Sawbones: A Marital Tour of Misguided Medicine - Dropsy

Episode Date: January 19, 2021

It's a true shame that the medical condition with perhaps the most adorable name, dropsy, doesn't really exists. Well, it exists but ... you know what, this is too complicated. Let's just do a podcast episode about it.Music: "Medicines" by The Taxpayers

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Hello everybody and welcome to Sobhones, a marital tour of misguided medicine. I am your co-host Justin McAroy. And I'm Sydney McAroy. Um, Sydney, we didn't talk about what our introduction to this week's episode would be. So why don't you walk me in, uh, naturally. Oh, naturally. Just a natural explanation of exactly why you chose this topic. Oh, okay. I think that's fair because we have not done. Is this our first episode we recorded in the New Year? It's our first episode. No. I'm replacing bloodletting. Our last episode that we put out, we had actually recorded right before the old year. Yes. As you call it, old year ended. Stinky year. New year began.

Why are 2021 tired 2020? Right. Did you just make that up? Yeah. I just came up with it. That's clever. It rhymes. We did not put out an episode last week.

I am sorry. I wanted to say that first. I'm sorry about that. Yeah. Sorry. Sydney was on hospital service and you're never going to believe this, but it is buck wild in the hospital. Yes.

I was just, I'm always busy year when I'm on inpatient medicine service, but this was especially busy. And I think probably this is true for a lot of you. A lot of your extra energy was being taken up by concern for the insurrection. So. Yeah, the light, the light, the light sprinkling of absolute trees in in chaos and. Yes.

And it just, it just was dusted lovingly over the entire week. And you know, like, I really thought we're going to start the new year out with some good old fashioned saw bones. That was really what I was kind of planning on. And then last week, everything sort of fell apart. So we're back this week. I'm going to try it again with a good old fashioned saw bones. I am not going to make any promises in terms of, uh, we'll always stick to this sort of stuff or that we won't have more to say about coronavirus or politically relevant,

current of it relevant topics. Certainly, I believe we will cover those again, but for now, here is just something that is an outdated term. We don't really use anymore with a lot of wacky wild treatments through the years. I'm still allowed to say it because there's a lot of outdated terms you don't use anymore that would not be a welcome

on our podcast. We are allowed to say it, it just doesn't really mean anything anymore. Okay. So I wanna talk about dropsy. Now, it feels bad to say it. It feels problematic, Sid. No, it's not.

I mean, it just doesn't, it medically speaking, if someone said they had dropsy, it wouldn't be very helpful. There she goes again. And it just feels like we're going to cancel. Maybe I'm confusing it with Cropsy. Cropsy. Are you going to quickly Google dropsy to make sure I didn't? No, I couldn't remember the name of Cropsy. Remember Cropsey. Cropsey. Are you gonna quickly Google Dropsea to make sure I didn't? No, I couldn't remember the name of Cropsey.

Remember Cropsey? No, I don't. Is that documentary watched about that urban legend in the art? Oh, yeah. Yeah, it's the whole one anyway. No, I am talking about Dropsea and I am not talking about Dropsea in fish.

When I first started looking up the history of Dropsea, I kept coming across fish articles. And right now I know there are like experts out there on fish who are laughing at me for not knowing this. I didn't know that this term is still used for a condition in aquarium fish, where they fill up with fluid, and I believe, unfortunately, pass away. And their bellies drop, like they float, and their bellies are dropped because like they float and their bellies are dropped because they're full of flow of drops. Oh, yes.

That thing's a little on the nose. It is, it is on the nose. It's dropsy. Yes, and so I am not talking about that condition in aquarium fish. I know nothing about aquarium fish other than now. I know it's like a dropsy. The thing about any animal that is not human,

she has made this extremely clear in our podcast. Look it up. Well, I mean, I know a little about cats, just because we've had them, but just like the right amount for a cat owner, not a cat expert. A normal amount, not weird amount. Well, no, just like not expert level.

