The mechanisms by which diuresis is accomplished by the various therapeutic regimens and the various specific diuretics are still only partially understood. There are sharp differences of opinion not only as to the mode of action, but also as to the point of action of the drugs. Within the last few years much experimental evidence has been advanced, principally by the German investigators1 and their American followers,2 to prove that the effects of the specific diuretics are primarily exerted on the tissues and that the traditional conception of the principal effect of the action of diuretics on the kidney is perhaps in error.
The importance of edema as a clinical therapeutic problem cannot be overstressed. There are considerable clinical data and some experimental evidence that the presence of edema is distinctly disadvantageous, and it seems almost beyond peradventure that the dropsical state adds measurably to the burden of
HERRMANN G, STONE CT, SCHWAB EH, BONDURANT WW. DIURESIS IN PATIENTS WITH CONGESTIVE HEART FAILURE. JAMA. 1932;99(20):1647-1652. doi:10.1001/jama.1932.02740720001001