DROWMN'i 



l)RO\VMXi. 



leading to a deposition of adventitious nutter in its substance, and the 

 consequent enlargement of the organ and the coosoliHstina of iU 

 tiiKM, is a common cause of dropsy, occasioned by the obstruction to 

 the circulation through UM vena port*, the effusion being in this case 

 often confined to UM cavity of the abdomen. 



The qilun, which n moists of a congeries of blood-vessels, and hii-h 

 is very apt to be enlarged and obstructed, may occasion effusion into 

 UM *M^n*n in UM **m+ manner as iliinssn of the liver. 



The kidoen are subject both to functional and organic diseases. 

 which an followed by effusion* into all the cavities, in consequence of 

 the failure of then organs to remove from the common mass of blood 

 UM superfluous and noxious principles which it is their office to 



Dropsical emisious are often poured into the uterus and ovaria, in 

 consequence of primary disease in these organs ; at other times tumours 

 are formed within or attached to them, which press upon and compress 

 UM trunks of neighbouring blood-vessels, and thus occasion dropsy by 

 a mechanical obstruction to the circulation of the blood. 



Dropsy is always a formidable and often a highly dangerous rlimiasn 

 lu acute forms, though attended with the most urgent symptoms, are 

 in general less unfavourable than most of its chronic forms, because in 

 the former, though the disordered actions may be very intense and 

 dangerous, yet they are more under the control of remedial agents, 

 and they often do not depend on any irreparable vice of the constitu- 

 tion, whereas the latter are the sign and the result of deep-seated and 

 surely advancing disease. Of course the prognosis in any particular 

 case must entirely depend on the seat and nature of the disease of 

 which it is the sequent 



There is no disease which requires a more varied treatment than 

 dropsy, because, like fever, dropsy may exist in, and be essentially con- 

 nected with, diametrically opposite morbid conditions of the system. 

 Dropsy may depend on a state of the system, for the removal of which 

 all other remedies will be tried in vain unless their application be pre- 

 ceded by a decided abstraction of blood : dropsy may depend on a 

 state of the system in which the abstraction of the smallest quantity of 

 blood may prove almost instantaneously fatal; in the former case 

 stimulants and excitants invariably increase the intensity of the dis- 

 ease ; in the Utter they are indispensable to the preservation of life. 

 On the clear discrimination of these two different states of the system, 

 and the two different classes of disease to which they give rise, and 

 on the sagacious detection of the different shades by which they may 

 appear to be blended with and lost in each other, the successful treat- 

 ment of dropsy mainly depends. 



(PKRrrosrriB ; HEART, DISEASES OF; PLEURITIS; LIVER, DISEASES 

 or; OVARIAN DROPSY ; HYDHOCEPHALUS.) 



DROWNING, the state of asphyxia [ASPHYXIA] produced by 

 the immersion of the body under water. When the warm-blooded 

 animal is immersed under water, and forcibly retained there, he 

 immediately begins to struggle violently, and uses every effort to rise 

 to the surface. These struggles are not at first the result of pain, but 

 of fear. It is proved by direct experiment that the obstruction to the 

 respiration which produces pain does not come on for some time. The 

 point of time when the painful impediment to respiration occurs is well 

 ascertained. For the reason assigned in the article ASPHYXIA, in the 

 space of three-quarters of a minute a violent effort is made to inspire, to 

 expand the lungs with air, but no air can enter. Every effort to inspire 

 is followed by a corresponding effort to expire. At each expiration a 

 small quantity of air is expelled from the lungs, and is seen under the 

 surface of the water in the form of bubbles ; for although the water 

 excludes the air from entering the lungs, notwithstanding the most 

 violent efforts to inspire, yet it cannot prevent some portion of air from 

 being expelled from the lungs by the violent efforts to expire. The 

 ultimate result of these repeated and violent expirations is greatly to 

 diminish the bulk of the lungs, and to bring them to the utmost 

 degree of collapse to which it 'is possible to reduce them by any 

 voluntary or instinctive efforts which the animal is capable of making. 



When a human being is drowned by accident, if the fall has been 

 from a considerable height and the water is not of very great depth, the 

 body is precipitated to the bottom of the water ; it then quickly rises to 

 the surface, partly because the specific gravity of the body, when the 

 lungs are full of air, is less than that of water, and partly because the 

 body is rendered still lighter by the air, always amounting to a con- 

 siderable quantity, which is collected and retained in the clothes. If 

 the person be not able to swim, he generally struggles violently, and 

 probably screams ; by these efforts the lungs are partly emptied of the 

 air they contained, the comparative weight of the body is increased, 

 and consequently it again sinks to the bottom, but it soon again rises, 

 and this alternate rising and sinking may occur several times in 

 succession. Whenever the body comes to the surface and the month 

 is above water, the painful impediment to respiration produces an 

 instinctive effort to inspire, and a hurried gasp is made to obtain air 

 Bat often the mouth is not sufficiently above the surface of the water 

 to obtain air without respiring a quantity of water along with it ; but 

 the quantity of water received in this manner is never great pro- 

 bably not more than is ex ( >clled by the cough excited by the irritation 

 of the glottis in consequence of the contact of the water and l. v Uu- 

 subsequent expiration. Every instant the body remains in the water, 

 for the reasons immediately to be assigned, the powers of sensation 



and of voluntary motion rapidly diminish, and at length, perfectly 

 insensible and motionless, it remains at the bottom of the water, 

 where, if wholly undisturbed, it continues until the disengagement of 

 various gases In the progress of putrefaction renders it again specifi- 

 cally lighter than water, and brings it once more to the surface. 



