Dropsy:  from the Middle English dropesie, short for idropesie, from the Old French equivalent hydropisie, and going back in time: Medieval Latin hydr0pisia, Latin hydropisis, and the Greek hydropisis.

Dropsy is the condition induced by a build up of fluids in the body.  In the colonial sense, it was any kind of edema with severe swelling of the legs and feet, with the ability for “pitting” to occur when you press against the flesh.  The medical philosophy for the time with this disease is that something is preventing the humours nd bloods to flow rpidly and cleaning throughout the body.  Thus it pools in certain places.  When pooled in the legs and feet it represents a certain form of edema (related nowadays to multiple causes, but primarily congestive heart failure or kidney failure).   When pooling occurs througout the body, and especially in the abdominal cavity, the condition represents more the true form of edema associated with the term “dropsy”, once this became better understood.  (See Wikipedia’s Edema and Bright’s Disease entries.)

The modern dropsy is Bright’s Disease, an edema produced due to the stoppage of the kidney as a result of stone formation.  This in turn prevents the normal rate of urine formation,causes blood and protein to be lost through the urine, and causes a back up of fluids and water soluble waste in the body.  Through osmosis and electrolytic activities, the body swells as water accumulates. 

Pathologically (not then known), this illness causes kidney failure.  There is also a stress induced physically and physiologically on the body resulting in a rise in Blood Pressure, which blood-letting helps ameliorate.   Cases of dropsy that are managed by bleeding therefore would best fit this sort of disease, as Osborn has defined it. 

There is also another form of dropsy in which fluids accumulate in the abdominal cavity, the release of which follows when the abdominal wall is punctured and a tube or drain inserted into the “round barrel belly.”   This form of fluid retention, known as ascites (which see in Wikipedia as well), is a result of various organ system problems.  Osborn may not have differentiated between the ascites and dropsy, suggesting he practiced a more externally based (from the skin outwards) approach to understanding disease and treating the body–an approach very typical for readers of Sydenham.

Ascites occurs when fluids in the blood stream diffuse into the gut space and accumulate, forming a round belly.  Liver, kidney and pancreas problems can lead to this, as well as pericarditis, congestive heart failure and nephritis.  These organs can also cause ascites due to bacterial disease onset, a more likely culprit for many of these cases during the colonial years.  The same bacterium that causes consumption (tuberculosis), pericarditis (referred to as “angina” in some cases), or pleurisy (chest wall pain assocaited with breathing) can also cause this condition to ensue.

Note how Osborn related this to consumption via his quip “an attendance to each other’.  Consumption in its simplest form represents a build up of phlegm in the lungs.  This phlegm can migrate elsewhere in the body and thereby cause dropsy, the build up of fluids in the abdominal area.  According to Osborn, once consumption progresses into dropsy, the cure becomes “entirely difficult if not incurable.”   A cough with “stoppage of the lungs” prevents the phlegm from being expelled, or being allowed to migrate elsewhere for removal through sweat or urine.

Consumption can impoverish (deplete and make weak) the blood by reducing its necessary healthy humors and “sharpening” (making pungent)  those humours that remain.   This may be related to the gross rancidity noticed for expelled consumptive lung tissue, blackened by decay and consumption due to the tuberculosis fungus (again, they did not know about a fungus being associated with this malady, only specific environmental conditions and weather conducive to the development and spread of this disease).

The mention of Quin Quini is important to note due to its cultural background and history.  This plant (Cinchona) came from New Spain.  The name Quin Quina is uncommon in traditional mid to late 17th C plant books.   Another example of local knowledge of names being passed down from one generation to the next.  The nearby Cadwallader Colden was also familiar with this name for Cinchona.  The tincture formula for Quin Qui suggests Myroxylon resin, but Cinchona preparations were also valuable when prepared as tinctures.

Notice that Osborn states “if the swelling should abate in the morning.”  This is probably in reference to early or mid-stage congestive heart failure.  As the day passes, one becomes edematous in the legs.  Upon lying down for the night, the heart has a chance to eliminate the excess fluids via the kidney (resulting in excessive nocturnal urination).