Oedema

“ As in the case of passive congestion of the lungs, so in oedema, advantage may be gained by changing the patient's position from time to time, so as to prevent the constant gravitation of fluid to the same portion of the affected organs. ”

“ When the ary-epiglottic folds are the seat of the oedema, the patient experiences either suddenly or gradually a difficulty of inspiration, while the expiration may be at first unimpaired, and with increasing sensation of constriction of the throat or of the presence of a foreign body, hoarseness, and stridor, but often without dysphagia, the most threatening paroxysms of suffocation supervene. ”

“ This pulmonary oedema, when it attacks the sound side, is acute, being produced by rapid pulmonary congestion, which causes free, albuminoid, and frothy expectoration, often ending in asphyxia. The serum and albumen of the blood by transudation pass into the bronchi and the alveoli, and fill them more rapidly than they can be expectorated: the subject dies by suffocation. Auscultation reveals fine vesicular râles, characteristic of oedema of the lungs, closely resembling the fine crepitation of pneumonia. Traube has named this oedema pneumonia serosa. ”

“ In acute purulent pleurisy the diagnosis is most difficult, especially at an early period, because the general symptoms and the local signs resemble closely those of ordinary pleurisy. When, however, the disease is further advanced, and we have the earthy aspect of countenance with oedema of the thoracic walls, we can be nearly positive in our opinion. Moutard-Martin117 speaks of this localized oedema at the level of the fluid as a certain indication of the purulent character of the fluid. ”

“ Another cause of pulmonary oedema is obstruction of the circulation of a part of a lung, such as may take place in pneumonia or miliary tuberculosis, the vessels of other parts becoming distended by backward pressure, so that the serum of the blood will exude into the air-cells or interstitial tissue. ”

“ The more rapidly the obstructing thrombus extends, the earlier and more extreme is the oedema likely to become, while the slower the advance of the thrombus, the more favorable is the opportunity for an enlargement of the collateral vessels through which a sufficient flow of blood is permitted to check oedema and preserve nutrition. ”

“ Pulmonary oedema is never a primary affection, but is always due to some preceding disease. In the first place, it may, as already stated, take its origin directly from congestion of the lungs, the walls of the obstructed vessels allowing the transudation of serum, which will collect in the air-cells and connective tissue and also in the mucous membrane of the terminal bronchi. In an early stage it may be present in the walls only of the alveoli without being effused into their cavities. ”

“ Later in the disease fatty casts are also present.
The patient soon develops dropsy, the extent of which varies in the different cases. Sometimes it involves only the face, sometimes the hands and feet, or there may be general subcutaneous oedema, serum in the serous cavities, oedema of the lungs and of the glottis. The patients lose their appetite; often there are nausea and vomiting. As a rule, there are cerebral symptoms—headache, drowsiness, stupor, delirium, muscular twitchings, convulsions, and coma. ”

“ Oedema is local watery effusion, which may have various causes and significance. Anasarca must have a general causation, either connected with the state of the blood or with disorder of the heart, kidneys, or liver, or of more than one of those organs at once. Pitting on pressure is the sign of watery effusion. Soft crackling under the touch distinguishes emphysema. A firm enlargement of the surface of the face and upper part of the body occurs in myxoedema. ”

“ The congested parts of the lungs are very dark in color, in some cases almost black; blood flows freely from a section through them, and serum exudes from the alveoli and interstitial tissue when oedema exists. If the altered condition of the lung has lasted for some time, the texture of the affected part may be so firm as to resemble that of the spleen ”

“ If extensive pulmonary oedema occurs, dry cups applied to the chest will afford relief to the dyspnoea and temporarily remove the oedema.
It has come to be a quite universal practice in this city to encase the chest in a layer of cotton batting or flannel covered with an oil-silk jacket. While this procedure has no direct influence on the course of the pneumonia, it promotes diaphoresis and protects the surface from sudden changes of temperature, and is always grateful to the patient. It is especially serviceable in children. ”

