AZOTURIA. 
521 
partly the cause. This may be so in some cases, though none of 
mine had sufficiently marked abduction of the limb to warrant 
the diagnosis. The cause may he a tissue change of pyrexia, 
local embolism interfering with nutrition, or altered nervous 
action due to pressure. One of my cases was complicated with 
a most distressing vesico-vaginal catarrh. 
Treatment .—Starting from the standpoint that we are dealing 
with uraemia, the endeavor of the intelligent practitioner will be 
addressed to ridding the system as quickly as possible of the 
poisonous matter I well remember, when a student, seeing these 
cases brought in, usually to be carried out again heels up. The 
routine treatment is to purge and bleed. The first part of the 
treatment I will pass over with the remark that if the patient would 
be accommodating enough to live until the purgative acted, it would 
be very good treatment indeed. Usually he dies before the purge 
acts. If he lives eighteen to twenty-four hours and goes on to 
recovery, there is the open question as to whether the purge or 
the vis medicatrix natures is to be thanked for it. Bleeding is, I 
think, to be recommended. It offers a means by which we are 
enabled to rapidly remove a large amount of urea from the body, 
and also tends to lessen the action of the remaining poison on the 
nerve centers. To bleed and purge, however, is to knock down 
with one hand and set up with the other, as nature, ever tenacious 
of her balance, will rapidly withdraw from the body fluids enough 
to make up the mass of blood, and thus hinder the action of a 
purge, depending as it does for its action in great degree on the 
maxim “ ubi irritato ibi affluxusT When I tell you that I rely 
almost exclusively on morphia, and my practice has been so suc¬ 
cessful that last winter about nine cases, most of them bad ones, 
made good recoveries, it may provoke a smile from those of you 
who are intensely practical. Let us see. What does morphia do 
for us ? In the first place, it puts a stop to the action of urea on 
the nerve centers; it quiets the irritable patient; it allows him to 
stand quietly in a sling, and so avoid knocking the bark off him¬ 
self in futile struggles. You may be still more incredulous when 
I tell you that my principal reason for the use of this remedy is 
to get its eliminator action, and you won’t get this from the use 
