Treattnent.--In 1872, we concluded our article on this subject in the following way. " In presence of a disease so serious as eclampsia, it is the duty of the physician not to limit himself to one mode of treatment, but he should have a choice of several methods, without being a partisan of any one, to the exclusion of all others." To-day, ten years later, we would give the same opinion, and although numerous works have been since written on this subject, we repeat what we have just said: There is no specific treatment for eclampsia. But we are not on this account wholly helpless when brought face to face with this disease, and if we have no exclusive method for treatment, it is no less true that we have at our disposal a certain number of means. which, fortunately, have given good results in many cases. We proceed to refer to these.
The treatment of, eclampsia may be divided into two great classes: the preventive treatment, the curative treatment. The last may be divided into the medical and obstetrical treatment.
1. The Preventive Treatment.—Does there exist a preventive treatment of eclampsia ? Since we consider eclampsia as almost always dependent on albuminuria, we do not doubt this, and the best way to prevent eclampsia will be to treat the albuminuria. It is necessary, then, in our opinion to resort at once to a milk diet, continued if necessary for weeks or months. But for this treatment to be of use, it must be tried in a thorough manner, and it will be necessary, often, t,o overcome the patient's prejudices, for they are easily induced to stop the treatment as soon as they become a little bett,er. So long as albumin remains in the urine, the treatment should be thoroughly continued. As soon as the albumin disappears, it should be stopped at once, but the patients ought only to return slowly and gradually to their ordinary diet. The examina tion of the urine should be continued every four or five days, and the treatment be renewed if albumin reappears, even in a small quantity. If the albumin has disappeared for eight days we can make use of tonics,— quinine, gentian, together with small doses of iron. We prefer the ex tract of quinine, and we give it in the following way: 4. Extract Quinim, Extract GentianFe, . 4 3 i.
Ferri Subcarbonatis, . 1 gr. xv.
Pulv. Rhei. . q.s. q.& M. Ft. pil. No. 100.
Sig. Take five or six pills during the day.
At the same time, the patients should take every two or three days a light purgative (Castor oil, mineral water or magnesia). Since we have employed this treatment, we have had only good results, and it has been used with success in cases seen by us in our own practice and also in con sultation. Unfortunately, there are cases in which the patients have such a dislike for milk that they can neither take it or keep it down. In such cases venesection should be our choice, as recommended by Cazeaux, Peter, Depaul. We withdraw from 4500 to 6000 grains of blood, accord ing to the case. Peter goes further, and advises wet cups to the lumbar region; i.e., he believes, " that the dreaded urwmic complicationa should be guarded against by general blood-letting ; that the renal congestion should be relieved by local blood-letting, this renal con gestion being the first and only cause of the disease. The congestion of the kidneys may also be relieved by purgation." Besides the means given above, others have advised numerous agents in which we have little confidence.
Diuretics.—These are recommended with more or less reserve by Fre richs, Braiin, Pajot, Cazeaux. Bailly prefers vegetable diuretics. The in fusion of triticum repens, adding or not some nitrate of potash, squills or digitalis. Braiin advises the use of vapor baths and also seltzer water and Vichy. Frerichs, theoretically, advises benzoic acid, lemon juice, or tartaric acid, with the hope of neutralizing the carbonate of ammonia produced in the blood by the decomposition of urea. Tannin, iodide of potassium and extract of aloes have also been recommended; Johnson and Collins have recommended emetics. •
Unfortunately all these means have an uncertain action, and venesec tion even, whether it be general or local, does not always suffice to pre vent the attack. Therefore, with certain restrictions, we have seen that Tarnier recommends the induction of premature labor as a means of pre venting eclampsia. We have given reasons which have induced us to reject it. We will not refer to them here.
[Nevertheless, the induction of premature labor meets with the ap proval of most American accoucheurs, provided that other means have been tried faithfully. It will be sufficient, in this connection, to quote the words of our distinguished teacher and writer, Lusk, of New York, who says, " My own convictions are clear that, so soon 9,8 grave cerebral symp toms develop, the period of folded hands has passed. The relief to be obtained from chloral and catharsis is, as a rule, of short duration, and we cannot go on giving chloral and cathartics to the end of gestation. Moreover, it is necessary to take cognizance of the well-being of the fcetus, which is threatened by the continued circulation of urea in the maternal blood. The induction of premature labor is attended by but moderate risks, if resorted to after the uremic symptoms have been got fairly under control. If employed as a last resort, its use then partakes rather of the nature of a forlorn hope. So far as my own experience goes, however, the practice of waiting upon nature has proved uniformly disastrous, whilst the induction of labor has furnished me with a certain proportion of recoveries."—Ed.] During Confinement.—Bailly advises the use of baths, of chloroform, and the termination of labor as rapidly as possible. We endorse the opinion of Bailly, excepting the baths and chloroform. We prefer chloral to chloroform. But we are not agreed with him in regard to the prophy laxis of eclampsia after labor. Bailly says that the rapid delivery of the placenta and blood clots is necessary. We cannot believe that he advises, by the words extraction of the placenta, the artificial de livery of the placenta. He knows better than any one the dangers and difficulties of the operation, and, moreover, the manipulations which are necessary would in themselves be sufficient to produce art attack of eclampsia. On the other hand, although we are advised to deliver the placenta as soon as possible, this is only practicable when the placenta is detached. Nature alone should indicate when one could or should deliver the placenta. As to general blood-letting after labor, we think that it only should be resorted to in exceptional cases, for nature alone should interfere in these cases. All accoucheurs, since Depaul has called their attention to this point, have noted the frequency of uterine hemorrhage during the third stage, in albuminuric women. It must be one of two things. If the hemorrhage is useful, why should we be eager to stop it? Or if it is useless, why should it be replaced by general blood letting? It is true that in the last ca,se, the amount of blood wished to be with drawn can be controlled; while, in the uterine hemorrhage, the loss may be considerable, but there will always be time enough to interfere and stop this hemorrhage before it reaches serious proportions. There is still another reason why we do not advise venesection after delivery. Albu minuric women are, by the fact of the disease alone, predisposed to puer peral complications, and those who have had hemorrhages, are even more apt than all others to suffer from complications. Certain authors have gone further, and said that puerperal mania has been produced by frequent and copious bleeding, and by the antemia which is the result. In such cases we limit ourselves to medical treatment, and, above all, to a milk diet as long as albumin remains in the urine.