USE OF DIURETICS. 517 



all, that combination is peculiarly useful in diuretics. Saline 

 purgatives also assist this action. Thus Sulphates of Soda and 

 Magnesia, Acid Tartrate of Potash, Tartrate of Soda and 

 Potash, Acetate of Potash, Citrate of Potash or Ammonia, are, 

 in the first place, saline purgatives, thus relieving general 

 venous congestion ; and, secondly, act upon, the renal epithe- 

 lium, draining the over-distended venous plexus, and accele- 

 rating the circulation through the gloinerulus. In other 

 instances dilators of the renal vessels may be combined with 

 these remedies, including Juniper and Spirit of Nitrous Ether. 

 (b) Disorder or disease of the kidney in association with 

 excessive blood pressure ; Brighfs disease with contracted kidney. 

 In the early stages of this disease, when its cause may be 

 discovered in indulgence in food and alcohol, or disorder of the 

 liver, the treatment consists in a thorough reform of diet, free 

 purgation, and elimination generally. Mercurial purgatives 

 followed by salines are especially valuable. In the more 

 advanced and grave form of high arterial tension, the cause is 

 usually beyond our power. All that can then be done is to 

 counteract the cause, remove its evil effects, and treat symptoms. 

 The food should be moderate in quantity, and chiefly non- 

 nitrogenous; stimulants must be avoided; moderate rest of 

 body and mind insured ; and various drugs administered. We 

 are unfortunate in possessing but few medicinal means of 

 reducing peripheral resistance for any length of time without 

 depressing the heart ; but the Iodide, Chlorate, Nitrate, and 

 other salts of Potash, Nitrite of Soda, Belladonna, and its allies 

 may be tried. Warmth is very essential in these cases. 



2. (a) Urinary derangements from nervous disorder or disease. 

 The treatment employed here must be entirely directed to the 

 nervous system. Bromide of Potassium, Valerian, and other 

 anti-spasmodics, including moral treatment, will relieve 

 hysterical diuresis ; and Opium and Ergot are successful in 

 many cases of polyuria of obscure and probably nervous 

 origin. 



(b) Local vascular disease. If the emulgent veins are ob- 

 structed by abdominal enlargement, this must be immediately 

 removed, if possible by tapping the peritoneum, for 

 example, or by inducing premature labour. In disease of the 

 renal vessels we can do but little by way of direct treatment 

 beyond relieving symptoms as they arise ; regulating the flow of 

 urine as well as possible, especially stimulating it if it 

 threaten to become deficient ; and removing the excrementitious 

 products by the bowels and skin, when the specific gravity 

 falls. 



3. Disease of the tubules ; " Acute Desquamative Nephritis" 



