(b). with this mahod, purgatives must be mentioned. Those which are constantly and with good reason employed (because they are easily managed) are calomel and jalap, to which we can add other purgatives, Bonita, sulphate of soda, etc. These only act as adjuvant& (c). reject all emetics, in spite of the fact that Legroux advocates them. Collins classes them with bleeding and calomel, and he is supported in this by Lever, Johnson and Johns. It is difficult to assign to each of these therapeutic agents the part which belongs to them.
have entirely given up the use of sinapisms, blisters, etc. Besides the irritation they produce, they may c,ause ulcers, more or less severe, or gangrene sometimes so extensive as to alone cause the death of the patient.
We believe the following are useless, if not dangerous: Fly blisters, sprinkling the abdomen with cold water (Denman), ice applied to the head, cold baths, anti-spasmodics, camphorated ether, valerian, assaftet ida. Bromide of potash has ieemed to be useful and efficient' in some cases, and Trousseau has prevented an attack by compressing the c,arotids on each side.
Jaquet has advised the use of a wet pack, and Porter seems to have had very good results from this treatment.
Brummerstadt recommends opium, but it should be given freely to have the desired effect. According to him, at the first onset of the attack, 1 to 2 grains of pure opium (or a corresponding amount of the tincture) must be given, and lat,er I a grain taken after each attack until narcot ism is reached. It must also be given after the last attack. Subcutaneous injections of morphine may be preferred.
[In this country many observers have obtained better results in the treatment of eclamptic seizures, from the subcutaneous administration of opium, than from any other method. It acts as quickly, nearly, as chloro form, and does not alarm the patient to such a degree. The injection should be given in full doses at once, one grain of morphia at least, and boldly repeated with the recurrence of fresh attacks. For our part, if the con vulsions did not yield to morphia, we believe that the immediate termi nation of labor offers the patient the best chance.—Ed.] Lately, subcutaneous injections of pilocarpine have been tried in.doses of grain, repeated if necessary, and it has been tried to induce labor by means of it, and again as a means of treating the eclamptic attacks. We will confine ourselves here to this last effect, and reserve for further consideration the ecbolic effects of pilocarpine. Here are the results: In 34 cases where pilocarpine has been used for eclampsia, it acted well in 20 ca8es, 2 cases died; 9 cases had such pulmonary complications that it had to be given up.
The results seem very encouraging; unfortunately, these cases prove very little, for pilocarpine has almost never bean given alone, but it has been associated with venesection, chloroform, or other means, douches, sounds intended to produce an abortion. It is thus difficult to say what part pilocarpine alone had in the cure.
Slinger, who has written the most complete work on pilocarpine, con cludes that it is not an ecbolic primarily, that it cannot bring on uterine contractions, but only reinforce and regulate them. lst. When the cervix ie more or less dilated, even when there are no true uterine contractions (the period of false pains), pilocarpine may produce labor. 2d. When there are irregular pains, piloc,arpine will regidate them. 3d. During the period of dilatation and expulsion, pilocarpine is a means of making the labor more rapid, by regulating the pains and making them stronger and more frequent; and when the head is delayed by the feebleness of the pains, pilocarpine, by shortening the confinem'ent, may take the place of forceps. The danger and inconveniences are easily overcome by the use of atropine, which is the physiological antidote.
As to eclampsia, pilocarpine by injection, is on which it will produce sweating and salivation, or at least the latter. In these cases alone can it replace other therapeutic means.
In dangerous cases it ought' not to be used exclusively. One of its ad vantages is to accelerate labor. Barker, on the contrary, who has used it in six cases, has seen bad results from it in every case, either in the heart or lungs, and does not believe that it should be used in eclampsia, and accepts it only as an adjuvant. Kroner has always seen it fail, both as an ecbolic and as a cure of eclampsia. Finally Marti-Autet, collecting the observations of different authors, and the experiments of Hyernaux and Chantreuil, has arrived at the following conclusions: 1. In a great number of cases, subcutaneous injection of pilocarpine has given a negative result. It has not brought on uterine contractions. (Welponer, Parisi, Hyernaux, Sanger.) 2. There-has been the same result in a number of experimenta on ani mals. (Hyernaux, Chantreuil.) 3. Under special conditions, the subcutaneous injection of pilocarpine seems to c,ause uterine contraction, when the wowan or animal experi mented on is already in labor or has arrived at term.