Medicine: Too Much Salt

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The dreadful dropsy grows apace, Nor can the sufferer banish thirst, Unless the cause of the malady has first Departed from the veins.

— Horace, Odes 11:2

Horace used dropsy (most commonly, a swelling of the feet and ankles) as a figure of speech for greed. But modern medical science has found truth as well as poetry in his lines. The cause of the malady, doctors now believe, is not water, but sodium, which prompts the body to hoard water in abnormal amounts — usually as the result of a heart or kidney ailment.

Last week Dr. Ferdinand R. Schemm, chief investigator at the Western Foundation for Clinical Research in Great Falls, Mont., learned that the National Heart Institute would grant $33,000 in the coming fiscal year to advance the work which has already made the Schemm treatment for dropsy world-famous.

More Water. Ferdinand Ripley Schemm, 50, son of a Michigan doctor, had set his heart on being a surgeon. But after three years of practice his hands were so injured by X rays that he had to make a fresh start. Back at the University of Michigan, he studied internal medicine while his wife got her M.A. and wrote her first novel, Fireweed.*

By the time he left for Great Falls in 1933, Dr. Schemm knew what he wanted to do. Inspired by Dr. Louis H. Newburgh's work at Michigan on kidney function and water balance, Dr. Schemm came to the conclusion that it was probably all wrong to keep victims of edema (dropsy) on a low-water regimen. Dr. Schemm learned that many medical men had suspected that the way to get rid of the water in dropsy was to give more water, not less. Cautiously he began to test the theory on heart-disease patients bloated by dropsy.

Less Brine. Like Dr. Henry A. Schroeder (then at the Rockefeller Institute), with whom he corresponded, Dr. Schemm was soon sure that he was on the right track. The nub of his idea was that dropsy victims were not waterlogged, but brine-logged. Edema fluid, said he, is no more fit for the body to use than sea water. Excess sodium in the body, usually in the form of its chloride (common salt), takes large amounts of water to keep it in solution. Often its demands are so great that a dropsy victim is simultaneously suffering from a shortage of water in other body functions—especially the kidneys, which are then unable to get rid of the brine.

The thing to do, Dr. Schemm decided, was to cut down the sodium taken in with food, to less than a gram a day (practicable only on a hospital diet). Thus, metabolic acids could take up the sodium already in the body, and give the kidneys enough water so that they could work properly and flush out the sodium salts through the urine—"using water as a medicine, which it is." By 1937 Dr. Schemm was telling Montana colleagues that his treatment was a success. "Restriction of water," he said, "is useless, harmful and a cause of suffering." It was 1942 before he published his findings, and then some traditionalist doctors were horrified. Gradually the Schemm treatment has won wider—but not yet universal— acceptance.