Oh my god. I can't like treat your cat, but I can tell you about owning a cat because I have owned a cat. Every pet ownership basically just boils down the tongue-to-tongue from chocolate. I think that's just every email that is talking to him chocolate, it would be fun.

I know a little more than that. Dropsy, the term when we're using it for humans, and we've talked, we've like used this term a lot on the show, but we've never really taken a deep dive into what it means and where it came from. Yeah, I've said it before. It sounds familiar. Yeah, because it was a very common diagnosis throughout medical history to just label like, well, what happened to that person?

No, they died of drops. That's too bad. The drops. You know, the drops. The drops. And so it's important to know, first of all, that the term dropsy, as it's been used through history, was really like a catch-all. It was anything that could cause swelling, a dima, fluid collection.

You know, if you found that symptom, that sign, I should say, a symptom is something you tell me about a sign is something I see. You tell me like, my stomach hurts. I couldn't see that on you. You would have to tell me. Well, I was just holding it and going, oh. Well, I would still say like, does your stomach hurt?

I'd be like, no, this is a dance. If your stomach was really swollen because it was filled with fluid, I could see that. I could examine you and find that and that would be a sign. So anyway, although I guess you could also tell me that, but the point exactly so The point being any anytime someone had swelling or edema whether it was of their abdomen their legs their whole body Whatever was swollen you could call it

Dropsy and now over time that would become less general and more specific until eventually it was no longer useful because we had names for everything. And there are a bunch of different reasons that you can have swelling. There's no one reason that you have swelling. So you can see why the term would eventually become sort of useless because... You just say swelling, right? Yeah, or I would tell you why. It's because of your heart, it or I would tell you why it's because of your heart.

It's because of your liver. It's because of your kidneys. And then I would, you know, use a medical term other than it's cause of we don't usually say that. Cause of. Yeah. Well, I mean, to be fair, I usually do end up saying that it's cause of your kidneys, but then I also elucidate the medical

terminology. And a bunch of the treatments that we would have used for dropsy, we don't really, as you may imagine, use today. No. The word dropsy comes from the middle English, which comes from the old French hydropsy, which comes from the Greek hydrops, which comes from the Greek hydro. Do you see where this is headed? Hydrox water, not the cookie.

Not the cookie, hydrox. Not the Oreo-like cookie. Or are... Or are... Or are our hydrox-like? Are they hydrox-like? Which came first? Hydrox.

Really? I didn't know that. You don't want to know how much I know about this topic. I really don't. You can start a podcast about that if you'd like. No, thank you. I already know I'm good. Okay. I don't want to be on it.

I was an asshole. No, I didn't think you were. My dear friend Bridget Lanecaster and America's Jazz Kitchen did an episode of their podcast proof, which is great if you love food. It's a great show. It's all about hydrox versus Oreo. Well, I think a lot of us know hydro is related to water. It's a great show. It's all about hydroxyls or you. I think a lot of us know hydro is related to water.

You get a hydro, hydroxy, dropsy. Dropsy. There you go. Related to fluid. When you talk about mentions of fluid retention, again, as you may imagine, as long as we have had people trying to write about medicine, you've had mentions of fluid accumulation, because there's so many different reasons why you might accumulate extra fluid in different parts of your body, that it's natural to assume ancient people

got it too. So you can find mentions of this in the Eberspapyrus. The thought process was that You can find mentions of this in the Eberspapyrus. The thought process was that maybe the heart becomes sort of weak or bored is one translation of the heart becomes bored. I get it, love, love, love, day in, day out. Let's mix it up, maybe a clunk, love, love, love, clunk. And it becomes over full with blood,

which is not exactly what we're talking about. It happened to the Grinch, you know, what could have happened to a human? I don't think that the Grinch is thought to have developed congestive heart failure, although, oh, that's a whole other episode. Her is hard, grew three sizes, he doesn't have the blood to support it, I'm saying he would become instantly anemic and blackout. Like right there, he's holding the sled, he's like, what I'm saying is he, does he have hypertrophic cardiomyopathy?

