DROPSY.
Treatment can only be commenced after a careful examination has determined the cause of the anasarca, and the removal of the swelling will be effected by those remedies which exert a specific action upon the primary disease. Thus in cardiac dropsy the effusion into the cellular tissue being mainly the result of diminished arterial and increased venous pressure, the proper treatment will consist in raising the power of the cardiac muscle by cardiac tonics and stimulating the kidneys by diuretics, as will be described under Heart, Valvular Diseases of. The dropsy of hepatic cirrhosis and portal thrombosis is due entirely to obstruction in the portal venous system, and is to be treated by tapping the peritoneal cavity or by establishing a new route for the blood to reach the heart, as described under Ascites.
Renal dropsy, whose treatment is described under Bright's Disease, must not be regarded as merely the result of the accumulation of water in the system owing to its faulty elimination through the diseased kidney; the altered condition of the blood and of the endothelial lining of the small bloodvessels are very important factors which must receive attention, hence the necessity for the elimination of waste products and the significa tion of a salt-free diet which, by diminishing the amount of sodium chloride in the exuded liquid, tends to cause its absorption by the peri pheral vessels.
The blood condition is the primary agent in the production of the anasarca of anemia, chlorosis and beri-beri, and of the local swellings in erythematous or urticarial affections, and should be met by free adminis tration of Calcium Salts.
Angio-neurotic edema or the anasarca of Quincke is little influenced by treatment; the only danger is through obstruction of the larynx caused by anasarca about the glottis, in which case a free scarification of the swelling or even a high tracheotomy operation may be indicated. The cause of the disease will probably be found to he a toxin like that produced in urticaria, whose selective action is upon the peripheral vaso-motor nerves; hence a large dose of a Saline Purgative in strong solution should be given. Codd has succeeded in cutting short the attack by injecting 4 mins. solution of Adrenalin, and Dryland recommends E gr. dry Thyroid thrice daily, which checks or prevents attacks and relieves the severe vertigo. Osier has found benefit from the administration of Nitroglycerin. Chloride of Calcium should always have a trial, and this 'acts beneficially in the allied oedema occurring in Henoch's purpura.