closely the maximum blood pressure. The increase of urinary flow continued after the fall of blood pressure to normal, and at the end of fifteen minutes it was the same as at the beginning of the experiment. They also perfused kidneys excised, noting the flow from the renal vein and ureter, and found that pituitary extract added to saline solution made the venous flow and ureteral flow less than when saline alone was used. They do not believe in a specific action on the kidney cell, and if so it is less marked than in the case of a 1 per cent. saline solution. It is due to rise in blood pressure.

Pal noted in cats that the diuretic effect of pituitary extract was marked, when given intravenously. He emptied the bladder of a cat to which morphia and curare had been given, and found that the intravenous injection of two cubic centimeters of pituitary extract filled the bladder in a very short time. As is well known, the bladder is generally empty after curare narcosis. Pal's experiments as to the size of the kidney after the use of pituitary were not uniform like those of Schafer. found that pituitary dilated the renal artery and contracted the coronary arteries.

Pal

Pal like Langendorff, found adrenalin dilated the coronary artery, whilst contracting the renal and other arteries. He found pituitary extract to dilate the renal arteries, but to contract the coronary and other arteries.

We made 70 experiments. The volume of the kidney was registered by means of an air oncometer and Albrecht's piston recorder.

Our experiments were mainly made upon. cats; a few were made with rabbits. The

3 Wiener, Medizinische Wochenschrift, 1909, P. 138.

animal was bound down, given 5 cc. of paraldehyde by the mouth. Then chloroform was given. The abdomen was opened in the median line over the bladder, the bladder drawn out and an incision made

into it. into it. A funnel-shaped glass tube with a flange was inserted into the bladder and the bladder tied tightly about the flange. Then the bladder was filled with the urine previously obtained from the bladder. If this was not sufficient to fill the bladder, Ringer's solution was added. By means of a piece of rubber tubing attached to the funnel-shaped glass tube the urine was allowed to drop into the capsule. This was permitted for about fifteen or twenty minutes when each drop was noted on the smoked drum with an electric marker. Then the extract of the gland, rubbed up with distilled water and filtered, was injected into the jugular and the drops of urine again noted on the drum. The bladder was kept moist with absorbent cotton wet with Ringer's solution. The blood pressure was frequently noted at the time the drops of urine were registered.

Spinal cord (% grain) had no effect on flow of urine; did not alter rate of pulse; increased blood pressure.

Prostate had no effect on flow; did not alter pulse rate; increased blood pressure. Ovary reduced flow; did not alter pulse. rate, but reduced arterial tension.

Spleen (1⁄2 grain) reduced flow; did not alter pulse rate; lowered arterial tension.

Testicular extract (% grain) did not affect flow of urine or pulse; increased arterial tension.

Iodothyrin (1 grain) increased the flow of urine to a small extent. It also increased the volume of the kidney, although at the time the general blood pressure was decreasing and the heart beat remained the

same. The first injection of iodothyrin in the cat elevated for the moment arterial tension, but it soon fell. The heart beat was increased.

Mammary gland (1-50 grain) produces a slight increase of diuresis. The volume of the kidney increased at the time the blood pressure was falling, whilst the heart beat was somewhat increased. In the cat the mammary gland extract increases the heart beat and temporarily increases the general arterial tension, after which it falls considerably.

The parathyroid (powdered extract 1-10 to 1-5 of grain) at first decreases the volume of the kidney and then greatly increases it. The increase of kidney volume is often so great that the registering pen cannot record it. The primary decrease of kidney volume is due to a temporary slowing of the heart. The subsequent increase of volume in the kidney is not due to any change in the rate of heart beat, and the general blood pressure at the time fell slightly. As a diuretic, the parathyroids were the most powerful of all the gland extracts. With the nucleoproteid prepared according to Beebe's method by Dr. W. N. Berkely the increase in the amount of urine was ten times that of normal (Exp. 21.) We found the parathyroids in a case of interstitial nephritis increased the quantity a half a pint a day. After the injection of the parathyroid powder glucose appeared in the urine to the extent of 3 per cent. The tests for glucose were by Fehling's solution, fermentation and the phenylhydrazin test.

Thymus slightly increased the flow of urine. It also augmented the volume of the kidney, although the pulse rate re

mained unaltered and the arterial tension was falling.

The pancreas increased the flow of urine. The volume of the kidney was slightly increased, whilst the general blood pressure was decreasing, and the rate of heart beat considerably increased.

After injection by jugular of pancreas the urine contained 4 of 1 per cent. of sugar, as shown by the fermentation and Fehling's test.

Schaefer, Houghton and Merril have shown that the pituitary extract (infundibular part) increased the flow of urine. The volume of the kidney was greatly augmented, so much so that the lever could not register at times.

