Treatment

When we are satisfied that the disease does not depend upon disease of the kidneys, we may use all the means in our power to get rid of the accumulated liquid by means of diuretics. The following may be taken, and changed as they seem to lose their effect. When the urine is strongly acid, which may be known by its depositing, on cooling, a sediment like brick-dust, the following may be taken, till the urine becomes clearer:

Nitre........................................One Dram.

Acetate of Potash.........................Six Drams.

Compound Tincture of Cardamoms..One Ounce.

Syrup........................................Half an Ounce.

Water sufficient to make...............Half a Pint.

A tablespoonful three times a day, or the following:

Liquor Potassae...........................Three Drams.

Tincture of Digitalis.....................Three Drams.

Tincture of Gentian......................Six Drams.

Compound Tincture of Cardamoms.,..One Ounce.

Syrup of Squills...........................One Ounce.

Water sufficient to make...............Half a Pint.

A tablespoonful three times a day:

When the urine has become clearer, a change may be made, and one of the following mixtures may be substituted, and the pills may be taken at the same time.

Tincture of Squills............................Six Drams.

Sweet Spirit of Nitre.........................One Ounce.

Tincture of Digitalis..........................Two Drams.

Spirit of Juniper...............................One Ounce.

Syrup.............................................One Ounce.

Water sufficient to make..................Halfa Pint

A tablespoonful to be taken three times a day.

Extract of Dandelion.........................Half an Ounce.

Bromide of Potash............................ Three Drams.

Spirit of Juniper.............................One Ounce.

Syrup............................................Half an Ounce.

Water sufficient to make..................Half a Pint.

A tablespoonful three times a day.

Pills of Aloes and Myrrh..................Two Drams.

Divide into 24 pills; one or two to be taken every night.

If the bowels are at all confined, and the patient is not too delicate, a rattling purgative occasionally will be of service, by producing a number of watery stools, which will relieve the system.

It will be necessary at the same time, to strengthen the patient with good nourishing food: boiled mutton, boiled chicken, fresh fish, beef tea, jellies, light puddings, and things of that kind. She may also take the following tonic, at the same time with the diuretics above prescribed:

Citrate of Iron and Quinine...............Two Drams.

Tincture of Orange Peel...................One Ounce.

Syrup...........................................Half an Ounce.

Water sufficient to make...................Three Ounces.

A tablespoonful three times a day. Or the following, much recommended by Sir Thomas Watson:

Tincture of Muriate of Iron...............Two Drams.

Tincture of Digitalis........................80 Minims.

Spirit of Chloroform........................80 Minims.

Syrup.........................................Half an Ounce.

Water sufficient to make..................Half a Pint.

Two tablespoonfuls two or three times a day.

On the other hand, if there be violent palpitations of the heart, with a strong, heaving impulse, you may appease the excessive action, and afford sensible comfort to the patient, by applying leeches, from time to time, to the chest.

In the Renal variety of chronic general dropsy, the treatment is not so simple. It is easier to say what we should not do, than what we should. The kidneys being out of order, are badly qualified for doing an extra amount of work, as they must do, if we give our patient diuretics, in order to increase the urine. When the urine is very scanty, and there is pain in the loins, blood may be taken from the loins by leeching or cupping. Fomentations or poultices on the loins are also efficacious in relieving pain, lessening renal congestion, and so increasing the secretion of urine.

When the state of the bowels will allow of it, a good deal of water may be got rid of by means of what are called drastic purgatives, such as produce copious and watery stools; but frequently in this complaint we have irritable bowels, or habitual diarrhoea, and then drastic purgatives would be improper.

Hot air baths are said to have been of much benefit in some cases, but all people are not so situated as to be able to avail themselves of them.

When from the state of the bowels we are unable to use drastic purgatives, and we cannot use the hot bath; or having used it without benefit, we must, even at the risk of increasing the kidney disease, resort to diuretics.

In this case we must choose which seem least likely to stimulate the kidneys injuriously. Cream of Tartar and Digitalis are particularly recommended for this purpose. The Cream of Tartar may be dissolved in boiling water, and with a little sugar and ginger added, may be taken as a common drink. The Digitalis may be taken in ten drop doses of the Tincture, three times a day.

Sometimes no impression is made on the Dropsy, although the discharge of urine becomes plentiful. A diet consisting exclusively of skimmed milk has of late been recommended in Renal Dropsy. This has in some cases proved highly diuretic, but some stomachs do not bear milk well.

From the difficulty of getting rid of the liquid by means of diuretics and purgatives, medical practitioners have turned their attention to acupuncture, which consists in puncturing the skin here and there with a fine needle. Dr. Watson says: "It is surprising how much fluid may be let out in this way, and how much relief may be bestowed by this trifling operation. The liquid trickles rapidly forth; and I have known it soak through the patient's bed, and form a pool on the floor of the room. In one instance, a physician being my patient, the limpid fluid which thus oozed from a puncture in his thigh was caught, and collected in a glass, by means of a little gutter of oiled silk. It was found that ninety minims, or a fluid dram and a half, escaped in a minute; which is at the rate of eleven ounces and a quarter in an hour, and this drain went on for upwards of four hours."

The surface in which punctures of this kind have been made, sometimes become red; erysipelas comes on, which it is difficult to arrest, and the patient sinks. In some of these cases the same event would probably have occurred, even although no puncture had been made, from mere tension of the skin, and the progress of the disease. When such appearances present themselves, the affected limb should be kept in a horizontal position, and strips of linen, wetted with Goulard water, should be applied.

The punctures should not be too near each other; an inch and a half at least should separate them. Neither should they be too numerous or too deep.

These punctures soon close up; and of late years, both in England and on the continent, the plan recommended long ago, by Mead, has been revived, of making a verticle incision through the skin in each leg, on its inside, about two fingers' breadth above the ankle. This method is found more convenient for the patient than a cupuncture. The fluid escapes rapidly, and it is generally believed that the hazard of sloughing is not greater than when mere punctures are made. The cut may be about an inch long; it should have a waterproof covering, so that the parts may be kept warm.

Sometimes a large flow of urine follows the drain thus made from the legs; with considerable relief to the breathing, and to the feelings generally.

In whatever way we manage to get rid of the water, it will still be necessary to guard against its re-accumulation, by paying proper attention to the health, and particularly to the state of those organs to which the dropsy was due. You may sometimes keep the disease of these organs in check, even when you cannot cure it.

In cardiac dropsies, besides the medicines already specified, un-deviating temperance and regularity of life must be enjoined; and the patient should always, and carefully, avoid all active motion or exertion of the body, and all strong emotion of the mind; whatever might tend to hurry the circulation.

In the renal variety of the disease, particular care must be taken to avoid exposure to cold, and changes of the weather. The surface of the body should be kept warm, and flannel from head to foot should be worn constantly. The diet should be nutritive, but not stimulating.

Much unnecessary penance used to be inflicted upon dropsical persons, by stinting their allowance of drink. It was natural to suppose that the accumulation would increase in proportion to the quantity of liquid swallowed. But experience has shown this opinion to be erroneous. The patient may safely be allowed to exercise his own discretion in this respect. When the peritoneum is full, distress is apt to ensue upon the distension of the stomach by drinks; but this source of suffering is soon discovered and avoided. The sick man is better able than his physician to judge which evil is the greater, the torment of unslaked thirst, or the discomfort which may be produced by its immoderate indulgence.