This is a whole other episode. We'll do this another day. I know you were another day. What, this Christmas, look forward to how the Grinch stole his last breath. How the Grinch stole Christmas and then develop hypertrophic cardiomyopathy and then saved Christmas.

What is it, Cooper, called? Grinchates Christmas. Grinchates Christmas. She got really into the grinch anyway. Anyway, so they thought maybe that was what was happening and your heart got filled up with blood. The heart was really seen for a lot of medical history as sort of just like a storage vessel.

Blood just sort of gets kept there periodically. And not for like it's pumping ability. It took us a while to figure that part out. What did they think was happening in there? They could feel it. No, I mean, you really think about this though. Because on this show, we have a, I would say this is a fault of ours,

of accusing ancient people of not being smart enough to figure this stuff out. But how easy is it to open a person's body up and look at what's happening inside while keeping that person alive? Well, to be fair, I guess, and now that I think about it, you can also feel the pulse in the neck, the wrist, et cetera.

So you wouldn't necessarily think this because you felt the pulse in there. That was the source of it. Yeah, I think that the fact that they got this far is pretty impressive. I'm gonna say that a lot this episode. I think a lot of the conclusions that were drawn were fairly impressive.

We just didn't have a great understanding of treatments most of the time. So even when a really clever connection was made, it takes a while for us to get to a therapeutic option that makes a lot of sense. That's your question. Do you as a physician ever start thinking about these like absolutely wild, delicate machines that are keeping everything going in there, just blow this herfus and get freaked out about

it? Is it ever happening? Yeah, constantly. Really? I don't know if it's true for all physicians, but yes. Okay. I thought you'd have some sort of sage wisdom about how to how you move past that. Really? I don't know if it's true for all physicians, but yes. Okay. I thought you'd have some sort of sage wisdom about how to, how you move past that.

No, I mean, just don't think too hard. Because I think too hard. If I think too hard about it, I can't trust you now a little bit. Don't think about, be grateful for it, and then I don't know, start planning what you're going to have for dinner or something to move on. Always a good play. They also thought that fluid might have Sydney is not a fair feature.

That's a very fair point. Fluid they also thought might have something to do with the kidneys. Again, this was sort of just like theoretical and it would take us a long time to really assert that, so it's impressive. I got to give it up to them that they would bring the kidneys into it, because I still mixed them up with the liver. The fact that they could keep tabs on the kidneys is pretty impressive. I mean, I guess both can cause fluid retention, but they did think it could be part of the

problem, but their treatment, I thought this was a very interesting treatment. They would take old papyrus, like especially old medical papyrus and burn them in oil and then apply the residue topically to whatever was swollen to the legs or the belly or whatever, which is like a really specific and kind of wild treatment. Yeah, not helpful, I guess. No, I can't see how that would have been helpful. Still very specific. Probably not very harmful. Hey, good.

Look at that. So, Hippocrates mentioned three different kinds of swelling that can occur. Hippocrates did a lot of work in describing things. The treatments didn't always pan out, but lots of effort in like writing the stuff down that he saw in observation. So there was hydrops, which was swelling of the abdomen due to fluid. So if you knew there was fluid in there

and the belly was swollen, you got hydrops. Anasaka is the word for swelling of the body tissues. Still use that now. If somebody swollen all over, head to toe, they've got anasaka. And then there was one called tempenitis, which you really don't hear a use. Occasionally you'll hear somebody

like really old school uses word, we really don't use it anymore, but it means gas in the belly. We're really just talking about having gas. Think about tempani, like the sound a drum might make, like the high pitch. It's the same kind of thing. When you see me tapping, the girls love for me to percuss their bellies,

which is when I tap, I hold my finger over their abdomen and then tap my finger and listen to the sound and you're listening for like dullness where there's fluid versus like a tempanic sound where there's air. Every parent has a different way to bonding with their kids. This is the Sydney.

