THE CANADIAN MEDICAL ASSOCIATION JOURNAL

chlorides, which are consequently retained inthe body, and thus prevenit the normal exeretion,f water, and possibly due to distension of theintertubular capillaries of the kidney mechanic-ally obstructing the lumen of the collectingtubules.No matter what the mode of its action actually

is, the salt appears to be the offender, and there-fore treatment should be directed towardslowering its amount in the body.

Hlaving arrived at these two conclusions, firstthat the kidneys were able to take care of thenitrogenous products in pre-eclampsia, and thatan excessive amount of salt was responsible forthe cedema, Harding, and Van Wyck made aseries of observations on patients fed on protein,carbohydrate, fat, mixed and starvation dietsin turn, but entirely salt free, and proved totheir own and our satisfaction that the patientsalmost inivariably improved steadily on or-dinary salt free diet. In a few days the waterbalance was restored, the cedema graduallydisappeared, the blood pressure fell and thequantity of albumen lessened, while the accom-panying headache and eye symptoms disap-peared. At the same time the volume of urineincreased and its specific gravity fell. Withthe addition of salt to the diet there was areturn of the cedema, high blood pressure andthe accompanying symptoms. With its removalfrom the diet the signs and symptoms againdisappeared. In other words oedema could beincreased or lessened at will by the addition orsubtraction of salt from the diet. This led tothe adoption of the following routine treatmentof pre-eclampsia at the Buruiside Hospital:

1. On admission the patient is isolated andput to bed.

2. She is given a mixed diet entirely salt free

until the excretion of chlorides has reached itslow level and the cedeiAa has disappeared, whena small quantity of salt, 3 grammes, is addedto the diet.

3. The bowels are opened daily with a mild

laxative. There is no great purging of thepatient.

4. Each day a record of the blood pressure,fluid intake and output is kept, and the urineis examined for albumen, while its specificgravity is noted.During the last five years there have been

one hundred and twelve cases of pre-eclampsiaadmitted to the hospital and while all were onsalt free diet, eighty-one were on starvation dietand thirty-one on the more liberal diet assuggested above. In no case did eclampsiadevelop. All showed signs of improvement andwere tided over until term or until labaur couldbe induced.

These results, we think, justifv our adoptionof the salt free diet in pre-eclampsia We feelthat it has several advantages over other linesof treatment owing to the fact that with it thecedemna disappears uniformly, the patients -arenot starved, and general improvement is usuaLBesides which, the treatment is logical and inharmony with the experimental facts.

Furthermore, we feel that a restriction ofsalt in the diet of all patients in the last halfof pregniancy is of decided value as a preventivemeasure, and deserves consideration in thegeneral prenatal care of all patients. Maternalmortality is much too high in this and othercountries, and the toxemias are responsible formany deaths. If we can in any way reduce theincidence of the toxaemias, then we shall nmostcertainly reduce both the maternal and thefcetal mortality. iMuch has already been doneby prelnatal care to wipe out eclampsia, andrestriction of salt is simply another aid at handtowards that end. We ask the co-operation ofthe profession to the extent of suggesting thatthe practitioners throughout the country under-take this modification of the diet of their ob-stetrical patients. We have already been as-sured the whole hearted support of the OntarioDepartment of Public Health in this regard,an-d in ten years we trust that eclampsia willbe one of the terrors of the past.

Hyperglyeaemia in Paralysis Agitans.-In astudy of eighteenl cases of idiopathic p)aralysisagitans, reported in the Journal of Neurologyand Psycho-Pathtology, June, 1926, Hurst stateshis belief that the hyperglycevemia which occurs

rather frequently in this condition is not relatedto the nervous affection, but rather to coincidentinvolvement of the vascular system. No evidenceof deficiency of liver function was revealed bythe levulose tolerance test in Hurst's series.

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