When the liver is greatly congealed, sometimes primarily, as when it has
been inflamed, indurated, or otherwise affected, or when from sympathy
with other parts, the process of sanguification ceases, and the affection
is called dropsy. When a great quantity of air is collected with a small
quantity of fluid between the peritoneum and intestines, so that the
abdomen when struck sounds like a drum, the dropsy in this case gets the
name of tympanites, being formed by flatulence about the stomach, belly,
and colon, and by chronic fevers. But sometimes from hardness of the
peritoneum and of the uterus in women, or from scirrhus, on the contrary,
a great collection of fluid with a very small proportion of air is formed
in the same parts, being confined as it were in a bladder, when the
dropsy is named ascites, and is occasioned by the afore-mentioned causes;
but, for the most part, it arises from hardness and scirrhus about the
spleen and liver, and from chronic defluxions about the intestines;
whereby it happens that the belly is swelled, while the rest of the
body is melted owing to its not being nourished. Sometimes throughout
the whole body a colder and more pituitous blood is collected, either
coming from the liver, or deriving its origin from a melting down of
the flesh of the whole body, which is as it were converted into water,
so that the whole body appears white and pituitous like a corpse, and
then the affection is called leucophlegmatia, dropsy of the flesh,
or anasarca, being occasioned by protracted fevers, cachexia of the
stomach, suppression of long-continued hemorrhoidal discharges, the
female flux, dyspnœa, inordinate insomnolency, and similar causes. In
treating these complaints, we commence generally with evacuation; but
in ascites and tympanites it is by administering hydrogogue medicines;
and in anasarca by bloodletting, more especially when the affection is
formed by retention of the hemorrhoidal or menstrual discharges, unless
the patients had been previously bled for cachexia; and in this case,
as in cachexia, the evacuation must be made at intervals. Then, having
carefully triturated the dried dung of an ox of the herd, boil it in
oxycrate or oxymel, and sprinkling on it a fourth part of sulphur, apply
it over the whole belly; or, apply a cataplasm of goat’s dung with the
urine of a child, made of the thickness of bath-sordes. These things
purge strongly by the belly; and we may use cataplasms made of leaven,
dried figs, calcined lime, nitre, iris, cardamom, native sulphur,
ammoniac, bay-berries, stavesacre, the dung of wild pigeons, all or
some of these may be used with oxymel. After which the epitheme, called
spongium, made of goat’s dung, evacuates the fluids in a wonderful
manner, both by the insensible pores and by the belly. Afterwards we must
apply desiccative plasters, that from willows, the Icesian, the barber’s,
that from bay-berries, the Polyarchium, and that from seeds. And the
following one is wonderfully efficacious, for it fetches, as it were,
the fluids from the deep-seated parts: Of the stone pyrites, dr. xij;
of native sulphur, dr. xij; of ammoniac perfume, dr. xij; of cumin, dr.
xvj; of nitre, dr. xij; add to a little wax and turpentine, and spreading
it upon a piece of skin, apply to the whole belly. Let them take the
propoma (liqueur) made by boiling the root of vervain-mallow in wine, or
macerate the wild cucumber in austere wine, and give every three days,
adding a cupful every day, until the dose amount to three cupfuls. The
following is a very compound mixture: Of balsam, of nard, of cassia,
of cumin, of liquorice, of St. John’s-wort, of bog-rush, of asarabacca,
of carrot, of amomum, of myrrh, of Macedonian parsley, of sweet hay, of
pepper, of hartwort, of cow-parsnip, equal parts. Each of these produces
a good effect by itself, and in like manner all the diuretics. Squill
baked and triturated with honey, and given as a linctus, provokes urine
without trouble; or it may be boiled in the water which is drunk. And
the following is an excellent remedy: Boil lb. ij of the inner part of
squills in iij sextarii of austere wine until it be reduced to one third;
give every day of this wine, beginning with a mystrum, until the dose