This is what I, they love it. And then I tell them it's okay that you the Sydney's. This is what they love it. And then I tell them it's okay that you just got farts in there. They love that. Wait, can you not tell if there's shorts in there? I mean, I can tell if there's air, but I know there's also places where I'm supposed to hear air. So it's like it's normal. I thought you were looking for.

Okay. You really thought I was looking for farts? I don't want to talk about it. Okay. Please. Don't ever tell them the truth. I will, I mean, I don't want to talk about it. Okay. Move on please. Don't ever tell them the truth. I will. I mean, what don't ever tell me the truth?

Generally, Hippocrates understood Adema as a symptom. A lot of Hippocratic medicine is sort of unique to the patient, right? It's not like this condition could occur in multiple people. It's like, oh, for you, it's because you don't eat this or you don't sleep right or you need to drink more of this or whatever it is. And that was a lot of hypocratic medicine. So there was an idea that you could find one root etiology, formal. In one patient, it might be an overabundance of flim.

We're dealing with four humors, kind of medicine. And so you got too much flim in your belly. There was also thought that maybe one of your organs liquefied, specifically your spleen, that sometimes your spleen could just liquefy spontaneously. And then your belly would be filled with liquefied spleen. Or perhaps your liver was just making a lot of fluid for some reason because livers were weird and they did lots of stuff we didn't understand. Dissentary was thought to sometimes cause fluid like you're having a lot of diarrhea

and fluids coming out and maybe some of that fluid is backing up and accumulating in your belly for some reason. There were some associations that hipocrates would make to like sort of dictate prognosis. Like, well, you've got hydrops of your legs and you have a cough, that's bad, which may have been true because you maybe had congestive heart failure and now you were developing fluid in your lungs. So that's probably a good guess. been true because you maybe had congestive heart failure and now you were developing fluid in your lungs. So that's probably a good guess. If you had a swollen belly and you stopped peeing, then the thought was, oh, that's bad.

And that was again probably true because it probably meant kidney failure. So there were some things that the, you know, that's about as far as, as far as it went there like, oh, that's bad. Well, our tools, our tools to treat it were not, we didn't have a lot, right? Yeah. Most of the things that at that point in history, you would have recommended for people to do are just take this medicine that might make you puke or poop or pee. A medicine that would make you pee might actually be helpful, a diuretic, but a lot of the times,

especially if we thought your spleen had liquefied, you would get a laxative with a thought being that if we give you enough laxative, then you'll just poop out all that spleen. There was also a mixture of veritrum and vinegar that was used for puking. This plant, by the way, is called false hellbore. This is a very poisonous plant, which will cause nausea and vomiting, so it would have been useful for nausea, but it also might cause heart failure. So I know, I looked that up. I thought that was a weird choice. He also mentioned that you could make a hole near the belly button and just drain

the fluid out. A shark? A hole there. Well, no. The belly button in the house. There's not an actual hole. It's tied up. Yeah.

But the idea is you could drain the fluid out. And this isn't wrong. We do this today. We drain fluid from your abdomen sometimes for various reasons. So again, a lot more high risk, I would say, back then. Galen, as with most things, sort of built on hypocrite stuff. He really didn't contradict a lot. He just kind of took his ideas and went a little further.

He did notice that if you had an irregular pulse, like your heartbeat didn't seem to be regular, but it was kind of all over the place, which probably meant you had an irregular heartbeat, maybe atrial fibrillation, which can be associated with heart failure. That plus swelling tended to be bad. He actually got it backwards. He actually thought that because you had so much fluid, your heart couldn't beat right, and that's why it was beating so strangely, as opposed to the other way around.

