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DROPSY & OEDEMA
Causes, Types and Treatment of the Condition
As a general rule oedema is caused by some failure in the action either of the heart or the kidneys, and it is not infrequently a complication or sequel of infectious and feverish conditions. There are also strange forms of a neurotic or hereditary type.
Abnormal leakage of the fluid part of the blood into tissues surrounding the blood vessels is a symptom attending many diseases. Dropsy is not a disease in itself, as is very generally but quite erroneously supposed. This explains why in the following pages there is no discussion of treatment, which should usually be directed to the underlying cause.
These are conditions in which fluid passes out from the blood or lymphatic vessels into the tissues, and produces a state of the body analogous to waterlogging. Inasmuch as gravity usually plays an important part in its production the legs are most frequently affected; but the oedema may be localised to other parts of the body, such as the face, arms or trunk, according to the various operant causes. In some cases the fluid exudes into the tissues of certain of the internal organs of the body as the lungs, the larynx or the uvula. In dropsy large quantities of fluid accumulate in the body cavities, such as the pleural and pericardial sacs, or the peritoneal space of the abdomen. This is more fully dealt with under the heading of Dropsy below.
 
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FLUID
All tissues of the body are mainly composed of water, which constitutes about one-third of the weight of the body. Thus three-quarters of the healthy tissues is pure water, and most of the tissues are continuously bathed in liquid. This is necessary in order to convey nourishment and to form the medium wherein varied chemical changes take place. Fluid is being constantly lost from the body through the lungs, skin, kidneys and bowels and must be as constantly replaced by the ingestion of water. Generally speaking, about six glasses of water daily should be drunk since roughly between 3 and 4 pints of water are given up daily from the body. A good deal of fluid is, of course, obtained from ordinary foodstuffs, but pure water should be drank to flush the bowels, blood and kidneys for purposes of body purification.
People with high blood pressure or kidney or heart disease need care in the amount of fluid that they consume, and should take medical advice on this point.
Conditions, such as fever or muscular exercise, which increase the loss of water call for increased consumption, the regulation being effected through the nervous system, which creates a sensation of thirst. By the time the tongue is dry and thirst is sensed, the body is approximately 5% dehydrated.
Loss of 10 per cent. of the body fluid is serious, and loss of double this quantity is fatal.
The water which we swallow is absorbed from the gut, specifically the upper portion of the small bowel, into the blood vessels, where it serves be carry food material to the tissues and remove from them their waste products. In warm-blooded animals it also aids in equalising the temperature of the body.
From the rich supply of minute blood vessels which penetrate every part of the entire body (with the exception of skin, nails, hair and corneal fluid filters through into immediate contact with all tissue elements. This colourless liquid, called lymph, is collected into small capillary spaces, which, in turn, open into definite lymphatic vessels, forming eventually main ducts that return the lymph into the great veins.
As the body fluid is filtered or secreted through different parts, it is altered in various ways. Thus in the joints it is changed by the delicatic lining membrane into a viscid liquid suitable for lubricating the moving surfaces.
Local excess of body fluid is due to circulatory inflammatory or eliminative trouble, as in dropsy, pleural effusion, etc. See Ascites; Aspiration; Blood; Dropsy; Effusion.
EFFUSION
Water, as it is populary called, may collect in any part of the body. The popular phrases "water on the brain," on the lungs, in the knee, and so on, give a fair picture of a frequent pathological occurrence. Technically these collections of fluid are called effusions, because they have flowed out, in the first instance, from the blood stream. The way in which this flow is brought about is described under the heading Dropsy.
The most common effusion is that occurring into the knee-joint as a consequence of sprain or strain. A sprained ankle is yet another example; so too are housemaid's knee and miner's elbow. Those are effusions resulting from injury of a sharp or a chronic kind.
Burns also cansc efFusions in the form of blisters, and the "weeping" surfaces of eczema belong to the same order. The poison of germs have a similar effect, as in the large effusions occurring in pleurisy and in some abdominal diseases.
Effusions are treated in different way according to their nature and original cause. See Ascites; Aspiration; Pleurisy; Sprain.
Non-dropsical Oedema
Oedema of the legs may occur in conditions apart from diseases of the heart or kidneys. Thus, in severe cases of varicose veins there is a certain degree af obstruction to the return of blood through the veins, and some swelling of the feet and legs ensues. The blocl:age of a vein . by the formation of a clot of blood, or thrombus, will give rise to swelling of the leg. Pressure of tight garters may also give rise to a mild degree of oedema.
