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DOMESTIC MEDICINE

CHAP. XXXVII.

OF THE DROPSY.

THE dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humour. It is distinguished by different names, according to the part affected, as the anasarca, or a collection of water under the skin; the ascites, or a collection of water in the belly; the hydrops pectoris, or dropsy of the breast; the hydrocephalus, or dropsy of the brain, &c.

CAUSES. - The dropsy is often owing to an hereditary disposition. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, that great drinkers die of a dropsy. The want of exercise is also a very common cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evacuations, as frequent and copious bleedings, strong purges often repeated, frequent salivations, &c. The sudden stoppage of customary or necessary evacuations, as the menses, the haemorrhoids, fluxes of the belly &c. may likewise cause a dropsy.

I HAVE known the dropsy occasioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by violent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a Iong use of poor watery diet, or of viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrus of the liver, a violent ague of long continuance, a diarrhoea, a dysentery, an empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepared, may occasion a dropsy.

SYMPTOMS. - The anasarca generally begins with a swelling of the feet and ancles towards night, which for some time, disappears in the morning. In the evening the parts, if pressed with the finger, will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and the perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough.This last is generally a fatal symptom, as it shews that the lungs are affected.

IN an ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits of a radical cure. Almost all that can be done is to let off the water by tapping, which seldom affords more than a temporary relief.

WHEN the disease comes suddenly on, and the patient is young and strong, there is reason however to hope for a cure, especially if medicines be given early. But if the patient be old, has led an irregular or a sedentary life, or if there he reason to suspect that the liver, lungs, or any of the viscera are unsound, there is great ground to fear that the consequences will prove fatal.

REGIMEN. - The patient must abstain, as much as possible, from all drink, especially weak and watry liquors, and must quench his thirst with mustard-whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds or other wild animals roasted, pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-raddish, rocambole, shalot, &c. He may also eat sea-biscuit dipt in wine or a little brandy. This is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon things as are mentioned above. If the patient must have drink, the Spaw-water or Rhenish wine with diuretic medicines infused in it, are the best.

EXERCISE is of the greatest importance in a dropsy. If the patient be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he is not able to walk or labour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, if possible, into a warmer climate. In a word every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient's body, two or three times a-day, with a hard cloth, or the flesh-brush; and he ought constantly to wear flannel next his skin.

MEDICINE. - If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong vomits, brisk purges, and such medicines as promote a discharge by sweat and urine. For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses. The patient must not drink much after taking the vomit, otherwise he destroys its effect. A cup or two of camomile-tea will be sufficient to work it off.

BETWIXT each vomit, on one of the intermediate days, the patient may take the following purge: Jalap in powder half a drachm, cream of tartar two drachms, calomel six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may take now and then a cup of chicken-broth.

THE patient may likewise take every night at bed-time the following bolus: To four or five grains of camphor add one grain of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day.

TAKE juniper berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom half a pound; infuse them in a quart of Rhenlsh wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by a an infusion of the ashes of broom in wine.

THE above course will often cure an incidental dropsy, if the constitution be good; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case, the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the patient's strength by warm and nourishing cordials.

THE secretion of the urine may be greatly promoted by nitre. Brookes says, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scruple of nitre, may be given twice a-day in a glass of strong cinnamon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English Pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual.

I HAVE sometimes seen good effects from cream of tartar in this disease. It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even to three ounces, if the stomach will bear it. This quantity is not however to be taken at once, but divided into three or four doses.

TO promote perspiration, the patient may use the decoction of seneka-root, as directed above; or he may take two table-spoonfuls of Mindererus's spirit in a cup of wine-whey three or four times a-day. To promote a discharge of urine, the following infusion of the London hospitals will likewise be beneficial.

TAKE of zedoary-root, two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm; cinnamon in powder, three drachms; salt of wormwood, a drachm and a half; infuse in an English pint and a half of old hock-wine, and when fit for use, filter the liquor. A wine-glass of it may be taken three or four times a-day.

IN the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged; but the operator must be cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and proper digestives, to prevent a gangrene.

IN an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very simple and safe operation, and would often succeed, if it were performed in due time; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any permanent relief will be procured. The very name of an operation is dreadful to most people, and they wish to try every thing before they have recourse to it. This is is the reason why tapping so seldom succeeds to our wish. I have had a patient who regularly tapped once a month for several years, and who used to eat her dinner as well after the operation as as if nothing had happened. She died at last rather worn out by age than by the disease.

AFTER the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. His diet ought to be dry and nourishing, such as is recommended in the beginning of the Chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel next his skin, and make daily use of the flesh-brush.

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