amount to an ounce. The following is an excellent diuretic: Of moist
alum, the size of a bean; dissolve in water; strain through a linen
cloth; and give to drink every third day, or every alternate day. Picra
given in oxymel, the theodoret, and the trochisk from bitter almonds also
suit with them. There are many hydragogues, but the following are of
approved efficacy: The seeds of the thymelæa (grana cnidia), xl or l; or
lathyrides, xx or xxx; or of euphorbium, v or vj siliquæ; or of flakes of
copper, dr. ij or iij; being mixed with crumbs of bread and formed into
pills; or the juice of the rind of elder-root, drunk with prepared wine;
or of the leaves of mezeron, of burnt copper, and of anise, equal parts;
give in water at first to the amount of dr. j; and afterwards of dr. ij,
or more. And the following are admirable pills: Of aloes, of euphorbium,
of grana cnidia, of each, oz. j; of rhubarb, oz. ss; mix together with
the juice of cabbage, and form into pills, and give to the amount of
viij or ix siliquæ. And the antidote from cloves evacuates water in a
wonderful manner. And we must try the effect of a hydragogue wine. The
following makes an excellent one: Of squills, oz. iij; of parsley-seed,
of the rind of the root of capers, of pepper, of each, dr. iv; of peeled
grana cnidia, dr. j; of the Indian leaf, two balls; of best wine, xij
heminæ; of raw honey, dr. xvj; beat together, sift, and macerate in the
wine, but triturate the squill. The dose is three cyathi. After the
evacuation of the water, we must use the theriac. And ox-dung dried and
drunk to the amount of a spoonful every day is of mighty use. We must
use the most stimulant clysters, unless the belly be spontaneously very
loose, in which case we must rather use things for drying it up. When
women are affected with dropsy we must use this pessary: Of anise, of
cardamom, of cumin, of nitre, of birthwort, of fenugreek, of pennyroyal,
of the inner part of figs, equal parts; mix together in the oil called
Susinum, and apply _per vaginam_. Afterwards we may use the natural baths
perseveringly, and the sand-bath, but we must abstain from the others;
but if they do ever go into a bath, let them sprinkle the body with
powders from nitre, salts, mustard, lime, and the like. These things even
without bathing are useful, when rubbed into the belly in a dry state,
or with oil. In anasarca they must exercise the other parts as much as
possible, and use dry friction in the sun. And a desiccative diet should
be taken. Let them, therefore, eat pickle, mustard, garlic, wild and dry
fowls, asparagus, picktooth fennel, leeks, wild carrot, and the other
wild pot-herbs; and the theriac salts, or those of Iamblichus may be
mixed with condiments; and old light diuretic wine may be used, or if
it is at hand, the wine prepared with salt water. But the patients must
abstain from much drink of any kind, and from water altogether.
When the dropsy is attended with fever, the patient must abstain from the
more heating and acrid food or remedies; but we may give them intermixed
with other things in case of urgent necessity. In tympanites, purgatives
and every medicine which wastes the body must be rejected, and also the
more drastic diuretics; and we must use both externally and internally
such things as can attenuate and dissipate the flatus; and dry-cupping
may be frequently applied over the whole belly. When those who have
ascites are not benefited by any of the remedies already described, we
must have recourse to paracentesis, which does not apply to any of the
other varieties of dropsy.
* * * * *
COMMENTARY. See Hippocrates (de Intern. Affect. 25; de Ratione Victus in
Morb. Acut.), and Galen’s Commentary on the same (Prognost.), with the
Commentary of Stephanus (ed. Dietz), and almost all the authors who treat
of hepatic diseases may be consulted.
Hippocrates gives a tolerably correct account of the causes and treatment
of dropsy. The varieties of the disease described by him are dropsy from
the drinking of cold water, from disease of the liver, and from disease
of the spleen. He further states that it is frequently the consequence
of protracted fevers, diarrhœa, dysentery, and quartan fevers (de Aer.