“ Serum is effused into the areolar tissue of the softer swelling at the circumference.
ŒDEMA, DROPSY, ANASARCA. Even under moderate inflammation some amount of effusion takes place into the texture or from the surface of a part. This effusive serous fluid called also serosity, resembles and probably is the scrum of the blood. When this passes into the areolar structure of a part it is called œdema, (though this is not always by inflammation) and if the serosity passes out extensively over the body, the disease is called anasarca or general dropsy. ”

“ When acute oedema of the lungs is due to Bright's disease in the acute or one of the chronic forms, it is often quickly fatal, though if properly treated it may disappear. When a consequence of chronic renal disease it is apt sooner or later to return. Chronic passive hyperæmia and chronic oedema of the lungs admit of only temporary relief, because they are occasioned by such diseases of the heart or kidneys as are themselves generally incurable ”

“ In infraglottic oedema, which is exceedingly rare and chronic in nature, there is steadily increasing dyspnoea, wheezing, cough, and abundant expectoration.
In acute cases of supraglottic and epiglottic oedema the suffocative paroxysms may last several minutes, and recur at irregular intervals of a few hours with increased intensity. If not relieved, patients become wildly excited or terror-stricken; they may throw the chest forward, open the mouth, grasp the throat outside or thrust their hands into it, and make convulsive movements in their struggles for breath ”

“ The disease may be acute or chronic, usually the latter. A portion or almost the entire surface may be involved, or it may occupy variously sized and shaped areas. The integument becomes more or less rigid and indurated, hard to the touch, hide-bound, and in marked cases immobile. Œdema may, especially in the more acute cases, precede the induration. Pigmentation, of a yellowish or brownish color, is often a precursory and accompanying symptom. The skin feels tight and contracted, and in some instances numbness and cramp-like pains are complained of. ”

“ The child is much dwarfed, the fingers and toes are short and stumpy, the cutaneous tissues seem to be thick and boggy, but do not pit on pressure, as in ordinary oedema. The facies is extremely characteristic. ”

“ The first symptom is usually a swelling of the joint and its vicinity. There is no redness or heat and no pain on movement. The peri-articular swelling, unlike ordinary oedema, scarcely pits even on firm pressure. ”

“ Oedema of genital regions is less marked than in nephritis or cardiac disease. We may also have localized areas of oedema 3 or 4 inches in diameter.
Ship beriberi, which has points in common with both beriberi and scurvy, shows oedema which may be limited to the lower extremities [556] or generalized. Epidemic dropsy is a type of beriberi in which there are fever and an erythema over the dropsical areas.
Calabar Swellings.—These seem connected with infections with Filaria loa. The swellings originate suddenly and disappear in three or four days. They are hard and do not pit on pressure. ”

“ Sometimes the hyperæmia resulting from vaso-motor paralysis is more persistent, and is associated with swelling of the parts from œdema—the so-called angio-neurotic œdema. The vascularity varies with external influences, and in cold weather the parts present a bluish appearance.
Trophic Phenomena.—Owing to the disappearance of the subcutaneous fat, the skin is smooth and thin, and may be abnormally dry. The hair is harsh, dry, and easily shed. The nails become brittle and furrowed, or thick and curved, and the ends of the fingers become club-shaped. ”

“ Anamnesis, ætiology, and present state, albumen in the urine, justified the diagnosis. Patient is pale, bloated, œdema pedum, no appetite, white tongue, thin feverish pulse, swollen spleen, watery diarrhœa alternating with constipation. Every drug produced vomiting, and he perfectly abhorred the old Quinine powders. I ordered four drops Arsen. brom. and a full meat diet. Improvement followed with the continuance of the treatment. After three weeks the spleen was reduced in size, his face showed better color, hardly any œdema. ”