In some cases there is an obstruction to the, lymphatic circulation of the legs; this may i result t'rom the presence of minute worms, such as the filaria sanguinis hominis, when the legs swell up and elephantiasis results. At times too, after childbirth the lymphatic vessels are occluded and the leg swells, giving rise to the typical white leg. Pressure of enlarged lymphatic glands and the obstruction of lymphatic vessels due to cancerous growths in the glands will also give rise to an oedematous state of the corresponding limb. There is also a rare condition of oedema of the legs, which runs in families, in which for no apparent reason the lower limbs become swollen. This is known as Milroy's disease, and once it has appeared it persists for the remainder of the patient's life. Oedema of the limbs is one of the characteristic signs of beriberi (q.v.). In the severe varieties of anaemia in adults oedema of the ankles is frequently noticed. In anaemia the oxygen-carrying power of the blood is impaired and the oedema therefore follows the same lines as that seen in, heart disease, as explained under Dropsy.
Obstruction to the main vein returning blood from the head and arms to the heart will give rise to a swelling limited to these parts of the body. Young men especially are at times troubled by the appearance of small areas of swelling of the skin and subcutaneous tissues which are of transient duration. This is known as angio-neurotic oedema, and is liable to occur in nervous individuals.
Internal Oedema
Oedema of the internal organs ls nearly always of grave significance. Acute oedema of the lungs is a comparatively rare condition associated with arterio-sclerosis (q.v.) and with chronic disorders of the kidneys. It is at times also met with in pregnaucy or in diabet,es, and it may occur as a complication of tapping a pleural effusion. The patient is suddcnly seized with great difficulty in breathing, and watery fluid wells up from the lungs in considerable quantities and pours out of the mouth and nose. In chronic oedema of the lungs, the lower lobes or bases gradually become waterlogged as the result of failure of the circulation in diseases of the heart and lungs, or as a part of the general oedema in affections of the kidney.
Oedema of the lining membrane of the pharynx is a serious condition which may cause: death from asphyxia Its emergency treatment. It results from a variety of causes, and may be associated with chronic: affections of the kidney or with abscesses in the region of the throat. ln kidney disease the uvula may swell up, with consequent difficulty in breathing or swallowing.
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OEDEMA: APPEARANCE IN NEPHRITIS
In acute nephritis, or Bright’s disease, swelling first appears on the face, and is most marked below the eyes, owing to looseness of the tissue here. The swelling then appears on the legs and may extend further.
In any acute inflammatory process there is in the early stage an output of fluid from the blood vessels into the connective tissue spaccs. Lymph is poured ont to dilute the irritant causin.g inflammation and to repair the damage, but the exact mode of production of the oedema of inflammation is unknown. It may give rise to localised swellings of the skin or deeper structures.
Treatment Of Oedema.
The treatment varies with the cause, and should be directed to the organ or system primarily at fault. Thus, in oedema due to heart failure, absolute rest in bed is of the utmost importance. Drugs such as as digitalis are of value. At the same time the elimination of fluid which has accumulated. in the tissue spaces is helped by increasing the excretion by the kidneys with the aid of diuretic drugs, and by the administration of saline aperients, causing loose, watery evacuations. In very severe cases it may be necessary to allow the fluid to drain from the legs by means of small punctures madc through the skin (see Southey's Tubes).
In chronic disease of the kidney, as far as possible all salts should be eliminated from the food, and the addition of a certain amount of protein, in the form of cggs, may cause the oedema to disappcar in a case which has been kept somewhat rigidly upon a milk regime.
The swelling of the legs which is associated with general disturbances, such as anaemia or beri-beri, can be relieved by improving the general nutrition of the body by the administration of drugs such as iron, and by a dietary which is rich in the neoessary vitamins.
EPSOM SALT. Magnesium sulphate is popularly known as Epsom salt, from its having been at one time obtained from the mineral water of Epsom. It is contained in sea water and in salt deposits, and the present sources of supply are either this natural salt, after purification, or the salt prepared by the action of sulphuric acid on native rnagnesium carbonates. It occurs as small, colorless crystals which have a bitter taste and are readily soluble in water.
