This section is from the book "The London Medical Dictionary", by Bartholomew Parr. Also available from Amazon: London Medical Dictionary.
When the unmarried libertine disguises her fault under the pretence of dropsy, we cannot expect to gain any information from enquiry into the state of the menses; for she can invent circumstances, as well as the principal fact. We must draw our conclusion, therefore, from the first appearance, the progress, and the state of the tumour. If a person of a phlegmatic, cachectic habit, finds a tumour gradually coming on, without beginning at the bottom of the abdomen, and a fluctuation is observable in this tumour; if, at the same time, the urine is scanty and the legs swell; we may conclude it to be dropsy. If, on the contrary, the tumour began to rise above the symphysis of the pubes; if there is no fluctuation; if the general health and appetite be good; we may suspect pregnancy. Yet, in the pregnant state, it sometimes happens that the uterus will rise on one side rather than the other; and in encysted dropsies the swelling is not general. Such circumstances occasion much doubt and uneasiness; for, in one case, the physician's character, in the other, the woman's, is at stake. In such situations we must rest in suspense, carefully watching the progress, and attending to the state of the breasts, and other symptoms of pregnancy. When the swelling has reached near the umbilicus, the round circumscribed tumour of the uterus can be distinctly felt, and can rarely be mistaken. We have, however, a recent instance before us, to show that mistake is not impossible. If there is still any room for hesitation, we should wait longer, nor proceed to active measures till the tumour has continued so long as to prevent any further doubt of its nature.
It happens also, as we have said, that married women who have no wish for concealment, or women of decidedly bad characters who cannot be injured by an illegal pregnancy, have sometimes equivocal complaints of this kind. Such doubtful cases chiefly occur at the change of life, when the cessation of the courses gives a colourable appearance to the suspicions of pregnancy. In this case, the general health, and the state or progress of the tumour, will enable us to decide; but we would deprecate any hasty decision of its being dropsy, and any violent remedies, till a sufficient period has elapsed to destroy the slightest suspicion of a pregnant state.
There is one other disagreeable situation for the practitioner; we mean, when dropsy and pregnancy are combined. If a married or an abandoned woman has dropsy, it is not impossible but that she may be also with child. The menstrual discharge will sometimes continue during the whole of pregnancy; and, in such circumstances, all suspicion sleeps. Yet the state of the breasts, an areola round the nipple, the capricious appetite, or the morning sickness, will give the alarm. These circumstances should be always attended to, and will suggest the necessity of caution. Every caution, however, has failed; and, in one instance, within our own knowledge, during the operation of a drastic purgative, a premature delivery came on, though every possible attention had been paid to the diagnostic symptoms.
Yet, again, a married couple anxiously wish for a child, and the lady begins to swell. Woe to the practitioner who shall announce that she is in a dropsy 1 Whatever the circumstances or his opinion be, he must be cautious of opposing openly the wish; he must watch with care till the continuation of the complaint will assist the discovery of the unpleasing truth; while, by safe but sufficiently active medicines, he can prevent the dropsy, should it be so, from gaining ground; and he will reflect that she may still be pregnant. In the worst circumstances of general health, also, a woman is sometimes with child; and, when dropsy would naturally occur, it is not an unpardonable error to consider any tumour in the abdomen as such. The physician, however, in every case of supposed ascites, should be guarded with the most unremitting caution.
Tumours of the abdomen may sometimes be mis-_ taken for dropsy, but the hardness and irregularity will soon discover the nature of the complaint. Wind, either in the cavity of the peritonaeum or in the intestines, is distinguished by the elasticity of the tumour, the want of fluctuation, and, in the last instance, by its variable state, and the relief felt from the occasional discharge of flatus.
The cure of ascites is a difficult task; and indeed the best concerted plans generally fail, as the disease is often a symptom of a decayed constitution, of the vis vitae no longer able to support the requisite equilibrium of discharges and absorptions. When dropsy follows frequently occurring paroxysms of asthma, it is generally found to arise from obstructions to the returning blood, in consequence of ossifications on the right side of the heart: where shall we find the solvents of these bony substances? When the disease proceeds from obstructed liver, we must reflect, that the veins from almost all the chylopoietic viscera center there, and that the whole venous system of the abdomen is consequently obstructed: where shall we find aperients and deobstruents of sufficient power to remove the obstacle ? When, from long continued excess, the whole system is weakened, where shall we find the restorative to renew youth, to give fresh vigour, and new powers to the whole machine, to approach the art of conferring immortality ? Yet medical authors draw their indications, and speak with confidence of their remedies: the inexperienced student believes, and is disappointed; is credulous, and soon becomes sceptical. It is our business to guard against each extreme; and to add, that, though the cure of dropsy is difficult, and often hopeless, yet that we can almost always alleviate, and sometimes cure.
If the indications to diminish exhalation and increase absorption could be followed, we might be more sanguine. The most frequent part of our duty, however, is to increase other evacuations, that nature may supply the defect, from the accumulated fluid of the cavities.
 
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