other hand, if profuse sweating is advisable in such a condition, it is best promoted by some method of applying heat which would cause the same physical results without the prostration.

If there is general anasarca, or even large localized edemas in nephritis, pilocarpine, by promoting a large excretion of water by the skin, if the patient is not allowed to ingest water, may cause resorption of the exudate. But while this process is going on the patient is likely to become debilitated. Edema with a weakened circulation, and certainly cardiac edemas, should not be treated by pilocarpine. If the kidneys are so damaged that applications of heat (if perspiration is desired) will not relieve the serious condition, neither will pilocarpine. Therefore pilocarpine treatment of serious conditions is generally inadvisable.

Pilocarpine has been suggested to promote secretion in the beginning of colds and acute bronchitis. The dose for this condition is small, and it is generally given by the mouth; but other treatments are better.

Pilocarpine has also been suggested to promote the mammary secretion in lactation, but its action for this purpose is doubtful, as when the dose is sufficient to stimulate the mammary glands it will also be sufficient to promote perspiration, which is likely to diminish the lacteal secretion.

The hydrochloride of pilocarpine has been used in 1 per cent. solutions in the eye for the same purpose as physostigmine (eserine) is used. It is a little less irritant than eserine, and, as above stated, will contract the pupils. Two or three drops of a I per cent. solution may be dropped into the eye, two or three times a day.

Pilocarpine has also been used in certain skin diseases, as psoriasis and dry eczema, but in most of these chronic dry conditions of the skin thyroid extract acts better. It has also been used to promote the growth of hair in baldness, but it is doubtful if there is any good reason for such use.

DRUGS USED TO DECREASE PERSPIRATION

Profuse, weakening perspiration often occurs at the time of the crisis of a disease or at any time when there is a rapid fall of

temperature in disease. It also occurs as a part of septic infection, is especially common in acute rheumatism, and is a serious symptom of tuberculosis.

The treatment of profuse perspiration is the application of dry heat, and the administration of 1200 to 100 grain of atropine sulphate. Preventive treatments are massage, warm alcohol rubs, circulatory stimulants, and anything that improves the general condition of the patient.

SECOND DIVISION

CLASS II

DRUGS USED FOR THEIR ACTION ON THE GENITOURINARY SYSTEM

All vegetable foods and drugs of strong taste and smell are mildly diuretic, such as onions, garlic, radishes, celery, asparagus, asafetida, and valerian, as they are mild stimulants to the kidneys. All of the spices are more or less stimulant to the genitourinary mucous membranes, and hence should be avoided in kidney, bladder and other genitourinary inflammations. Tea and coffee should also be avoided when these regions are inflamed or irritated. All of the turpentines are stimulant to the kidneys, and in any large amount are irritant.

Anything that irritates the kidneys, or any poison that is ingested and irritates them during its excretion will cause the following symptoms, in the order named: increased frequency of urination with diminishing amounts of urine passed; backache; perhaps vesical tenesmus and urethral burning; later an increased amount of mucus in the urine; then albumin; then blood; and finally suppression; and, after some drugs, strangury. The treatment of such an acute inflammation is that of acute nephritis.

So-called diuretic drugs, whose names were legion, have become of less and less importance, until only a certain few have stood the test of efficiency and are of value. It is by no means always possible to increase the amount of urine, and especially is success often lacking when diuresis is most needed.

The amount of urine is increased:

1. By increased blood-pressure. (a) Hypertension.

(b) Increased heart action.

(c) Cold to the surface of the body.

(d) Nervous excitement (fear, hysteria).

2. By drugs that raise the blood-pressure.

3. By drugs or substances that stimulate the secreting epithelium of the kidneys.

The amount of urine is diminished:

1. By low blood-pressure.

(a) Insufficiency of the heart.

(b) Shock.

(c) Hemorrhage.

(d) Heat to the surface of the body.

2. By drugs that lower blood-pressure.

3. By fever.

4. By kidney lesions.

5. By pressure on the kidney blood-vessels.

Therefore, to increase the output of urine, with the kidneys intact, we must raise the general blood-pressure by heart tonics or by vasocontractors; or we must increase the bulk of the blood (by water); or we must give drugs that actually stimulate the kidney epithelium.

