- 

 mation of the pleura lining the cavities of the chest, inflammation and 

 congestion of the lungs, the consolidation or hepatisation of the sub- 

 stance of the lungs, and the obliteration of the air-vesicles by the 

 deposition of tuberculous matter, may give rise to effusion either into 

 the cavity of the chest, or into the cellular tissue forming the paren- 

 chyma of the lungs, or into the cellular tissue diffused over the wholo 

 body. 



Inflammation of the liver, generally of a slow or chronic nature, 



