:"..:ormal saline solution given subcu taneously acts very well as a diuretic. K. C. MeIlwraith (Canadian Pract. and Rev., June, 1901).
The serum-treatment has no place in the routine treatment of puerperal sep sis; it should be used only in desperate cases after failure to obtain improve ment by other and usually more effi cient methods, and if no improvement is shown after use for two or at most three days and the injection of 40 to 60 cubic centimetres (10 to 15 tlui drachms), it should be discontinued. Its use is not free from danger, it usually lowers the pulse and temperature, but at the same time it has a correspond ingly depressing effect upon the patient, and it has not apparently lowered the mortality of the disease.
With regard to the general treatment of puerperal sepsis, early curettage of the uterus carefully performed aS soon as the diagnosis is established is of pri mary importance, and the same result is not accomplished by any other method of procedure. Following curet tage, and sometimes in place of it in the mild eases, intra-uterine douches have proved to be of much value. For constitutional treatment, one must mainly rely on stimulation, tonics, and forced feeding, with moderate diuresis and catharsis. F. A. Higgins (Boston Med. and Surg. Jour., May 2, 1901).
These few drugs failing to control the premonitory symptoms or eclampsia sud denly developing, measures of a surgical nature are called for.
Surgical Treatmen.t. — Where the symptoms which forebode the ment of eclampsia do not yield to the dietetic, hygienic, and medicinal ment outlined, the surgical measure de manded is evacuation of the uterus.
In eclampsia occurring during partu rition delivery should be effected as quickly as possible under deep amesthe sia. When possible, without loss of time, the cervix should be widened by hydro-static dilators, and the smallest ossible incision When the condition of the cervix is the cause of delay after artificial dilatation, incision as deep as may be necessary should be made. Ilicinorrhage arising, from this cause may he controlled by tampons of gauze or by pressure-forceps. In such eases, considering the amount of hremorrhage from the incision, there can never be any question of adopting venesection. When the patient is unconscious, no attempt should be made to make her swallow; a suitable stomach-pump should be in variably used for the introduction of nourishnient or medicine. Amesthetics
should be used to the surgical extent only during the operation of emptying the uterus, and either chloroform or ether may be used. The most exact asepsis is required; infection prolongs the convulsion stage of eclampsia. P. Zweifel (Centro.lb. S. Gyniik., Nos. 40 to 45, '95).
In the Prague hospital the rule is to deliver as rapidly as possible consistent with avoiding injury. A mixture of chloroform, ether, and alcohol is an espe cially safe preparation, the ancesthetie being administered not only during the operative proceedings, but also to mod ify the convulsions. Morphine is also constantly employed. The prolonged warm bath and the hot wet pack are very important. The only beverage per mitted is lukewarm milk. Knapp (Monats. f. Geburts. u. Gyniik., B. 3, 3Iay and June, '96).
Albuminuria is a premonitory sign too important to be overlooked. Termina tion of the delivery is in all cases de sirable, and it must be rapidly brought about in serious cases. Therefore from the beginning of the attacks we must act continuously in that direction. In very urgent circumstances we must not hesitate to dilate the cervix. If this accouchrinent force is difficult, too slow, or impossible without too much injury, we must have recourse to Ctesarean sec tion. N. Charles (Jour. d'Accouche thetas, Oct. 11, '96).
In puerperal eclanipsia the chief aim is to empty the uterus of its contents as quickly' as possible. The cervical canal should bc dilated, first by means of Beg,ar's graduated sounds and afterward with the fingers, until the orifice has attained a diameter of three centimetres. Podalic version, according to the Drax ton-Hicks method, then practiced and one toot extracted. This done, the uter ine orifice is again dilated by separating its edges on one side by means of the child's leg, upon which the band of the operator exerts (the foot being already extracted from the wound) energetic lateral pressure, and on the opposite side with the hooked index of the other hand. When dilatation of from eight to ten centimetres has thus been Obtained, it only remains to extract the child. As soon as the umbilical cord has been severed the placenta should be detached and the uterus compressed with the two hands for about an hour; this com pression suseitates the uterine contrac tions, preventing any serious htemor rhage. Drejer (Sem. AI6d., Oct. 31, '90).