CURATIVE TREATMENT. • Medical Treatment.—The eclampsic attack has appeared and the preg nant woman, during labor or after delivery, is in its power, either because the albuminuria was not recognized or treated, or it may be because the milk cure, or preventive treatment has failed. What is to be done? Before entering into the discussion and into the valuations of. the two great methods of treatment, the antiphlogistic and the antesthetic treat ment, there are a few little points that it will be best not to overlook, for they are applicable to all cases, and when they are disregarded, they may, sometimes, cause complications more or less serious.
During an eclamptic attack, the patient becomes completely unconscious, suddenly, even in a moment. The horizontal position, both during and after the attack is indispensable, and this position will he of advantage, because, in general, during the attack, patients are not at all likely to change their position. Unfortunately, it happens too often that eclamptic women are taken by surprise and fall unconscious, and are thus ex-posed to those lesions which are seen in epileptic cases (wounds and burns) which, although they have no influence on the attack, may retard the cure.
Airing the room, loosening the clothing, in a word, every thing which facilitates the free movement of the chest, have a true influence, and there its another cause still which may aggravate the condition of the patient, the distension of the bladder. The thine, it is true, is not secreted abundantly in eclampsia (so little is secreted that sometimes it is difficult to procure enough to establish the presence of albumin), but, in some exceptional cases, the bladder is so distended with urine that it may be the cause of serious complications, and Lamotte has cited two cases in which the convulsions seemed to depend directly on this distension, since the evacuation of the urine by the catheter caused it to cease at once. One should never forget to see that the bladder is empty.
Often, also, patients are worried by attendants who wish to restrain them. A careful watching of the patient is all that is necessary, bee,ause touching often excites a patient, and at times it may be the means of renewing the eclampsia. Auscultation and abdominal palpation should be resorted to only exceptionally, and only when it is necessary to be sure of the condition of the child. All the more is this true of the vaginal
touch, which, whether the prostration of the patient is real or apparent, produces nearly always in her a feeling of revolt or repulsion, which makes itself known by a low groan or even by some excitement, and may pro duce the eclamptic attack itself. This abstention, however, has its limits, and one should not forget that frequently labor comes on during eclampsia, that it may be extremely rapid, that dilatation, scarcely commenced when we first examine, may take place in a few hours or less, and that uterine contractions, continuing to take place in spite of the coma, may overcome the resistance of the cervix and of the perine um, and expel a child which, if it survives, is exposed to all the risks consequent upon unexpected delivery. It is best then to assure ourselves from time to time, by examination, in regard to the progress of the labor in the interest of the child. Another reason is that thus we may know the time when intervention is possible, an intervention which, if it is not always in the interest of the mother, as we shall see, is so for the child in a certain number of cases.
At the beginning of the attack the tongue hangs outside the mouth, and the spasmodic closure of the jaws exposes it to cuts and te,ars, which are accompanied by swelling, impeding respiration and deglutition, not to speak of hemorrhage. The tongue must be replaced and kept behind the jaws or teeth. It has been advised to place between the teeth a handle of a spoon, a cork, a piece of cloth or wood. These agents, how ever, are not without their inconveniences, and Depaul has in his museum a piece of wood nearly 5.5 inches long, which did considentble damage. This piece of wood, first placed between the jaws, was displaced by one end; it sank into the cesophagus, and injured the ranine artery under the tongue, from which there was a severe hemorrhage, which did not kill the patient, but was only stopped by the use of the cautery. The simplest way consists in replacing the tongue behind the teeth at the beginning of the attack, and to keep it there by the use of a cloth held by both hands during the attack.