Prognosis.—The prognosis of pulmo nary oedema is grave in all cases in which it occurs as a complication, its gravity depending on that of the causative affec tion. In the so-called "idiopathic" cases, those occurring independently of any primary disease, the chances of recovery are much greater. The oedema following Bright's disease and pneumonia present a particularly unfavorable prognosis.
Treatment. —Edema of the lungs be ing due in practically all cases to another disease, the treatment of the latter is the foundation of the measures to be adopted plus one very important indication: to sustain the heart by every means possible, heart-failure being the main cause of death. Caffeine, digitalis, and strychnine are the mainstays as far as remedies are concerned.
There are three elements in the pro duction of acute oedema which have to be combated: First, the enormous pul monary hypertension and the sudden or rapid enfeeblement of the right ventricle overcome by this hypertension; second, the troubles of innervation, cardio-pul monary; and, third, the very frequent renal impermeability.
To counteract the first, a large general bleeding to the amount of 10 or 12 ounces and injections of caffeine may be ordered. Against the second prepara tions of strychnine may be employed. On account of the third, a milk diet may be given, and theobromine ordered in doses of 20 to 40 grains a day. Huchard (Gaz. des HOp., Apr. 29, '97).
Derivatives are of value to relieve as much as possible the vascular engorge ment. In the early stages a hot mustard foot-bath affords considerable relief, espe cially if coupled with the copious use of dry cups over the infiltrated area.
When the oedema shows signs of in crease or when the case from the start assumes severe symptoms, venesection should at once be resorted to.
If the pulse is full and the heart act ing vigorously, the spasm of the minute arterioles can be as readily relieved by nitroglycerin or morphine as by the de pressing effect of the abstraction of blood. If the immediate origin of the trouble is the weakened muscle of the heart, showing its feebleness by fre quent, irregular, and inefficient contrac tions, with a small and fluttering pulse, one should give at once under the skin grain (0.000G gramme) of atropine sulphate, with grain (0.0012 gramme) of strychnine sulphate. This is to be in serted just below the clavicle in order to reach the heart with the least loss of time. While this is being absorbed at tention can be given to preparations for venesection, if it should prove necessary. Atropine rapidly contracts the vessels, stimulates powerfully the sympathetic system. increases the force of the heart's beat, raises arterial tension, stimulates the respiratory centres. and dries up the secretions of the skin and mucous mem branes. The dose required is whatever may be sufficient to produce its physio- ' logical effect, easily gauged by watching the amount of dilatation of the pupil. It is safe to begin with V,. grain (0.00012 gramme), and repeat in a half hour or at longer intervals until the iiystem is well under its influence. Charles O'Donovan (Amer. Medicine. Sept. 14, 1901).