Dropsy is of two kinds-or originates either from derangement in the circulating organs,

I. CARDIAC DROPSY.

Or originates from derangment of the secreting organs,

II. RENAL DROPSY.

The term dropsy is applied to all exudations of water into cavities or into the cellular tissue, and the different varieties are not subdivided under the above heads, but apply to both forms. The causes of dropsy are various and originate from a variety of circumstances. Any impoverished state of the the blood will produce an effusion of water and cause dropsy. When there is any obstruction to the free passage of the blood through a part, there will be effusion into a cavity or transfusion into the cells forming water. This water or fluid is usually of the following constitution:

This water is not the liquor sanguinis of the blood, nor is it pure serur but it in all cases contains more or less albumen, but the largest part is pure water the protoxide of hydrogen mixed with salts.

In many cases there is pus, fibrin and albumen with globules of blood, which gives to the fluid a muddy, dirty appearance, but in most cases the fluid is as pure and clear as water.

When the blood does not circulate for want of power in the heart, arteries, capilaries and veins, the disease is cardiac; or produced from the heart, that is, general dropsy or

HYDROCELLULASIS.

From udor water-cellula-cells—that is, water in the cellular tissue, and this may be specified by the anatomical parts, as hydrocellulasis, anasarca, acites ; that is, that swelling of the neck from the transfusion of water into the cellular tissue of the neck, which occurs in compression of the jugular veins or any obstruction to the return of the blood to the right oricle, which is sometimes produced by anurism of the aorta. The patient will have a swollen and ademitus skin and cannot lie down for fear of suffocation, when the lower extremities will be quite natural provided the circulation is good. The obstruction may be at the ilio-pectinial ligament-Poupart's ligament -by obstruction in the saphona vein, and we will have varicose veins and dropsy of the cellular tissue of the lower extremities-hydrocellulasis extremeta.

The obstruction may be in the liver, produced by congestion and inflammation of the liver, the flow of the blood through the portal vein, and then we have an effusion into the peritoneal cavity which we call hydroabdominis or acites. The effusion taking place alone from the portal vein, which collects the blood from the viscera of the abdomen, and has to pass through the liver to assist in the formation of bile. The obstruction may be in the pulmonary veins or in the pulmonary capilaries, and then we have

HYDROTHORAX,

or dropsy of the chest. This obstruction may be from tubercles, pneumonia, pleurisy, or compression of the bronchial veins by an anurism or other tumor formed in the thorax which will obstruct the ready flow of the blood to the heart, or there may be derangement and disease of the mitral valve, by which the blood is regurgitated as it were back into the lungs by the systole or contraction of the left ventricle.

The obstruction may be in the heart itself-hydrocardiasis-dropsy of the heart. This may be from obstruction in the semiluna valves by which the blood in the heart cannot pass out to the lungs or through the general circulation through the aorta. This may also occur from rheumatism of the heart whereby there is a subacute inflammation of the pericardium and an effusion of serum or water into the space around the heart or in the heart.

All

Abdominal dropsy may be produced by compression of the ascending enal cava by enlargement of the spleen, liver, or stomach, or by anurisms of the abdominal aorta, or cancer and induration of the pancreas, or tumors in the mesenteries, or tuberculosis of the mesentery, omentum. inflammation may obstruct the capilary circulation and cause transfusion of serum, forming dropsy of the particular part. These obstructions to the circulation forming CARDICAL DROPSIES may be from an infinite number of other diseases, caused by a like infinite number of external causes.

RENAL DROPSIES.

These occur mostly from a want of absorption or secretion of the kidneys. Exhalation and absorption are not equal. This is often caused by change of temperature, when the exhalants and absorbants as the skin, the lungs, the kidneys and alimentary canal are changed in their action and water is accumulated in the blood, or rather the proportion of the serum to the red globules and the fibrin are increased, making a watery blood, then effusion may take place in the weakest organ of the body as before and form the above named varieties of dropsy as given in cardiac dropsy.

This one quality may be produced by scarlet fever-scarlatina,—and this is one of the most common causes of renal dropsy, or it may be from smallpox, measles or any eruptive disease that will or does affect the exhalents of the skin throwing too much work on the kidneys, the lungs and the alimentary canal. Renal dropsy is often caused by disease of the kidney itself, acute inflammation of the kidney. Evisceration of the pelvis of the kidney by a calculous degeneration of the tubulæ urinifiri, and effusion of albumen as in abuminuria, diabetes mellitus, where the system is reduced by the discharge of albumen in one case and the discharge of sugar in the other. The kidneys may be congested by malarial causes, and we will have hæmaturia from this cause; as I have seen in several cases, and in all such the convalescence is slow and tedious. Most cases of diabetes die from dropsy. Most cases of Bright's disease (albuminuria) die from dropsy. Most cases of chronic "diarrhoea die from or with dropsy. As the blood becomes so thin from the want of chyle in the blood, that it absorbes water from the stomach in the place of pure chyle, and this fills the blood with water faster than the kidneys can take it up. Hæmorrhgies from the nose, lungs, stomach, uterus, and from all wounds involving the arteries or the veins, excessive bleedings, or the use of poisons, especially arsenic and its compounds.

