Medical Treatment.—The very multiplicity of the remedies suggested by different writers, proves their small value and uncertain action. The idea is to resort to rectal alimentation, but this is uncertain, because the enemata soon cause diarrhcea, a condition often associated, as we have seen, with uncontrollable vomiting. Raw meat is often repugnant, and prolonged rest on the back, sea voyages and walking, are not easily recommended to women in this condition. The oldest form of treat ment is the antiphlogistic (venesection, leeches, etc.), but the results have been contradictory. Some physicians l*ve applied leeches directly to the cervix uteri with success. Local revulsives, sinapisms, blisters, etc., as well as purgatives and emetics, have sometimes succeeded, sometimes failed; the same may be said of acids, alkalies, aromatics, and antispas modics. Opium, especially, seems to have a decided action, whether given by the mouth or hypodermatically (the latter method being prefer able), while applications of belladonna to the cervix have been successful. Hydrocyanic acid, tincture of iodine, iodide and bromiie of potassium, oxalate of cerium (used by Simpson in 45-grain doses), tincture of nux vomica, calomel in small doses, pepsin, cold, alcohol (especially Kirsch, brandy, and iced champagne), and ice internally and externally, may be mentioned as empirical remedies. Ether-spray, applied to the epigastrium and along the spinal column, has recently been recommended, also electricity and subcutaneous injections of ether. All of the foregoing remedies have succeeded in some cases, but as a rule they have failed.
[Other remedies which we have found in certain cases of value, are: The hydrate of chloral, in grain doses repeated every few minutes, till 15 to 20 grains have been taken, and associated for a time with the re cumbent position. The hydrochlorate of cocaine, in grain doses, has twice given us good results, but in other instances failed. Very hot water sipped slowly will often answer.—Ed.] There remains then, 3d. Surgical consists in cauterization of the cervix uteri, a procedure originally suggested by Bennet, and used successfully by various authorities. Bennet confines the cauterization with nitrate of silver or iron to the region of the os externum, with the view of checking the vomiting without interrupting the pregnancy, while Giordano, on the contrary, aims at terminating it, and hence applies the caustic as high up as the os internum. Copeman haa been successful in the em ployment of digital dilatation of the cervix. We have never obtained any results with this treatment unless it caused abortion. Moreau has cured patients by replacing the uterus when it was malposed. [Cope man's method is of greater utility than the reader would judge from the author's statement. Obstetricians in this country, who have resorted to it, report numerous successes, even in desperate cases. Either the finger or the steel-branched dilator may be used, a necessary precaution being to pass neither beyond the internal os. Where miscarriage results, the chances are it is because this precaution has been neglected. Of the advocates of this method in this country, we may mention Goodell, Muncie, Wylie. The latter claims for it precedence over all other meth ods.—Ed. I
4th. Obstetrical consists in the induction of abortion, in preference to premature labor. If the child is viable (after the seventh month), we must act at once in the interests of both the mother and the child. Sin:mond (1813), was the first to practice this measure. Since then a large number of successful cases have been recorded, in fact two-thirds of the cures are obtained in this way. The determination of the proper time at which to interfere is one of the most delicate questions in our profession. Dubois affirms that inter ference is most proper during the second stage, when the following conditions are present: Incessant vomiting of all. ingesta, ev en a small quantity of water; marked feebleness and emaciation, preventing the patient from making the slightest exertion, attacks of syncope, following the least movement or excitement, profound alteration of the features, marked continued fever, extreme acidity of the breath, and, finally, the failure of every applied remedy.
[In our opinion it is not good practice to wait for the appearance of the symptoms of the second stage before resorting to the induction of abortion, for then we simply add the additional shock of labor to a constitution already strained to the utmost by the vomiting. In case the usual remedies by the mouth, associated with rectal enemata of peptonized milk (and these will not induce diarrhcea if cold water enemata precede each nutrient enema), and also with dilatation, do not succeed in releasing the woman from the vomiting, which if it continues will kill her, then, before exhaustion seta in, miscarriage or premature labor should be induced. A consultation should always precede any operation of the kind.—Ed.] Leven believes that we can prevent the development of uncontrollable vomiting, and that we can atop it after it has begun. The following are his views. which we are far from adopting in every respect: Dys pepsia, loss of appetite and vomiting begin with pregnancy. The woman craves the most indigestible articles, such as can only aggravate the existing dyspepsia, while she feels an aversion for solid nourishment (meat, fish, etc.), which the stomach requires in order to remain in health. The same may be said of her desire for stimulants. Physicians have habitually humored, rather than checked, these tendencies, think ing that the vomiting would cease spontaneously as the pregrnancy advanced. On the contrary, the stomach, after having been injured by improper diet, becomes so irritable that it will not tolerate nourishing food, and the woman really dies of hunger. If the physician recognizes the condition as dyspepsia, and begins his treatment at the outset of pregnancy, the result will be different. For several days nothing should be given but liquid nourishment (not soups, which are imitating, but milk), while hot applications and sinapisme are used over the region of the stomach, phosphate of lime, or bismuth, being administered inter nally. Milk will be tolerated for a few weeks, when the stomach will gradually be able to retain solid food.
We can not accept these conclusions, because they do not explain why vomiting should suddenly cease after simple dilatation of the cervix.