EDEMA 193 



Theocin in doses of 0.2 to 0.3 gram, or theocin-sodium-acetate 0.3 to 0.5 

 gram four times daily sometimes produces a remarkable diuresis in pa- 

 tients with general aiiasarca. It is usually not well borne, however, and it 

 may induce vomiting and purging. In some cases it is without diuretic 

 effect, and in nearly all cases it loses its diuretic effect after two or three 

 days. It is advisable to order its administration for a period of three days 

 and to discontinue its use earlier if its untoward effects become pro- 

 nounced. If it produces no diuresis within three days further administra- 

 tion is of no benefit. 



The administration of diuretics in edema of diffuse nephritis or of 

 chronic parenchymatous nephritis is almost without exception of no benefit, 

 but striking effects are seen in the edema of heart failure complicating 

 chronic interstitial nephritis or hypertension. 



Purgatives. The administration of purgatives is nearly always ad- 

 visable, but violent purgation with irritant hydragogue cathartics should 

 be avoided. Calomel is of value for its diuretic effect as well as for its 

 purgative action, and should be used in conjunction with a saline cathartic. 

 The most useful cathartic is magnesium sulphate, given in doses of 15 

 to 30 grams, in saturated solution, and this may be repeated daily, the 

 object being to produce several watery evacuations every twenty-four 

 hours. Other salines, or jalap, elaterin, or podophyllin may be used. 



Thyroid Extract. Eppinger found that the administration of thyroid 

 extract to certain patients with edema resulted in a very great improve- 

 ment, often in complete. disappearance of the edema. His best results 

 were obtained in patients with myocardial disease in which edema was 

 out of proportion to the other signs of cardiac disease, and in chronic 

 .parenchymatous nephritis. 



Eppinger gives the following indications and contraindications for 

 thyroid therapy in edema : 



Indications for Thyroid Therapy. 



1. Markedly edematous forms of heart failure due to pure myocar- 



dial disease. 



2. Certain forms of renal disease. 



a. Chronic parenchymatous nephritis (nephrosis), with 



marked edema. 



b. Diffuse nephritis, with edema, without evidence of cardiac 



failure. 



~No beneficial effects have been noted in 



1. Edema following emphysema of the lungs. 



2. Edema following chronic interstitial nephritis. 



Contraindications to Thyroid Therapy. 



1. Heart failure, with exception of cases of pure myocardial disease. 



2. Coronary sclerosis. 



