Acceleration of labor by safe methods, large doses of morphine to suppress the attacks, avoidance of administering med icine by the mouth, stimulation of dia phoresis by external remedies—all these appear to promise most success in treat ment. Veit (Festschrift f. Carl Ruge,'96).
Whenever albumin is discovered in the urine of a pregnant woman, she should, without delay, be put upo» a strict milk diet, for albuminuria is to be regarded as a symptom of the state of autoin toxication which results in eclampsia. Tarnier says that he has never seen eelampsia supervene in pregnant women suffering from albuminuria who have been for seven days upon a strict milk diet. During the convulsions the tongue is best preserved from injury by placing a folded handkerchief between the teeth, which pushes the tongue back, and also prevents the teeth from closing. The pa tient should be placed immediately under the influence of chloroform. A rectal injection of about GO grains of chloral should next be given; it is advisable to begin with a large dose rather than repeated small doses. If necessary the injection of chloral may be repeated sev eral times, giving as much as 250 to 300 grains in twenty-four hours. The in halation of chloroform should be con tinued during the atta.cks. Bleeding is reserved for the rare cases which are dis tinctly "sthenic" in type. As a diuretic agent, half a pint or more of a saline solution containing. 1 per cent. of chlo ride of sodiutn, may be injected into the buttock. and the injection repeated sev eral times. No interference is required until the cervix is fully dilated, when the child may be extracted -with forceps or by turning. Delivery by such forcible methods as rapid dilatation or incision of the cervix is condemned. Oui (L'Eclio Mkt. du Nord, May, '97).
The treatment consists in controlling the convulsions by iworoitm/ narco8i8, speedy evacuation of the uterine con tents, and diaphoresis, with a view to re establish skin function and reduce the tension. Kedarnath Dass (Indian Med. Record, April 16, '9S).
The nearer the term,the easier the pro cedure of emptying the uterus; the same statement applies to the multipara over the primipara. The steps of the pro cedure are, in brief, the following: -Un der the most absolute asepsis of patient, instruments, and hands of operator and assistants, ordinarily under chloroform aniusthcsia, the cervix is dilated by the steel-branched or other dilator. Great
care is requisite not to rupture the mem branes. The cervical canal is then firmly packed with sterile gauze, and the upper portion of the vagina as well. The woman is put to bed and if she complain of much pain codeine should be used freely in suppository (gr. ii to iv repeated every four to six hours), for reflex nerv ous irritability must be controlled. At the expiration of about twenty-four hours, under absolute asepsis and chloro form anmsthesia, the gauze is removed, and, if the cervix has softened and is dilatable, manual dilatation is resorted to. If the cervix has not softened and the symptoms are not urgent the canal should be repacked for a further period of about twenty-four hours. Dilatation by the hand having been accomplished to the requisite degree—that is to say, until the closed fist can be withdrawn with ease, the membranes being intact, elect ive version is performed, followed by im mediate extraction, else the lower uterine segment may close on the foetal head. When the membranes have ruptured de livery from the brim by axis-traction for ceps is indicated. After delivery—when the pulse is full, strong, bounding—uter ine vencsection is allowable until the pulse becomes soft. Where, on the other hand, the pulse after delivery is rapid and weak, no time should be lost in the thorough uterine tamponade.
Where eclampsia develops without pre monitory symptoms, or where delay with the premonitory symptoms has ruled, there is no time for the preliminary tam ponade. Under absolute asepsis and chloroform aimsthesia manual dilatation is at at once instituted, associated, in very rare instances, with the Diihrssen incisions, the uterus being then emptied.
In post-partum eelampsia there is no scope for surgery, and dependence must rest on drugs (veratrum and the nitrites), on repeated high saline rectal irrigation, and in free catharsis, using elaterium or croton-oil. Whether the case be of the sthenic or asthenic type, these rules hold good, except that in the latter type hy podermoclysis of saline solution should be added, and in the latter venesection.