The two principal methods of treatment at present, are: lat. The antiphlogistic. 2d. The antesthetic method. Each of these methods has ardent admirers and violent opponents. Should preference be given to one, or will advantage be gained by using them together ? A. Antiphlogistie and local blood-letting, purgatives, revulsives.
(a). General was formerly the prevailing opinion, and Mauriceau, Dionis, Sauvages, Dewees, Burns, Hamilton, Chaussier, Baudelocque, and also P. Dulbois, Cazeaux, and above all Depaul and Peter, are the defenders of this theory, which counts among its adversa ries such men as Maygrier, Peterson, Biwisch, King, Blot, Camp bell, Sedywick, Churchill, Litzmann, Williams, bliquel, Schwartz, Legroux, Thomas, etc. But even among its advoeates there is a differ ence of opinion. It is only necessary to cite the two professors of the French school: while Depaul favors copious and frequent bleeding, Pajot states that " he has seen the method employed so often without success, that he does not advise it,. He has not, however, banished bleeding com pletely in the treatment of puerperal eclampsia; in certain robust and ple thoric women it is useful." Thus Depaul does not hesitate to withdraw at least 30,000 grains of blood from a woman in a few hours. Dewees proposes to bleed at each attack. Hamilton proposes to withdraw three pounds of blood and repeat the operation if necessary. The bend of the knee is the situation most usually selected. A sufficiently large vein is opened to obtain a rapid and continuous flow, and this is not always easy on account of the move ments of the patient. Bleeding is practised at any time when the convul sions appear, before, during, or after labor, with this exception, that one ought to consider, in cases when the disease comes on during or after labor, the amount of blood lost at delivery. In acting thus, says Bareuis sau (1876) " one diminishes the general mass of the blood, ono relieves the nerve centres, which have a tendency to become congested, and by making the spinal bulb anomie we deaden reflex irritability, which keeps up the hyperaemia, and by which the convulsive attack may be revived." The advocates of moderate blood-letting, compared with copious and repeated, believe that the advantages of extensive blood-letting are more than counterbalanced by the serious complications in the present and in the future. For the present, it is to be feared that depletion, carried beyond certain limits, would itself become a cause of irrit,ation to the brain and spinal cord, as is the case after profuse hemor rhages, of which the final symptoms are almost always convulsive. For
the future, the bleeding impoverishes the blood. of an eclamptic patient, whose blood is already very poor, and forces the unfortunate patient into a chloro-aniemic state, the intensity and persistency of which may give rise to great alarm. Lee, in 19 cases in which he withdrew a large amount of blood, haareported 19 deaths, and 35 eases cured in 35 patients where the blood-letting was moderate. Braiin himself, who is so op posed in a general way to bleeding, accepts moderate blood-letting in robust and plethoric women. There results from statistics at our Clinic the following: Cured. Deaths. Mort.
58 women having been bled once with or without leeches, 34 24 41.3 per cent. 24 " several bleedings, • . . . 11 13 54 General mortality by bleeding, . . • . . . . . 45 4 The conclusion to be drawn from these statistics is that moderate vene section is always followed by a less mortality than the more copious bleed ing. Therefore we prefer moderate bleeding, although, aside from the general action on eclampsia, we can state the following facts: First and most often, the pulse undergoes marked changes; although it may be very feeble, it becomes less rapid and stronger, being easily felt under the finger; this is one of the first and most evident effect,s of bleed ing. But there is still another effect which it is well to state, although in many cases it is not constant, i.e., that nearly always there is a greater interval between the attacks. This is undoubted, for in a certain num ber of observations, in those eases in which the attacks continued in spite of the bleeding, their violence was lessened and the intervals which separated the attacks was greater. In 297 cases gathered from various authors, we find: It is seen from these tables, which have a total of 494 eases, that a con clusion cannot be drawn, for in comparing them we obtain: While in the Clinic, where the repeated bleeding is used with greatest severity, the mortality has risen to 54 per cent., exceeding considerably the mortality of single bleeding, in our own observations and at the Maternity, on the contrary, the mortality of single bleeding exceeds that of repeated blood-letting. It is Impossible, therefore, to draw any con clusions in favor of one or the other method, and we c,an only state the favorable influence which blood-letting has on the course of the attacks. This is one reason why bleeding should not be discarded entirely.