242 THE TREATMENT OF DISEASES. 



undue pallor and a peculiarly white glistening appearance of the skin ; but in chronic 

 cases, where the effusion of fluid is great, the skin often becomes smooth, shiny, and 

 of a dull red or purple colour. In some situations as over the shin-bone, for 

 example it gets livid or blackish, and may even be broken, so that sloughs form. 

 The water of dropsy is liable to change its place in obedience to the force of gravity, 

 so that when the patient is up and about the swelling usually first becomes visible in 

 the feet and ankles. In the morning, after the horizontal position has been main- 

 tained for some hours, this probably disappears, but the neck and face become bloated 

 and puffy. The feet towards evening usually swell more than the hands ; and for a 

 very obvious reason, for the hands receive the dropsical fluid from the arms alone, 

 but the feet that which sinks down not only from the legs and thighs, but from the 

 head and trunk as well. 



The principal symptoms attendant on dropsy are those of the disease to which it 

 owes its origin, but the effusion may itself give rise to the most distressing conse- 

 quences. Thus, a large accumulation of fluid in the abdomen often by its pressure 

 impedes the action of the heart and lungs, causing painful shortness of the breath. 

 The patient may, on this account, be unable to lie down, and the fatigue, sleeplessness, 

 and exhaustion so caused may materially aggravate his sufferings. Other symptoms 

 frequently associated with the different varieties of dropsy are palpitation, dryness 

 of the skin, excessive thirst, vomiting, and constipation. The pain and inconvenience 

 arising from swollen legs need only be mentioned. 



We will now consider the treatment of dropsy. It may, perhaps, be urged that 

 it is unsound in principle to treat, or endeavour to treat, what is confessedly a mere 

 symptom, instead of directing our attention to the disease on which it depends. This 

 is quite true, but it must be remembered that in many cases the original disease is 

 beyond the reach of our art ; whilst in almost every case, even if only temporarily, 

 we are able to relieve many of the most distressing symptoms by getting rid of some 

 of the effusion. 



In the majority of cases, we endeavour to promote the discharge from the body 

 of the superabundant fluid by purging the patient or by increasing the action of the 

 skin or kidneys. 



Bitartrate of potash often proves very useful from the copious watery stools 

 it produces. It is especially serviceable in dropsy arising from Blight's disease, 

 as it tends to prevent watery accumulation to a dangerous degree beneath the skin, 

 or in the cavities containing the more important organs, as the heart and lungs. 

 With the water, too, it draws off many of the effete and poisonous matters which 

 in this disease are retained in the blood. Jalap may be used for the same purpose 

 as the bitartrate of potash, and it is often convenient to administer them together. 

 A powder, composed of twenty grains of compound powder of jalap, with ten grains 

 of bitartarate of potash, forms an efficient combination (Pr. 98). This dose, which is 

 intended for an adult, may be taken every alternate morning for a week. It should 

 be borne in mind that free purging has always a tendency to reduce the strength, 

 and care should be taken to see that it does not become excessive. 



.Resin of copaiba acts powerfully on the kidneys, and in the majority of cases 

 proves of considerable value in the treatment of dropsy. In some instances it has 



