A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
The dropsy in many cases will vary in amount, and even disappear at
times without any treatment. It is regularly most marked with the large
white kidneys and with those kidneys which are neither large white nor
atrophied, especially when there is complicating heart disease and the
patient is anæmic. Generally speaking, it is best to keep dropsical
patients in bed most of the day. We attempt to get rid of the oedema by
the skin, the bowels, and the kidneys, to regulate the heart's action,
and to improve the condition of the blood. Hot-air baths or hot-water
baths repeated every day, the milder hydragogue cathartics, and the
different diuretics may all be used with advantage. If the dropsy is
excessive, it may be necessary to tap the peritoneal or pleural
cavities or to puncture the skin of the legs and scrotum. Sometimes
bandaging the legs so as to exert moderate pressure seems to assist in
getting rid of dropsy. To regulate the heart's action we find that
digitalis, convallaria, and the iodide of potash are often of service.
To improve the condition of the blood the systematic use of iron and
oxygen is indicated. The most hopeless cases are those in which there
is complicating heart disease and those in which the dropsy steadily
increases, although the patient is passing from 60 to 100 ounces of
urine daily.
Disturbances of the stomach are of different kinds and dependent upon
different conditions. There may be simply loss of appetite or
discomfort after eating, or nausea, flatulence, and vomiting; and these
symptoms will be associated with chronic catarrhal gastritis or with a
stomach that is anatomically normal. Sometimes, although there is
occasional nausea and vomiting, the appetite continues good, or as part
of an uræmic attack there will be constant vomiting.
The habitual dyspeptic disturbances are to be treated like other cases
of gastric dyspepsia. A regulated diet, the vegetable bitters, the
mineral acids, or the alkalies are sometimes of service. The repeated
and persistent vomiting of uræmic attacks is a most distressing symptom
and one often very difficult to control. The patients must be fed with
small quantities of fluid food or of prepared meat. The most efficient
remedies are those addressed to the condition of the circulation.
Hypodermic injections of morphia, enemata of chloral hydrate,
inhalations of nitrite of amyl, convallaria in small doses by the
mouth, are all of service.
The anæmia from which the patients suffer is to be combated by the
systematic use of iron and oxygen. Any efficient preparation of iron
will answer, but it must often be given in considerable doses.
Sometimes the bichloride of mercury in small doses answers better than
iron. The oxygen should be inhaled for from five to thirty minutes
twice a day.
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