We try, further, in all our pregnant women, to build up the constitution, by tonics, iron, quinine, wine, etc. But we have little faith in the action of these agents in albuminuria, and they are excluded by the treatment which we will recommend shortly.
It is the same with diuretics, which to us, as to Jaccoud, appear per haps more hur.ful than useful; with diaphoretics which are inefficient. As for tannin and iodide of potash, they are simply adjuvants, and it is the following treatment, in our opinion, that it is best to use, for it is by far superior to all others. This is the milk diet recommended by Tar nier: " 4th day, and following days, four quarts of milk, or milk ad libitum without other food, witliout other drink.
" In the severe cases, if prodromata of eclampsia appear, put the patient at once on three or four quarts of milk per day.
" The influence of the milk diet is never slow in manifesting itself, and in eight or fifteen days after the commencement of the treatment, the al buminuria is diminished very considerably or even cured." More radical than Tarnier, we put the patient at once, and in all cases. on a milk diet, without limiting the dose which she ought to take, and prohibit immediately all other kinds of food or drink.
To a,ccustom the patient gradually to a milk diet, (wbich ought to be taken pure, not boiled, no sugar, but warm or cold as desired—we pre fer it cold), the first day they may take a coffee-cupful every half hour or three quarters of an hour or more. The coffee-cup is replaced the next day or the day after by a tea-cup, and when the patient becomes accustom ed to milk, she may take it in bowls-full, day or night, when she feels in clined.
Since we have employed this treatment, we have seen eleven cases of albuminuria more or less grave; in ten cases we have seen it entirely suc cessful. Albuminuria, if it has not entirely disappeared, at least dimin ishes in enormous proportions, and in ten cases the women have gone to term and been confined, without eclampsia, of living children. Twice only have we failed; in one case the woman was syphilitic, and the albumin uria had persisted six months after the confinement. There was no eclampsia. The woman was delivered at seven months of a dead child, hav ing in it and on its placenta syphilitic lesions.
In the other case the milk diet completely failed. It is true that the patient bore it badly, it was not taken continuously, and consequently the method was imperfectly used. But for successful treatment, it is necessary that it should be administered for a certain time, that it should be done in a rigorous and exclusive manner, and that it should be com menced as early as possible.
But this is not always possible, and one meets, unfortunately. in certain cases an irresistible repugnance. We have seen such a case in consultation, and were obliged to resort to venesection, and to purgatives.
The woman was seized, nevertheless, with eclampsia, which was cured by chloroform and chloral. One need not fear to continue the milk diet for a long time, even after the disappearance of the albutninuria, far this disappeamnce may be momentary. Besides, the patient once accustomed to the diet, it is well borne, and we have continued it for three months in the case of one of our patients, who was &livered at term, without eelampsia, of a well nourished child. 'rhe albuminuria only disappeared eight days after confinement.
There remains tbe question of the artificial interruption of pregnancy.
This question WAS raised for the first time by Tarnier, in case of al buminuria gravidarum, the notes which he added to the treatise of Cazeaux.
" All accoucheurs," says Tarnier, " are agreed that labor is a favorable circumstance in eclarapsia. We might ask them if, to arrest albuminuria of pregnancy, and to prevent possible convulsions, one ought not to con sider the induction of premature labor. This question has generally been answered in the negative. Indeed, observations are not wanting to de monstrate that after suitable treatment, above all after the use of vene section, the albuminuria may diminish, that eclampsia, even after having appeared, may disappear, and it is not rare to see under these circum stances, the pregnancy, continue its course, and terminate in a normal confinement. These observations, together with the fact that the women with marked albuminuria do not necessarily have eclampsia, indicate, that one ought only to consider the question of premature labor as pre ventive treatment in eclampsia with great caution. We 'believe, how ever, that the induction of premature labor may, in exceptional cases, render some service. Suppose, at the outset, a woman eight months pregnant, albuminuric, threatened with eclampsia, in whom labor com mences prematurely and spontaneously; certainly this last circumstance would appear to the majority of accoucheurs favorable, and nothing would be tried to stop the labor. Admit this, and one will be very near accepting the induction of premature labor. One must not believe, on the other hand, that eclampsia awaits the appearance of labor to declare itself, and that complications will arise at the same time with labor. Often, on the contrary, eclampsia appears before the end of pregnancy, labor only coming on afterward; here the prognosis is still less grave, as the labor is more advanced. For all these reasons, we believe that we should not discard absolutely the induction of premature labor, but in or der that we may feel authorized to propose this operation, we should re quire that the following conditions should coexist: " 1. That pregnancy has reached the end of the eighth month, in order that the new-born child can be raised without too great risk or difficulty.