EDEMA 189 



including the early application of such methods as are described below, 

 in order to prevent the accumulation of large amounts of fluid in the 

 subcutaneous tissues and serous cavities. Of especial importance is the 

 early treatment of heart failure, by rest in bed, and proper drug and 

 dietetic therapy, and of infectious diseases by a bland, salt-free diet. 



The prevention of the attacks in recurrent forms of edema, such as 

 urticaria and angioneurotic edema, may be possible. An investigation of 

 such patients should be made in order to determine the particular proteins 

 to which the patients are sensitive, so that the patients may be protected 

 from contact with them. In some cases desensitization is possible, by the 

 subcutaneous injection of the appropriate proteins, at first in minute 

 doses, and later in gradually increasing doses. When the attacks are 

 attributed to intestinal disturbances especial attention should be paid to 

 the diet, and to keeping the bowels open. The conditions of the nasal 

 mucosa should be studied; relief is sometimes obtained by the removal 

 of polyps, or the correction of obstructive deformities. 



Etioldgic Treatment. Since edema is often improved by treatment 

 designed to relieve the underlying condition it is the first duty of the 

 physician to establish, as early as possible, a diagnosis of the condition 

 responsible for its occurrence. It is especially important to' recognize the 

 edema of heart failure, so as to institute appropriate treatment of the 

 cardiac condition. In uncomplicated cases of heart failure, the diagnosis 

 is usually not difficult, but when edema due to heart failure occurs during 

 the course of chronic interstitial nephritis or primary hypertension, it is 

 often mistaken for the edema of nephritis. The results of treatment in 

 cardiac cases are often striking, and the possibility of this etiology should 

 not be overlooked. In case of doubt a patient should be treated as though 

 heart failure were present, and until the therapeutic test has been shown 

 to be negative. 



The Edema of Heart Failure. In cases of heart failure with slight or 

 only moderate edema it is, as a rule, unnecessary to apply therapeutic 

 procedures designed primarily to relieve edema, since in such cases it 

 generally disappears rapidly as the result of measures undertaken to 

 relieve the underlying condition. Rest and digitalis are the important 

 remedies. 



In more advanced or severe cases special dietetic measures, particularly 

 limitation of fluid and salt intake, and the administration of diuretics and 

 saline cathartics are often indicated. These measures are discussed below. 

 Special attention should, however, be called to the Karell regime. This 

 regime is indicated in particularly obstinate cases of edema but also is 

 often used as a routine in beginning the treatment of any case in which 

 edema is a prominent symptom. 



The Edema of Nephritis. The edema of glomemlo-nephritis, unless 

 complicated with heart failure, is usually not so marked as to require 



