32 



MEDICINE. 



Practice, constitutional derangement, as connected with the di- 

 -y " gwtive organs, or merely by its mechanical pressure 

 upon the great trunks of the absorbents ; the power 

 which mercury is conceived to possess in discussing 

 glandular tumours, being independent of its action on 

 the kidney. As to the second indication in the cure 

 of Dropsy, to prevent the re-accumulation of the fluid 

 after it has been removed, all that can be said on this 

 point may be included in the single direction of adopt- 

 ing every means for improving the general health, we 

 must avoid the exciting causes, and we must endea- 

 vour to strengthen the digestive organs by temperance, 

 exercise, preserving an open state of the bowels, and 

 by the proper exhibition of tonics. 



Treatment After these general remarks on Dropsies, as constitut- 

 or Ansr- ing an order of diseases, we must proceed to make a 

 <* few observations upon the different genera. Concern- 



ing Anasarca we have little to add to what has been 

 said above, either as to its symptoms or its cure ; for 

 as it is the most universal in its seat, so it presents us 

 with the fewest peculiarities with respect either to its 

 symptoms or its treatment. Purgatives, exhibited ac- 

 cording to the strength and constitution of the patient, 

 of wliich the neutral salts and the hydragogues will 

 probably be found the most appropriate, are sometimes 

 alone able to effect the removal of the effusion. If 

 tlic-p fail we proceed to diuretics, of which squills, in 

 combination with calomel, suggest themselves as the 

 first to be tried. Along with these, or rather to com- 

 plete the cure after they have accomplished their ob- 

 ject, we must have recourse to the same kind of tonic 

 treatment which is employed in other diseases, where 

 the strength has been much reduced. 



Ascit*s. Ascites is a more formidable disease than Anasarca, 



as it generally depends upon a structural affection of 

 some of the abdominal viscera, or upon a local derange- 

 ment, which is out of the reach of medicine, or is con- 

 nected with some other morbid condition of the sys- 

 tem. The disease is characterized by distension of the 

 abdomen, in which the fluctuation of a fluid may be 

 distinctly perceived, and to this local symptom, which 

 properly constitutes the disease, we have always con- 

 siderable disturbance of the system generally, loss of 

 appetite, and torpor of all the organs concerned in the 

 function of digestion ; the usual deficiency of urine oc- 

 curs, and as the disease advances, the strength fails, 

 the flesh wastes, and ultimately hectic, with complete 

 atrophy, supervenes. Besides other causes of uneasi- 

 ness, the patient suffers great distress from the mere 

 bulk of the abdomen, which is often so large as ma- 

 terially to interfere with the various vital and organic 

 functions, especially the respiration and the circula- 

 tion. The fluid is usually effused in the general cavity 

 of the peritoneum, but in some cases it is contained in 

 a partial cyst; in these instances the constitutional 

 symptoms are generally less urgent, as the affection 

 may be supposed to proceed from some cause of a 

 more local nature, which, at its commencement, has 

 but little effect upon the system at large. It is indeed 

 principally from the proportion which the general 

 bears to the local symptoms, that we are to form our 

 judgment respecting the seat of the effused fluid, whe- 

 ther it be encysted or not, a fact of some consequence 

 in the treatment of tke disease, and one of very great 

 importance in its prognosis.. 



Treatment. In treating Ascites, the only point to be considered, 

 in addition to the general principles which we have 

 laid down above, respects the propriety of discharging 

 the water by an operation. Where the tumour is very 



large, and where it seems, by its mechanical bulk, to Practice, 

 injure the action of any of the functions that are essen- s-y ' 

 tial to life, we occasionally find it necessary to punc- 

 ture the sac, but, for the most part, we derive little 

 permanent benefit, and it would appear that we not 

 unfrequently bring the disease more rapidly to a fatal 

 termination. Ascites, when it proceeds from a struc- 

 tural disease of any of the abdominal viscera, which is 

 one of its most frequent causes, can only be effectually 

 treated by the employment of those remedies which 

 act upon the diseased organ ; and it must be confessed 

 that, in these cases, our prospect of success is very 

 limited. A cautious use of mercury, in combination 

 with squills, is perhaps the best remedy that can be 

 tried ; but it will be often found ineffectual, and a va 

 riety of occurrences almost daily present themselves, 

 which will demand our attention, and oblige us to 

 swerve from any regular plan of treatment which we 

 may wish to adopt. 



Hydrothorax, or Dropsy of the chest, is characterized Hydroth- 

 by difficulty of breathing, which is increased in the ho- rax - 

 rizontal posture, by disturbed sleep, palpitation of the 

 heart, irregularity of the pulse, and frequently by all 

 the symptoms of general Dropsy. Sometimes, by cer- 

 tain motions of the body, or by certain postures, the 

 presence of the fluid in the chest may be perceived by 

 the patient himself, and it may be felt by the practi- 

 tioner, when he employs a peculiar method of striking 

 the chest, or pressing upon the contiguous parts. The 

 immediate cause of Hydrothorax, like that of Ascites, is 

 generally a disease of some of the viscera ; and as, from 

 its local situation, it is more connected with the func- 

 tions which are essential to life, its prognosis is more 

 unfavourable. It has been generally supposed that 

 this species of Dropsy is more peculiarly adapted for 

 the administration of digitalis than any other remedy ; 

 a circumstance which, if correct, may perhaps be ex- 

 plained by the power which this remedy possesses 

 over the circulation. When we determine to prescribe 

 this substance, it should always be done with the 

 greatest caution ; and if we do not find it to be useful 

 after it has been taken for a short time, we are not to 

 expect any benefit from the farther continuance of it ; 

 for were we to persevere, we should probably expe- 

 rience its deleterious effects. Purgatives are always 

 indicated in Hydrothorax, and the operation of the va- 

 rious neutral salts, as being the least stimulating, and 

 at the same time possessing the hydragogue property, 

 we conceive to be the most appropriate. It may be 

 doubted whether blisters or other remedies applied ex- 

 ternally to the chest can be of any avail in this com- 

 plaint ; and with respect to the operation for discharg- 

 ing the fluid by an artificial opening, besides the ob- 

 jections that were urged against the analogous practice 

 in Ascites, we have here the additional objection, that 

 it is more difficult and painful, that it is less easy to 

 ascertain the unequivocal existence of water in the 

 chest, and that the subjects of Hydrothorax are more 

 frequently persons advanced in life, of a bad habit of 

 body, or debilitated by other diseases, and therefore 

 less likely to derive any benefit from the discharge of 

 the fluid, than many of the subjects of Ascites, so that, 

 upon the whole, we should conceive, that it can only 

 be under a very rare combination of circumstances 

 that this operation should ever be recommended. 



With respect to the other kinds of Dropsy, we have 

 already given an account of Hydrocephalus among the 

 diseases affecting the head ; for although it may be cor- 

 rectly placed among the Hydropes in a nosological sys- 