Which, meaning? When your heart's not pumping rhythmically, effectively, then you can get fluid back up and so on. Oh, I see what you're saying. So like in... He had the cause. A riddenness. Yeah. the chicken and the egg were backwards. Right.

He also advocated things like laxatives, things to make you puke, things to make you pee bloodletting, which I mean, probably helped a little in some case. I mean, that's not a treatment we use today, but I can see we're removing a little bit of the blood volume might have been. Can't believe it a full-ferred endorsement of bloodletting. No, I'm not saying that,

but I could see where you would do that and see maybe a slight improvement temporarily and think you had done something good. And then some pastes made of like lard and corn flour and manna and things like that. And a lot of these ideas were still based on the humors. This was all a humoral theory of medicine. Based on the idea that your fluids just kind of wandered

around your body aimlessly and accumulated different places and you needed to just sort of empty some out and add more to them and balance them out and they were the problem. They weren't the result of a problem. They were the problem and I think that's really one of the core differences in how we see a demon now versus then is the idea that the fluid itself is the issue as opposed to it is the symptom, it is the sign of an underlying issue. It wouldn't be a new year of solbons without getting plenty up in the mix. Oh, yeah.

And I want to tell you what plenty of the elder had to say about it. Perfect. I'm ready. But before we get to that, I know. I know. Let's head to the billion department. Let's go. The medicines, the medicines that ask you let my God before the mouth. Let's go!

Welcome back to FireSide Chat on KMAX with me in studio to take your calls as the dopest tool on the West Coast, Oliver Wong and Morgan Rhodes. Go ahead, Collar. Hey, I'm looking for a music podcast that's insightful and thoughtful, but like most of it helps me discover art and thin haunts that I've never heard of. Yeah, man, it sounds like you need to listen to Heat Rocks every week, myself, and I'm Morgan Rhodes and my co-host here. Oliver Wong talked to influential guests about a canonical album that has changed their lives.

Guess like Moby, Open Mike Eagle, talk about albums by Prince, Johnny Mitchell, and so much more. Yo, what's the show called again? Heat Rocks Deep Dives into Hot Records. Every Thursday on Maximum Fun. Okay, you gave me the classic Plenty Teas, and I'm ready for Plenty of Plenty. So Plenty of the Elder, of course, had some ideas of how to treat dropsy in it. And if this is your first sawbounds that you've listened to, welcome.

Thank you. Plenty of the Elder wrote profusely about everything. Yeah. Whether he understood it or not. All of the natural world and had treatments for everything. Whether he understood it or not. All of the natural world and had treatments for everything. Some of his ideas were usually something to do with animal excrement. That was very common among plenty of his ideas. Classic.

He advised drinking boars urine or you could take cow dung or bull dung. He said any herd animal really will work. Burn it and then take the ashes of that, put that in some honeyed wine and drink that, and that would be useful for drop sea. And it's important if you're going to do this, whatever herd animal you choose, make sure you use a boy animal for a boy and a girl animal for a girl. Oh, because otherwise.

Yes. You're wasting your time. Exactly. That was very important. You could also apply the dung right to the parts of you that were swollen. So just rub some poop on your legs or belly or whatever. Right there.

Your face, if everything's swollen, we'll just rub it on there. And if all of that excrement stuff is too gross for you, there's always goats blood. Sure. Yeah. Is that less gross? I have no. I don't have a good metric on that, honestly. Really? Yeah, I'm afraid I don't have to take that from you. Yeah, I don't gross? I have no. I don't have a good metric on that, obviously.

Really? I've taken that from you. Yeah, I don't actually know what's gross. Vis-a-vis blood and poop anymore. As I mentioned, there was this kind of theoretical tie to the kidneys for a long time. Aviceno was the first one to write that there was a connection for sure between the kidney because the kidneys and swelling, because until then everything was sort of blamed

on the liver and the spleen. Again, the liver got a lot of blame for different things. Some of which were true, because you can't have liver conditions that caused swelling, but then others just because the liver was a mystery. But the treatments were very similar. A lot of herbal preparations, everything from caraway, to wormwood, to radish, just all kinds of different kind of herbal things.

