ARETAEUS ON THE DRY SKIN OF DROPSY.

Abstract

RETA1/;t;S, tile Cappadocian, in tile second century A.D. was clearly conversant with many kinds of liver disease. In On the Causes and Symptoms of Chrouic Diseases, Book I, he refers to the "dropsy" of certain chronic hepatic afflictions, noting what is still true today, that "the best tiling is for it (tile accunmlated water) to be discharged by the urine; for the passage by it (the urine) is safer and less troublesome .... " Later, Aretaeus observes, "Sweating, if copious, carries off the disease . . . for dropsical persons generally have not a moist skin." The relationship between edematous states ("dropsy") and sweating is not entirely clear and requires further investigation, but it is probable that Aretaeus was right. Streeten et al. a have demonstrated that a metabolically provoked increase in aldosterone secretion in normal men is accompanied by a marked fall in the sodium excretion of the sweat glands. Berger and Steele e have also found, in a few patients, reduced sodium loss through perspiration in congestive heart failure and cirrhosis of the liver, but in a large number of children with congestive heart failure, Morgan and Nadas a showed that perspiration, grossly, and sweat sodinm loss, quantitatively, were considerably augmented. However, the factors responsible for sodium retention in cirrhosis and in heart failure are probably not identical, as is so commonly suggested by the efficacy of mercurial diuretics in the latter but not in the former. Moreover, the sympathetic nervous stimulation of heart failure, while variable, may be very strong, and whether neurogenic evocation of sweating or its endocrine suppression prevailed in a given case might well depend upon several independent variables. All things considered, incomplete evidence suggests that the Cappadocian's observation of dry skin in hepatic anasarca was accurate and significant. His empirical conclusion was shared by a patient of mine, a physician, whose duodenal ulcer had been effectively treated by subtotal gastrectomy. The doctor thereafter noted profuse generalized diaphoresis if he ate hastily or drank a malted milk. This manifestation of the "dumping