Excerpt from The Medical News, Vol. 35
Thus it may be convenient to mention, as the first group, cases in which slight passive dropsy occurs in connection with mere debility. This is common enough, and especially so in the aged and in those whose occupations compel them to remain for long periods standing. Although often unattended by any discoverable disease either in heart or kidneys, its occurrence of course always suggests an examination of those organs.
In the second group we may place cases in which the ?dema is due to positive impediment in the heart. In these it will almost always be confined at first to the feet and legs, and it will be purely passive - that is, unattended by any inflammatory induration of the parts affected.
In the third group ?dema from disease of the kidneys may be placed; and of these cases we may remark that not unfrequently from the first there is swelling of other parts - the eyelids, backs of hands, etc., and very frequently dropsy of the serous cavities.
Of the three forms of ?dema just mentioned, it may be said that they are almost always symmetrical and of nearly equal severity in the two limbs. Those which are to follow, however, do not observe this rule, and although any one of them may affect both legs, it is far more common in most of them to observe the symptom on one side only. This onesidedness, of course, attracts our attention to a local cause.
In the fourth group we may include all cases in which the ?dema is due to mechanical obstacle to the return of venous blood. The commonest example of this class is in the instance of pregnant women in whom the weight of the uterus, pressing upon the iliac veins of one or both sides, very frequently causes what we may suitably call venous ?dema of one or both legs. Ovarian tumours, or any other kind of tumour in the abdomen, may produce similar results. And let me here remark that it is by no means certain that the swelling in these cases will wholly disappear when the cause is removed; for not very unfrequently we observe cases in which repeated pregnancies have at length induced a condition of permanent dilatation of the veins with swelling of the feet. The risk of the ?dema becoming permanent is, however, far less than in certain cases which I shall have to mention presently in which local inflammation occupies the chief place as a cause.
In the fifth group we will place all cases in which there is actual disease of the venous trunks. In cases of phlebitis of the main vein of the limb you have seen the extremity become suddenly much swollen and ?dematous, and in such cases the ?dema will always be, both as regards its extent and its permanence, in relation with its cause. In plugging of superficial veins, we rarely observe any great amount of ?dema, and the same remark is true of the numerous cases in which the superficial veins become entirely disabled by varicose dilatation. In these cases the deeper trunks are efficient to carry on the circulation. In connection with this group I must mention the disease known as phlegmasia dolens, which has by many been associated, and perhaps correctly in some cases, with venous occlusion. I find it difficult, however, to believe that plugging of veins is the usual cause of this affection; for, if it were, the deep veins would often be obliterated, and the result would be compensatory enlargement of the superficial ones. The phenomena of phlegmasia dolens are far more like those of lymphatic than venous obstruction, and it ought probably to be included in our next group.
The sixth group shall include those cases in which the ?dema is wholly or chiefly due to lymphatic obstruction. So little has as yet been made out as to the pathology of the lymphatic system, and so few are our opportunities of post mortem examination in this direction, that we are obliged to be somewhat less certain in our statements regarding this group than in any other. I. Это и многое другое вы найдете в книге The Medical News, Vol. 35 (Classic Reprint)