Dropsy.

During the last thirty years of the preceding century, Dropsy and Tympany amount to 23,366. In the present century, dropsy makes about one twentieth share in the London funerals. It has been alledged, that more women die of this internal deluge than men; and, according to Sydenham, more of the former at the final menstrual ebb, than at any other period. But, so far as my reading extends, neither the age, sex, mortality absolute or comparative, have to this day been decided from facts or numbers; but rather principally in the mode of tradition, and aphorisms of individual oracles. I therefore, through my learned friend, Dr. Sims, procured the registers of diseases in the Aldersgate Dispensary of London, which is accessible to all ages and diseases, and to both sexes: the result of this scrutiny is as follows:—Out of 70,000, during seventeen years, from 1770 to 1788, the dropsical amounted to rather more than one twentieth part of the whole maladies; that is, to 1,188: of which number, I find there were of males, 439; females, 749; cured, 674; relieved, 56; discharged or not accounted for, 275; dead, 186. Of these their sundry ages were, from birth to the 10th year, 106; from 10 to 20, 53; from 20 to 30, 112; from 30 to 40, 249; from 40 to 50, 321; from 50 to 60, 209; from 60 to 70, 110; from 70 to 80, 23; from 80 to 90, 9. Total, 1,188. These include every genus and species of dropsy, the hydrocephalus and hydrocele; neither of which were numerous: and the former principally fatal to children under ten years of age. Anasarca was the most frequent genus; and next to that, Ascites. Besides, all cases of anasarca and œdematous legs were ranged in this dropsical group; nor was it possible to form an estimate of the genera separately, as the word Hydrops was often indefinitely used.

From these data we may draw the following conclusions: That dropsy is more inimical to the female than to the male sex: but at the same time it must be recollected, that in London, and other cities, the women are considerably more numerous; which somewhat detracts from the comparative excess in them of dropsical mortality. For reasons, which medical men of experience will anticipate, we may add to the dropsical dead list some of the relieved, discharged, and not accounted for. It appears, therefore, that, under skilful medical treatment, rather more than one half of dropsies, promiscuously, were cured; that about one third or fourth died; that dropsical ravages are principally amongst adults; for notwithstanding that one half of the community are under twenty years of age, yet but a small portion of these are dropsical. It is chiefly against adults, and those in the decline of life, that dropsy prowls with slow and sullen destruction; and is, as 8 to 1, more fatal after twenty, than before that period. We may here also observe, that, by retrospection to a former proposition, a sort of medical geometry and trigonometry, a gross estimate may be formed from the deaths, of the number of dropsical in a community.

Dropsy in the Brain

and Spine, hydrocephalus, and spina bifida, is most frequent in infancy and childhood; but is often very difficult to detect, and the symptoms at the beginning are dubious. The most usual symptoms are loss of appetite, strength, spirits, flesh; fixed pain in the head and eye-brows, drowsiness or restlessness, heaviness, stupidity; pale countenance and tongue; obscure or double vision, dilated pupil, insensibility of the retina, even when exposed to the darting rays of the sun, or of a candle; the hand often applied to the head; irregular pulse; vomiting. It is commonly slow in increase; from months to a year, or more. It is seldom cured; and the fatal termination frequently palsy and convulsions. The external hydrocephalus, or local anasarca, is soft and elastic to the touch, and the enlargement visible. The spinal dropsy is sometimes complicated with hydrocephalus; in it a tumour turgid with fluid, the size of a chesnut, or larger, is protruded from the opening in the lumbar vertebræ of infants.

Dropsy of the Thorax,

hydrops pectoris, and pericardii: in one or both sacs of the pleura, or in the pericardium; or in the pulmonic cellular texture. This is much less frequent than the abdominal; and is often very difficult in the early stages to be detected, as the same, or nearly similar symptoms, occur in some other diseases of the breast: such are difficult and laborious respiration, especially on any exercise or motion, or in a horizontal posture, and gradually increasing; frequent cough, at first dry, but after some time, with mucous expectoration; weight and oppression in the breast; disturbed sleep, and sudden startings, with anxiety and dyspnœa; necessity of an erect posture; palpitation of the heart, and irregular pulse: there is also commonly scantiness of urine, œdematous tumour of the feet and ancles; a pasty paleness of the face; and sometimes a fluctuation of water in the thorax is perceptible to the patient.

Sometimes it is circumscribed and local; at other times, it begins by anasarca, and is complicated with universal dropsy of the other cavities, or with asthma; sometimes it consists of hydatides. It is distinguishable from the empyema, and from the polypus and aneurism of the large vessels, by the symptoms peculiar to each. After some fevers, thoracic dropsy has formed with surprizing rapidity in one or two days. The fatal event is often preceded by spitting of blood, anxiety, and accelerated respiration. In the dropsy of the capsula of the heart, the pericardium, there is difficulty of respiration, and of laying on the left side; quick, weak, intermittent pulse, palpitation of the heart, syncope, dry cough; anasarcous ancles, scantiness of urine: and sometimes a sensation of fluctuation during the motion of the heart. In dropsy of the mediastinum, the symptoms are conjectural.

