Dropsy or Edema

This project is for people who died of dropsy/edema.

Dropsy: An old term for the swelling of soft tissues due to the accumulation of excess water. Dropsy or oedema, as it is known in the United Kingdom, is commonly seen with inflammation of an artery or major organ such as the kidneys, liver, and heart.

The Medical Dictionary defines Dropsy (Edema) as: “an abnormal accumulation of serous fluid in a body cavity or in the cellular tissues.” Most people with this condition refer to edema of the affected region.

In years gone by, a person might have been said to have dropsy. Today one would be more descriptive and specify the cause. Thus, the person might have edema due to congestive heart failure.

Edema is often more prominent in the lower legs and feet toward the end of the day as a result of pooling of fluid from the upright position usually maintained during the day. Upon awakening from sleeping, people can have swelling around the eyes referred to as periorbital edema.

The Middle English dropesie came through the Old French hydropsie from the Greek hydrops which in turn came from the Greek "hydro" meaning water.

What Are the Causes of Dropsy (Edema)?

We must look at both pathological and physiological conditions when discussing what causes dropsy. The leaking fluid from blood vessels causes the nearby tissue to swell and inflammation occurs. Common minor dropsy cases are seen with:

• Excessive consumption of salty food
• Premenstrual symptoms
• Pregnancy
• Prolonged sitting or standing position
• Use of medications such as estrogens, steroids, nonsteroidal anti-inflammatories, high blood pressure medicines, and diabetes drugs known as thiazolidinedione
• The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body.

Classifications:

• Cutaneous edema is referred to as "pitting" when, after pressure is applied to a small area, the indentation persists after the release of the pressure.
  • Peripheral pitting edema, as shown in the illustration, is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis.
• Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipedema, and myxedema.
• Edema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates.

Organ-specific Edema:

• In certain liver and kidney diseases, low levels of albumin in the blood can contribute to fluid retention.
• Heart failure, cirrhosis of the liver, venous insufficiency, and a kidney disease called nephrotic syndrome are the most common systemic diseases that cause edema.
• Excess fluid that accumulates in the lungs is called pulmonary edema.
• Excess fluid that accumulates in the abdominal cavity is called ascites.
• Edema of unknown cause (idiopathic edema) occurs primarily in women.
• Varicose veins or thrombophlebitis (a blood clot in an inflamed vein) of the deep veins in the legs causes edema that is localized to the legs.
• Cerebral edema is extracellular fluid accumulation in the brain. It can occur in toxic or abnormal metabolic states and conditions such as systemic lupus or reduced oxygen at high altitudes. It causes drowsiness or loss of consciousness, leading to brain herniation and death.
• Edema may also be found in the cornea of the eye with glaucoma, severe conjunctivitis or keratitis or after surgery. Sufferers may perceive coloured haloes around bright lights.
• Edema surrounding the eyes is called periorbital edema or eye puffiness. The periorbital tissues are most noticeably swollen immediately after waking, perhaps as a result of the gravitational redistribution of fluid in the horizontal position.
• Common appearances of cutaneous edema are observed with mosquito bites, spider bites, bee stings (wheal and flare), and skin contact with certain plants such as Poison Ivy or Western Poison Oak, the latter of which are termed contact dermatitides.
  • Another cutaneous form of edema is myxedema, which is caused by increased deposition of connective tissue. In myxedema (and a variety of other rarer conditions) edema is caused by an increased tendency of the tissue to hold water within its extracellular space. In myxedema this is because of an increase in hydrophilic carbohydrate-rich molecules (perhaps mostly hyaluronin) deposited in the tissue matrix.
  • Edema forms more easily in dependent areas in the elderly (sitting in chairs at home or on aeroplanes) and this is not well understood. Estrogens alter body weight in part through changes in tissue water content. There may be a variety of poorly understood situations in which transfer of water from tissue matrix to lymphatics is impaired because of changes in the hydrophilicity of the tissue or failure of the 'wicking' function of terminal lymphatic capillaries.
• In abnormal removal of interstitial fluid is caused by failure of the lymphatic system.
  • This may be due to obstruction from, for example, pressure from a cancer or enlarged lymph nodes, destruction of lymph vessels by radiotherapy, or infiltration of the lymphatics by infection (such as elephantiasis). It is most commonly due to a failure of the pumping action of muscles due to immobility, most strikingly in conditions such as multiple sclerosis, or paraplegia. It has been suggested that the edema that occurs in some people following use of aspirin-like cyclo-oxygenase inhibitors such as ibuprofen or indomethacin may be due to inhibition of lymph heart action.
• Hydrops fetalis is a condition of the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments.

