The clinical causes of oedema may be due to the following conditions:–.
(a) Those due to cardiac insufficiency– here the dropsy starts and predominates in the most dependent parts, that is, in the feet and ankles, and on the back if the patient has been lying in bed.
(b) Dropsy due to hepatic diseases– always begins and predominates in the abdomen although the legs may subsequently swell by reason of pressure of the fluid on the veins in the abdominal cavity.
(c) Dropsy due to renal diseases– starts at eye lid and face and are general in distribution.
(d) Besides these some swelling of the ankles at the end of the day is seen in Anaemia.
(e) Pressure upon the veins or lymphatics from a gravid uterus, abdominal tumour cause oedema.
(f) Epidemic dropsy and Beri-Beri cause oedema of legs.
The treatment of dropsy comes under two heads medicinal and dietetic.
The drugs most useful are:–.
Acetic Acid; Antim Tart; Apis Mel; Apocyn. can; Arsenic alb; Asparagus; Aurum met; Baryta c; Bryonia alb; Camphor; Cantharis; Carbo veg; Chimaphila; China; Chelidonium; Colchicum; Conium mac; Digitalis; Dulcamara; Erigeron; Ferrum met; Fluor. Ac; Helleborus; Helonias; Hep. sulph; Hyosc; Iris v; Kali c; Kalmia; Lact ac; Lachesis; Ledum; Leptandra; Lycopodium; Merc sol; Mur ac; Natr mur; Phos; Ran. bulb; Rhus t; Sabadilla; Sabina; Sambucus; Squill; Silicea; Sulph; Terebinth; Verat vir; Zinc met.
These drugs may be grouped into three different classes (i) those from animal sources (ii) those from vegetable kingdom (iii) those derived from chemicals or minerals.
In the above list of drugs only three drugs are taken from the animal kingdom Apis and Cantharis belong to the class Insecta and Lachesis belongs to Reptilia. Nothing can be drawn from this classification of these three drugs.
Of the drugs derived from Vegetable kingdom, which are 26 in number we find that all of them belong to different Natural Orders except 12. These 12 drugs come under 4 Natural Orders.
(a) Liliacea. Asparagus, Helonias, Sabadilla, Squill, Veratrum vir.
(b) Ericacea. Chimaphila, Kalmia, Ledum, Pal.
(c) Scrophulariacea. Digitalis, Leptandra.
(d) Solanaceae. Dulcamara, Hyoscyamus.
Even from such a classification we cannot find any light leading to the therapeutic value of these drugs. There is hardly anything common in them some grow in meadows, some are wild, others are cultivated and still others grow in damp places or mountain regions.
The drugs taken from chemical or mineral sources show no brighter picture from such point of view and we are thus obliged to gather the therapeutic value either from the provings or experience by clinical uses of from both.
From my personal experience in a large number of cases I have found that whatever may be the cause and whatever may be the symptoms, unless some other remedy is very strongly indicated or there is some very special indication, the patient should be given Lycopodium.
After taking 2 or 3 doses of Lycopodium 30, if the patient seems to improve, wait and watch the result. Do not give any more medicine if there is sufficient improvement and allow the action to continue. If there is not improvement or the improvement be very slight, Apis should be given. If the trouble still persists, Ars. a. should then be given. The additional indications for these three main remedies are given below.
Lycopodium will suit cases whether arising from cardiac, renal or liver troubles. Dropsy is prominent particularly in the lower half in the body; urine scanty; hypertrophy of the heart and dyspnoea, worse when lying on back or from motion. The swollen legs are covered with ulcers from which serum continually oozes this condition is seen in two other drugs, namely Rhus tox and Arsenic alb.
Apis mel will be more suited to cases of renal and cardiac origin. The urine is scanty, albuminous, and full of casts; swelling about the eyelids; feet oedematous; great ascites with great soreness of abdominal walls; great dyspnoea, cannot get breath except when sitting up; absence of thirst;, the surface of the body feels sore and bruised, in some cases the pain is of burning character; pale waxen skin; eruption resembling nettle- rash, red pimples or erysipelatous rosy appearance of the anasarcous limbs.
Arsenic alb. has been useful for conditions arising from cardiac, liver or kidney disorder. It has been named the great medicinal trocar. The urine is dark, casts abundant; Dyspnoea worse when lying down; oedema of face and of the lower extremities; eating and drinking cause vomiting. “The oedema of Arsenic is more or less general beginning with puffiness of the eyes and swelling of the feet and ending in general anasarca.”
