In anasarca, (as general Dropsy is called), in most cases, at the outset, the skin is dry, and the urine is scanty; and the anasarca is observed to increase or decrease, as the quantity of urine diminishes or increases. The watery fluid, which should escape from the skin and through the kidneys, collects in the tissue beneath the skin. As the disease advances, the tendency to effusion of serum is increased not only by the sluggish movement of the blood in the veins, from progressive debility of the heart, but also by one of the causes of that debility, the thin and watery condition of the blood itself.

This complaint may exist in various degrees, from slight infiltration of the tissue, scarcely noticeable until, after remaining in the upright posture for some hours, it accumulates in visible swelling about the ankles, to the other extreme, in which the integuments are everywhere stretched to the utmost, even to bursting; the insteps bulging upwards; the legs and thighs enormously enlarged, cylindrical, unshapely, and exhibiting partial vesications; the surface of the trunk of the body capable of being kneaded and moulded like dough; the skin of the penis distended, and, in consequence of its confinement by the froenum, twisted and circum-volved so as materially to impede the outward passage of the water; the scrotum as big as a child's head, preventing the miserable patient from bringing his thighs together, and from lying upon either side; the hands swollen; the face and neck bloated. With all this, the peritoneum is generally full of liquid, and at length the cavity of the chest; and towards the termination the water invades the brain.

The patients in this state usually complain of shortness of breath and palpitation of the heart, of a sense of impending suffocation if they attempt to lie down or to stir themselves actively: of tightness and distress across the region of the stomach, relieved somewhat by eructation, increased by food and drink; of weight and stiffness of the limbs; and sometimes of drowsiness.

Chronic Dropsy may be divided into Cardiac Dropsy, when the disease depends upon disease or debility of the heart, and Renal Dropsy, when it depends upon disease of the kidney.

In Cardiac Dropsy you will often find, in persons who are growing old, irregularity of the pulse; occasional shortness of breath; more or less expectoration, sometimes tinged, sometimes even loaded with blood. Eventually the ankles begin to swell; and the. patient (if his life be not cut short earlier in some other way) becomes by degrees decidedly and universally dropsical.

Many of the direct signs of diseased heart may exist, therefore, while there is no anasarca: intermissions and irregularity in its movements, palpitation; but when dropsy has set in, we may expect those signs also which denote dilatation of the right chambers. The heart is heard and felt to beat beyond the proper limits; the pulsations become feeble and unequal, if they were not so before; the patient is liable to fluttering palpitations, to extreme and panting shortness of breath on the slightest exertion, even on taking food into the stomach, or lying down; his skin assumes a dusky hue, and his lips and extremities are apt to be livid.

In these cases the Anasarca first becomes manifest about the ankles. During the earlier stages the swelling disappears in the night, and returns towards the next evening. It is sometimes confined, for a long while, to the legs; but ultimately it creeps up towards the trunk of the body; the thighs enlarge, the loins and flanks become doughy, the scrotum fills, and the water collects in the cavities of the abdomen and chest. In extreme cases the dropsy is universal, swelling the head and face and upper limbs. Sometimes, the fluid continuing to increase, the cuticle is raised by it, and large blisters take place on the limbs, or some part of the skin sloughs, and the fluid drains off by this vent in great abundance, to the great relief of the patient.

In Renal Dropsy the swelling is often first noticed in the face, and in the upper extremities; in the eyelids, in the cheeks, and upon the backs of the hands. These are uncovered, and therefore visible parts. Perhaps an equal amount of swelling might be found, were it looked for, in the feet and ankles. It takes place more suddenly and more universally, from the vessels of every region of the body at once, than Cardiac Dropsy. Cardiac Dropsy arises from mere mechanical delay of the blood; and that delay is felt most at the greatest distance from the heart, and in the most depending parts of the body. The early swelling of the face and hands is the more marked in proportion as the kidney disorder is recent and acute.

But disease of the heart and disease of the kidney may both exist at the same time.

When general dropsy depends upon disease of the heart, the cheeks and lips are occasionally florid, often purplish or livid, frequently dusky, whereas, in Renal Dropsy the complexion is generally unhealthy dingy sallowness.