A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
Dropsy arises when the transudation is accumulated. As dropsical
accumulations are transudations from the blood, essentially
blood-serum with a diminished percentage of albumen, and as such
blood-serum is practically lymph from its presence in the
lymph-vessels, dropsical effusions are to be regarded as stagnant
lymph. Such stagnations may be present in the small lymph-spaces
within the connective tissue, or in the larger lymph-sacs, as the
peritoneal, pleural, pericardial, and scrotal cavities. In like
manner, the stagnation may take place in the cavities of joints and in
those of the brain and cord, although the latter represent functional
rather than structural lymph-canals.
The term oedema is applied to the accumulation in the
connective-tissue lymph-spaces in general, while the term anasarca is
confined to those cases where the subcutaneous lymph-spaces are
concerned. The accumulation in the great lymph-cavities is known as
ascites when peritoneal, hydrothorax when pleural, hydropericardium
when pericardial, hydrocele when in the cavity of the tunica
vaginalis, hydrocephalus if within the ventricles of the brain, and
hydromyelocele when within the central canal of the spinal cord.
The accumulation of dropsical effusions may be considered as possibly
resulting from an obstruction to the channels through which the
transudation should flow, or from insufficient force to overcome
normal obstructions, or from an abnormally increased transudation.
Lymph-channels are frequently obstructed, but no appreciable diffused
retention of lymph results unless the thoracic duct is obstructed.
This rare affection is followed by enormous distension of the thoracic
and abdominal portions of the parts beyond the stenosis. Ascites and
hydrothorax may follow, but not necessarily any considerable oedema of
the peripheral parts of the body. As a result of the distension of the
thoracic duct, rupture is not unlikely to take place, and the effused
fluid contains chyle.[26]
[Footnote 26: Quincke, _Deutsches Archiv für Klin. Med._, 1875, xvi.
121.]
{70} That the obstruction is not followed by oedema is attributable to
the innumerable anastomoses between the lymph-spaces, and also to the
probability that a part of the transuded fluid returns to the
blood-vessels when the obstruction is impassable.
The forces necessary to promote the flow of lymph have already been
mentioned, and their entire removal is inconsistent with life. A
diminution of their activity is more likely to result in a diminished
flow of lymph than its accumulation, although a slowing of the
lymph-current may represent a favoring element in the accumulation of
an increased transudation.
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