PATHOLOGY, 
340 
tumour by the mod rigid abftinence. For the fame pur- 
pofe, fmall bleedings are occafionally proper. Such 
means will palliate the difeafe, and poftpone its termina¬ 
tion, though they will feldom cure it. 
When dropfy owes its origin to adecreafe in the quantity 
of the blood, or in the alteration of its quality, both 
which are commonly connected, our endeavour muft be 
diredled to reftore this fluid to its natural Hate. Fre¬ 
quent and fmall bleedings of courfe effect a diminution 
of its quantity; and a regular attention to the ftate of 
the digeftive organs is the only method of improving its 
quality. With refpefit to the diet, this fttould not be too 
low ; and fmall quantities of wine may be allowed. The 
bowels mull be kept open, and the mucous fecretions in 
general excited. Exercife alfo, either active or paflive, 
mull be ufed regularly. Catarrh and afthma occurring 
with dropfy require no difference in their treatment on 
that account. 
When either from the effefils of idiopathic inflamma¬ 
tion, or from general plethora, or from difeafed blood, a 
Hate is induced which may be properly called the chronic 
ftate of dropfy, which is frequently met with ab aborigine 
in old and debilitated perfons, and in which the difeafe 
feems nearly ftationary, the water very flowly collefiling, 
the fanguineous functions tardy, and the digeftive organs 
weak; when, in fa£l, a diminution of abforption feems 
the caufe of the diforder’s continuance, two alternatives 
prefent themfelves, which muft be adopted chiefly as the 
conftitution of the patient is good or bad, and as the 
quantity of effufed liquid is great or fmall. Thefe are— 
the removal of the water by furgical means, as by fcari- 
fying the Ikin in Hydrops cellularis, by paracentefis tho¬ 
racis or paracentefis abdominis in hydrothorax and afcites. 
(See Surgery for thefe operations.) A morbid ftate of 
the conftitution, or very old age, would prevent us from 
fcarifying the Ikin, left gangrene of the wounded parts 
fhould enfue ; and the punfture of the abdomen lhould 
never be ufed unlefs the quantity of fluid contained is 
very great. It Ihould be remarked alfo, that, if the waters 
feem to be contained in cyfts, no very favourable prog- 
nofis fhouldbe given of the ultimate fuccefs of the ope¬ 
ration ; and the praftitioner fttould be aware, that in thefe 
cafes he is apt to meet with fo gelatinous a ferum, that 
it will not always flow through his canula. Paracentefis 
thoracis is at all times a dangerous operation ; and, 
though it has on fome occafions been found ufeful, yet 
the danger of wounding the lungs, and the uncertainty 
of the figns of hydrothorax, caufe it to be very feldom 
ufed. 
The means of exciting the abforbents are few and un¬ 
certain ; nor will they have any effedl, except in the par¬ 
ticular cafes under immediate confideration. Of the 
medicines which promote the afilion of the abforbents, 
mercury holds a very high rank, but its operation on 
thefe veflels is uncertain ; neverthelefs it is found ufeful 
in practice during the chronic ftate of dropfy. It Ihould 
be given in fmall dofes ; and may be advantageoufly com¬ 
bined with diuretics. As a more direfil mode of pro¬ 
moting abforption, preflure has been tried in many cafes. 
Thus in H. cellularis artuum, bandaging the limbs, and 
in H. cellularis totius corporis and H. abdominis, fric¬ 
tions with the hand and flefli-brufti are advantageoufly 
employed. The good effects of preflure in thefe cafes 
probably induced a phyfician of eminence, SirG.Blane, 
to try the fame praftice in chronic hydrocephalus; and, 
it is faid with fuccefs. When however we confider the 
notorious ill effedls preflure exerts on the brain, we Ihould 
not be inclined to expert much from this practice ; but 
the high authority on which it refts obliges us to men¬ 
tion it. 
As medicines which have exerted a happy influence on 
dropfy under all circumftances wherein they could be 
made to aft, we muft mention diuretics. Thefe medicines 
are however very uncertain in their operation ; and it is 
a curious anomaly, that the weakeft fometimes anfwer 
where the moil powerful fail. Their exhibition is of 
courfe likely to be fruitlefs in cafes where tumours or 
difeafed liver occafion dropfy ; but, in inflammatory and 
in chronic idiopathic dropfies, they are generally ufeful. 
