ralr mei fumigations of value in croup. The inditations of this treatment are re •rssirn of the suprasternal notch during with retraction of the infra t r raeic walls, stridulous breathing, rspness aphonia at times, and livid i•y• of the surface resulting from the de f. _iPnt oxygrmation of the blood. The amour t of the mercurial salt to be vapor ized variPs from 5 to 20 grains, repeated at in•Prvals varying from one-half to two t•rPe hours. according to the severity rf thP symptoms—in the average case 15 grains hourly. The patient is to be kept in the vapor-saturated atmosphere, within a tent, for a period varying from ten minutes to half an hour. Fruitnight (Areh. of Ped., June, '95).
All the mercurial preparations possess diuretic properties, but these are espe cially marked when calomel is employed. The increase of urine may range from a few ounces to as much as 370 ounces (Jendrassik). When adininistered in moderate doses repeated every three or four hours, the diuretic action appears early in some cases and only after four or five days in others. According to Lipari, tolerance for calomel is greatest in those cases in which diuretic action is most rapidly produced. On the con trary, the tolerance is least in those in stances where the production of diuresis is retarded. The main untoward feature of its use is the marked tendency to cause ptyalism and other nianifestations of rnercurial intoxication. Hence the pa tients should be carefully watched. Cal omel is especially efficacious in dropsical conditions of cardiac origin.
Six doses of 11/2 grains each may be given during the day, one every three hours. In cases in which there is a comparatively small cardiac lesion with marked dyspncea and hypertrophy or dilatation, with albuminuria, cedema, and ascites, this treatment is useful. After the first few doses have been given, as a rule, an increase in diuresis is estab lished, and on the second or third day quite copious evacuations of the bowels take place. There is marked improve ment in all the symptoms, cardiac and otherwise. Even when the calomel is no longer administered these good results persist for from tNventy-four to forty eight hours. In order to prevent ex cessive salivation, or to relieve it when already produced, the following mouth wash is used:— 4 Chlorate of potas., 2 12 drachms. Tannic acid, 4 grains.
Distilled water, 10 ounces.-11.
The calomel does good by relieving the congestion of the liver and the renal circulation, thus indirectly reducing the resistance to the heart produced by arte rial pressure. At the same time an ab
solute milk diet is ordered. Of 107 cases of grave cardiac disorder with distressing symptoms of failure of the heart, treated in this manner by Moraldescu there were 14 deaths: 2 died of pneumonia after the heart-symptoms were relieved; 3 died before the treatment had sufficient opportunity to be tried; the remaining 9 were of advanced years and the dis ease was also far advanced.
Mercury is especially of value when there is no concomitant renal or he patic disorder, and hurtful, according to Huchard, when the urine contains albu min.
Calomel is a very valuable diuretic in the dropsy of heart disease, but useless in that depending on renal or hepatic affec tions. Two and one-half grains are given four' times a day until ten doses are taken. The increase in the secretion of urine does not appear until the third or fourth day. Should no result follow in four days the treatment is stopped, to be recommenced after eight days. If suc cessful on the first trial, a second course of ten doses is carried out after two to four weeks. H. Nothnagel (Then Monats., May, '88).
The best results from mercury are seen in cedema resulting from cardiac failure. Diseases of the kidneys limit or entirely abolish the diuretic action. It is impor tant that full doses be given, as small amounts are not diuretic. For the first two days the secretion of urine is di minished, but afterward it is augmented. Action of the drug is due to the irrita tion which it produces while passing through the kidneys. W. Bieganski (Archiv f. kiln. Med., Sept., '88).
Calomel is useless in cardiac diseases complicated with cirrhosis, and hurtful in renal or heart disease if albumin be present in the urine. H. Huehard (Revue Gem. de Clin. et de Tiler., Apr. 25, '89).
Continuance of the treatment during diuresis will not alter or increase the effect. Its action is most marked in dropsies due to heart disease. Its action in dropsies of hepatic origin is not to be relied upon. Pathological changes in the kidney prevent or abridge its action. Small doses will prove of no avail. The diuretic action may, in all probability, be ascribed to the irritating effect which the mercury, during its elimination, ex ercises upon the renal epithelium. G. A. Fackler (Jour. Amer. Med. Assoc., Aug. 16, '90).