NEPHRITIC DROPSY. 105 



rated, it is in the peritonaeum that the serous collection will first take 

 place ; it is in this way we may suppose that certain diseases of the 

 liver become causes of ascites. If, in fine, the obstacle to the free 

 return of venous blood exists at the very centre of the circulation, 

 namely, at the heart, we must then draw the theoretical conclusion, 

 that in this case, the circulation of the venous blood being every- 

 where embarrassed, serous collections must form in all directions, 

 and the dropsy become genei*al. This case, anticipated by theory, 

 is actually established by experience ; all practitioners know that 

 dropsy is one of the 7nost common symptoms of the different organic 

 affections of the heart. 



The next cause of dropsy is cold^ applied in such a manner as to 

 check the secretion of the skin. From this cause we have frequently 

 general anasarca, and effusions into the pleurse, the pericardium, the 

 peritonaeum, &c. These cases are, from the attendant constitutional 

 symptoms, called inflammatory dropsy. 



A third cause of dropsy is some exanthematous disease, and 

 especially scarlatina. 



A fourth cause of dropsy is the granular degeneration of the 

 kidney, first pointed out by Dr. Bright, and lately elucidated by the 

 admirable researches of Dr. G. Johnson, of King's College.* 



A fifth source of dropsy is debility, exhaustion from loss of 

 blood, &c. 



A sixth and frequent cause of dropsy is obstruction to the flow 

 of the venous blood, owing to tumours pressing on the large venous 

 trunks, and glandular enlargements, as hypertrophy of the liver, &c. 

 The presence of albumen in the urijie depends on the presence 

 of blood, or else of the serum of blood. If serum only be present, 

 the albumen may be detected by boiling a portion of urine, and add- 

 ing nitric acid ; if the entire blood be present, the red particles may 

 be detected by the microscope, and will render the urine smoky or 

 dusky in colour. 



These conditions of the urine in dropsy depend on a congested, 

 or irritated, or diseased state of the kidney, so that the capillaries of 

 the Malpighian bodies either exude serum, or else are ruptured and 

 pour out blood. 



NEPHRITIC DROPSY [Dropsy from Brighfs kidney). 



Dr. Bright first pointed out, in 1827, the frequent connexion 

 which exists between dropsy and what has since been called granu- 

 lar degeneration of the kidney, and the presence of albumen in the 

 urine, as an indication of the latter lesion ; but it has been reserved 

 for Dr. G. Johnscm, of King's College, to detect the real nature of 

 this most prevalent and fatal disease. 



* See two excellent lectures, by Dr. Todd, of King's College, in the London 

 Med. Gaz. Dec. 19th and 26th, 1845. 



