Pilocarpine liable to produce a kind of bronchorrhcea which is almost always fatal. Case seen in consultation of a child, 2 years of age, who had recently had scarlet fever. The attack was not a severe one, but it was followed by kidney disease, which resulted in general ana sarea. A single dose of pilocarpine was administered, and as a result of this bronchorrhcea, was rapidly produced, ac companied by the most intense dyspncea, so that the patient soon succumbed. Other cases seen, however, in which the remedy acted with the most happy effect. J. Lewis Smith (Med. News, Aug. 1, '96).
While pilocarpine is a dangerous remedy, which should always be used with great discrimination, bad effects never personally observed from its use; only from to 'I, grain administered, however, usually combined with some cardiac stimulant, such as strychnine or digitalis. J. Blake White (Med. News, Aug. 1, '96).
External application of pilocarpine in the dorso-lumbar region, employing an ointment of 3 ounces of vaselin and from grain to 1 '/, grains of pilocarpine nitrate. Surface frequently covered with a layer of cotton, which is allowed to remain on during the day. Out of eighty cases, the acute were rapidly restored to health and chronic eases were improved. There was marked diaphoresis and diu resis and albumin often disappeared from the urine. Julia (Lyon ned., Dec. 6, '96).
Hydragogues, as elaterium, the saline cathartics, and compound jalap powder, are useful as adjuvant measures. The extract of elaterium to V, grain) is prompt in action, and magnesium or sodium sulphate (1 drachm) given in hot concentrated solution every hour, or a calomel purge, may also be recommended. In extreme cases of dropsy it may be necessary to relieve the tension and dis tress by the use of a small trocar and eannula, with a drainage-tube (Southey) attached to the latter after the trocar is withdrawn, or by multiple punctures. If either hydrothorax, hydropericardium, or ascites assumes serious features, as pirations will become necessary. To the diaphoretic treatment may be added ounce doses of the spirit of Mindererus in water. This, combined with aconite, aids in controlling the fever that may be present and in preventing the vasocon striction that is often premonitory of ummic symptoms.
If the urfemic convulsions do not promptly yield to diaphoresis and cathar sis, venesection must be resorted to, the withdrawal of as much as a pint or two of blood often saving life. Occasionally
inhalations of chloroform are needed to subdue the violent convulsive seizures, as in eclampsia. Their recurrence may be prevented by the use of rectal injec tions of potassium bromide (1 drachm) and chloral drachm).
Contraction of the arteries with in creased tension and beginning muscular twitchings require the use of chloral hydrate, nitroglycerin, and, possibly, morphine.
_Nausea and vomiting may be held in control by minute doses of cocaine, cracked ice, dilute hydrocyanic or hydro chloric acid, bismuth, or by the addition of soda- or lime- water to the milk.
There is little advantage in diuretics other than the simple diluent drinks already mentioned, at least early in the course of the disease. Later, potassium bitartrate or acetate, sodium benzoate, as adjuvants to the water, and stimulants to relieve cardiac depression, or caffeine citrate and the infusion of digitalis, may be given, well diluted.
In infectious nephritis of young sub jects, with or without anasarca, tinct ure of cantbarides in doses of IO to 12 drops is very beneficial. It is contra indicated in the interstitial nephritis of arteriosclerosis and in lead poisoning. Mile. A. Myszynska (The-se de Paris, No. 24, '96).
Care must be taken during convales cence that the patient be not exposed to cold. The diet must not be changed to solids either too suddenly or too rapidly, and particularly does this rule hold in the matter of meats. Milk should form the mainstay of the dietary, and light watery vegetables, fruits, and cereals may be gradually added. The anoemia will indicate the ferruginous tonics.
The fatal result is reached in many cases only because the rigid course of management necessary to stem the prog ress of the disease is not enforced until irreparable mischief is done to the kid neys. The patient should avoid fatigue, mental wear, errors in diet, exposure to cold or damp, and keep the skin thor oughly protected. The urine should be examined at stated periods (monthly) to ascertain whether any trouble is still lurking or has been redeveloped. Jacob Price (Med. and Surg. Reporter, Apr. 24, '97).