LIVER

liver, &c.; general dropsy, or dropsy which depends on causes acting on the system at large, is due chiefly to diseases of the heart, kidneys or lungs, occasionally on lardaceous disease, more rarely still on diabetes or one of the anaemias. broadly speaking, 50% of cases of general dropsy are due to disease of the heart or aorta, and 25% to renal troubles. the natural tendency of all diseases of the heart is to transfer the blood pressure from the arteries to the veins, and, so soon as this has reached a sufficient degree, dropsy in the form of local _oedema_ commences to appear at whatever may be the most depending part of the body--the instep and ankle in the upright position, the lower part of the back or the lungs if the patient be in bed--and this tends gradually to increase till all the cavities of the body are invaded by the serous accumulation. the diseases of the lungs which produce dropsy are those which obstruct the passage of the blood through them, such as emphysema and fibrosis, and thus act precisely like disease of the heart in transferring the blood pressure from the arteries to the veins, inducing dropsy in exactly a similar manner. the dropsy of renal disease is dependent for the most part on an excess of exudation, due largely to an increase of arterial and cardiac tension. this in its turn produces arterial thickening and cardiac hypertrophy, which, if the case be sufficiently prolonged, brings about a natural removal of the fluid. in kidney cases, in the absence of cardiac disease, the dropsy will be found to appear first about the loose cellular tissue surrounding the eyes, where the vessels, turgid with watery blood, have less efficient support. the dropsy of chlorosis is very similar to renal dropsy, a toxic condition of blood being present in both; also other forms of anaemia, as also hydraemia, tend to produce or assist in the production of dropsical effusions. for the treatment of dropsy the reader is referred to the articles on the several diseases of which it is a symptom. briefly, however, tapping of the abdomen or puncture of the legs are constantly resorted to in severe cases. dehydration by diet is very valuable under certain circumstances when the dropsy is other than renal. and there is the routine treatment by drugs, purgative, diaphoretic and diuretic as the symptoms of the case may demand. it may be well to mention that there are certain affections which may be termed _spurious dropsies_, such as _ovarian dropsy_, which is only a cystic disease of the ovary; _hydrometria_, dropsy of the uterus, due to inflammatory occlusion of the os uteri; _hydronephrosis_, dropsy of the kidney, due to obstruction of the ureter, and subsequent distension of these organs by serous accumulations; other hollow organs may also be similarly affected. having no known relation to the preceding is _epidemic dropsy_, the first recorded outbreak of which occurred in calcutta in the year 1877. it disappeared during the hot weather of the following year, only to recur over a wider area in the cold months of 1878 to 1879, and once again in the cold of 1879 to 1880. since then only isolated cases have been recorded in the immediate neighbourhood of calcutta, though epidemics have broken out in other places both by land and sea. at the end of 1902 an outbreak occurred in the barisal gaol, bengal, in which nearly one-third of the cases ended fatally. dropsy was an invariable feature of the disease, and was either the first symptom or occurred early. the lower limbs were first affected, trunk and upper limbs later in severe cases, the face very rarely. it was accompanied by pyrexia, gastro-enteritis, deep-seated pains in limbs and body, and burning and pricking of the skin. various rashes appeared early in the attack, while eczema, desquamation and even ulceration supervened later. anaemia was very marked, giving rise in mauritius to the name of acute anaemic dropsy. the duration of the disease was very variable, the limits being three weeks and three months. death was often sudden, resulting chiefly from cardiac and respiratory complications. the cause of the disease has remained obscure, but there is reason to suppose that it was originally imported from the madras famine tracts.