It really was in the 17th century that we started to evolve an idea of the causes of dropsy as opposed to dropsy as a distinct problem in and of itself. And the reason we figured that out was that we started to figure out the circulatory system. The idea that our fluids move through a system of tubes and not just sort of like gooshed around in there. I mean, that really, that was a revelation. And as I said, you can see why that would be hard to figure out if you weren't, you know, we take for granted now that we know this stuff how hard would it be to just look inside a cadaver and know what everything was doing when that body was alive?

Guys, these are all tubes. Yeah, it's just bunch of, well, I mean there were tubes but like there was also just a bunch of gushy fluid. I won't get into that. Things change. Let's just put it that way. I can't believe you just self-sensored. It's a first. It's someone's first. All right, bring your kids. You can't get a complete understanding of the human body from dissection. Right. You can get it understanding what it looks like, but not what all it does, maybe. And so it took us a while to figure that out. So once we started to get the idea that

fluids move in a certain fashion through certain systems, Then we started to understand that this accumulation of fluids was not the problem. It was where was something going wrong that resulted in an accumulation of fluids that was the problem. In the 18th century, one thing that really helped and we've done a whole episode on this so I don't wanna belabor it too long,

but we've talked about the drug, digitalis, digoxin, fox glove. We've done an episode about that before. The reason that we figured out more about what could cause dropsy is because William Withering began to use fox glove and then he isolated the active ingredient from it, digitalis, on patients with dropsy, and found success. And this is because of the effect that this has on the pumping ability of the heart. It strengthens the pumping ability and can combat congestive heart failure.

So he started to understand, based on the fact that my patient had dropsy, I gave them this heart medicine that got better. The heart has something to do with drop C. Does that make sense? And around the same time, we began to understand that some people who died of drop C on autopsy, we would find like irregular heart valves. We at that point, we knew what a normal heart looked like.

So we would start to see that the valves of the heart looked very different in these patients, which again led you to believe that maybe this has something to do with the accumulation of fluid, which had something to do with why the patient passed away. So we kind of figured it out backwards. Right. The development of the stethoscope was a big part of this because then we learned how to hear the gushing. The gushing. Well, I mean, crackles of fluid or rails of fluid, all the different sounds we can hear in the lungs because of fluid or regular heartbeats, the different ways that the heartbeats that could lead to fluid, we could hear all that with the Seth scope.

We also, in that time period, develop percussion, which I've already talked about some, but that's, I mean, it's tapping on your body. Yeah. If you've ever had a doctor tap on your lungs or tap on your belly, that's what we're doing. We're listening for gas first fluid in a very sort of rudimentary way, but it was actually a really useful physical exam technique that was developed to check for like fluid before it got obvious. So we could hear that there was fluid there before it got to a point that you came in and said something is wrong. Dr. John Blackle would begin to really understand kidney disease as a cause of dropsy, and that

would help at this point to start to divide out those patients from the heart patients. That was sort of the first thing. There were heart patients, there were kidney patients, eventually liver patients. We would start to sort of sort out dropsy into these categories. And he described like, not only do you get the edema, the swelling, but you also notice that they don't produce much urine, just as hypocrite he's did, but also that they could have seizures with this. There was a specific odor to their breath,

which can happen in kidney failure. Yeah, it's in ketosis too. Yeah. And he tried everything for it. He didn't have a treatment yet, but he tried OPM, Turpentine Copper, tobacco. There's a plant called Squills, which has been used for, I mean, since ancient times. Squills.