DRUGS USED TO INCREASE THE AMOUNT OF URINE

The best drugs for this purpose are those listed in the classification, but before administering such a drug, it is essential to note some general physiologic principles.

The skin and the kidneys act and react upon each other; the more secretion or excretion by the skin, the less by the kidneys, and the reverse. If the skin cannot act during fever and is hot and dry, the kidneys soon become congested, and frequently excrete albumin. On the other hand, a profuse sweat during a feverish process may not only cause the urine to become concentrated, but it may also cause it to contain albumin. When

a large amount of skin has been destroyed by burns, and the secretion and excretion of the skin is seriously interfered with, the kidneys are likely to become irritated, and the urine to become albuminous. Any serious skin disease that attacks a large portion of the surface of the body, preventing its normal activity, may also cause kidney disturbance. The obverse of this is also true, namely, in chronic nephritis the skin is called upon to do extra work, and it, sooner or later, becomes dry, irritated, and perhaps eczematous. When this condition of the skin develops the prognosis of the kidney disturbance is grave. Acute inflammations that attack large surfaces of the body, as scarlet fever, erysipelas and small-pox, also tend to cause kidney irritation, congestion, and perhaps inflammation.

In any of these conditions named treatment aimed at a modification of the urinary secretion is advisable. If the urine is concentrated and diminished in amount, plenty of water should be ingested, with perhaps some non-irritating drug that would increase the output of the urine. Often, however, the kidneys should be relieved by causing the skin to become more active, by hot baths and hot drinks, or by other methods that cause perspiration.

If albumin is found in the urine, the diet should be non-irritating and bland; often meat, tea, coffee, spices and condiments should be withheld, and no drugs should be allowed that could irritate the kidneys. If congestion of the kidneys has occurred, the treatment should be such as would prevent acute nephritis, if possible, and it may be inadvisable to push the ingestion of water. This, however, is determined by the cause of the kidney irritation. In general infection it may be well to give extra amounts of water, even at times by high enemas.

Local congestion of the kidneys may be relieved by heat, applied as in body baking or by electric light baths, or by moist hot applications to the lumbar region. This is not with the object of causing elimination of toxins in uremic conditions, but with the object of relieving the congestion in the kidneys by dilating the systemic blood-vessels, especially the surface vessels. It should be emphasized that if there are edemas, either from kidney insufficiency or from cardiac insufficiency,

the ingestion of water should not be pushed, in fact it may be well to diminish the intake of water.

There is probably no such thing as a "sedative" diuretic; hence if the kidneys are inflamed, everything should be taken out of the diet and every drug omitted that carries or produces salts difficult for inflamed kidneys to excrete. In other words, so-called diuretic drugs should never be administered in acute and rarely in chronic nephritis.

The amount of urine is increased by buchu, which is a mild stimulant to the kidney epithelium; by caffeine, which raises the blood-pressure, stimulates the heart, and is also a mild stimulant to the kidney epithelium; by digitalis, which strengthens the heart and raises the blood-pressure; by scoparius, which stimulates the epithelium of the kidneys; by squill, which may raise the blood-pressure, and stimulates the kidney epithelium; by theobromine sodio-salicylate (diuretin) which slightly raises the blood-pressure and is a stimulant to the kidney epithelium.

DRUGS USED TO RENDER THE URINE ALKALINE

If the urine is very acid and irritates the bladder and urethra, as evidenced by an increased desire to urinate, with more or less pain, all food that increases the acidity of the urine should be withheld, a diet of milk and cereals given, plenty of water should be drunk, and no mineral acids should be taken. With this increased acidity of the urine there may be lumbar backache joint pains, and other signs of disturbances from uric acid.

In this condition potassium or sodium citrate, given in doses of 2 grams, three times a day, directly after meals, combined with a modified diet, is effective treatment. The old "A. B. C." mixture, i.e., potassium acetate, potassium bicarbonate and potassium citrate, is a heritage used in the treatment of gonorrhea that may be buried without causing privation. The acetate and the bicarbonate are more disagreeable and no more efficient than the more pleasant citrate of potassium.

If there is acute bladder or urethral inflammation, the potassium or sodium citrate should be pushed to the point of rendering the urine alkaline, ever though it is necessary to give a 2-gram dose four or five times a day to accomplish this purpose.