. Transactions. real importance in the manage-ment of clinical nephritis. Closely allied to this state of irritability of the vessels is theirsusceptibihty to fatigue. Schlayer, in his paper before the Kongressfiir innere Medizin in 1912*, demonstrated how the excessive useof a common diuretic of our daily food, ordinary salt, which alwaysleads to increased output of water in the normal kidney, in thediseased kidney may produce rapid diminution of diuresis. Asharp restriction in the salt intake may then be followed by increas-ing outputs, both of water and salt. He made similar observationswit
. Transactions. real importance in the manage-ment of clinical nephritis. Closely allied to this state of irritability of the vessels is theirsusceptibihty to fatigue. Schlayer, in his paper before the Kongressfiir innere Medizin in 1912*, demonstrated how the excessive useof a common diuretic of our daily food, ordinary salt, which alwaysleads to increased output of water in the normal kidney, in thediseased kidney may produce rapid diminution of diuresis. Asharp restriction in the salt intake may then be followed by increas-ing outputs, both of water and salt. He made similar observationswith the purin diuretics. Mosenthal and Schlayer (personal com-munication) have subsequently studied this in detail in experimentaltoxic nephritis. Their results, which will appear shortly, make itclear that abnormal susceptibility to fatigue is highly characteristicof the vascular system of the diseased kidney. This fact, like * Schlayer, Ueber die Ermiidbarkeit der Nierenfunktion, xxix Kongress Med., Diuresis of four days duration from a single dose of caffeine, gr. i, ina patient with chronic nephritis and myocardial insufficiency. The sohdulack cokmins represent the intake of water, and the hatched cohmins theoutput of urine, each in c. c. for each 24 hours. THE BEARING OF FUNCTIONAL TESTS ON TREATMENT. 17 the allied phenomenon of vascular over-irritability, must never beneglected in treatment. It justifies the already established customof Rombergs Tiibingen clinic, where the caffein diuretics werenever given continuously, but intermittently, and in comparativelysmall doses. Our practical experience with these drugs at thePresbyterian Hospital bears out Schlayers thesis. It is sometimespossible to obtain diuresis persisting for forty-eight hours or morefrom so small a dose as a single grain of caffein. When a diureticof this type is indicated, as a rule we use theocin, giving threedoses of 3 grains each for a single day, and not repeating until thediuresis result
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