PATH 
to the concurrent effect of breathing an impure atmo- 
■fphere, fuppreffed perfpiration, want of exercife, and a 
‘previous life of intemperance. Hence probably a very 
■violent kind of-inflammatory dropfy. 
4. Hydrops thoracis, dropfy of the chert ; (Hydro¬ 
thorax, Sauv. Cullen, 4 'C-) Senfe of oppre(iion in the 
-chert ; dyfpncea, increafed by exercife or dedumbiture : 
livid and puffy countenance; purple lips; urine red and 
/pare; pulfe irregular; edematous extremities; palpita¬ 
tion and fudden rtartings during fleep. 
The flu&uation of water in the ribs may fometimes be 
felt. According to Laennec, mediate aufcullation fee p, 
■244, 5.) furnifhes certain indications of the exiftence of 
fluid in the.chert, and even difcovers its extent. A great 
diminution, or indeed a total abfence, of the found of 
refpiration ; the appearance, difap pea ranee,. and return, 
of egophony, are the rtgns here manifefted by the ufe of 
the ftethofeope. Whetf the pleuritic effufion is very 
abundant on its firrt formation, the abfence of refpira¬ 
tion is then totally uniform, and fo complete that no 
found whatever can be heard, however forcibly the refpi- 
ratory efforts may elevate the thorax. The only part in 
which there is an exception to this, is an extent about 
three fingers breadth from the vertebral column. This 
■exception feems to depend on the lungs being in contaff 
with the parietes of the chert at the part above men¬ 
tioned ; and therefore the interpofition of fluid between 
thofe parts, with its p re flu re on the lungs, which are the 
ca.ufe of the abfence of the found of refpiration, do not 
liereexift. In cafes where the lungs are attached to the 
fides of the chert in other points, from adhefions of an¬ 
cient date, the fame exception may however exift in the 
parts thus affe&ed. Sometimes, although the quantity 
of fluid effufed is not diminifhed, the found of refpira¬ 
tion will return at the end of a few days; but it is with¬ 
out any mixture of rattles, unlefs pulmonary catarrh ex¬ 
ift at the fame time, which may help to make its diftinc- 
tion from pneumonia. When the effufion is not confi- 
derable, the found of refpiration commonly refembles 
what it is in children. When the fluid is difappearing, 
this found returns from above downwards, as the furface 
of the fluid defeends ; except in cafes when this order is 
interrupted by adhefions of the lungs to the thoracic 
parietes. To the above figns muft be joined egophony, 
which is charafteriftic of it, and conftantly indicates a 
colleftion of fluid when it is moderate in quantity ; but 
it difappears when the quantity of fluid is very confider- 
able. It ismoft evident when the fluid has leaft confid¬ 
ence; and therefore is generally moll diftinft in the 
fituation of the upper part of the collection. Egophony 
may be fufpended fome minutes, or even hours ; but it 
reappears when the patient expectorates. Many authors 
have noticed an increafe in the volume of the fide in 
which the collection of fluid exifts in a great degree. 
This fometimes exifts in a very remarkable manner. It 
difappears as the cure advances, and the fide occafionally 
becomes at length fmaller than in the natural Hate. 
5. Hydrops abdominis, afeites, or dropfy of the belly: 
tenfe, heavy, and equable, inturnefcence of the whole 
belly ; diftinCtly fluctuating to the hand upon a flight 
ftroke being given on the oppofite fide. 
It is this fluctuation which in ordinary cafes diftin- 
guifhes dropfy from pregnancy. Antonia Scarpa has 
however related cafes tending to fhow, that, either 
from excefs of liquor amriii, (in which cafe third 
is abfent, and the natural form of a belly containing 
a gravid uterus is retained.,) or from effufion from the 
peritoneum, (in .which cafe third is prefent, and the re¬ 
gular form of the fundus uteri is not found,) dropfy and 
pregnancy may co-exift. Thefe cafes are of courfe very 
rare, and are to be relieved only from the extreme dan¬ 
ger and dyfpncea which attend them by punCture. 
Scarpa direCls this to be done (when vve wifh to avoid 
wounding the uterus) in the hypochondriac region, be¬ 
tween the edge of the reCtus mufcle and the edge of the 
V.ol. XIX. No. 1307. 