Abdominal Dropsy,

including the ascites, the dropsy of the ovaria, fallopian tubes, and womb. The ascites, or exudation between the peritoneum, intestines, and viscera, is much more frequent than the hydrothorax. The symptoms are enlargement and prominence of the belly; sense of fluctuation to the fingers and ears on striking it with one hand, and applying the other to the opposite side; the urine scanty, turbid, and high-coloured; costiveness; the thirst at the beginning is inconsiderable, but generally becomes irksome and insatiable; the skin dry; the body sluggish, and increased in weight: the countenance becomes squalid, sallow, and unwholesome; the upper part of the body and arms emaciated, and, sooner or later, the ancles œdematous. Where there is a large accumulation of water the diaphragm is impeded, with difficulty of respiration and dry cough, particularly in a horizontal posture. The serous transudation is the general form of ascites; but sometimes it is of a gelatinous consistence, and more of coagulable lymph from the blood, and the fluctuation not perceptible: in other cases it is inclosed in numerous morbid cysts, called hydatides; which cannot be known to a certainty until after the experiment of tapping. It may, however, be suspected, where there is no general cachexy, dropsy, thirst, or scantiness of urine; where the appetite and sleep are natural, and the tumour has begun in one part of the abdomen.

Some survive many years under ascites, and after reiterated evacuations by tapping; on the whole, often amounting to several hogsheads of water. In others, there are instances of accumulation so extraordinary, sudden, and profuse, as to render it necessary to be drawn off repeatedly in the short interval of a few weeks. It occurs either singly, or as a part of universal dropsy. Ascites encysted; from broken constitutions; unsound viscera; the consequence of other diseases; chronic; with decay of appetite; with urine considerably disproportioned to the drink, are all species unfavourable, some desperate. But in the most deplorable stages, patients entertain some hopes of recovery.

Dropsy of the Ovaria, fallopian tubes, and womb, are female, and not unfrequent maladies. It is rarely that both ovaria are affected. The disease begins with a soft tumour at one side of the abdomen, generally increasing by slow gradations, and at length sometimes to an enormous size and weight, so as to distend the whole abdomen: it is accompanied with several ascitic symptoms, and with pain about the pubis and loins; but the fluctuation is imperceptible, or obscure; and the extravasation is often encysted and gelatinous. That in the fallopian tubes requires no particular description after the preceding, which it so nearly resembles. Both are often incurable. Dropsy of the womb is a very rare disease: it has been described as occurring either in the pregnant or unimpregnated state; and in the latter case, as contained within the cavity of the womb, or between the fetal membranes and the womb; or within the layers of the membranes. I cannot find an author to satisfy my doubts respecting the accurate diagnostick of this disease; and therefore shall not copy what I distrust.

Dropsy of the Cellular Membrane,

externally, in the cellular texture under the skin; the species anasarca, leucophlegmatia, œdema. It generally appears first in the lower extremities, and there too only in the evening, disappearing by a horizontal posture in the night: at length, it reaches up, progressively, to the legs, thighs, trunk, and scrotum; and in some instances, to the face, particularly in the mornings. The intumescence of the skin is pale and soft, and, on pressure of the finger, indents; but is soon again filled up with water. As it increases to a universal anasarca, there is difficulty of breathing, particularly after exercise, scanty urine, thirst, decay of strength, slow hectic diminution of the natural heat, and more or less insensibility of the skin, which is dry. Sometimes the legs and thighs only are enlarged and distended to a monstrous magnitude; their skin bursts, ulcerates, or is irritated to erysipelatous inflammation. It is either complicated with ascites or hydrothorax, or beginning as œdema, and increasing to anasarca, it oozes through all the external cellular texture; and having inundated all the out-works, proceeds in drowning the vital organs.

Dropsy of the Scrotum,

hydrocele. This is a local disease, confined to the male sex; and to which all ages are subject. There are two principal species; that between the vaginal coat and testicle, and that in the spermatic chord; and either collected in cysts, or dispersed through all the cellular membranes inclosing the spermatick vessels. In general, hydrocele is confined to one testicle, at the beginning is not painful, and neither diminishes nor disappears: it has usually a conical pyriform appearance, the large end downwards: sometimes it is very hard and incompressible; and when the membranes are much thickened, it is not transparent: there is slow gradual accumulation of the fluid from below: it is incapable of reduction, or return into the abdomen through the rings: it is not affected by posture, cough, or sneezing of the patient: there is neither nausea, vomiting, quick pulse, nor is the fecal discharge interrupted. If the quantity of water is considerable, the testicle cannot be felt, at least not distinguished. In most cases the spermatick vessels may be felt at their exit, through the abdominal rings; but sometimes the hydrocele tumour reaches up to the rings, and renders such cases puzzling to discriminate, as the spermatick chord is then concealed. Again, hydrocele of the spermatick chord has been mistaken for rupture, from its ascension to the rings: this species feels like a distended bladder.