Squills, potassium, Fox glove, scarification, like cutting at the area of the kidneys, all different kinds of things. Dr. Richard Bright would then build on this work and he's really credited with like our understanding kidney disease as a cause of dropsy. His work really built on that. But initially, even as we began to understand this,

moving into the mid 1800s, we still didn't have a lot of great treatments. We've talked about on the show that the idea of a natural diuretic, we've understood that for quite some time. We knew that there were some things that made us pee. But we didn't have what we would think of today as a lot of patients call fluid pills. I've never heard of that. Really? That's what I have found in my experience. Most patients just call my fluid pill. And

it means the pill that's supposed to remove their fluid. Are you going to die of reddit? Yeah. We didn't have a ton of those that were synthesized compounds from some sort of herbal preparation or something. We didn't have that. And so one of the treatments that was used in the mid-1800s was developed and then all the way up until the 1960s. And that's going to sound wild when you hear what this is

were these tubes that were called southeast tubes because they were developed by Reginald southe Dr. Reginald southe basically they were these thin silver tubes that you would insert into legs that you would insert into legs. Oh. Yeah. To try to drain the fluid. Oh, that's rough. Yes. And you know what's, here, and again,

we talk about this a ton on saw bones. And if you were someone who's experienced either yourself or as a medical professional experienced swelling in the legs, you're probably thinking that wouldn't work very well. And it wouldn't. And it didn't work. Maybe you would have gotten, I'm sure something came out. Something's gonna come out. Yes, but... Nobody gets away, Scott Fried, jamming tubes in their body. I always, I will say that this is a question I have heard from patients many times in my career, which is, if I've got swelling somewhere, why can't you just stick a needle in and pull it all off? It feels like I'm not going to be able to do it.

I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it.

I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. I'm not going to be able to do it. and I have heard from patients many times in my career, which is if I've got swelling somewhere, why can't you just stick a needle in and pull it all off? It feels like that should work. Right. Basically, it feels like all that's I really need to do here, it just lants this and...

And we do that sometimes when there's swelling in the abdominal cavity, in the lungs, we do procedures that do pull off fluid. So sometimes we do. But the problem is we're talking about the difference between fluid accumulating in a body cavity, in an opening, and fluid sort of soaking through tissues like a sponge. Just like the idea of can you use a syringe to pull liquid out of, I don't know, fish

bowl versus a paper towel? Yes, yes. That's a good way to think about it, exactly. I usually say think about like a big piece of sponge. If you have a big giant piece of sponge and you stick a tiny little needle into one end of it, can you suck all the fluid out of that sponge? No, but if you did have a fish bowl, exactly. And that's very similar.

So it's weird, the Southy tubes really lasted a long time for something that I can't imagine was extremely effective. There were also mercury compounds. We've talked about Kalamil. We've talked about mercury a lot on the show. It was a really good laxative and it did work as a diuretic. This is not me by the way, plugging mercury. Please don't use mercury. We have a fan over here. We have laxatives and diuretics today that are not toxic as well, so use those. But before we knew that, it was used as a diuretic and a laxative.

It was a better laxative, but you could still use it as a diuretic. And again, fox glove was still used, squills were still used. It was really in the 1940s when Henry Schroeder started to talk about, you know, salt has something to do with fluid retention, you know, where there is salt, there is fluid. So a low salt diet will help you keep fluid off. Also had an effect on blood pressure. This is also around the same time we figured that stuff out. And then soon after that, we sort of accidentally discovered that the new sulfonilamide, the new antibiotic compounds that were sulfidrugs that were coming out,

had some diuretic effect that would make you pee. The ones of the time, I'm not saying the ones now do, but the original. And so based on the way they worked, we developed a drug called Acetazoleamide or Diamox. You may have heard of, it's not a very popular diuretic now, but that was the first one that came out in the 50s.

