Once upon a time, the syndrome known today as fluid overload was referred to as "dropsy," from the Greek word for water. Dropsy was used to describe a group of symptoms that included lung congestion and swelling of the legs, feet and abdomen -- all symptoms that are now known to be associated with heart failure. In this article we'll look at the evolution of treatment for this condition.
Hippocrates of ancient Greece believed in the theory of four "humors" (a term the ancient Greeks used for a liquid or semiliquid substance in the body) -- black bile, yellow bile, blood and phlegm. According to the theory, when the four humors are in balance, the result is good health, and any imbalance between them results in a personality problem or an illness. Bloodletting, accomplished either by the cutting of a vein (venesection) or with leeches, was used in ancient times to treat illnesses by restoring balance in the four humors and purging the body of impurities. The practice was enthusiastically embraced by the Egyptians, Greeks and Romans and became very popular during the Middle Ages.
The Roman physician Aulus Cornelius Celsus recorded the use of bloodletting in the treatment of dyspnea (difficulty breathing because of pulmonary edema, or fluid overload in the lungs) and orthopnea (difficulty breathing while lying down caused by pulmonary edema). There's evidence that the Egyptians also used sweating and substances with laxative properties to remove excess fluids in patients with dropsy. Other recorded treatments included cupping, which was used for disorders associated with an excess of blood. In cupping, which is still used today, empty cups are applied to a patient's skin. The air is then pumped or vacuumed out of the cups to draw blood toward, or even through, the surface.
Cauterization (searing or burning living tissue), which had been used from ancient times to treat wounds, was another way to remove excess fluids in patients with dropsy. There is a reference to Alexius I, the ruler of the Byzantine Empire in the early 12th century, being treated for dropsy with cauterization.
Read on to find out how fluid overload treatment has evolved since then.