Hydrocele has not only been mistaken for rupture, but also for scirrhous testicle, and venereal induration. Indurated and scirrhous testicle is rounder, harder, painful, and the spermatic chord distinguishable at the rings: it has, however, frequently a quantity of extravasated and surrounding fluid. Besides, scrotal hydrocele and hernia, hydrocele and scirrhous testicle, hydrocele and encysted dropsy of the spermatic chord, have been seen combined. Some hydroceles are several years collecting: others are very suddenly formed, especially from extravasated blood, external injuries, violent muscular exertions; these likewise have been mistaken for ruptures. Hydroceles vary in the quantity of fluid and magnitude, containing from ounces to several quarts; some are enormous in size, reaching half-way down to the knees, and occasioning great load, and pain in the back. The colour of the extravasated fluid is also various; clear, limpid, pale, straw, yellow, grumous, dark, bloody. Many, from choice or necessity, are contented to drag on life, not chusing to risk what is termed the radical operation and cure; but merely by frequent repetitions of the scrotal puncture or palliative remedy. Sometimes the skin and cellular membrane of the scrotum, in inveterate hydrocele, is prodigiously thickened.

The predisposing and occasional causes of Dropsies,

comprehending all the preceding genera, are in consequence of various acute and chronic distempers; broken constitutions, cachexy; intermittent, remittent, and scarlet fevers; repelled erysipelas; rickets; jaundice; biliary obstructions; suppression or repulsion of habitual or wholesome evacuations, as menses, hemorrhoides; general debility from various causes; atony of the sanguinous vessels, and of the exhalents, and transudation of serum through them; excessive evacuations by hemorrhage, diarrhœa, perspiration, or other excretories; sudden and large draughts of cold water when the body is much heated, especially if not discharged by urine or sweat; excess of fluids, of spirituous liquors; languid circulation; sedentary life; watery trades; moist air; suppressed perspiration, and watery excretions; tenuity or impurity of the blood; tenacious adhesion and agglutination of the coagulable lymph; increase of serous fluid in the blood; diseases and also ruptures of the lacteals and lymphaticks, and of the kidneys, ureters, and bladder; defect of lymphatic absorption; obstructed and scirrhous viscera, mesentery and lungs; asthma, polypi, ossified arteries, excessive fatness, and other causes intercepting the circulation of the blood: diseases of the stomach and digestive organs, and those of sanguification; laxity of the external subcutaneous cellular membrane; debility of the muscular solids and fibres, and of the tela cellulosa; hereditary; hydatides; violent muscular exertions, external injuries.

Tympany.

There are two species; that where air is confined within the intestinal tube; the other, where it is extravasated between the intestines and peritoneum: this last species very rarely occurs, and only from an erosion or hole of the intestines. The symptoms of Tympanites are, tumour and tension of the abdomen, and compared to the stretched head of a drum, without fluctuation or thirst; and not altered by a change of posture, nor is the body increased in weight: there is inappetency, indigestion, colick pains, eructation, and explosion of fetid air by the mouth and anus; costiveness, sallow complexion; and, from the distension of the abdomen, difficulty in breathing: in the inveterate stages of the disease, ischury, dysury, emaciation, hectic, and atrophy. Its increase is generally quicker than ascites; it is also chronic, and contumacious to medicine. Tympany of the womb is also mentioned by authors; but is a very unusual occurrence: it is described by local heat, pain, tenesmus, tumour, discharge of fetid air. The causes of Tympanites are, atony and palsy of the intestinal tube; excessive purging; chronic colick, dysentery and diarrhœa, or their premature suppression; suppression of the lochia or menses; the consequence of rickets, intermittent fevers, asthma, hypochondriasis; diseased abdominal viscera; excess of pituita, or bile; complicated with ascites, and the intestinal tube debilitated by soaking in water.

Excess of Fat,

obesitas, polysarcia; including anasarcous obesity, abdominal corpulency, and their complication. This is a frequent malady of adult age in this island. Those, unfortunately for themselves, thus stuffed and loaded with grease, are clumsy, unwieldy, inactive, lethargic; on any exercise or motion, they are panting for breath; and may be compared to cumbrous hulks. The causes hereditary; laxity of the cellular membrane, or tela cellulosa; esculent luxuries, sensual living, epicurism, malt liquors, excess of oleaginous secretion from the blood.

My original intention was to have proceeded to the next group, as arranged in the medical catalogue: but whether we enter upon their discussion now or hereafter, is a matter of no moment. However modern nosologists may plume themselves on classification, it appears to me as attended with no difficulty, nor requiring any exertion of genius: we may with as much facility as shuffling a pack of cards, throw diseases into endless arrangments and associations.