They could intentionally take this and it'll make you pee. Yeah, kind of drug. What would follow that are advances in the specific sorts of treatments. In the 50s, we got thiozide diuretics, chlorothaladone, hydrochlorothiocides still in use today, blood pressure and diuretic effect. Then after that, in 1964, we got furocemide, also known as lasex, which is sort of the prototypical, it's called a loop diuretic, it's a fluid pill, a lot of people take it to keep fluid off for a variety of reasons.

Again, I know this seems like we've circled back around. So we, we, we called drop C one thing because we didn't know the difference. We spent centuries parsing out heart patients from liver patients, from kidney patients, for all the different reasons that you could get drop C. And then we come back around to just giving everybody a diuretic. Right there in front of us. Which is not entirely true. After that, we would develop more diuretics. We would figure things out like for kidney patients dialysis,

which can help keep fluid off. And then maybe a kidney transplant, depending on the kidney disease. In the cardiac field, we started to develop an understanding of why do patients get heart failure? Is it because of maybe an irregular heart beat like we alluded to, or is it because of a Schema heart disease, meaning coronary artery disease, blockages

and heart attacks and that kind of thing? And how can we modify all those risk factors so that we prevent it instead of just waiting for it to happen and then try to get the fluid back off? And we got better drugs for treating the heart after that developed. And then we teased out liver disease, cirrhosis and all the causes of cirrhosis and how to treat that and how to manage the fluid accumulation that can come with that. And other things like thyroid disease and then now I think we know when it's just gas. We got it.

The term drop C because of that is not really used for humans, as I said, anymore. There's so many different reasons that fluid could accumulate, that when we see swelling, our question is why not necessarily immediately what to do about it within reason. If you have a lot of fluid in your chest and you can't breathe, of course, we're going to want to do something about it first. So you want to treat the cause, but not the symptom. Have you been waiting the whole show for that? Yeah, actually, I have, looking for the exact moment to do it.

I will say a small disclaimer, swelling. I know I've named a lot of scary things that can cause swelling. You should start with this disclaimer. I got silver needles all through my life. Please don't try to drain your fluids, please. Here's the, here's the thing that sucks it. I didn't even realize it's not swollen. It's just

a beautiful muscle. Are you kidding me with these things? Look at these games. There are times in pregnancy you can get swelling. Sometimes it's just caused by circulation issues like what we call venous stasis meaning it just it's taking a while for the blood to make its journey back to the heart after it's made it out to the extremities. There are lots of different reasons you could have swelling. There's certainly not all Life throughout name is I've mentioned a lot of scary stuff So I'm gonna throw that out there But it is it is again because drop C is not one thing There are myriad causes if you have swelling to worth a trip to your doctor to

Ask him what your dropsy could mean. And call it dropsy because your doctor will probably flip her lips. I think we'll get a kick out of it. I would say today most people associate dropsy with heart failure. That's where you get most. But it's important to know dropsy really could have been used. It was an all purpose word for fluid accumulation for much of history.

And it's just weird. And nowadays it's nothing. Folks, thank you so much for listening to our podcast. Unless you're a fish. We want to remind you that we have a new version of our book. It's a book about medical history. It's just like sobans. So if you like sobans, you'll like this.

It's called The Sobons book. It's now paperback. Got new content about quarantines and anti-mass parades and new illustrations by Sydney sibling Taylor-Smurl. You can get it at bit.ly-solbonsbook. Also wanted to say if you ever thought about starting up a podcast, head on over to bit.aui4tslash mackerelroy podcast book and get a copy of everybody has a podcast except you. It's pre-order. It is available in just about a week or so. So please go pre-order that now if you would be so good. Thank you to the taxpayers for the use of their song medicines. It's the intro and outro of our program. And thanks to you.

And keep wearing your masks. Keep saying safe, get your vaccines when you are eligible, when it's your turn. Yep. And that is going to do it for us until next time. My name is Justin McAroy. I'm Sydney McAroy. And as always, don't go whole in your head. Alright! Maximumfun.org

Comedy and Culture Artist Oat? Audience Supported Artist out? Audience supported.