Saline cathartics are, therefore, important remedies in the treatment of renal and cardiac dropsy. Free purgation also influences the condition by reflex action. The lessened hyperemia of the kidneys, the diminution of the blood pressure, and the reflex stimulation of these organs, resulting from the action of the purgative, are frequently followed by greatly increased activity of the renal function. Saline purgatives probably have their greatest use, however, in the treatment of gouty individuals. Their action has recently been made the subject of investigation by MacCallum, who concludes that the purgative is caused by an increase in peristalsis and by increased secretion of fluid into the intestine, both of which can be directly observed. The investigator is also of the opinion that even when these salts are introduced into the intestine, they must be absorbed into the blood before they can produce their purgative effect, and that they affect the intestine by increasing the irritability of the nerves and muscles, as Loeb has suggested. Their action in producing less solid feces is not due to the prevention of the absorption of fluids from the intestine, but to the production of an increased secretion of fluid into the intestine.- Medical Record.

THE PRACTICAL TREATMENT OF LUPUS ERYTHEMATOSUS.

Dr. T. G. Lusk (Post-Graduate, Vol. XX., No. 10) gives a brief review of the various most efficient remedies used in this disease. The treatment, at best, has been very discouraging, one thing after another is tried until improvement is seen, or the patient is not seen, which is apt to follow such methods. He quotes Crocker: "For my own part, I try calamine lotion; collodion with or without salicylic acid; mercurial plaster; benzoline, and sometimes the spirit-soap treatment, and if good results are not obtained, I try linear scarification." As for internal treatment, wholesome diet, sound hygiene, and remedies necessary to put the patient in the best physical condition are recommended. Thompson's solution, freshly prepared, and given in increasing doses, as recommended by Bulkley; and iodoform pills

containing one or two grains each, as advocated by Whitehouse, have been valuable in many cases.

Externally, only mild measures should be used in the highly erythematous patches, whether large or small, such as boric acid in calamine lotion, lotio alba, collodion, etc.

In the chronic type the only method he uses at the present time, and with almost invariably good results, is, (1) Soft plaster-mull of mercury, preceded by friction with tincture of green soap, until all scales are removed. (2) The application twice daily of a 50 per cent. solution of resorcin in alcohol until decided inflammation results. (3) The continuous application of Lassar's paste until reaction subsides, when the 50 per cent. resorcin solution is resumed until irritation again ensues. It is then to be discontinued and the paste again applied, etc.; this process being repeated until a cure results. In discussing the paper Dr. Stern reported brilliant results with high frequency treatment.- St. Louis Med. Rev.

EDEMA OF THE FEET AND LEGS.

Bryant (The London Practitioner) mentions a case in which the excessive ingestion of chlorides was followed by not only retention of fluid in the tissues and a consequent increase in weight, but also by marked edema of the extremities. The patient was accustomed to taking 300 to 600 grains of salt a day. Examination of his urine showed the presence of 1.86 per cent. of chlorides, i. e., nearly three times the normal amount. After reducing the amount of salt ingested the edema disappeared and the urine contained only .98 per cent. of chlorides. Widal and Javal found that, in cases of interstitial nephritis, doses of sodium chloride up to 150 grains did not give rise to edema, but in cases of parenchymatous nephritis, the result was different, edema was produced. They found that the chlorides were not excreted entirely, and that, as a result of their retention, the fluid in the tissues was retained. They further showed that by increasing the amount of chlorides in the diet the edema increased; but, on the other hand, if the ingestion of chlorides was diminished

the tissues were drawn upon for their reserve chlorides, and as they were used up the edema disappeared. They also demonstrated that there was a definite relation between the hydration of the body and the chloride retention, by changing three men suddenly from a diet rich in chlorides to one almost devoid of chlorides, the result being a reduction of the body weight of four or five pounds. The belief expressed by Widal and Javal, that the elimination of chlorides by the kidneys is a specialized function of these organs, offers the best explanation of the occurrence of edema of the legs in this case. It may be presumed that for a considerable time the kidneys had been able to deal with the excessive amount of chlorides presented to them for elimination, but it is equally reasonable to suppose that sooner or later there would be a limit to this overwork, followed by a breakdown if persisted in, and that it was a failure of this specialized function to continue at high pressure which led to an abnormal retention of chlorides in the tissues, and thus produced the dropsy.― Charlotte Medical Journal.

CLINICAL EXPERIENCES WITH CERTAIN DRUGS IN HEART DISEase. Thomas E. Satterthwaite calls attention to the fact that in the year 1900, according to the last census, as many as 70,000 persons died of heart disease in this country. Also that of the nine principal causes of death, heart disease was third on the list, in point of frequency; tuberculosis holding the first place and pneumonia the second. And now that apparently successful efforts have been directed against tuberculosis, and pneumonia has been investigated by a commission, heart disease should logically be next attacked. In so far as drugs were concerned he regards suprarenal gland as the most powerful heart stimulant known. As to the dangers from the nitrites and nitrates, about which much has been written, he finds their effects are always evanescent. Ordinarily in angina, hypertension, and arteriosclerosis they are useful, but if they produce violent pulsations in an arterio-sclerotic they should be suspended. For advanced cases of this affection the tetranitrate of erythrol was specially

adapted, owing to its prolonged action. But after all iodine in some form or other should be the main reliance. Strychnine is a reliable heart stimulant, but should be used with discretion and in moderate doses. Larger doses produce nervousness and insomnia. It should never be continued more than a couple of weeks at a time. Cactus he finds a good heart regulator, and strophanthus is excellent if prompt action is needed. Digitalis acts best when the arteries are flaccid, and just enough is given to restore normal tension. If the drug produces too much tension, the work of the heart is unnecessarily increased. In acute endocarditis, the fat heart, fatty degeneration, advanced arterio-sclerosis, aortic diseases, and cardiac neuroses, digitalis may do serious harm. In deficient or failing compensation digitalis is useful up to the point of producing normal arterial tension, after which its action is harmful, except in so far as it may increase diuresis. Circulatory depressants such as antimony, veratrum, pulsatilla, and hellebore are out of date in the treatment of cardiac diseases. But aconite is useful certainly in cardiac neuroses. There are some drugs in particular the action of which requires further investigation, because we are not sufficiently acquainted with their active principles or modes of action. These are adonis vernalis, trythropleum, epocynin, and cretegus.- Medical Record.

PATHOGENESIS AND TREATMENT OF DIABETES INSIPIDUS.

This comparatively little-known disease was the subject of a paper read by Dr. Schmidt before the Clinical Society of Vienna. He said that two causes were mainly responsible for the quantity of the urine—namely, (1) increase of the arterial tension and of the velocity of the blood circulating in the kidneys, and (2) dilatation of the vessels of the same region. It was not likely that an increased chemical action due to special irritation of the parenchyma cells took place at the same time. As yet all descriptions of diabetes had the drawback of not exactly stating the blood pressure at the time in question. The changes producing polyuria, and polydipsia as well, could be

looked for either in the nervous system, such as pathological changes in the cerebellum, in the medulla spinalis, or in the vagus nerve (tumors, hydrocephalus, apoplexy, cerebral shock, disseminated sclerosis, cerebro-spinal meningitis, section of the vagus at the throat, or pressure by an aneurysm of the aorta); or, secondly, in the action of diuretics or similar chemical agents producing a dilatation of the blood-vessels. Severe cachectic and anemic diseases were also likely to produce polyuria, perhaps on account of the hydramia always present in carcinomatosis, chronic phthisis, and pernicious anemia. The treatment consisted generally in the exhibition of vaso-constricting remedies, such as secale. cornutum, digitalis, strychnine, adrenalin, and the like. But the results were very unsatisfactory. Dr. Schmidt proposes another way. His idea is to produce hyperemia in another but neighboring region, especially in the mucosa of the intestinal canal and in the skin so as to relieve the renal capillary system. In three cases he prescribed an energetic purgative, consisting of one gram of podophyllin, mixed with a sufficiency of powder and extract of rhamnus frangula, and divided into 40 pills, two of which were taken every evening. The purgation induced in this way acted as a counter-irritant and Dr. Schmidt succeeded in considerably benefiting his patients, so that they are now practically well. In cases which are able to sustain a sweating treatment by the use of the hot Turkish bath the relief obtained by the action of the sweat glands is still more marked, but care must be taken to ascertain that there is no atheroma of the vessels, degeneration of the myocardium, asthma nervosum, or tachycardia which would be contra-indications against such a radical procedure. The best results are obtained in polyuria combined with constipation and diminished perspiration. The Lancet.

TREATMENT OF TUBERCULOUS PLEURISY WITH EFFUSION.

Dr. Theodore Potter, Indianapolis, presented the following deductions: I. The profession has gone too far in accepting the general principle and following the general practice that