Page:The American Cyclopædia (1879) Volume VI.djvu/274

 DROPSY DROSTE fined to a single serous cavity, or to the areolar tissue within a limited space. In medical no- iiK'Mchiture dropsical affections in the different serous cavities are expressed by the prefix hydro in connection with the names of the serous structures. Thus, hydrothorax is the name for a dropsical effusion into the pleural cavity ; and so hydropericardium, hydrocepha- lus, hydroperitoneum, &c., denote dropsy in the several situations which these names ex- press. An effusion into the areolar tissue is called oedema ; thus, oedema of the face, of the limbs, and of different internal organs. An exception to the usual significance of the name oedema is afforded by the affection known as oedema of the lungs ; the dropsical effusion in this affection taking place, not into the areolar tissue, but into the air cells. Dropsy is said to be general when effusion into the areolar tissue beneath the skin exists more or less over the whole body, accompanied with effusion into certain serous cavities, especially the pleural and the peritoneal. The name anasarca is used to denote general dropsy. In all cases dropsy is a symptom of disease seated elsewhere than in the situations where the dropsical effusion takes place. Thus, the local dropsy of most frequent occurrence is hydroperitoneum, called also ascites and hydrops abdominalis. Here, the effusion into the peritoneal cavity is gen- erally symptomatic of disease of the liver, and especially of that form of disease, caused by spirit drinking, called cirrhosis of the liver, other names being gin liver, whiskey liver, and hobnailed liver. The explanation of the dropsy in these cases is as follows: The veins from the organs within the abdomen unite to form the vein called the vena portm, which passes into the liver. All the venous blood contained in the other abdominal viscera circulates in the liver, and passes thence to the heart to enter the general circulation. In cirrhosis of the liver, the circulation within this organ is obstructed, and venous congestion of the other abdominal organs results. Serous transuda- tion into the peritoneal cavity is the effect of this congestion (portal congestion, as it is called). Sometimes a tumor within the abdo- men is so situated as to press upon the vena port and occasion an obstruction to the pas- sage of blood through this vessel, and in this way hydroperitoneum may be produced. In other local dropsies the rationale, in general, is similar; that is, the dropsical effusion is the result mainly of the hydraulic pressure due to a persistent over-accumulation of blood in the veins which are in relation to the part where the dropsy takes place. The same principle is chiefly concerned in the causation of general dropey in a certain proportion of cases. The dropsy in these cases is due to an obstruction affecting the venous system throughout the body. In the great majority of these cases the obstruction is incident to diseases of the heart, and it is customary therefore to dis- tinguish them as cases of cardiac dropsy. Cer- tain organic affections of the heart, before they end fatally, give rise to more or less general dropsy or anasarca. In other cases general dropsy depends in a great measure on a morbid attenuation of the blood, which becomes wa- tery, and hence the serous portion tends to transude through the pores of the vessels. This is the explanation, at least in great part, of the occurrence of general dropsy in cases of certain affections of the kidneys included under the name Bright's disease. The blood becomes watery, or hydrsemic, in consequence of the constant elimination of albumen by the kidneys. The dropsy in these cases is distin- guished as renal dropsy. In by far the larger number of cases of general dropsy it is either cardiac or renal. Not infrequently, however, there is a coexistence of disease of the heart and disease of the kidneys, and then venous obstruction and watery blood may concur in producing the general dropsy. When not de- pendent on disease of the heart or the kidneys, general dropsy is a symptom of hydreemia, together with feebleness of the circulation. It occurs sometimes as a sequel of prolonged in- termittent fever. The treatment of dropsy, either local or general, involves measures indi- cated by the diseases which stand in a causa- tive relation to the dropsy; for example, the disease of the liver in cases of hydroperitoneum, and of the heart or of the kidneys in cases of cardiac or renal dropsy. Exclusive of these indications, it is often an object of treatment to effect either removal or diminution of the dropsical accumulation. Remedies which pro- duce watery evacuations from the bowels, and those which increase the secretion of urine, are chiefly relied upon for the accomplishment of the object just stated. This is also some- times promoted by producing free perspiration. The employment of the cathartics called hy- drogogues, and of diuretics, is to be governed by an appreciation of the diseases coexisting with the dropsy, by the condition of the pa- tient, and by the varied circumstances pertain- ing to individual cases. The liquid in serous cavities may be removed by a puncture or an incision, an operation called paracentesis, or vulgarly tapping. In some cases of dropsy of the chest paracentesis is resorted to (called also thoracentesis), but this operation is much oftener employed in pleurisy with effusion than in cases of dropsy. Tapping of the abdomen (^paracentesis abdominalis) is often employed, and is in many cases useful, not only by reliev- ing suffering but promoting recovery. In cases of general oedema, or anasarca, if the effusion be very large, great relief is sometimes obtained by minute punctures of the lower limbs, through which the serum drains away in abundance. DROSTE, Annette Elisabeth, Baroness Htils- hoff, a German lyrical poetess, born near Mun- ster, Jan. 12, 1798, died in a villa near the lake of Constance, May 24, 1848. Her health was bad, and her whole life was devoted to religion, study, and poetry. She left many compositions,