Treatment. — The treatment of eelampsia may be considered io advan tage under the following headings: (1) prophylactic; (2) medicinal; (3) sur gical.
Prophylactic Treatment.—If the preg nant woman has been carefully watched by the medical attendant, only excep tionally will eclampsia develop, because , the institution of certain prophylactic measures or early resort to certain sur gical measures will nullify or prevent the development of certain phenomena which apparently underlie or enter into the causation. Thus, it is not sufficient, after a perfunctory fashion, to examine the urine for albumin, but the total ' amount passed and the amount of urea contained in it should be ascertained at intervals. Further still, explicit direc tions should be given in regard to the necessity of securing free action of the sudoriparous glands by means of fre quent baths, and thorough action of the intestinal canal should be maintained. When the excretory organs of the body are acting physiologically those elements of tissue-waste which, retained in the body, favor the development of eclamp sia, are excreted. When skin, bowels, and kidneys are clogged, the reverse holds true, and sooner or later, in preg nancy, symptoms appear which, if not properly appreciated and when possible eradicated, are forerunners of cclampsia. When urinalysis reveals the presence of kidney disease--wlaether organic or func tional—steps should be taken at once to modify thc symptomatology for the bet ter by recourse to hygiene and dietetics, and, such measures failing, after reason able interval medicinal and surgical treat ment enter the foreground.
The presence of albutninuria is un doubtedly of great value, but too many physicians trust to it alone, and the ex aminations are made only at long inter vals. The inedical man may usually feel sectire so long. as the urea! elimination is near the normal,-100 or 500 grains per diem; but this is not, alone, an abso lutely reliable guide. A most important and neglected element in the prognosis is the daily quantity of urine. If every pregnant W01111111 were taught to measure the urine once or twice weekly during the later months of preg-nancy, and im pressed with the necessity of keeping it at or above three pints per day, eonvul sions in childbed would be almost un known. C. Jewett (Brooklyn Med. Jour., Aug., '99).
Chief among the hygienic measures stand hot baths and gentle catharsis; foremost among the dietetic measures rank-s milk diet (associated with the ad ministration of an assimilable and non astringent form of iron).
Milk treatment is most efficient from a prophylactic point of view, though it does not necessarily cause the other alarming symptoms, besides the fits, to vanish. The alleged disappearance of albuminuria does not necessarily occur, even after prolonged treatment by milk diet. The same may be said of the /edema: this treatment seems to have no effect on it. The above facts are em phasized. because some obstetricians have ver,y naturally given up milk diet on account of persistence of albumintiria and (edema. Such a step is a. mistake, for, if the treatment be continued, labor will proceed without any fits coming on, though the legs remain swelled and tbe urine albuminous. Ferre (L'Obstkrique, Nov. 15, '96).
Analysis of 4S eases. The uterine douche alone NV:1S sufficient to check the infective process in 15 cases. Explora tion and curettage of the uterus were fol lowed by a rapid fall of temperature in 8 cases, a gradual fall in 10 cases. a tem porary increase followed by a rapid fall in 2 eases, and no effect on the tempera ture in 13 cases. A. W. AV. Lea (Med. Chronicle, Aug., '99).
There are three main channels through which toxic substances may be got rid of. viz.: the bowels, the skin, and the kidneys. In eclampsia the urinary sys tem is chiefly at fault, but the two other channels must not be neglected. Ilot pack or bath to produce free action of the skin, with enemata to promote elim ination of toxins by the bowels, and, to get the kindeys to act, large saline in jections are advocated. The solution used was 1 part of bicarbonate of potash to I of common salt: 1 drachm to the pint of sterilized water at 100° F. The bicarbonate of potash is added to obtain the diuretic action of the potash salts. The apparatus used is an aspirator trocar and eannula, a few feet of rubber tubing, a test-tube-shaped filler, and a piece of adhesive plaster. The injection is made conveniently under the edge of the Irreast before delivery; the lax ab dominal wall, after delivery. From 1 to 4 pints may be employed. Absorption begins at once, and is complete in fifteen or twenty minutes. In seventeen eases saline injections were employed to in crease the flow of urine, and so aid elimi nation by the kidneys. Analysis showed a marked increase in the daily excretion of urea and uric acid, and there is prob ably a corresponding, increase in the ex cretion of the poison which causes the disease. Jardine (Practitioner, Dec., '99).