In toxic hæmoglobinuria, proceeding, for example, from confinement in a close place, where carbonic oxide or arsenuretted hydrogen are disengaged, recourse must be had to transfusion, so as to restore vivified red globules to the blood.

Injections of chloral, for producing anesthesia, have been followed by death from asphyxia. It is therefore prudent to abstain from their use, now that we possess an agent like bichloride of methylene, which never fails in its effect, and the employment of which is perfectly safe.

Uræmic Diathesis.-The kidneys being designed to eliminate the urea from the blood in the form of uric acid and urates, it is necessary to consider the disorders which may result from insufficient elimination. These disorders, be it understood, are referable to a poisoning; hence, the name of renal toxamia, proposed by Ruth.

Urea of itself is not a poison, since it has been introduced in relatively enormous quantities into the blood of animals without occasioning either death or poisoning. These disorders, according to Professor Freirichs, are due to carbonate of ammonia, formed at the expense of the urea accumulated in the blood. To this theory, the absence of a ferment has been opposed; but are there not the albuminous matters of the blood which might act as ferments? What is certain, is that animals whose kidneys had been extirpated, perished with symptoms of putrid decomposition, as M. Cl. Bernard has demonstrated.

Typhus, which is characterised by scanty urine, is, properly speaking, only a uræmia. It will be objected that septicemia may have arisen from operative proceedings; but the same typhoid symptoms are produced when the cutaneous pores of an animal (a horse, for example) are obstructed by means of an impermeable coating. Now, the skin supplements the kidneys in the elimination of the urea, under the form of sudoric acid.

In Asiatic cholera, in which the suppression of urine is

complete, a typhoid state is seen to supervene during the period of re-action, which can only be explained by the retention of urea in the blood.

The urine, under normal conditions, eliminates quite a series of unassimilable products, true organic wastes, which, under the influence of oxidation, or any other chemical action, tend to be metamorphosed into urea. A portion of these substances undergoes that transformation in the tissues, in the blood, and perhaps also in the kidneys. Another portion is eliminated by the urine without further change. If anuria declares itself, all these products do not delay to accumulate or to decompose in the blood and in the parenchyma, and their action on the nerve substance is interpreted by the uræmic phenomena. (Spring.) These morbid forms are numerous; I can therefore only indicate them here briefly.

Uræmic Accidents.-These are generally nervous disorders, which sometimes assume the character of depression, and sometimes that of excitation. As Rosenstein remarks, the depressive influence affects preferably the brain and the organs of sense, even to the point of constituting an acute anæmia of the encephalon; that is to say, in uræmia there is invariably impoverishment of the blood or hydræmia. Postmortem examinations show that in uræmia there is œdema or at least anæmia of the brain, as Dr. Monod has proved in cases of children who died from uræmia.

The symptoms which characterise uræmia are the following: intellectual apathy, somnolence, and coma. Uræmic coma may be in all points similar to apoplectic coma, but it commonly happens that it is not as profound nor as permanent; the patient recovers sensibility and consciousness from time to time; the coma is then replaced by stupor. It is after a few of these remissions that the coma becomes persistent. (Spring.)

We see here verified what I have previously mentioned concerning apoplectiform fever and its treatment; that is to

say, it is necessary to avoid blood-lettings, but recourse must be had at first to hydroferrocyanate of quinine, against the accessions.

The febrile re-action which accompanies uræmic attacks, presents sometimes considerable elevation of the animal temperature (40°c.). In this case, recourse must be had to veratrine:

A granule every half-hour;

but the hydroferrocyanate of quinine must be immediately reverted to, as soon as the temperature falls to 37°c.

Such is the treatment of acute uræmia. As regards chronic uræmia, its forms are very diverse. Thus, taking note of the organs of sense, it is observed that amblyopia may even extend to complete loss of vision, owing to sub-retinal œdema, which the ophthalmoscope will enable the physician to distinguish from retinal hemorrhage. Phosphoric acid, sulphate of strychnine, and hydroferrocyanate of quinine must be given in this case :

A granule of each, together, every hour.

