Where, notwithstanding these meas ures, the evidences of organic kidney dis ease become intensified, or where, these evidences lacking, the symptoms sug zestive of impending eclampsia develop, time for action has come, justifiable lay having. reached its limit. In the past and even to-day expectancy has been and is too often the cause of untoward re sults.
With the exception of the fulminating type of eclampsia—where art almost al ways fails, it may be stated that prompt action. of the nature to be described, will, in the vast proportion of cases, prevent the development of eclampsia. Medicinal Treatment.—In the pres ence of the prodromal symptoms of eclampsia, but little reliance can be placed on drugs. Where urinary insuffi ciency exists, indeed, it is very able if the routine administration of drugs do not harm. Certainly the potas sium salts are very likely to irritate the kidneys. The ingestion of large amounts of water by mouth and repeated duction of warm normal saline solution into the blood.-stream will accomplish more than any and all drugs together.
The treatment of eclampsia should be, in the first pla.ce, prophylactic. A care ful examination of the urine at short inten-als in the late months of preg nancy, together with a careful watch for tlie first evidence of toxannia, should be the dnty of everyone who undertakes the Care of these cases.
Van llenssalaer suggests venesection, carried to the point of tolerance, and then followed by the subcutaneous injec tion of a normal salt solution. This method need not be confined to the plethoric, but even a weak pulse and profound coma do not contra-indicate its use, for the rapid introduction of the Wal"111 salt solution following venesection counteracts the effects of bleeding, filling the vessels and stimulating the heart. From a pint to a quart of blood can be safely withdrawn from the veins of a, patient of average weight, providing, the injection of the salt solution is followed up at onee. J. L. Itothrock (North western Lancet, NOV. 15, '97).
In eclanipsia the supporting rather than the stimulant treatment favored. Venesection followed by infusion is the ideal treatment for the casting off of the toxins with which the blood is crowded, and the most efficient way of supporting the patient. Salt infusion alone is but a partial remedy. O. Engelmann (Boston Med. and Slug. Jour., Nov. 0, '99).
Series of cases of puerperal eclampsia treated by rest. pure mill«liet. injec
tions of morphine to control convulsions, and the re,gular administration of thy roid extract in doses of 0.30 gramme (3 grains), repeated, if necessary, every three or four hours. The symptoms, especially • headache, albumin in the urine, cedema, amblyopia, etc., began and steadily continued to disappdar. Thy roid extract is also of value to prevent convulsions in women who give a his tory of eclamptic seizures during pre vious pregnancies. H. O. Nicholson (La Semaine Aredicale, May 21, 1902).
As regards treatment in the early stages., when there are increased tension of pulse and diminution of urine thyroid extract should be given twice or thrice daily, and proteid foods should. be en tirely forbidden at first. Iodide of po tassium in small doses has been re garded as a specific for puerperal albu minuria; the iodine has been proved to be picked out by the thyroid gland and may be elaborated into the active iodothyrin. Tt has been suggested to give infusions with iodide of potassium instead of ordinary saline infusions in cases of eclampsia. If convulsions have already occurred, then the use of thy roidin by the mouth will not be rapid enough. Liquor thyroidii, or, better still, fresh thyroid juice, from 10 to 15 minims, should be given by hypodermic injection and repeated every hour or two if not followed by signs of improve ment. For the immediate treatment of the convulsion morphine is the best. remedy. lt inhibits the various proc esses of metabolism, and this gives op portunity to the thyroid gIand to re cover itself. The dose should be large: not less than 1/2 grain for the first injection. II. O. Nicholson (Lancet, June 29, 1901).
Intravascular antisepsis appeals to the mind of every scientific observer of septic conditions of the blood. An in travascular antiseptic or germicide must be destructive to bacteria and at the same time not injure the patient. For maldehyde possesses this specific influ ence. as shown by experiments on ani mals. :Maguire used solutions 'upon himself as strong, as 1 to 500 without any liamolytic changes. Case of septi eamia personally treated with success by formalin injections, using an aqueous solution, 1 to 5000. Formalin in nor mal salt solution would be better than aqueous solution, although no lifernoly sis follow's the infusion of formalin iu distilled water. Theoretically, however, salt solution is preferable. Barrows (New York Medical Journal, Jan. 31, 1903).