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Updated: July 3, 2025
The right arm healed, but the left showed erysipelatous inflammation, culminating in edema, which affected the glottis to such an extent that tracheotomy was performed to save her life. Five weeks after convalescence, during which her conduct was exemplary, she again cut her arms in the same place.
When compensation fails with these patients, the first sign is pendent edema of the feet, ankles and legs; subsequently, if there is progressive failure of compensation, the usual symptoms occur. The treatment is principally rest and digitalis, and the recovery of compensation is often almost phenomenal.
Dauboeuf, Garraway, Hemming, Skinner, and Cobner mention roseola and scarlatiniform erythema after minute doses of quinin. In nearly all these cases the accompanying symptoms were different. Heusinger speaks of a lady who, after taking 1/2 grain of quinin, experienced headache, nausea, intense burning, and edema, together with nodular erythema on the eyelids, cheeks, and portion of the forehead.
When an otherwise apparently well person begins to complain of weariness, or perhaps drowsiness in the daytime and sleeplessness at night, or his sleep is disturbed, or be has feelings of mental depression, or he says that he "senses" his heart, perhaps for the first time in his life, with or without edema of the feet and legs, or pains referred to the heart or heart region, we should presuppose that there is weakening of the heart muscle until, by perfect examination, we have excluded the heart as being the cause of such disturbance.
It is of value if there is edema in nephritis; it is of doubtful value in heart disease; it is rarely of value in diabetes insipidus; and in epilepsy its value consists probably in allowing the bromid that may be administered to have better activity in smaller doses, the bromin salt being substituted in the metabolism for the chlorin salt.
Although the arterial pressure has been high before arteriosclerosis developed, and may remain high for some time in the arteries, unless the heart fails, the distal peripheral pressure, as in the fingers and toes, may be poor in spite of the high blood pressure. When the left heart begins to fail, pendent edema readily occurs.
Flatulence from any cause must be avoided. It dilates the stomach and intestines, causing them to press on the diaphragm, so that the heart and respiration are interfered with. Also, an increased abdominal pressure, especially if there is any edema or dropsy, is bad for the circulation. A distended, tense abdomen is serious in cardiac failure.
Pechlin offers an example from the foot; Boerhaave from the skin of the hand; Ephemerides from the knee; Albertus from the foot; Zacutus Lusitanus from the left thumb; Bartholinus a curious instance from the hand; and the Ephemerides another during pregnancy from the ankle. Post speaks of a very peculiar case of edema of the arm alternating with the menstrual discharge.
The location of the edema will aid in deciding which condition is most in evidence. If the edema is pendent in feet, legs and perhaps genitals when the patient is up, with its disappearance at night, and more or less backache and pitting of the back in the morning, it is the heart that is most rapidly failing.
Jennings mentions an instance of extensive fracture of the skull, 14 pieces of the cranium being found. The patient lived five weeks and two days after the injury, the immediate cause of death being edema of the lungs. His language was incoherent and full of oaths.
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