The digitalis, in dofes of five to tw-elve drops thrice a- 
day in a folution of cream of tartar, is perhaps the moil 
ufeful diuretic for inflammatory dropfy that w’e know of. 
In chronic cafes, fquill combined with calomel is more 
potent. But a variety of diuretics are in the Pharmaco¬ 
poeia, as cantharides, turpentine, See. which may be ufed 
when thefe common articles fail. On the fame plan of 
counter-irritation, draftic cathartics, as elaterium, fcam- 
mony, and oil of croton, have been ufed: their ufe fttould 
(generally fpeaking) be confined to cafes of inflammatory 
dropfy. 
We muft now retrace our Heps to deferibe two difeafes 
which we palled over in Dr. Good’s claffification of this 
genus, where they occurred as the fecond and third fpe- 
cies, under the titles of Hydrops capitis (water in the 
head), and Hydrops fpinse (fpina bifida). We palled 
thefe over becaufe they each of them require a diftinft 
elucidation; for they by no means agree in the general 
charaders of dropfy. Hydrops capitis is defined by Dr. 
Good as an “edematous intumefcence of the head, the 
futures of the Ikull gaping.” This, however, is merely 
the charadter of a very rare difeafe, and has no reference 
to the fyinptoms of hydrocephalus in the common ac¬ 
ceptance of the term. 
The term Hydrocephalus, or Hydrops capitis, does not 
apply to this difeafe in any of its ftages except the laft ; 
for, in its firft ftage, this malady is actually Cephalitis; 
Cephalitis, however, varying in intenfity, and traceable 
to a variety of caufes. The children who are predifpofed 
to hydrocephalus, are thofe who have large brains, or 
unufual activity of the cerebral functions. But the ab- 
fence of thefe phenomena by no means enfures a child 
from liability to the difeafe in queftion. Generally, for 
fome time before more marked fymptoms come on, un¬ 
ufual quicknefs of apprehenfion, vivacity of manner, and 
reftleflhefs, are apparent. In fome children this increafe 
of fenfibility reaches to an aftonilhing height, and indeed 
forms completely that erethifmal ftate of brain before 
defcribed under dyfpepfia, p. 136. 
But a more formidable fet of fymptoms than the above 
are thofe which difplay ditninijhed cerebral energy. The 
children begin to be indifferent to every thing : their ac¬ 
tivity, vivacity, and good temper, vanilh; they diflike 
light and notice; the lively colour of their countenance 
and brightnefs of their eyes begin to fade; and their 
fprightlinefs paffes into dulnefs. Their bowels are con¬ 
fined, their urine fcantyq their reft difturbed. The larger 
children, on fitting up in bed, complain of giddinels; 
they are alfo fubjeft to rheumatic pains in the limbs, but 
particularly in the nape of the neck, calves of the legs, 
and foies of the feet. The fmaller children exprefs the 
fame feelings by a certain rocking of the head, by fud- 
denly becoming filent in the midft of a cry, by whining, 
and moving their hands towards their heads. The pulle 
is irregular, and fometimes intermits altogether: it is 
commonly the feventh, ninth, fixteenth, feventeenth, or 
thirty-firft, pulfation which is weaker or deficient. From 
a ftate of reverie they are roufed with a deep figh, and 
begin again to notice thofe about them, of whofe pre¬ 
fence they had been apparently unconfcious; the colour 
of the face changes, and they are alternately fiulhed and 
chilly. When afked if any thing ails them, they anfwer 
with an indifferent “No.” They walk without firmnefs, 
and, in ftepping forward, they often raife the foot as if 
they were ftepping over a threfliold; they totter and flag¬ 
ger as if drunk. 
Sometimes in this ftage, the infant, though in a ftate of 
health, frequently vomits, wakes fuddenly with a cry, 
becomes foporofe from an overloaded ftomach, and has 
an irregular pulfe. Sleepleffnefs, unufually continued 
fereaming, without any other complaint; hanging the 
head 