The renal cortex increased the flow of urine. The volume of the kidney in doses of 1-50 to 1-25 of a grain did not change.

Adrenalin decreased momentarily the volume of the kidney, whilst the blood pressure rose and the heart was slowed. Afterwards the kidney volume was greatly increased.

All these agents, the renal cortex, pituitary extract, pancreas, parathyroid, mammary gland, thymus, iodothyrin and adrenalin, are diuretics. The above agents, except adrenalin, do not markedly increase general tension except for a moment, and then lower it. It is inferable that the very short rise of blood pressure does not produce the diuresis, which continues for a considerable time afterwards.

The increase in volume of the kidney shows a lessening of pressure in the blood vessels of the kidney. As neither general nor local increase of arterial tension plays any part in the diuresis, it must be referred to an action on the renal epithelium itself. Appended are some of the experiments:

THE THERAPEUTIC VALUE OF DIAPHORESIS IN THE TREATMENT

, 1910

, Vol. V., No.

11.02

5 8

OF OCULAR DISEASES.

BY

AARON BRAV, M. D.,

Ophthalmologist to the Lebanon Hospital,

Philadelphia.

Artificially induced sweating, as a therapeutic measure in the treatment of various diseases of the eye, must be considered of great importance. Though often neglected it constitutes an efficient agent in the domain of ophthalmic therapy. It is a valuable adjunct to the medicinal agents employed both by local application and internal administration. In fact it often enhances the efficacy of the various medical agents used in the treatment of diseases of the eye.

Active diaphoresis may be induced either for its direct curative effect acting favorably upon the inflammatory process, or with the intention of impressing the general system and through it influence favorably the ocular condition.

Diaphoresis may be induced (a) by thermic influences (b) hydriatic measures, (c) by means of medicinal agents (d) and by all these agents combined. The thermic and hydriatic measures wherever possible should be employed with preference.

The Russian vapor baths and the Turkish hot air baths are the most convenient

and the most effective means to produce active diaphoresis. They are to be found in nearly every town of any size, are obtainable for a small recompense and therefore accessible to all classes of patients. When we take into consideration that most patients in whom the diaphoretic treatment is indicated are of the ambulatory type and are not necessarily confined to bed the utility and value of these public sweating places become obvious. In places where these baths are not accessible or where the patient is bedridden and cannot avail himself of them, some substitute bath based on the same principle can be devised at home, this is especially probable with the Turkish hot air bath. Hot air can be generated by a self-devised inexpensive apparatus at home by means of an alcohol lamp over which is placed a curved chimney pipe leading to the bed the covers of which have been elevated and held in a semicircle form by some heavy wires. The wet pack may be employed when the above. self-devised apparatus is not on hand. In all these selfmade sweating processes in order to enhance diaphoresis it is well to administer large amounts of water. This promotes a more rapid and a more effective stimulation of the sudorific glands. Medicinal diaphoretics should be avoided as far as possible and should be employed only when no other means is on hand to produce an active diaphoresis. Several varieties of diaphoretic baths have been devised by the Germans but the above mentioned is the most easily prepared and can be used even in the poorest of homes with convenience. For the ambulatory cases however the most reliable and most practical is the Russian and Turkish bath. To the Russian bath the objection is often raised that the patient is exposed to catching

cold. This however can be avoided by a stay in the anteroom during the cooling process. Every modern bath house is provided with such rooms where the patient can rest comfortably. Of course the atmosphere in these places is not an ideal one and may in some cases have an ill effect upon the various organs, even give rise to congestion in the brain, a thing that would destroy the very object for which the bath has been prescribed. Yet in carefully selected cases it is, after all, the best means of inducing diaphoresis when pains are taken not to employ it where any fear of congestion exists. At any rate the benefit derived from the bath often far exceeds the harm it may produce. The effect of diaphoresis can be stated briefly to consist of (a) its action as an evacuant, (b) its action as revulsive, (c) its alterative effect, (d) its action as an absorbent, (e) its action upon the circulatory system, (f) its action upon the nervous system, (g) and its effect in enhancing the efficacy of the various medications employed in combating the inflammatory condition.

In diaphoresis we find a very valuable though much neglected agent in the treatment of various ocular diseases. Too little importance has been attached by the American text book writers to this therapeutic agent yet if my observations may be trusted it is one of the most effective means in combating some inflammatory diseases of the eye.

Its action as an evacuant results from the stimulation of the sudoriferous glands. which increase their activity abstracting large amounts of fluids, volatile substances, organic and inorganic salts, carbon dioxide, uric acid and urea as can be gathered from an analysis of the constituents of the perspired fluid. The sudoriferous glands are