&c.) He mentions a species of dropsy which he calls the dry (Aph. iv,
11), which has been generally referred to tympanitis. See Littré (t. iv,
416.) In certain cases attended with dyspnœa he recommends venesection;
and Galen in his Commentary states that these cases are, when the disease
is preceded by suppression of the hemorrhoidal or menstrual discharges,
or is connected with plethora. But no one, he says, ventures to bleed in
tympanites or ascites. Hence Avicenna and most of the ancient authorities
forbid venesection in dropsy, except under the circumstances mentioned
by Galen. Galen says, indeed, in his work (de Venesect. ad Erasistrat.)
that he had sometimes cured dropsy by bleeding; but it is not to be
understood that he approved of it as a common practice. In short, he
was no Sangrado, but had anticipated Blackall. One of his hydragogue
potions is composed of cantharides. (De Reg. in Morb. Acut.) Hippocrates
recommends us to perform paracentesis thoracis in the side at the third
rib from the last. He also approves of paracentesis abdominis in cases of
ascites; and directs us to burn the region of the liver, when that viscus
is affected. He further approves of free scarifications of the testicles
and thighs. He has described hydrops uteri, or hydrometra, a case which,
although of rare occurrence, is occasionally met with. See Van Swieten
(Comment. 1224); Vesalius (de Fabrica Hum. v, 9); Monro (Works), and Dr.
A. T. Thomson (Paper in the Med. Chir. Trans. xiii, 1.)
Galen gives a long list of external and internal remedies for dropsical
complaints. (Sec. Loc. ix.) Ox-dung mentioned by our author was a
common remedy in ancient times, according to Galen. Diogenes Laertius
relates that the celebrated Heraclitus died lying in a bed of it. Upon
the authority of Antonius Musa, Galen recommends a cataplasm containing
elaterium, stavesacre, and hyssop. He recommends a vinous preparation of
elder. Pliny particularly commends this medicine in dropsy, and most of
the ancient authorities make mention of its diuretic properties. Galen
says that the liver is affected in all cases of dropsy. (De Locis, v,
6.) In like manner Stephanus, the commentator on Hippocrates, states
that in all cases of dropsy the liver is affected, either primarily or
sympathetically. Hippocrates refers one species of dropsy to disease of
the parts situated in the loins, by which Galen and Stephanus agree that
he means the jejunum, mesaraic veins and kidneys. (Ed. Dietz. 139.)
Celsus describes three varieties of dropsy, namely, ascites, anasarca,
and tympanites. He enjoins restriction as to food and drink, and
recommends walking, friction, and sudorifics, such as heated sand and
warm baths. He gives a long list of diuretics, as iris, valerian,
saffron, cinnamon, &c. In tympanites he recommends emetics, cupping
the belly, rubbing it with rubefacients, and applying sinapisms to it,
or burning eschars on it with heated irons. In anasarca he recommends
scarifications at the inner part of the leg, squills in a linctus, and
the like. He approves of tapping in ascites.
Aretæus describes the symptoms of dropsy with great accuracy and
elegance. He says it is a most unseemly disease, from which few recover,
and those more by the aid of the gods than of art. He treats of the
three varieties already mentioned, and also makes mention of hydatids.
Hydatids, by the way, are described also by Galen (Comm. ad Aphor. vii,
55), and Rhases (Cont. vii). He remarks that it is wonderful how much the
patient in dropsy flatters himself with hopes of recovery, more than in
many other diseases far less dangerous. He states that there are partial
dropsies, such as of the head, lungs, liver, spleen, and uterus. He
mentions among the exciting causes of the disease the drinking of cold
water, flatulent food, and the insect buprestis (_meloe vesicatoria_ L.)
From a passage in Plutarch, it would appear that certain forms of dropsy
had at one time been thought infectious. (De Serâ Num. Vind.)
Dioscorides and Ruffus praise elaterium as a hydragogue in dropsy. In the
‘Euporista,’ baked squills and oxymel are particularly commended, with
various cataplasms externally.
Cælius Aurelianus states fully the causes of dropsy, such as cachexia,
protracted fevers, hardness of the liver, spleen, peritoneum, or uterus;
dyspnœa, cæliac affection, dysentery, retention of the hemorrhoidal or
menstrual discharges, abstinence, an unseasonable draught of water,
especially of salt water, the abuse of medicines, and so forth. He
maintains, however, that the disease is the same, from whatever cause
it arises. The common symptoms of all its varieties are said by him
to be swelling, torpor, difficult breathing, disturbed sleep, thirst,
diminished urine, and sometimes latent fever. He informs us that
Erasistratus in his dissections generally found the liver indurated.
