" 2. That the albuminuria should have reached a certain degree, or that the patient should suffer from some prodromata of eclampsia.
" 3. That the woman should be a primipara, or that she should have suffered from eclampsia in a previous pregnancy.
" 4. That the medical treatment has proved inefficient,particularly vene section.
"Under these conditions, the induction of premature labor seems to me rational, and I am disposed to adopt it, unless further facts give a deCided contradiction to my present way of thinking." We do not know whether Tarnier would still persist in these views since he has adopted a milk diet and such wonderful results have been obtained from it; but they have been accepted by Morieke, who goes fur ther than Tarnier, and, considering all treatment as useless, strongly ad vises the induction of premature labor; also Schroeder, who admits the induction of labor; and Richardson, who wishes that all treatment should be first tried, and when nothing diminishes the quantity of albumin, and when the quantity of urine becomes less and less marked, that the induc tion of premature labor should be practised; Lohlein, Odebrecht, Martin, who wait for some evidence of eclampsia.
We are opposed to Tarnier, and these other authorities, and we discard the question of premature labor for the following reasons: 1. The success which we have had with the milk diet is such that we believe all other treatment useless, particularly when the milk diet is care fully and sufficiently observed during pregnancy, and soon enough to produce its effects.
2. 'When the albuminuria is slight, tile interruption of pregnancy ap pears useless, the gravity of the accidents which occur in pregnant women, who are at the same time albuminuric, being, in general, in direct rela tion with the amount of albumin.
3. When albuminuria produces serious symptoms, it depends upon, not only pregnancy, but also a serious renal affection, which may progress after confinement, and cause, as the observations of Hoffmeier prove, the death of the patient.
4. Labor, as we have seen, has a marked influence in the production of albuminuria and of eclampsia; and as the induction of prenaature labor, and with still more reason abortion, always requires a certain length of time, the result may be that during this time the patient may be placed in a condition still more unfavorable than that in which she already is, by the mere fact of the albuminuria from which she is suffering.
Finally, although it is true that, in a number of cases, albuminuria has disappeared after the death of the kettle, and the real cessation of preg nancy, there aro many other instances where it has reappeared at the onset of labor, accompanied or not, by eclampsia.
But, although we reject the induction of labor, and still more of abor tion, it is not the same with interference after labor has once come on. In this case nature herself shows the way, and as soon as possible without danger to the mother, we hasten to end the labor.
But we never interfere before dilatation of the cervix is complete, and if the contractions are energetic, and the woman a multipara, then we should leave the case to nature. If, on the contrary, the woman is a pri mioara, and labor proceeds slowly, and the contractions are feeble, as soon as the dilatation is complete or the cervix largely dilated and dilatable, WO end the labor by forceps or by version. It is finally a fact, confirmed by all accoucheurs, that labor generally proceeds rapidly in albuminuric women, except in cases of dystocia, and this gives the child a better chance of surviving.