O L O G Y. 339 
falfe ribs. As to puncturing the womb itfelf, this is of 
courfe a very dangerous experiment. Scarpa thinks, 
however, that it may be tried in cafes of imminent dan¬ 
ger; and he quotes inftances in which it has been done 
without ill effeCts. See “ Sulla Gravidanza fuflequita da 
Afcite, Memoriae del Cav. Ant. Scarpa, 1817.” 
Dr. Good makes three varieties of this fpecies, the laft 
of which feems to 11s quite out of place, fince the difeafe 
is the fame as inflammatory dropfy, though differently 
produced. 
cc. Atonica; preceded by general debility of the con- 
flitution. Often the refult of feurvy, or fevers of various 
kinds. 
£. Parabyfmica ; preceded by or accompanied with op- 
pilation, or indurated enlargement of one or more of 
the abdominal vifeera, ufually the liver; the gall-bladder 
of which is often enormoufly enlarged and turgid. See 
Phil. Tranf. 1710-ia. vol. xxvii. Yonge, Mem. de Paris-, 
1701. Du Verney, ACt. Erud. Lipf. 1713. In the laft, the 
bladder weighed ten pounds twelve ounces, bad no mea¬ 
tus, contained various tunics, and was filled with a cof¬ 
fee-like liquor. The fubftance of-the liver is often found 
loaded with hydatids. In one inftance it weighed 
twelve pounds. Gooch's Cafes, 4 c- p. 170. 
y. Metaftatica j from repelled gout, exanthems, or other 
cutaneous eruptions. 
6 . Hydrops ovarii, dropfy of the ovarium : heavy and 
painful inturnefcence of the iliac region on one or both 
fides, with a fenfe of dragging; gradually fpreading over 
the belly; with obfeure fluctuation. 
7. Hydrops tubalis, dropfy of the fallopian tube: heavy 
elongated inturnefcence of the iliac region, fpreading 
tranfverfely ; with obfeure fluctuation. 
8 . Hydrops uteri, dropfy of the womb ; heavy circum- 
feribed protuberance in the hypogaftrium, with obfeure 
fluctuation ; progreflively enlarging, without ifehury or 
pregnancy. 
In the treatment of no other kind of difeafe has the 
prefent age more reafon to exult in its improvement in 
the therapeutic art, than in that of dropfy. No longer 
trammelled by that fatal devotion to fyllem which led the 
older praditioners to preferibe in the fame manner for all 
difeafes in which the prominent fymptom of watery efr 
fufion caufed them to be ranged under the fame title ; we 
look to the ctmfe of dropfy entirely for the rule of treat¬ 
ment. It is true, we are often puzzled to find this caufe; 
but at all events, our knowledge is in the generality of 
cafes fufliciently accurate to lead to beneficial treatment. 
Thus, if it feems that local pain has preceded or ftill 
accompanies a dropfical effufion, efpecially if this pain has 
its feat in the pleura or peritoneum, vve do not hefitate to 
treat it as fimple inflammation. In doing this, however, 
we are of courfe as much regulated by the ftate of the 
pulfe, the appearance of the blood (generally buffy and 
th ejirum eufily couguluble), and the febrile commotion of 
the conftitution, as the local pain. The meafure of free 
bleeding is to be followed by counter-irritation (efpe¬ 
cially if the difeafe owes its origin to fuppreffion of fome 
accuftomed morbid aCtion), and by the excitement of 
the fecretion of the mucous membrane, efpecially of the 
urinary paflages, by diuretics, and of the bowels by draf- 
tic cathartics. The difeafe continuing obdurate, full 
dofes of mercury will be well calculated to remove it. 
Ifdropfy feems to arife from mechanical obftrudlion, ftill 
local bleeding may occafionally be proper to reftrain the 
inflammatory action which all morbid produfts tend to 
produce by the ftimulus; but our chief attention muft be 
directed to the removal of the mechanical impediment. 
Thus, when a fluggifli ftate of the liver exifts, the excite¬ 
ment of the fecernents of this organ by mercury affords 
great relief to the dropfical fymptoms ; but, if tubercles, 
hydatids, or other arterial morbid tumour, exift in the 
liver, mercury muft be interdi/led ; and the only chance 
we can afford the patient is to keep up a very frequent 
naufea by tartar emetic, and cut off the fupplies from the 
4 S tumour 