“There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally the patient is burning hot.” “Little blisters form in the oedematous legs and these burst and serum oozes forth. The skin itself is rather tense and has a pale waxen hue.” Farrington differentiates Apis and Arsenic alb. as follows: Arsenic a. has the same transparency of the skin, and is also of use in dropsies of renal, cardiac or hepatic origin.
The difference between the two remedies are these; Arsenic has intolerable thirst, but the patient usually drinks only a small quantity at a time, because water annoys the stomach. Eating and drinking both cause vomiting. The patient exhibits marked restlessness. But the real difference between the Apis and Arsenic is one of degree. Arsenic is more deeper in action and hence indicated in more advanced cases and the Arsenic patient always presents more irritability of fibre. Both Arsenic and Lycopodium can be used before and after Apis; Lycopodium can be used both before and after Arsenic.
The next group of remedies are Apocyn c., Aur. met., China., Digitalis, Hellebore, Sulph. The value of these remedies is more or less as palliatives. Apocyn c. has sluggishness of all functions and there is great debility. There is a sense of oppression in epigastrium and chest; fluttering of heart; pulse irregular and intermittent, and sometimes extremely feeble; the stomach is in an irritable state, so that he cannot retain any food, not even water. Apocyn, can. will be more suitable for the cardiac than the renal cases.
FARRINGTON says that it is much used for general dropsies, swelling of any part of the body, ascites, hydrothorax, etc. usually without any organic disease as cause. Apocyn. can. should be used in the mother tincture, and it is better that it should be freshly prepared. Aurum met. is useful in cases from cardiac and hepatic troubles, specially with cirrhosis of liver; there is fatty degeneration of heart.
China should be thought of where there is much drain on the system; history of anaemia or excesses; in drunkards; old people and cases connected with liver troubles. Digitalis for cardiac cases; heart weak and irregular; cyanosis; doughy swelling of the abdomen; scanty albuminous urine; characteristic slow pulse which may be even slower than the beating of the heart; there may be a cold sweat on the surface of the body.
Helleborus should be remembered in dropsies and ascites following intermittent fever in scrofulous children; in acute cases specially after specific infectious diseases; great debility; urine, scanty, albuminous and with casts; difficulty of breathing the patient breathes easier when lying down. Sulphur should always be remembered as a great absorber of fluids.
The third set of remedies are Acetic ac., Asparagus, Bryonia, Cantharis, Chelidonium, Colchicum, Dulcamara, and Flouric acid. Great emaciation and prominent gastric symptoms are the leading factors in the selection of Acetic ac. in cases of dropsy. Its position is somewhat between Apis and Arsenic a. It is useful when the face and limbs have a wax-like appearance; it is specially indicated when the abdomen is belching, water-brash, diarrhoea; thirst is present ( absent in Apis). Asparagus suits old people with weak pulse and pain about the left acromion. Bryonia may be useful after specific infectious diseases; the oedema increases by day, becomes less at night; great thirst and scanty urine. Cantharis, dropsy from atony of urinary organs; painful urination and great emaciation.
The following case of ascites was cured by Hempel with Chelidonium. A boy was attacked with light yellow, watery diarrhoea, in few days ascites, supervened. Complexion very pale and sallow; urine scanty, light, yellow, clear and sour; palms of hands looked remarkably yellow. Chelidonium cured him in a week.
Colchicum acute case in connection with renal affections; it is indicated in dropsy with suppression of urine; the urine is scanty and contains blood and albumen; there is constant urging to urinate but little is voided. Dulcamara is useful for sudden anasarca after exposure to cold or after drenching. Flouric acid, after abuse of alcohol; general emaciation; genitals terribly swollen; great oedema of lower limbs from feet to abdomen.
Coming to the dietetic portion of the treatment of cases of dropsy we find that almost all the schools of treatment agree in giving a salt-free diet. The allowance of salt in the diet should depend on the amount of chlorides retained. More energetic physicians withhold water altogether and give milk instead. Though this practice is extremely hard on patients, yet when pursued, often leads to excellent results.
It is more prudent to follow a middle course, that is, to allow water very sparingly. Milk with well-boiled old rice and Man manda [Man manda is prepared by cooking together the powdered meal of root-stalk of Alocasia Indica (great-leaved Caladium) 9 tolas, powdered rice 18 tolas, milk and water 48 tolas each, boiled till the water is evaporated. No other diet except milk is allowed. Ed] form traditional articles of diet in cases of dropsy.
The bowels should be kept clean and steps should be taken to ensure free drainage of urine. Cold and chill should be strictly avoided.