“ The symptoms of œdema come on gradually in some cases, in others with alarming rapidity. They often follow ulcerations of the soft palate, and of the root of the tongue, as shown in treating of diseases of that organ, occurring on the patient being exposed to cold or moisture, or supervening rapidly when discharge from the ulcerations is by any accident suddenly suppressed. The difficult breathing, with cough and violent attempts at expectoration, takes place in paroxysms, and often to so alarming a degree as to threaten immediate suffocation, especially during the night. ”

“ All parts of the skin and subcutaneous connective-tissue are hypertrophied, the lymphatic glands are swollen, the lymph channels and bloodvessels enlarged, and there is more or less inflammation, with œdema. Secondarily, from pressure, atrophy and destruction of the skin-glands, and atrophic degeneration of the fat and muscles result. ”

“ Oedema of the lower extremities (of the left extremity in cancer of the sigmoid flexure) will often be observed as a result of the interference of the cancerous mass with the return of blood from the extremities by pressure upon the large veins. The combination of pain, tumor, constipation, tympanitis, progressive wasting, and the cachexia that sooner or later supervenes, stamps eventually most cases with unmistakable characters. ”

“ There is frequently oedema about the ankles. In the jejunum we find small haemorrhagic spots from the size of a pea to that of a half dollar. A worm may be found in the center of this spot. In sections from the tissues injured by the bite we note an infiltration of eosinophiles. The heart often shows fatty degeneration with dilatation. The liver and kidneys usually show fatty change while the spleen is generally shrunken. Sandwith noted splenic enlargement in many of his autopsies but such enlargement must have been due to other causes. ”

“ Glottic oedema occurs extremely seldom, but the designation oedema glottidis is often used, no matter what portion of the larynx is affected. Laryngeal oedema usually affects both sides; occasionally one side more than the other, still more rarely one side exclusively. ”

“ There is also a hemorrhagic inflammation of the liver; and oedema and congestion of the brain, with or without apoplexy, are other symptoms of the disease. There are other lesions, but the chief are in the kidneys, liver, and brain.
The aetiology of the disease is not yet known, and there are very many theories offered to explain it. The prognosis is always serious, and the condition is one of the most dangerous found in pregnancy. The mortality varies, but it is about from 20 to 25 per centum in the women, and from 33 to 50 per centum in the children. ”

“ Another characteristic feature of the disease, probably sooner or later present in every case, is the œdema which occurs in the parts most affected, especially in the lower extremities. It is persistent œdema, and results in an elephantiasis-like condition. It is well marked in the left foot and ankle of our case. The striking blue or purple colour of the small nodules (which is absent in the pendulous tumours) seems, as in other cases, to be due to the venous blood contained in the blood-vessels or extravasated. What pigment there is 139in the growths is probably derived from blood. ”

“ Non-inflammatory collections of fluid also occur in general œdema. In these conditions the pleuræ are not cloudy or dull, while in the case of inflammation the pleural surfaces are dry, cloudy, dull-shining, injected, rough or covered with fibrinous or purulent exudate. ”

“ Chronic Oedema of the Leg.—In some cases there is a distinct swelling of the leg some time after the operation. This exposes the limb to the infliction of sores from striking with the opposite foot, with, of course, the difficulty in healing we have just described.
Persistent Pruritus.—This annoying sequel occurs in the neurectomized limb, with or without gelatinous degeneration, and appears to be without a remedy. The itching in some cases is so intense as to lead the animal to constantly gnaw at the top of the foot. ”

“ They are in general all those that are agreeable to the Oedema, which are variously us'd, as Liniments, Fomentations, Cataplasms, and Plaisters: Internal Medicines ought also to be much consider'd, as Diaphoreticks, Sudorificks, and Purgatives, when they are assisted by a regular Diet. ”

“ Thus any organic lesion which may produce oedema and malnutrition of the cutis and epidermis as in kidney diseases, any condition of imperfect metabolism as in dyspepsia or malnutrition, or seborrhoea, may be the predisposing cause. ”