The change in the system produced by continued submenu. i 

 consequent suspension of respiration, and the necessary extinction of 

 life, are all referrible to one pathological condition, namely, a change 

 in the nature of the blood. The water prevents any portion of air 

 from entering by the trachea to the air vesicles of the lungs ; con- 

 sequently no air comes in contact with the venous blood contained in 

 the capillary branches of the pulmonary artery which are spread out 

 u].ii the walls of these air vesicles ; the venous blood which flows to 

 the lungs is therefore incapable of being converted into arterial I>1.. 1. 

 whence the lungs can deliver to the left side of the heart only \ 

 blood to be sent out to the system. As the circulation goes on, all the 

 arterial blood in the body is at length converted into venous, and flows 

 into the great venous trunks of the system, by which it is returned to 

 the right side of the heart, and thence to the lungs, where it undergoes 

 no change, but remains venous. These currents of venous blood, and 

 of venous blood only, are successively sent out to the system. Hut 

 venous blood is incapable of mainlining the action and vitality f 

 the brain and spinal cord, of the heart, of the voluntary muscles, or 

 of any organ of the body, and consequently, when nothii 

 venous blood circulates in the system, the death of all the on 

 the sure and quick result, and the organs die in the order and mode 

 already described. [ASPHYXIA.] 



Taking the average of a great number of experiments, it is found 

 that when an animal is forcibly and continuously held under water, the 

 blood in the arteries loses its vermilion colour, and begins to grow 

 venous in the space of three-quarters of a minute. In one minute and 

 a quarter it is obviously dark. In one minute and a half, no dill 

 can be distinguished between the blood in the arteries and the blood 

 in the veins; consequently, in an Animal that is submersed and thai 

 never.rises to the surface, the system is brought completely under the 

 influence of venous blood in the space of one minute and a half, and 

 though the body should remain under water half an hour, the blood 

 does not become sensibly darker, because it can only be completely 

 venous. 



Circumstances may make a few seconds difference in regard to the 

 point of time when these phenomena take place. If, for example, an 

 animal be submersed at the instant of expiration, the colour of the 

 blood is lost somewhat sooner than when it is submersed at the 

 instant of inspiration, and if the animal be much alarmed and struggle 

 violently, the change takes place with greater rapidity ; but the differ- 

 ence from any cause of this kind never amounts to more than a few 

 seconds. Age however is capable of effecting a more remarkable 

 difference. It is proved by numerous and accurate experiment* that 

 the younger the animal the longer it can live when deprived of air by 

 submersion. If, as is commonly the case, an adult warm-blooded 

 animal be irrecoverably dead in tha space of four minutes after com- 

 plete and continuous submersion, an animal of the same species only a 

 few days old will live twelve minutes. A pup will live considerably 

 longer than a young dog, a young longer than a middle aged dog, and 

 a middle aged longer than an old dog. 



Sensibility and the power of voluntary motion are diminished the 

 moment the arterial blood begins to lose its vermilion colour ; an 

 animal is completely insensible, and has wholly lost all power of 

 voluntary motion, that is, it is in a state of apparent death, as soon as 

 the arterial blood is completely venous. In one minute and a half, 

 then, after complete and continuous submersion, animal life is com- 

 pletely extinguished. But by the prompt and vigorous use of tin- 

 appropriate remedies, recovery from this state is possible ; because the 

 organic functions go on for a considerable period after apparent death, 

 and death is not real until the organic functions have wholly ceased. 

 Nevertheless, though the organic functions may continue for an 

 indefinite period after the animal functions ore extinguished, from t.-u 

 minutes to half an hour, or more, yet, in no instance in which tin- 

 experiment has been fairly tried has any adult warm-blooded animal 

 that has been completely and continuously submersed for the space of 

 four minutes been capable of resuscitation, though all the means 

 storing animation may have been instantaneously and most n> 

 and judiciously employed. Accordingly it is found in practice that 

 the immediate and vigorous use of the best means for restoring anim a 

 tion often foil when the person has not been in the water mor. 

 four minutes. In general, however, if the body has not been in tlu 

 water longer than from five to eight minutes, the prompt an- I 



! S ' use of the proper means for restoring animation will succeed; 

 no doubt, because in some one of or in all the times that the body lr.it 

 come to the surface air has been obtained and conveyed to the lungs 

 in the hurried gasp instinctively made at these moments. Still it is 

 exceedingly rare that persons ore recovered who have been in the water 

 minutes; occasionally however animation is restored after o 

 ion of twenty minutes, or even half on hour; and apiKt 

 authenticated cases are on record in which resuscitation was n < 

 plished after the body had been in tlm w.itt-r for three -fourth* of an 

 hour. In those cases, circumstances must have favoured the occa- 

 ..i'Mial iiHpimtion of air; it is utterly impossible that life can have been 



