A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.
- Austin Flint I
- Date:
- 1884
Licence: Public Domain Mark
Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![return-flow of blood from the vente cava?, produce general dropsy when the hindrance is suificiently great. General dropsy is characterized by anasarca and transudations into the serous sacs. Tlie most fi-equent and important of the mechanical causes of general dropsy is cardiac diseat^e. The mechanical causes of local dropsy are those of venous hyperiemia, which have already been mentioned. The most important of the local dropsies is hydro-perito- neum or ascites dependent upon obstruction of the vena portie. Thrombosis of the portal vein (pyle-thrombosis) and certain hepatic diseases, especially cirrhosis, cause portal obstruction with ascites. It is noteworthy, that, while venous hyperajmia, which is attended by in- creased blood pressure and retardation of the circulation, is ibllowed by dropsy, simple, active hypercemia, wliich is accompanied by increased pressure and velocity of the blood-current, does not lead to inci'eased transudation. Gene- ral dropsy, due to a morbid condition of the blood, in the majority of cases is connected with those affections ot the kidney embraced under the name Bright's disease. The hydremia, which results from the excretion of albu- men by the urine in this disease, is not the immediate cause of the dro[»sy, but it induces in the vascular Avails a change Avliich renders them more per- meable. That hydrtemia is, not an immediate but an indirect, cause of dropsy, has been demonstrated by the experiments of Cohnheim and Litten,* who found that when the vascular walls are healthy, large quantities of dilute solu- tion of common salt can be injected into the vessels of animals without caus- ing increased transudation in tlie situations in which dro[)sy occurs in man. Other cacliexia3, especially the cancerous and the tuberculous, may be attended by hydraimic di'opsy, although this is usually less in degree than that of Bright's disease. Some etfusions, which have been regarded as dropsical, are really inflammatory in their origin, that is, due to an inflammatory alteration in the coats of the vessels. This is usually true of the so-called collateral oedema, that is, the oedema in the neighborhood of inflammatory infiltrations, tumors, etc. It is also true of oedema glottidis, and many cases of hydrocele and hydrocephalus. Exudation —Inflammation. The distinctions between an exudation and a transudation have been already mentioned, as well as the difficulty of enforcing them in all cases. The lead- ing characteristic of an exudation is, that it is a product of inflammation, a process to be considered in this connection. According to the classical definition of inflammation, a part is acutely in- flamed when it is hot, red, swollen, and ])ainful. But tliis enumeration of the four cardinal symptoms (calor, rubor, tumor, dolor) gives no information as to the pathological nature of the process. No topic in medicine has been the subject of so much research and speculation as the nature of inflammation, but, even at the present time, it is impossible to give a eomjdete and correct definition of inflammation from a pathological or an etiological stand})oint. From the earliest times two opposing theories regarding the process of inflam- mation have been held. According to the one, the essential phenomons, in inflammation are referable to the blood and to the bloodvessels; accord- ing to the other, the essential changes are in the solid tissues outside of the bloodvessels. A great advocate of the former theory was John Hunter. Re- cently it has been developed especially by Cohnheim. Virchow, on the other hand, rejecting the Hunterian doctrine, maintained that the primary and chief effect of an inflammatory irritant is tlie excitation of the cells of a part to ' Cohnheim mid Litteii, Vircliow's Archiv, Bd. 69, 1877.](https://iiif.wellcomecollection.org/image/b21198135_0045.jp2/full/800%2C/0/default.jpg)
