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Dropsies

disease, dropsy, local, anasarca, kidney, inflammation, albuminuria and condition

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DROPSIES - increase of size has been mentioned as one of the objective phenomena of disease, with especial reference to its frequent de pendence on the presence of dropsy. This condition may be defined as consisting in the effusion of fluid, either throughout the general areolar tissue, or within some cavity. But it is not possible to regard every local effusion as a disease of uncertain or variable seat, or as one arising out of a general condition of system ; and it is therefore important to note its simultaneous occurrence in more than one locality, as giving more certain evi dence of the operation of general causes. Anasarca will, for this reason, be taken as the type of general dropsy.

The local accumulations of fluid which occur in association with the general disease, are as numerous as the serous sacs which are found in all the great cavities, and it is not our busi ness here to enumerate them ; they are to be viewed as merely subordinate to anasarca. Local effusions, on the other hand, limited to one serous membrane, must be excluded from our consideration at present, as they are only of value in so far as they prove the previous existence of inflammation. An exception must, however, be made with regard to ascites, which is less fre quently a consequence of inflammation, and acknowledges at least more than one cause for its production.

Serous cysts are a very common cause of local dropsy : they will be considered under the head of morbid growths ; that con nected with the ovaries alone being referred to here, as it is im portant to point out the characters by which it is known from ascites.

§ 1. Anasarca.—Marked by painless swelling, which is free from the redness of inflammation, except in so far as tension pro duces tenderness of the skin ; it receives and retains the mark of the finger when pressure is made. General dropsy is very fre quently associated with, disease of the heart or of the kidney ; so much so, indeed, that these organs must be carefully examined in all cases of anasarca.

When such an association is made out, the disease is very often called car diac or renal dropsy ; but these terms are objectionable, because both organs are often found simultaneously affected, and the relations which they express convey an idea of causation which is not true. There are various points of detail in which the dropsy principally associated with cardiac disease differs from that of renal disease ; these will be learned by experience, and give a certain readiness in diagnosis, but are not altogether trustworthy, and are only of use when taken in connection with a more extended examination.

Among these, the complexion of the patient is the consideration of most mo ment, because of its bearing on treatment ; whether it be dusky and bloated, or pale, waxy, and ex-sangtime. All the intermediate conditions will be found in cases of dropsy with disease of these organs ; but, while the one extreme indicates obstruction to the venous circulation, the other marks deterioration of the blood, and thus they point to the heart and the kidney respectively as the chief seat of disease.

The next consideration has reference to the extent of the effu sion, whether the anasarca be universal or local. The effused serum necessarily tends to gravitate towards the most depending parts ; and this is aided in the erect posture, by the weight of the column of blood pressing with greater force on the capillaries of the lower extremities: limitation to the feet and ankles must, therefore, be excluded from the idea of localization, except when one leg only is oedematous.

The history, again, divides the cases into those in which it has come on suddenly, and those in which it has been more gradually developed, disappearing and reappearing during a long period, or steadily increasing from the time it was first observed.

a. The sudden form, or acute dropsy, generally arises from ex posure to cold, and is very common, either with or without exposure, as a sequel of scarlatina; the urine is very often albu minous, but not always so. When albuminuria is present,, disease of the kidney sometimes seems to commence in such an attack, from which the patient never thoroughly recovers; more com monly, the appearance of albumen in the urine is quite transient, merely indicating congestion; on the other hand, acute dropsy with albuminuria may be the first evident symptom of disease of the kidney. When unassociated with albuminuria, it proba bly depends on a slight degree of capillary phlebitis, causing retardation of 4he cutaneous circulation; it is then accompanied by a febrile state, and may be the direct consequence of checked perspiration, or of the exposure which produced this effect. The same condition of the cutaneous capillaries probably accompa nies the kidney congestion in all eases where fever is present. If the exciting cause be more local, and its action more intense, dif fuse cellular inflammation is set up in place of anasarca; the two diseases are thus pathologically allied though presenting appear ances totally distinct.

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