The causes of dysmenorrhoea may be either extra-uterine or intra-uterine. The treatment differs markedly in the two classes of cases, and what would relieve in one would be worse than use less in the other. Three factors are con cerned in the production of the pain of clysnienorrlicea, viz.: contraction of the muscular fibres of the uterus or Fallo pian tubes; increased spasm or blood pressure in the tissues of uterus or ap pendages,—congestion; neuralgia of the uterus or the appendages. The cause is to be treated. Nearly all cases are bene fited by rest at the periods, hot vaginal douches during and between the periods, and, in inflammatory eases, tampons of glycerin and ichthyol, and saline aperi ents. Morphine and alcohol will give great relief, hut must never be recom mended; the administration of alcohol to young women at such times is to be blamed for much of the secret drinking that prevails. The drugs most useful are bromides and belladonna, antipyrine and cannabis Indica, and both viburnum prunifolium and viburnum opulus. Op erative measures should only be resorted to when other and less severe remedies have failed. In cases due to spasmodic contraction of uterus or stenosis of cer vix (if there be no signs of extra-uterine disease) dilatation is often of SOIIIC serv ice, but is seldom of more than tempo rary benefit. In cases due to chronic pelvic peritonitis, binding down and matting together the uterus, ovaries, and tubes,—cases in which the ovaries are cystic and the tubes, perhaps. occluded and the uterus retroverted and adherent to the reetum,—very marked and per manent benefit results from a, "conserva tive operation" on the appendages. The abdomen should be opened, the uterus, ovaries, and tubes freed from the adhe sions, and after ignipuncture of the cys tic or selerosed ovaries the fundus fixed to anterior abdominal wall. In grave and otherwise incurable lesions of the appendages, such as abscesses of the ovary or pyosalpinx, the removal of the diseased organ is strongly indicated. Martin (Brit. Med. Jour., Oet. 24, '97).
The use of pessaries for the relief of displacements, while it frequently modi fies the dysmenorrhcea, seldom cures the displacements; hence such means are used with far less frequency than for merly. The same may be said of the cut ting operations which Ns-ere once so popu lar for the relief of dysmenorrhcea sup posed to be the results of anteflexion of the uterus.
ECLAMPSIA.—Gr., 'x'Act14.1,::, a shin ing forth.
Synonym.—Puerperal convulsions.
Deflnition.—Eclampsia is a sy-mptom atic disorder characterized by convulsive or epileptiform seizures that suddenly come on prior to, during, or after labor.
Symptoms.—The physician 1-vho sys tematically examines the urine not alone for albumin and casts, but also for urea, and who keeps check of the amount of urine passed in the twenty-four hours is not likely to be caught napping even in those cases in which, although there never has been a suspicion of renal im pairment, the kidneys are nevertheless diseased. Pari passu with diminished excretion of urea the risk. of tox[emia
increases, and the most dangerous form of eclampsia—that which develops sud denly (without much premonition) and passes into coma and death—frequently depends on -urinary insufficiency as re gards excretion.
The clinical history of cases of the form of toxmmia under consideration is variable. As a rule, there exists a pre monitory symptomatology, consisting in cephalalgia and dimness of vision or alteration from that which is normal in the person.
Instances of convulsions during preg nancy- observed in which every fit was regularly preceded by transitory amauro sis, as well as by ccdema of the face, which was also of short duration. Two sets of convulsions occurred during preg nancy: the first about the end of thc seventh month, four attacks taking place within twenty-four hours; the second in the course of the eighth month, when two fits were observed. After the last convulsion a healthy child was delivered. The mother made a good recovery. The two prominent symptoms above men tioned developed before eaelt of the six fits. Olshausen has been able to collect only three cases of eclampsia in which the fit was preceded by all aura, as was this case. Rabczewsky (Przeglad Chir tirgiezwy, vol. ii, Pt. 3, '95).
Rarely arc convulsions unheralded. In the -vast majority of cases there were prodromal symptoms. Frequent urinary analyses, both qualitative and quantita tive, sbottld be made, and, if albumin is found or the amount of the solids greatly diminished, suspicion should be aroused. Any abnormal symptoms—such as head ache, disturbances of vision, or cedema— should put us on our guard. When such symptoms appear the patient must be put on a milk diet with large quantities of sterilized water; hot baths employed, and the bowels kept active by catharsis and saline enemas. The continuance of these symptoms demands induced labor.
In post-partum eclampsia, if the pa tient is plethoric and vigorous, venesee lion is the best remedy; if anfemie and weak, veratrum, accompanied by the tiansfusion of the salt solution, is indi cated. E. D. Thomason (Med. Record, May 23, '96).
Albumin and casts may or may not be present in the urine according to whether a nephritis complicates the pregnancy or not. