TREATMENT OF THE DROPSICAL FORMS OF DISEASES By Professor GERMAIN SÉE. Member of the Academy of Medicine, and of the Faculty of Med- Gentlemen-From the point of view of treatment we must dis- 1. The oedema of the extremities which sometimes appears as the 2. The dropsy which results from coëxisting disease both of the *Delivered in "La Charite" and translated for the NORTH CAROLINA MEDICAL 243587 TREATMENT OF SIMPLE CARDIAC DROPSIES. The simple cardiac dropsics demand both diuretic and purgative treatment. Among the diuretics I shall have occasion to recommend the following as being especially useful:-milk, convallaria, digitalis, squills, and certain accessory means which sometimes further the removal of dropsical effusions. 1. Milk ought almost exclusively to be administered in grave cases. Let your patient drink it freely and use no other drink or food, taking three or four quarts a day. In the oedemas of the initial stage give milk in less quantity as aliment and diuretic; one or two quarts a day. 2. The Lily of the Valley is the most powerful of diuretics in cardiac dropsies, and will succeed when given alone, and without the aid of milk. 3. Digitalis (to which I shall soon allude again) has the frequent disadvantage of provoking nausea, of taking away the appetite, and causing constipation. 4. Squills and the diuretic wines containing squills, sometimes, though rarely, act better than digitalis. 5. Accessory or doubtful means. The diuretic herb ptisans, (pyrola, parsley, broomtop, cleavers, etc.) the white wines, beer, the gaseous waters have no certain durable action, and present serious inconveniences. GENERAL CONSIDERATIONS RESPECTING DIURETICS. The most powerful cardiac medicaments, namely, digitalis and convallaria have a triple medicinal property, that is, to say, they act at the same time as cardio-vascular remedies, as respiratory medicaments, and as diuretics. Under the first head they surpass all other modifiers of the circulation, central and peripheral. As far as being respiratory medicaments is concerned, they are preferred to the preparations of iodine, and to erythrophlæum. As diuretics, they occupy indisputably the first rank, and we can establish the following hierarchy: 1. First, in general repute, if not in importance, is digitalis, whose diuretic action is due to augmentation of intra-renal vascular tension, which is produced under the influence of the remedy. 2. Convallaria has the same mode of action, and its diuretic properties are far more prompt, more energetic and more enduring than those of digitalis. 3. Milk; its diuretic effects result from its very composition, and not from the increase of intra-vascular renal pressure, augmenting the secretion of urine, (as is the case with digitalis) its diuretic components are sugar of milk and salts of potash, which by their dialytic action seem to facilitate the exosmosis of the water of the blood as I have shown in my treatise on the dyspepsias.* The indications for milk are so clear and positive in cardiopathy with dropsy, that the milk-treatment suffices often of itself to cause the disappearance of dropsical effusions. 4. Squills is often prescribed as an adjuvant of digitalis; it has most of the inconveniences of the latter without the advantages. It enters into the composition of a great number of preparations known as diuretic wines, etc., whose diuretic power is very variable; in the diuretic wine of the Hotel Dieu it is associated with digitalis; in that of "La Charité" it is combined with bitters. 5. Caffeine, employed for many years past by Dujardin-Beaumetz, has been recently considered by Lépine and Hachard as a powerful diuretic, possessing at the same time a regulating action on the heart, in certain forms of asystolism, which are still undefined, but in that form especially which Gubler has described under the name of cardio-plegia, or paralysis of the heart. Before pronouncing on the value of this medicament, I wait for more precise explanations, and especially for a more serious study of its physiological effects. At first the dose used to te from five centigrams to three grams, (1 to 45 grains), but Hachard recommends with good reason the larger dose. The physiological action must vary as the dose is fractional or large, therefore we are not surprised at the discrepancies which characterize the therapeutical history of this drug. Some say that caffeine augments the secretion of, urea, and raises the temperature, *V. Studies on the uses of Milk in "Les Dyspepsias, Gastro-Intestinales," by Germain Sée, Paris, 1881. |