TH Of the DROPSY. ་ Here are three fpecies of dropfy mentioned by phyficians both ancient and modern; the leucophlegmatia or anafarca, the tympany, and the afcites. An excess of ferofities is common to them all; which being collected form a fwelling; either all over the body, as in the leucophlegmatia; or in the belly, which is fometimes fo bloated, that a found is frequently heard proceeding from the wind inclofed, as in the tympany; in which cafe there is alfo generally found fome share of water, made perhaps by the condenfation of the confined vapour : at other times the belly is fo filled, that the fluctuation of the water may be easily perceived, either upon moving the body, or patting the part with the hand, as in the afcites. The feat of the leucophlegmatia is in that membrane, which modern anatomifts call the adipose, or rather the reticular or cellular membrane, and which lies between all the membranes of the body and the mufcles. Some The tympany is of more forts than one. times the confined vapour bloats up the abdomen, which gives a hollow found upon being struck. And that vapour is an exhalation from fome mortified vifcus; and therefore when let out, it is always extremely fœtid. This is a rare cafe, and yet I have feen one remarkable inftance of it in St Thomas's hofpital, It was in an old man, whofe belly fwelled to that degree Upon opening gree of tightnefs, that it founded like a drum upon being struck; nor could a paffage be procured downward either for excrement or wind, though the most powerful cathartics had been given. the abdomen after death, there flew out with noise fuch an exceffively ftinking vapour, that the furgeon cried out, he was poifoned. We foon found the fource of this ftench to be the colon, which was inflamed and mortified, and adhered to the stomach mortified likewife. But yet it fometimes happens with out any putrefaction, that an elaftic air engendered in the abdomen, and not finding any vent, pufles forward, and bloats up the integuments by its expan five force. And this is not pent up in the cavity of the belly, but in the very inteftines; which it stretches to fuch a pitch, as to deftroy their contractile power; and then their capacity is fometimes widened to an almost immenfe degree *. The afcites, or third fpecies of dropfy, is formed three different ways. For fometimes the water is extravafated between the tendons of the tranfverfal mufcles of the abdomen, and the peritonæum, and by feparating them, forms a tumour +; at other times. the ferofities getting in between the two lamina of the peritonæum (for this membrane is double) forces them afunder, and forms to itself a large receptacle ; but most commonly the water is collected, and ftagnates in the wide cavity of the abdomen itself. And upon diffection I have fometimes obferved this water * See memoires de l'academie royale des fciences, for the year 1713, pag, 235. and Philofophical Tranfactions, + See Chefelden's anatomy, book iii. No 414. chap. 4. to to be very clear, with many little transparent strings, composed of flender veficles that feemed linked together, floating in it; which were the coats of the burfted lymphatic vessels, whofe valves feparated them into different pieces, and formed hydatids. But there is no fpecies of dropfy worfe than that of the ovaries in women. For thefe organs firft grow fcirrhous, then they are inflamed, and at length gangrened; they likewife fwell to a vast fize, being gradually ftretched by the juices iffuing out of their bursted lymphatics, which are very numerous. Hence this disease is very feldom cured. These are the chief ways of forming collections of water in the belly, and I have feen inftances of them all more than once: but the following cafe, which fell under my notice, while I was physician to the hospital, is very uncommon. A widow of forty-two years of age, who never had a child, complained of pains in her back, and difficulty of making water, for about twelve months; after which time the perceived her belly to fwell, and there foon appeared manifeft figns of an afcites: wherefore he was tapped three different times; but the waters foon collected again after each tapping, and fhe died in a fortnight or three weeks after the laft puncture. Upon opening the body, there iffued firft from a cavity, formed by the feparation of the tendons of the tranfverfal muscles from the peritoneum, a great quantity of water, in which floated many large entire hydatids. And afterwards, upon cutting the peritoneum, feven or eight pints of a thickish and viscid humour were taken out, mixed with many corrupted glands. We wondered that none of the intestines appeared, which we fought in vain, until, cutting through a membrane, as thick as leather, we at length found the ftomach with all the intestines and omentum collected into a narrow compafs, and, as it were, lying hid there. The membrane immediately inclosing them was the inner lamina of the peritoneum; whofe outer part being, as I have already obferved, almoft as thick as leather, did fo far impofe on us at first sight, that we took it for the whole peritonæum. Thus the three fpecies of afcites above mentioned vifibly occurred together in this body, a curious, appofite, and useful cafe. Befides all thefe collections of water, other parts of the body are alfo liable to the fame diftemper, as for example, the brain and testicles. But water is no where attended with greater danger than when collected in the breaft and this fpecies of dropfy most commonly happens to those who have long laboured under a difficulty of breathing, that fort efpecially which arifes from polypi in the blood-veffels ; while the ferofities of the blood tranfude though the membrane of the lungs. I have feen feveral cafes of this kind, where there was from a pint to a quart of water collected, fometimes in one fide of the breast only, fometimes in both, and fometimes alfo in the very mediastinum. Now, as this water increases daily in quantity, by hindering the play of the lungs, it at length ftops refpiration, and the patient dies fuddenly. In fine, in perfons who had been long fubject to a palpitation of the heart, and fhortnefs of breath, the pericardium itself has been found after death vastly diftended with water. But it is time to come to the cure of these dropfies. In the leucophlegmatia, an incifion ought to be made made in the infide of the leg, two fingers breadth above the ancle, as far in as the cellular membrane, and no farther; in order to ferve as a drain for the water, which should run for fome days. And during this time, let the leg be fomented with a decoction of emollient and warm herbs, with an addition of camphorated spirit of wine; which method I have often found to be of great fervice, not only in this fpecies of dropfy, but even in the afcites itself: nay, in fome cafes it has proved an abfolute cure, by draining off an almost incredible quantity of water for many days. together. But care must be taken, not only in this particular incifion, but in all others that are made in any part of the body for drawing off the waters, not to over-exhauft the patient's ftrength; which is as much affected by this evacuation, as if the fame quantity of blood were drawn. Wherefore the patient is to be fupported by all poffible means, left what was intended for his cure may haften his death; whereof I have feen two inftances, one of which, indeed, happened by my own fault, in not estimating the patient's ftrength with fufficient caution, and the other by the rafhnefs of a furgeon. And yet it is aftonishing, how great a quantity of water, drawn off in this manner, hydropics fometimes bear to lofe, with ease and benefit: as will appear by this fingular case. A gentlewoman, related to me, of near fifty years of age, and of a good strong habit of body, was feized with an anafarcal and afcitical dropfy at the fame time; whereby her belly fwelled to fuch an exceffive degree, that when fhe lay in bed fhe was quite oppreffed by the weight. When her cafe was judged almost desperate, I gave it as my opinion, that the only |