594 PRACTICE OF PHYSIC. 



these remote causes cannot be removed, the cure of the dropsy 

 must be difficult, or perhaps impossible. In many cases, there- 

 fore, the following indications will be to little purpose : and par- 

 ticularly, that often the execution of the second will not only 

 give the patient a great deal of fruitless trouble, but commonly 

 also hurry on his fate. 



MDCLXXVI. The second indication for evacuating the 

 collected serum, may be sometimes executed with advantage, 

 and often, at least, with temporary relief. It may be perform- 

 ed in two ways. First, by drawing off the water directly from 

 the dropsical part, by openings made into it for that purpose : 

 or, secondly, by exciting certain serous excretions ; in conse- 

 quence of which, an absorption may be excited in the dropsical 

 parts, and thereby the serum absorbed and carried into the 

 blood-vessels, may afterwards be directed to run out, or may 

 spontaneously pass out by one or other of the common excretions. 



MDCLXXVII. In an anasarca, the openings into the drop- 

 sical part are commonly to be made in some part of the lower 

 extremities ; and will be most properly made by many small 

 punctures reaching the cellular texture. Formerly, consider- 

 able incisions, were employed for this purpose ; but, as any 

 wounds made in dropsical parts, which, in order to their heal- 

 ing, must necessarily inflame and suppurate, are liable to be- 

 come gangrenous ; so it is found to be much safer to make the 

 openings by small punctures only, which may heal up by the 

 first intention. At the same time, even with respect to these 

 punctures, it is proper to observe, that they should be made at 

 some distance from one another, and that care should be taken 

 to avoid making them in the most depending parts. 



MDCLXXVI II. The water of anasarcous limbs may be 

 sometimes drawn off by pea-issues, made by caustic a little be- 

 low the knees ; for, as the great swelling of the lower extremi- 

 ties is chiefly occasioned by the serous fluid exhaled into the 

 upper parts constantly falling down to the lower, so the issues 

 now mentioned, by evacuating the water from these upper parts, 

 may very much relieve the whole of the disease. Unless, how- 

 ever, the issues be put in before the disease is far advanced, 

 and before the parts have very much lost their tone, the places 

 of the issues are ready to become affected with gangrene. 