His external applications are very similar to those of our author. He
particularly commends a vinous tincture of squills as a hydragogue. He
approves highly of paracentesis, and has answered all the objections
which had been made to the operation. He mentions that Asclepiades
practised scarifications at the ankles.
The ordinary cases of dropsy are well stated by Serenus Samonicus in the
following lines:
“Corrupti jecoris vitio, vel splenis acervo,
Crescit hydrops, aut cum siccatæ febre medullæ,
Aut avidæ fauces gelidum hausere liquorem.”
Among his internal remedies he mentions broom-seeds, the wine of squills,
elder, and hellebore.
Alexander states that a coldness of the liver is the cause of dropsy, in
consequence of which it is no longer able to form blood, but converts
the fluids into water, phlegm, or air. Hence the distinction of dropsy
into ascites, anasarca, and tympanites. In certain cases of anasarca he
permits venesection, in order to relieve the depression of the system.
He adds afterwards that, if not only the liver, but also the spleen and
stomach appear hard, and especially if combined with plethora of blood,
venesection is to be had recourse to before all other remedies. But in
ascites and tympanites he agrees with Galen in condemning venesection,
and trusts principally to purging and friction. Like our author, he
commends copper and the leaves of elder. Exercise, he says, is adapted in
an especial manner to dropsical complaints, either by sea, on horseback,
or in a couch. Horace, by the way, no doubt, alludes to the established
practice of taking exercise for the cure of dropsy in the following
passage:
“Atqui
Si noles sanus, curres hydropicus.”
(Epist. i, 2.)
Alexander has stated correctly that the disease sometimes derives its
origin from disease of the uterus, kidneys, spleen, liver, colon, heart,
or other organ of the body. He remarks that dropsy is apt to come on in
phthisical cases.
Our author has merely condensed the account given by Aëtius. His list
of diuretics contains squills, spikenard, alum, spurge, burnt copper,
&c. Like Hippocrates, he approves highly of scarifications at the inner
ankle. Upon the authority of Antyllus, he recommends lying in heated
salt. In like manner, Galen and some of the other authorities speak
favorably of insolation while the patient lies on sand, wheat, or the
like. The _sand-bath_ is mentioned as a remedy for dropsy by the earlier
modern writers on medicine. See Theodoricus (iii, 33).
Leo, like preceding authorities, refers all dropsies to a coldness of
the liver, and says they are mostly incurable. We do not find that
Avicenna, Rhases, Avenzoar, and Serapion make any material alteration
on the practice of the Greeks. In certain cases of anasarca they permit
venesection, but generally condemn it in ascites. They praise mezereon or
the chamelæa strongly as a diuretic; and also make mention of colocynth
and scammony. Haly Abbas treats separately of anasarca, ascites,
tympanites, and dropsy from a hot cause. When anasarca is connected
with an obstructed secretion, he approves of bleeding; and, in general,
recommends abstinence from drink, exercise in the sun, friction with
sand or hard towels, sulphureous baths and diuretics. He concludes with
an advice not to persevere too long in the use of any one medicine. In
the treatment of ascites, he recommends mezereon, colocynth, &c., but
disapproves in general of paracentesis. For tympanitis he prescribes
various carminatives, such as parsley, fennel, spikenard, mastich,
southernwood, melilot, &c. Alsaharavius expresses himself strongly
in favour of venesection for anasarca; and for all kinds of dropsy
recommends the sand-bath, sudorifics, and the common remedies mentioned
above. The general causes of dropsy upon which Rhases most insists are
induration of the liver and debility of the kidneys, so that they no
longer attract the aqueous superfluity of the blood. He approves of
paracentesis and scarifications of the feet and testicles when they
are much swelled. Among his hydragogues, the most powerful are white
hellebore, elaterium, scammony, and euphorbium. He mentions that he
had known several dropsical cases cured by a spontaneous diarrhœa, and
hence he recommends us not to stop one when it comes on. When dropsy is
connected with the retention of a natural evacuation, he approves of
bleeding. He speaks favorably of the elder as a diuretic.