We have thus drawn as distinctly as possible the difference between dropsies caused by the circulation and dropsies caused by the want of co-ordination between the exhalents and the absorbents, renal dropsies. By a careful review of what we have said, it will be seen how complicated is the true pathology of dropsy, and that the word dropsy in its strict sense is only a symptom and all its special varieties are merely special symptoms of special

diseases, either involving the circulating organs or the glandular-receivi or secreting organs.

SPECIAL DROPSIES.

In our description of special dropsies we will begin with anasarca-hydro cellulasis.

Symptoms. This is known first by a swelling of the eyelids, the fee during the day and the hands during work—as the very first symptoms, the eyelids are swollen in the morning, the feet at night and the hands wher hanging down for any length of time. The countenance is pale and anemic the skin pits on pressure, leaving a white space where the pressure i made. The respiration is short, the abdomen swells, the legs enlarge and the whole body is filled with water, or the general cellular surface is filled with water.

CAUSES OF HYDROCELLULASIS.

The principal cause of general dropsy of the cellular tissue is rheumatism of the heart, producing valvula disease, or from the exanthemetosu fevers, or scarlatina, variola, rubeola and the syphiloid eruptions. Hæmorrha gies are also a very frequent cause of this form of dropsy. Diarrhoea and consumption, or tuberculosis of the lungs and the mesenteries, indurations of the spleen and liver, diabetes mellitus, diabetes insipida, albumenuria &c., about in the order in which we have mentioned them.

TREATMENT OF HYDROCELLULASIS.

There are some general hygienic rules to be followed in the treatment of al dropsies, especially general dropsy. In all cases should be further specially directed to the primary cause as well as the medical treatment.

Hygienic rules for treating general dropsy :

The diet should be nutritious and easily digested; nothing should be eaten that is not well digested.

The clothing should be flannel or woolen to keep up the exhalations from the skin and lungs.

MEDICAL TREATMENT.

All coughs, colds, diarrhoeas, inflammations and indurations should be cured by their specific treatment. Then to relieve the accumulation of the water we should excite the kidneys by diuretics, the best being the salts of tartar. The alkaloids, jalapin, buchin, digitalis, horse-radish, mints, gin tinc. of juniperi seminis.

We should excite the glandular system to absorption by giving mercurials, antimonials, purgatives and diaphoretics. The best of these is calomel, tartar emetic, elatereum and quinine, or we may select diuretic purgatives such as jalap, cream of tartar, leptandin, &c. When the water accumulates in any portion to such an extent as to be liable to produce sloughing or gangrene we should resort to surgical means such as puncturing the scrotum, the legs, the arms, and the penis, all of which I have seen saved from gangren

by letting out the water with a trocar or lancet. When the water accumulates in the brain and cannot be removed by any or all the remedies above suggested, we may and ought to perform paracentesis capitis; that is, relieve the pressure on the brain by evacuating the water through the smallest canular and bandaging the head with adhesive strips, and continue our treatment by absorption. If the water accumulates in the chest, producing

HYDROTHORAX,

we should perform paracentesis thoracis, and let out the water to allow the lungs to expand and the blood to be better arterialized and made richer. This should be carefully done so as not to admit air or produce an accumulation of pus, which, if it is formed, must be let out also and in the same manner, and the general treatment by absorption and excretion continued.

If the water accumulates in the pericardium we may use compression by bandaging as we should in all other cases where dropsies are formed in serous cavities, but it is not practical to puncture the sack surrounding the heart. We'should use all means to produce absorption by restraining the patient from water, from eating watery food, excite perspiration by quinine, use diuretics and purgatives continued doses; but in moderation and not to debilitate or affect the digestion.

If the water accumulates in the peritoneum, forming acites-hydro-abdominis, and it cannot be removed by purgatives, diuretics and diaphoretics, we may relieve the tension of the abdominal wall and also the pressure of the viscera by performing the operation of paracentesis abdominis. This form of dropsy is more amenable to purgatives than any other, and more good has been done by tapping in this disease than in any other. I have used it with success in four cases out of five that I have performed the operation. One was tapped twice and died; one was tapped three times and recovered ; two were tapped twice and recovered; one was tapped only once and recovered; one I inserted after tapping three folds of thread of silver wire and left it in as a seton for ten or twelve days until the wire was enclosed by peritoneum and ceased to run, when I took it out. Patient recovered so as to be able to leave the hospital for Alabama. He felt no inconvenience from the silver wire, but had to be tapped again before he was able to walk about. But during that time I applied my pressure and internal remedies to great advantage, and he never was so bad afterwards.

When the accumulation takes place in the ovaries, forming also acites, we should be very careful of our diagnosis and the history of the rise of a tumor in the right or left iliac region, and its gradually rising should be particularly noticed, and also in these ovarian dropsies the general health is not much impaired at first, and never so great until the last stages. It does not affect the respiration so much; it does not so early prevent the patient