4. Under these conditions, the uterine contractions come on some min utes after the injection of the pilocarpine; they increase in frequency for a time, then remain stationary, and finally diminish. Renewed injections give like results. (Kleinwachter, Sanger.) 5. At times the action is sufficient to expel the foetus. (Schauta, San ger, etc.) 6. Now and then the action has been insufficient to expel the &Ana. (Sanger.) 7. Hence, it seems reasonable t,o assume, that if pilocarpine is given at term or during labor, it seems to have a real influence on uterine contrac tions; before term, subcutaneous injections of pilocarpine are usually in sufficient to produce premature labor.
All these agents are really palliatives or adjuvants, and if they are useful in some cases, they fail in many others. They cannot then consti tute, so to speak, a method of treatment. Generally, they have been com bined with venesection, chloroform, chloral, and premature labor, there fore, it is not possible to say just what has been useful. Eclampsia is es sentially rapid in its course, and a great number of these drugs are slow in their action; therefore we think that they will be more successful if they are not employed alone, but are associated with other means, and in particular with venesection i.e., the antiphlogistic treatment.
B. Antesthetie agents are usually employed. Ether, which has given place to chloroform, and lately chloraL In 15 cases re ported by us in which ether was employed:—influence none or not evident, 2 deaths in 3 cases; aggravation of the course of the disease, 4 deaths in 4 cases; diminution or cessation of the attacks, 8 cures in 8 cases. The general mortality, then, is about 40 per cent. But since the substitution of chloroform for ether, the antesthetic method as applied to eclampsia has been thoroughly tried, and has given some authors most surprising results. Unfortunately. contradictory facts have been collected, and we think that anEesthetics, no more than venesection, can be considered an heroic remedy for eclampsia. Is the method rational? The opponents of chloroform object to it on the grounds: 1. In a great many cases not only are the attacks not diminished under the influence -of an =esthetic, but they come on more frequently, and more strongly. 2. Although chloroform arrests the attacks, they reappear in the in terval between the inhalations, and the woman cannot be kept under chloroform for some time without danger. 3. Chloroform is irrational,
because it produces congestion of the nerve centres, and may thus in crease cerebro-spinal congestion, which is already so much dreaded in eclampsia. 4. Chloroform increases the asphyxia of eclamptic subjects already predisposed to this complication; 45. The use of Chloroform in some eclamptic cases has been followed by the appearance of puerperal mania.
Depaul, filially, who is one of the most determined opponents of chloro form, admits that it does modify to a certain extent the attacks of eclamp sia, but they exist, none the less, as well as all the complications that go with them—congestions, central hemorrhages, pulmonary congestion, etc.
The opinions of authors are divided on this subject; while Richet, Gros, Sprengler, Scanzoni, Brafin, SpAth, Meinsinger, Blot, Charrier, Richardson, Bazin, Macario, Wittle, Li6geard, Maugenest, Fearnet, Derby, Siwisch, Wrieger, Chailly, Channing, Campbell, Schneiseson, Schroeder, Spiegelberg, are advocates of this method, others, as De paul, Pajot, Tarnier, Jacquemier, Ganiot, Bailly, are more conservative, or even reject it all together.
We believe that it is not at all necessary to accept it exclusively, nor reject it absolutely; and, if chloroform has failed in a good many cases (we have had in our own practice an unfortunate example), there are others where it has rendered excellent service. In one article we collected 63 cases in which chloroform had been administered by inhalation or in ternally, and the following are the figures: The figures of the avemge mortality are only raised to 11 per cent., but this we believe is too small, and because the successful cases have been published and the unsuccessful ones not. Nevertheless, taking the highest figure of the mortality, i.e., in the unfortunate cases-33 per cent., and we have pretty nearly the figures obtained by us in the Maternity by venesection-34 per cent.; and a much lower figure than at the Clinic--45 per cent. This would seem to settle the question, but, on the other hand, if we compare all statistics at the Maternity, we find that the mortality by bleeding is 34.7 per cent.; by the use of chloroform, 50 per cent. The results, therefore, are somewhat contradictory.