254 CHAPTER 28. 



514. Direct removal of the %'luid. 



In very urgent cases removal of the fluid may be effected by mechan- 

 ical means, such as tapping, and scarification. The operation, however, 

 is not in general of much avail, as the fluid usually forms again. In 

 those cases in which the accumulation is considerable, and from its 

 proximity to important organs is likely to produce a serious result, such 

 as positive obstruction to the respiration, it may be necessary to have 

 recourse to tapping ; but except under such circumstances the fluid 

 should not be removed by mechanical means. 



515. Indirect removal of the Fluid. 



Removal of the fluid in less pressing cases may be best effected 

 indirectly by rousing the action of the skin by means of stimulants ; 

 whilst at the same time the secretions of the bowels and kidneys may 

 be increased by very mild doses of aperient, or by more active doses of 

 diuretic medicine. Iodide of potassium in doses of half a drachm with 

 two drachms of powdered gentian, and two drachms of ginger twice a 

 day will be found to answer best. Hydrochlorate of ammonia one 

 ounce, and tincture of gentian half an ounce in twelve ounces of water, 

 may be given therewith, on alternate days. 



Tonics also, especially sulphates of iron and copper, are very useful in 

 restoring tone to the system. The above medicines may be given in 

 combination. If the symptoms indicate arrest of the secretions of the 

 liver, calomel may be given combined with gentian and ginger. 



Friction and pressure to the part, when practicable, are very useful in 

 restoring a healthier and more vigorous tone to the vessels. In slight 

 cases, such as swellings of the legs, these latter remedies together with 

 judicious exercise will generally be found sufficient to cause the out- 

 poured fluid to be reabsorbed, and perhaps also to prevent further effu- 

 sion. 



516. Removal of the causes. 



Whilst treating the effect, we must not, however, forget to search for 

 and, if possible, remove the cause. 



If the dropsical swellings be due to temporary affection of the heart, 

 medicine appropriate to allay the ailment will be required ; but if there 

 is chronic disease of that organ, it is hardly worth time and money to 

 treat the case. 



If it be an after-result of disease of the lungs and pleuraB, the best 

 remedies are those indicated in the Chapters on diseases of the Respira- 

 tory organs. If the cause be traceable to disorder of the kidneys or 

 liver, those organs must be treated. The necessary information will be 

 found in Chapters 55 and 56. 



If the cause lie, as is most commonly the case, in general debility, 

 the strength will need to be improved by generous diet, fresh air, 

 decrease of work, moderate exercise, good grooming and tonics. Friction 



