Depaul goes still further when he says, " if the cervix is already dilated, although insufficiently, and the child living, there is reason to fear that in the new attack the child may die. Auscultation will enable us to foresee this by the disturbances in the fcetal circulation. If, at the same time, labor goes on slowly, if the cervix is rigid, the hope of saving the child would warrant a more active interference and furnish an indication for lateral incisions of the cervix." But when the cervix is neither dilated nor dilatable, when, in a word, labor has not commenced, ought'one to artificially induce labor ? Authors are far from agreeing on this subject. While Kiwisch, Hoist, Wieger, Grenser, Litzmaun, Stoltz, Simon, Thomas, Schillinger, Legrour, Braiin, declare that the prompt evacuation of the uterus is of the greatest impor tance in the treatment of eclampsia, and that it is necessary to induce it as rapidly as possible, in cases in which labor has not already come on; others, with Tarnier, Busch, Bailly, accept the induction of labor; only under certain circumstances, and have recourse to it only when the medical treatment has failed absolutely, and, in spite of the convulsions, the labor does not come on spontaneously. Finally, P. Dubois, Pajot, Blot, Depaul, discard it entirely. We ally ourselves with those who hold this last opinion. Our reasons are as follows: 1. Eclampsia is only a symptom of a general disease which the emptying of the uterus cannot eradicate at once.. 2. In a good many cases not only do the convulsions continue after labor, but even they are produced after confinement. 3. Eclampsia is art acute disease, rapid in its course, and the time required for the induction of labor surpasses often the duration of the eclampsia. 4. When, on the contrary, labor does come on, on account of the eclamp sia itself, it progresses rapidly, and allows generally of some interference without danger to the mother. .5. All irritation in or around the uterus is sufficient, sometimes, to cause a convulsion much more so will it be the same with processes which are employed to induce labor. If we for
mulate these objections, and if we discard the artificial induction of labor, -with how much greater reason should we reject forced delivery. Of this, there cannot be question in any cage.
But to these theoretical reasons we can add others which result from figures collected in our article. Thus: in 127 cases the attacks have come on before labor in 105 cases, and they have continued in spite of delivery, or they have come On only at this period, in 75 cases. Of 75 cases at the Maternity, in 38 cases the attacks have persisted, or were produced after delivery. In 297 cases, 155 of them have had the attacks continue or ap pear after labor, i.e., in a total of 478 cases, 278 times the attacks have continued or were produced after delivery, i.e., in more than half of the cases. We do not then believe in the absolute efficacy of labor in puer peral eclampsia; therefore we discard the induction of labor.
If now we resume the therapeutic indications of eclampsia, they may be stated as follows: 1. Albuminuria once established, put the patient at the beginning on a milk diet, bleeding if necessary beforehand to the extent of 4500 or 6000 grains without going beyond this limit; 2. If this preventive treatment fails, and if eclampsia develops, venesection must be performed a;nd from ten to sixteen ounces of blood withdrawn. An enema containing from one to four drachms of chloral should be given, and, if necessary, during the paroxysm a few inhalations of chloroform; 3. If labor begins, it is to be terminated as quickly as possible by forceps or version. We must, however, await the dilatation of the cervix. In excep tional cases the cervix should be incised if the child is alive and the at tacks continue unabated; 4. Premature labor is never to be induced, and still less abortion; 5. For post-par/urn eclampsia give chloral, and, if necessary, chloroform during the paroxysms.