Hamoglobineemia. — Azotemia, Etc. 465 



One of the most effective agents is water. If the patient is 

 thirsty he should have all he will drink, and if not, it may even 

 be given from a bottle, or thrown into the rectum. A still more 

 effective resort would be to*introduce water intravenously in the 

 form of a normal saline solution, or even to pass it into the 

 trachea through a small cannula or large hypodermic needle. 

 This serves to dilute the over dense blood, to stimulate the kid- 

 neys and other emunctories to active secretion, and to retain in 

 solution the haemoglobin, urea and other products which would 

 otherwise cause greater irritation. This would be especially ap- 

 plicable after the blood-tension had been diminished by phle- 

 botomy. 



Warm fomentations to the loins or croup are not without their 

 influence. They tend to soothe the irritated parts and to solicit 

 the action, of the kidneys more particularly. The old resort of a 

 fresh sheep skin, with the fleshy side in, may be used as a sub- 

 stitute. 



Perhaps the most important indication is to secure depletion 

 from the overloaded portal system and liver. Where nothing 

 better offers, a pint or quart of castor oil, or a pound of Glauber 

 salts, or a half drachm of podophyllin and four drachms of aloes 

 may be given. If available 1 to 1^ grains of eserine, or 7 

 grains of barium chloride may be given hypodermically or intra- 

 venously in distilled water or that which has been raised to the 

 boiling point. This may be supplemented by frequent injec- 

 tions of hot soap suds or even of laxative saline solutions. If the 

 bowels can be roused to free secretion the removal of toxic 

 matters from the portal blood and the delay in the progress of 

 similar matters through the liver will go far toward securing a 

 favorable result. When free purgation has been secured recov- 

 ery can usually be counted on. 



The action on the bowels must be followed up by diuretics to 

 eliminate the offensive matters from the general system. Colchi- 

 cum has been recommended because of its action in increasing 

 the solids of the urine, and this may be combined with saltpeter 

 or other diuretic, or the latter may be used alone and repeated 

 twice a day. If, however, the patient can, by the free use of 

 common salt or otherwise, be induced to drink freely of water, 

 the elimination through the kidneys will be sufficiently secured. 

 30 