A peculiarity to which the physician should direct his attention, is whether the pupils preserve their contractility or not. He will thus distinguish symptomatic amaurosis from organic amaurosis; that is to say, he will abstain from superfluous or hurtful treatments.

As to the hearing, there are buzzings and ringings, arising from a dryness of the membranes of the internal ear. Deafness, in this case, proceeds from oedema of the auditory utricles. Vertigo and disorders of the motory.co-ordination (vide Otitis), and cephalic pains, generally of a hemicranic character, may result from it. The same treatment is indicated here as in amblyopia.

As to the organs of motion, there are convulsions-most often clonic-due also to cerebral anæmia, or hydræmia. These convulsions assume the form of epilepsy, and are preceded by the epileptic aura. It may be comprehended

how much the treatment should vary here, according as there is softening or induration of the tissue of the spinal marrow. To give bromide of potassium in all cases, would be like the famous "Prenez mon ours of the late M. Scribe (in L'ours et le Pacha).

In hydræmic epilepsy, arseniate of iron, arseniate of strychnine, and digitaline must be given :—

Three granules of each, together, daily.

Bromide of potassium is only indicated in acute spasms.

In uræmia, intolerable pains sometimes exist in the limbs. and articulations, which should be calmed by morphine and hyosciamine :

A granule of each, together, every half-hour, until sedation.

The administration of the Seidlitz salt is very important, as it will prevent gastric disorders, arising from a bilious state. Gastralgias and enteralgias will be calmed by strychnine and hyosciamine:

A granule of each, together, every half-hour, until sedation.

If there are disorders of respiration: dyspnoea, angina pectoris, etc., as they may terminate suddenly in pulmonary oedema, they must be combated without delay by arseniate of iron, arseniate of strychnine, and hyosciamine:

A granule of each, together, every half-hour, until sedation.

Passive epistaxis is also seen to supervene in persons addicted to alcoholics; these hæmorrhages must be combated. by hydroferrocyanate of quinine and arseniate of iron :

A granule of each, together, every quarter-of-an-hour, until the epistaxis ceases.

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Hydruric Diathesis. In a state of health, the mean proportion between the fixed principles and the water of the urine is as follows, according to Vogel :-In 1000 parts: water 960, urea 23.3, uric acid 0.5, sodium chloride 110, phosphoric acid 2.3, sulphuric acid 13, ammonia 0-4; when this proportion exceeds 2000, it may be said that there is hydruria. Hydruria

must not, however, be confounded with a momentary augmentation of the mass of liquid caused by copious libations; the urine is not impoverished in such a case, there is simply an addition to it of the water imbibed. In true hydruria, there is a loss of density, that is to say, of the proper elements of the urine. This state is often observed in epileptiform hysterias, and is connected with uræmia, the extractive principles of the urine being left in the blood. The same remedies are therefore indicated as in uræmia.

I would here make a remark relative to fermented or distilled drinks, the consumption of which increases every day in consequence of a deplorable abuse, which the force of opinion has been unable to repress.

The popular saying, "The blood of drunkards turns into water," is well known; indeed, the alcohol destroys the red globules, and the ether (le spiritus) infiltrating into the tissues, the blood becomes watery. I will add, that the want of saline principles (distilled or fermented drinks containing little or none) and the increased intravascular pressure, produce albuminuria. (Vide the latter.)

The abuse of fermented drinks induces, therefore, hydruria. It is known, indeed, that great beer-drinkers are bloated and infiltrated. One might allege extenuating circumstances in favour of hopped beers, but in most of the so-called beers, the hop is a myth, independently that the sprouting barley is replaced by glucose, and the gluten eliminated, in order to render the beer clearer. The hop is replaced by bitters which do not possess its antifermentative qualities, therefore, beer turns sour, and causes colics and intestinal crudities. I may also add, that instead of a potable water, a selenitic water is often used. In place of a wholesome drink, tonic and nourishing, we get a beverage agreeable to the eye, but debilitating. It is useless to say why the environs of beer-houses are inundated.