Tr eatment. —In many cases hydramnios passes almost unnoticed. The indications are confined to combating the ordinary diseases of pregnancy, without the necessity of special treatment. At other times, on the con trary, the conditions are exceptionally serious, and then intervention is necessary, which is either medical or obstetrical.
Medical treatment is in general of little use. All forms designed to combat the " dropsy," diuretics, purgatives, sulphate of quinine and opium, have been employed. All seem to have failed. Phlebotomy has, at times, seemed to succeed.
Modern works on the composition of the blood in pregnant women have, however, rejected bleeding in the treatment of pregnancy. We believe that the writers have gone too far in this regard. Of course we do not believe in the ancient method, in which bleeding was practised to an incredible extent, as in the observation of Mauriceau, where a woman had been bled 72 times during her pregnancy; but we believe in certain cases bleeding has ita advantages; and, without speaking here of bleeding employed as preventive of eclampsia, we have seen (as interne at the Charit6) Beau, who certainly was not partial to bleeding, practise it in a number of pregnant women, and never have there been other than good results. Our teachers did not reject it utterly, and P. Dubois, Cazeaux and Jacquemier, advised it in certain e,ases, where women considered as plethoric were threatened with abortion; and they have cited cases where, thanks to a rapid and moderate depletion of the vascular system, the preg nancy has continued ita course.
Surgical account of the serious condition, and the threatened life of the mother, it is necessary to interfere. Nature, indeed, seems to indicate the means, in provoking premature contractions, which induce rupture of the membranes and int,erruption of the pregnancy. Whatever Guillemet may say, all obstetricians agree that it is by the cer vix that the fo3tal sac must be penetrated, and if there are some instances where puncture of the uterus has been done, it was due to an error of di agnosis, and, though Scarpa, Camper, Noel Desmarais, etc., have cited cases where a puncture has not been followed by accident, and certainly by the woman's recovery, it should be rejected. Consequently rupture of the membranes should be adhered to. But here, still, different ques tions are presented: 1st. The point of perforation. 2. The moment for intervention.
1st. Point to rupture the is seen at once that there is no time for hesitation. The cervix being generally partly open from the premature contraction, the membranes rush into the inter nal os. Nothing is simpler than to perforate them with a stylet, Bound or trocar. But this rupture is not always without difficulties. At the moment of the rupture, the liquid, by reason of its great quantity, rushes out in torrents, tends to enlarge the opening in the membranes, and so to sweep along the fcetal membrane, cord and fcetus. On the other hand, the uterus, in consequence of the rapid evacuation of the liquid, tends to contract with a rapidity dependent on the quantity of liquid evacuated. Further, there is the possibility of detaching the placenta, at one or many points, and of hemorrhages. Finally, this rapid evacuation induces symptoms analogous to those seen when the pleural or abdominal cavities are emptied too rapidly, in pleurisy, hydrothomx or ascites, namely syn cope. Different methods have beer advised for this end. The first, which is an absolute rule when one has to puncturo the membranes for hydramnios, or for narrowing of the pelvis—that is,when the fcetus is move able beyond the superior strait, or in the excavation—is never to rupture the membranes except in an interval of contraction, the woman lying with the buttocks raised, so as to increase the inclination of the pelvis back ward. The use of the stylet or troc,ar, to make only a little opening, has been advised, but the liquid increases the size of the opening.
Tarnier, according to Guillemet, operates as follows: he places the in dex finger on the bulging membrane; at the same time the other fingers, closed in the palm of the hand, are applied as exactly as possible over the vulvar orifice at the movement of contraction. The membranes are rup tured by the nail of the index finger. At this moment, instead of with drawing the hand, it is pushed against the vulvar orifice. In this man ner a nearly perfect prevention of the issue of fluid is obtained. This procedure does not seem to us to be likely to be followed by the hoped for success; for if it preventr3 the escape of fluid from the vagina, it does not prevent the rent enlarging itself. The liquid, it is true, can not flow away externally, but it can flow into the vagina, and it will do so the more according as we have chosen the period of uterine contrac tion to rupture the membrane.