Epsom salt acts as a hydragogue cathartic, that is to say, it produces profuse watery motions of the bowels. It is a useful drug, therefore, in dropsy, as by carrying off a large amount of water by the bowel there is a corresponding depletion of the waterlogged tissue. Ordinarily, when the intention is simply to open the bowels, the dose is taken in about a third of a glass of water, preferably warm. This should be taken after rising in the morning. To prevent griping Epsom salt is sometimes combined with aromatics, as in the official compound senna mixture, commonly called black draught, and in the unofficial "white mixtnre." In place of the ordinary salt the effervescent Epsom salt may be taken. The doses of Epsom salt are: For a single dose, 120 to 240 grains; for repeated doses, 30 to 90 grains. The doses of the effervescent salt are twice those quantities.
DROPSY: A SYMPTOM OF DISEASE
Waterlogging of the Tissues by Blood Fluid
Abnormal leakage of the fluid part of the blood into tissues surrounding the blood vessels is a symptom attending many diseases. Dropsy is not a disease in itself, as is very generally but quite erroneously supposed. This explains why in the following pages there is no discussion of treatment, which should usually be directed to the underlying cause. See Anasarca; Ascites; Bright's
Disease; Heart; Oedema; Tapping.
Dropsy is a leakage of the watery part of the blood into the tissues surrounding the blood vessels. Every healthy man and woman has drospy in the sense that very small leakages of that kind are always going on. The disease is only an exaggeration of the normal state.
When the blood reaches the tissues its current slows down so that the tiny cells to which it is bringing food and oxygen may obtain them. The oxygen which it brings immediately passes through the wall of the blood vessel and is caught up by the cell. The food, on the contrary, must flow slowly or percolate through. Digestion renders food fluid so that it can be mixed with the blood and carried all over the body in the blood stream. This fluid food is able to pass through the walls of very small blood vessels as water will soak through thin paper. When the blood is flowing through the tissues the soaking process goes on and the fluid food leaves the vessels and reaches each of the tiny cells. That is to say, the blood always loses a little of its fluid while passing through the tissues.
The cells take as much of this fluid as they require; what they leave flows slowly on into very tiny vessels called lymphatics, and the exuded fluid is spoken of as lymph. These lymphatics join other tributary lymphatics until the main stream is reached. This is the thoracic duct, a large vessel which runs up the body beside the backbone; it ends by emptying its contents into the large vein in the neck, so that the lost fluid returns to the blood after the work of feeding the cells has been accomplished. This is, therefore, another l:ind of circulation-not of the bloodt exactly, but of the fluid part of the blood.
Lymphatic Obstruction
If a lymphatic gets stopped up there will be no escape for the fluid along its normal channels, and the tissues in the neighbourhood will swell. up with fluid. The larger the lymphatic which is stopped up the larger the area in which dropsy will occur.Again, if more fluid leaves the blood vessels than normal, there may not be room enough in the lymphatic vessels to carry it all away, so swelling will again result.
Thus the two great causes of dropsy are; some stoppage or obstruction of the lymphatic cbannels, and too great a flow of fluid out of the blood vessels. Both these causes may contribute to dropsy. The cause of an increased flow of fluid from the blood vessels may be obstruction of a vein, and dropsy of the leg from a tight garter may readily occur; or the circulation in the vein may be sluggish, as when it is varicose, with the same result.
In the same way poisons applied to the skin itself produce swelling in some cases. A bee sting is often followed by great swelling, that is to say, by dropsy of the place stung. Flnid at once flows out of the vessels in greatly increased quantity and there is a big swelling. When the sting is pulled out of the skin drops of clear fluid will flow out after it through the puncture. This is the fluid which should be passing along the lymphatic vessels, as soon as the poison is gone the swelling subsides. Naturally, however, some of the poison is carried away along the lymphatic vessels and thus, as explained under the heading Adenitis, inflammation may spread from a finger up the arm to the body.
This swelling, which comes as a result of a sting or of a dirty wound, is true dropsy. though it only affects a very small part of the body. Between it and the great dropsies of the body as a whole there is only the difference of quantity.
Another cause of dropsy is furnished by cancer. The cancer cells tend to move about the body by means of the lymphatic channels. Very often they completely block up these channels. When this happens swelling occurs at once. Such swelling is often seen in the arm when cancer of the breast is present, for the lymphatics from the breast join those of the arm in the shoulder.
Again, cancer or cirrhosis of the liver may block up all the lymphatics in that and neighbouring organs and so cause a huge outflow of fluid into the abdomen. In many instances the abdomen becomes filled with water. and has to be tapped, i.e. punctured and drained, to give relief to the patient. Naturally so serious an interference with the flow of the food fluid has a very bad effect on the feeding of the body cells and so tends so hasten death. Tapping, too, only gives temporary relief; the body soon fills up again with water, because the channels for that water are closed.
