DROPSY OR OEDEMA


Under normal conditions there is a physiologic balance between the circulation of blood and the lymph, so that no more fluid exudes into the tissue than it needs; but in diseased conditions this balance is frequently disturbed and the amount of transudate increases in such a manner as to cause the tissue to become distended. This condition is known as dropsy.


Dropsy is chronic effusion of fluid of into the serous cavity. It is the distention of the interstices of the tissues by a clear watery slightly albuminous fluid, closely resembling blood-plasma in composition. Provision is made for its removal from the tissues, after it has fulfiled its purpose, through the lymphatic vessels, which begin as mere clefts and gradually develop into larger and larger vessels, so as top provide a system of tissue drainage.

Under normal conditions there is a physiologic balance between the circulation of blood and the lymph, so that no more fluid exudes into the tissue than it needs; but in diseased conditions this balance is frequently disturbed and the amount of transudate increases in such a manner as to cause the tissue to become distended. This condition is known as dropsy.

Various explanations have been given of the causation of oedema. One of the earliest was that it was due to hydraemia from retention of water which the kidney could not excrete. But marked hydraemia may occur without oedema, and even total anuria need not cause dropsy. The next hypothesis was that the capillary endothelium was damaged by toxins and, therefore, became unduly permeable. But it has been shown experimentally that such damage actually hinders the passage of fluid from the blood to the tissues.

There is more in favour of Widals view that defective elimination of salt by the kidney leads to accumulation of water by raising the osmotic pressure of the tissues. The chief difficulty in this view is that salt retention does not always cause oedema. This discrepancy has been explained by the view that the chlorides may be free or in combination, and that only the former increases osmotic pressure.

There is, however, no evidence of this differential behavior of chlorides. MLean and Russel point out that if water is not eliminated its retention would lower salt concentration, which would lead to retention of salt until the balance was restored. It is obvious, therefore, that the same effect will be produced whether the primary defect in the kidney relates to elimination of salt or water. Yet another explanation that has been advanced is that of Martin Fischer-that there is an acidosis which increases the permeability of the tissues but this has not been confirmed.

An important advance was made when Epstein showed that a feature peculiar to chronic Parenchymatous Nephritis was a great reduction in the protein content of the blood and exudates, almost entirely affecting the albumin, so that amount of globulin is always increased relatively and sometimes absolutely. In chronic Interstitial Nephritis, on the other hand, while the residual Nitrogen fluctuates considerably, there is no change in the protein composition of the serum. In chronic PArenchymatous Nephritis the daily drain on the protein may even amount to 10 per cent of the total protein in the blood.

This causes a fall in the osmotic pressure of the blood, giving the tissues the controlling power to absorb and retain fluid. In support of this view it may be mentioned that the oedema produced in perfusion experiments with normal saline or Rigers solution is prevented by the addition to the perfusing fluid of colloids which are in osmotic equilibrium with the colloids of the lymph and tissues. Salt retention and protein depletion are probably the most important causes of oedema in Nephritis; in different cases either may be the predominant factor.

From the pathological point of view the cause of oedema may result from three different conditions.

I. Increased transudation from the blood.

II. Impeded removal of fluid from the tissues.

III. Change in the chemical composition of tissue juices.

INCREASED TRANSUDATION FROM BLOOD,

may be caused by:.

(a) Hyperaemia-Active hyperaemia cause oedema because of the increased blood-pressure and associated increased transudation. It more commonly occurs in passive hyperaemia.

(b) Changes in the quality of blood. This condition may permit a greater amount of transudate than normal and so cause oedema. Such hydraemia is seen in diseases of kidney, where the retained water passes through the blood vessel walls into the tissues.

(c) Changes in the walls of the blood vessels- Dropsy is seen in cases with malnutrition of the blood vessel walls.

(d) Change in vascular innervation. This is best illustrated by the angioneurotic local oedemas occurring from dietetic errors.

II. IMPEDED REMOVAL OF FLUID

from the tissues, because of obstruction or inefficient action of veins and lymphatics..

(a) Obstruction of the lymphatics is rarely followed by dropsy.

(b) Obstruction in the veins is one of the most important mechanical causes of dropsy.

III. CHANGES IN THE CHEMICAL COMPOSITION OF TISSUE JUICE.

Fischer regards it as essentially depending upon variations in the water absorbing capacity of colloids, depending upon variations in the chemical reaction of the tissue juice.