There are also serious health conditions that may result in edema swelling. These disorders can be pre-existing conditions, or the severe inflammation may be a major indicator of an underlying issue. You can see the dropsy illness in humans with:

• 1. Heart Failure
  • Congestive heart failure leads to edema as the heart fails to properly pump blood, and it collects in the lower extremities and sometimes in the abdomen. If the blood builds up in the lungs, as in the case of pulmonary edema, it may present breathing difficulty.
• 2. Liver Damage
  • Liver damage, cirrhosis, may cause fluid buildup in the legs and possibly the abdomen, which is known as ascites.
• 3. Kidney Damage
  • Kidney damage that affects the organ’s blood vessels may lead to nephrotic syndrome, which is a reduction in the blood protein levels. This protein is referred to as albumin and is created by the liver. With an insufficient amount, edema can occur.
  • Kidney diseases are common when there is excess sodium and fluid in the blood. Dropsy can be seen around the eye region as well as the legs.
• 4. Vein Damage
  • Vein issues such as chronic venous insufficiency may result in edema. This leg condition occurs when the veins become weak or damaged, and impairs the blood circulation. Swelling is seen with the accumulation in the veins of the legs. It becomes a serious condition requiring immediate medical attention when the swelling is sudden in one leg and accompanied by calf pain.
• 5. Lymphatic System Issues
  • Lymphatic system problems may affect the ability of lymph nodes and lymph vessels to properly drain the tissues excess fluid, resulting in edema. This is often seen with cancer surgery.

Dropsy Symptoms

The dropsy illness is characterized by the swelling of the feet, ankles, and legs with possible puffiness visible in the hands and face. Other symptoms from the underlying cause can also appear, such as:

• Distention of extremities
• Changes in the skin of the affected region such as tightness
• Shiny or gleaming appearance of skin
• Skin depression or a pitted appearance when the area is touched
• Abdominal pain
• Chest pain
• Urine reduction
• Panting or breathlessness

Treatment:

• Therapy for edema consists of treating the underlying conditions, restricting salt intake, compression stockings, elevation of the extremity, and often using diuretics (medicines that induce urination).
• Treatment may also involve positioning the affected body parts to improve drainage.
  • For example, swelling in feet or ankles may be reduced by having the person lie down in bed or sit with the feet propped up on cushions.
• Intermittent pneumatic compression can be used to pressurize tissue in a limb, forcing fluids – both blood and lymph – to flow out of the pressurized area.
• Treatment of persistent edemas, such as idiopathic bilateral lymphedema, may also use manual lymphatic drainage, a low-pressure massage technique designed to pump lymphatic fluid by a similar mechanism.
• Home Remedies for Dropsy:
  • Salt intake should be cut down, as salt retains water in the body and worsens the symptoms of dropsy.
  • When sitting, legs should be kept elevated, as this helps the blood flow towards the heart from gravity and decreases the symptoms of dropsy.
  • Walking for short periods of time also helps in maintaining the blood flow towards the heart.
  • Wearing stocking helps in decreasing the swelling.
  • Alcohol intake should be cut down to prevent liver cirrhosis.

Notable who died of dropsy/edema:

1. Wikipedia - Deaths from edema (113 listed)

• George Monck, 1st Duke of Albemarle (1608-1670) - died of edema
• Anne of Denmark (1574–1619) - Queen consort of Scotland, England, and Ireland by marriage to King James VI and I; died of a dangerous form of dropsy.
• Benjamin Bartlett (1714–1787) - an English numismatical and topographical writer; died of dropsy. (https://en.wikipedia.org/wiki/Benjamin_Bartlett )
• John Canton (1718–1772) - a British physicist; died of dropsy. (https://en.wikipedia.org/wiki/John_Canton)
• John P. Cassidy (1855–1891) - American baseball player; died of Men vs. Women...dropsy. (https://en.wikipedia.org/wiki/John_Cassidy_(baseball) )
• [Barbara Villiers, 1st Duchess of Cleveland (Royal Mistress of Charles II) Barbara Palmer, 1st Duchess of Cleveland (1640-1709) - (aka: Barbara Villiers, Countess of Castlemaine) suffered from oedema, known at the time as dropsy. Today, this would be described as oedema of the legs, with congestive heart failure.
• Peter Faneuil (1700–1743) - a wealthy American colonial merchant, slave trader, and philanthropist who donated Faneuil Hall to Boston; died of dropsy. (https://en.wikipedia.org/wiki/Peter_Faneuil )
• Michel de Nostredame (aka Nostradamus) 1503-1566) - French physician, reputed seer; his gout, plaguing him with pain for many years & making movement very difficult, turned into edema, or dropsy.
• Luke Short (1854-1893) - American Old West gunfighter, cowboy, U.S. Army scout, dispatch rider, gambler, boxing promoter and saloon owner; had Bright’s disease, today known as acute/chronic nephritis which contributed to a slight puffiness in his face & accumulation of fluid in his lower legs known as dropsy. (https://en.wikipedia.org/wiki/Luke_Short)

Resources & Additional Reading:

• MedicineNet Newsletters - Medical Definition of Dropsy
• Doctors Health Press - What is Dropsy (Edema)? Causes, Symptoms, and Home Remedies. 23 July 2017
• Wikipedia - Edema
• ePainAssist - Dropsy: Causes, Types, Symptoms, Treatment, Home Remedies. Reviewed by: Pramod Kerkar, MD, FFARCSI
• NCBI - Dropsy. Jeff Aronson, clinical pharmacologist. BMJ. 2003 Mar 1; 326(7387): 491

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