Heart and Kidney Dropsies
Finally, there, are dropsies of heart and kidney disease. That of heart disease occurs, as a rule, only when two of the auricles of the heart have ceased to contract normally. This trouble is called auricular fibrillation (q.v.), because these auricles, instead of beating firmly and strongly, quiver but never contract as a whole.
The cause of the dropsy in these cases is not very easy to understand. The explanation is that the greatly weakened heart is unable to do its work and so the blood is not pumped properly and tends to accumulate in the veins and the auricles themselves. This really amounts to a stopping up of the veins, and so of the trunk lymphatic which flows into them. Also, the patient becomes in danger of forming a thrombus (clot), since the blood pools in the auricles. This can lead to very serious consequences like emboli, stroke, or heart attack.
It is easy to understand why. when the heart begins to beat properly a.gain, the dropsy at once goes away. Some of the most extreme cases of dropsy are due to heart disease. Paticnts may be absolutely waterlogged so that the skin breaks in places and; allows the excessive mass of fluid to pour out. This condition is less common than it used to be owing to improved methods of treating heart diseases.
The dropsy of kidney disease is less severe than that of diseases of the heart and may be confined to the eyelids and face. It is probably due to the action of poisons in the blood which the diseased kidney is failing to get rid of. These poisons make the nerve, which control the small blood vessels become irritable, with the result that the vessels tend to open wide on the least provocation. The face, being the most exposed part, is most subject to such provocation.
Dropsy often occurs to a slight extent during attacks of rheumatism.
The treatment naturally depends on the cause. If the heart or the kidneys are the cause, treatment should be directed to these organs. Like breathlessness, dropsy is a symptom of many diseases. Nor is there, usually, much doubt as to its origin. Thus, long before it appears in heart cases signs of heart weakness will have been apparent. In any case, however, a doctor should always be; consulted when this symptom shows itself.
EPSOM SALT. Magnesium sulphate is popularly known as Epsom salt, from its having been at one time obtained from the mineral water of Epsom. It is contained in sea water and in salt deposits, and the present sources of supply are either this natural salt, after purification, or the salt prepared by the action of sulphuric acid on native rnagnesium carbonates. It occurs as small, colorless crystals which have a bitter taste and are readily soluble in water.
Epsom salt acts as a hydragogue cathartic, that is to say, it produces profuse watery motions of the bowels. It is a useful drug, therefore, in dropsy, as by carrying off a large amount of water by the bowel there is a corresponding depletion of the waterlogged tissue. Ordinarily, when the intention is simply to open the bowels, the dose is taken in about a third of a glass of water, preferably warm. This should be taken after rising in the morning. To prevent griping Epsom salt is sometimes combined with aromatics, as in the official compound senna mixture, commonly called black draught, and in the unofficial "white mixtnre." In place of the ordinary salt the effervescent Epsom salt may be taken. The doses of Epsom salt are: For a single dose, 120 to 240 grains; for repeated doses, 30 to 90 grains. The doses of the effervescent salt are twice those quantities.
OEDEMA, MALIGNANT: In Animals
The organism of this disease of the horse gains s access to the tissues either from the intestinc (rarely), or commonly from the skin. It is a common sequel to deep lacerated wounds, . such as deep cuts from Iciclcs, castration wounds, dirty contaminated instruments' used in dressing, and so on. The tissues become hot and swollen and crackle on touching. The temperature rises but falls again before death, which occurs in 1 to 3 days.
Prevention consists in thorough disinfection of all deep wounds and protection a against contamination. Immediately a deep a wound becomes swollen and hot, it should be opened and disinfected with iodine, hydrogen peroxide or carbolic acid. Medicinal treatment is useless.
DROPSY: In Animals. This is the term applied to an accumulation of fluid in the peritoneal cavity of an animal. It is generally due to disease of the liver, but may result from heart or kidney trouble. Dropsy is rare in horses, cattle and sheep. It is comparatively common in pigs, due to hardening of the liver (cirrhosis). The latter disease is said to be caused by feeding pigs with termented swill and middlings.
Dropsy in the dog and cat is not infrequently due to tuberculosis of the liver. Treatment has proved of little use in any animal and, unless the veterinary surgeon in charge thinks there is good reason for prolonging treatment, it is generally kinder to put the animal out of its misery.
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