OBSTETRICS AND GYNAECOLOGY Eclampsia.—The exact pathology of eclampsia has not yet been solved. Obata, as the result of injecting mice with extracts of human eclamptic placenta, considers that it is an intoxication by placental poisons made possible by a weakening in its normal capacity of neutralization on the part of the maternal blood. Treatment of the condition on conservative lines has recently gained ground against more radical measures, and control of con vulsions by hypnotics with venesection and administration of oxy gen have replaced operative procedures. Under these conditions mortality has been reduced by more than 5o%.
The chief direction in which change of view is taking place among gynaecologists is that of the treatment of uterine fibroids. The old method of curetting has given place in large measure to hysterectomy, which in turn may be destined to give place to radiological treatment in a large proportion of cases. In several important gynaecological clinics on the Continent surgical treatment of uterine fibroids is the exception in an uncom plicated case.
In pernicious anaemia (q.v.) it has been shown that one of the cardinal features is an increase in the mean diam eter of the red cells which is independent of the degree of the anaemia and persists through the course of the disease. On the other hand anisocytosis increases with the anaemia. In the re missions which occur naturally or after splenectomy, though the haemoglobin may rise there is little change in the diameter of the red cells. In treatment transfusion has been found of little value, but benefit has resulted in some cases from removal of a portion of the bone marrow from the tibia. Apparently removal of some of the bone marrow acts as a stimulus to regeneration of marrow and therewith of the blood cells that are needed by the body. Re cently great success has followed administration of liver or of a non-protein substance derived from liver (see ANAEMIA). Pur
pura is described as being of two varieties (I) that which is de pendent upon destruction of blood platelets; ( 2) that which occurs in anaphylactic conditions and is due to direct injury of blood ves sels. In the platelet variety a blood platelet antiserum has been prepared and is of therapeutic value.
Diseases of the heart and great blood-vessels have been studied by the electrocardiograph, and numerous condi tions, particularly heart block and those in which the nervous mechanism of the heart beat is concerned, have been investigated. Systematic examination of recruits in whom cardiac symptoms de veloped during early training resulted in a clearer perception of those abnormalities of heart action which were transient and of little importance as distinguished from those which were signifi cant of disease.
Cerebrospinal meningitis (q.v.) and lethargic encephalitis (q.v.) have received much attention. In cerebrospinal meningitis it has been shown that three, possibly four, different types of meningococcus occur and that antiserum treatment to be successful must be homologous. Epidemics could usually be traced to a carrier and the chance of their occurrence was greater where men were confined in a relatively narrow space, e.g., barracks. A special method of treating carriers by means of inhaling chloramine-T was instituted with some success. In the case of lethargic encephalitis, it appears probable that the cause will be found to be a filter-passing virus.
In the case of herpes in rabbits and herpes in man, including herpes zoster, it has been found possible to transmit keratitis and some other special conditions from animal to animal and man to animal by means of a filter-passing virus. When this has occurred microscopical appearances are found in the nervous system apparently identical with those met with in lethargic en cephalitis. The whole question, therefore, is in an unsettled con dition.