A close student of the medical journals of the old school of medicine cannot fail to notice a bewildering mass of evidence, each of which very often conflicts with the other. Yesterday, it was the perfidious Bacillus which was the root of all diseases. To-day it is the disturbance in the endocrine system. To-morrow it is just possible that changes in blood-alkalinity will be alone held responsible for all our troubles.

They are never sure about their truths, and are constantly shifting ground, even in such important matter as the origin of diseases. The Ayurveda, on the other hand, has stated, once for all that that is impropriety of food and conduct and not bacteria, always starts the train of disturbances and finally develops into a disease.

Latest advances in Blood-chemistry have proved that diseases cannot be produced without variations in the P.H. ion concentration in the blood. If this means anything, it means that bacteria cannot invade the human system, if the P. H. ion remains unchanged, a statement that agrees closely with Charaks dictum. It in only when the P.H. ion is changes, that bacteria can invade the system, or they are already present they can cause disease and that the root cause of disease is to be sought for elsewhere.

As an instance of the shameless changing of theories we may mention here the attitude of the old school about giving salt in Anasarcal conditions. Old students of the Calcutta Medical College will remember the cheap sneer at Ayurveda College will remember the cheap sneer at Ayurveda, of some of the distinguished clinical teachers there, for advising the withdrawal of common salt from the dietary in Dropsy cases.

The doctors extolled the diuretic virtues of salt, and advised giving salt in more than normal quantities, to promote diuresis and lessen the Anasarca, in sublime oblivion of the fact that their colossal ignorance and conceit could not but hasten the unhappy patients to their graves. The professors laughed at the absurdity of Ayurveda. Unfortunately for scientific medicine, however, the discovery of Widal and Javal about the effects of retained chlorides filtered into India in the late nineties.

The exponents of scientific medicine had to make a volte-face and this they did with the same self-complacency as before. Nothing daunted, the professors then began to teach that oedema was due to sodium chloride retention and advised the withdrawal of salt from dietary, in Anasarcal conditions. The past was quickly forgotten and the Western system was still looked upon as the exclusive repository of scientific wisdom, and poor Ayurveda still continued to be condemned light-heartedly as nothing but unscientific.

This is not the place for a complete vindication of Ayurveda and Homoeopathy which can with-stand and have withstood the uninformed and prejudiced criticisms of those whose only passport is their ignorance, pure and absolute, of the merest elements of Ayurveda or Homoeopathy, and the day is not distant when Homoeopathy and Ayurveda will outgrow the determined opposition of the dominant school.

The conceptions of diseases in Homoeopathy are as unchanging as those of the Ayurvedic system and they are too well known to the readers to be repeated here. It will not be quite out of place to say a few words on the origin of disease according to the Ayurvedic school.

Life according to Ayurveda is maintained by (Vayu) or air, (Pitta) or fire and (Kapha) or water, which are therefore the fundamental constituents of the human body. any deviation of these fundamental constituents from their normal state gives rise to diseases, and so long as these remain normal, there can be no disease. So long as the three elemental principles, Vayu, Pitta and Kapha remain in their normal state inspite of disturbing causes so long does the human body continue in perfect health.

If the three elemental principles are strong enough to tide over an invasion, however powerful, without any evil consequences, the human body must be free from all diseases and must enjoy perfect health. But as soon as any one of these three fundamental constituents deviates from its normal condition, illness appears, the intensity of which is to be measured only by the extent of deviation.

The disturbance of Vayu, Pitta and Kapha depends primarily on — or the Law of Karma. This is not the place to go at any length into the mysteries of this mysterious universe. To confine ourselves strictly to the barest requirements of Ayurveda,– or the Principle of contradiction gives rise to — or confusion, Moha to — or egoism, Ahankar to Karmaphal or the Law of Karma or Law of Action which lays down that as you sow, so must you reap. Action can be destroyed only by experience or suffering or –. Action accumulates much faster than it can be destroyed by experience. Accumulated action is called — . The very small portion of it under the influence of which a man is born, is called his —.

Diseases spring really from this — and from mans action if this life which is called in Ayurveda — — or improper food and conduct. It is this — which exerts a supreme influence on the three elemental principle of –, — and — and explains why in some cases they can defy the strongest invasion. The chain of causation begins with God, the Ultimate Cause, and passes from egoism to the Law of Karma, from the law of Karma to Prarabdha or allotted effects, from Prarabdha to the fundamental constituents of –, — and –, and finally from these fundamental constituents to — — or improper food and conduct.

D C Das Gupta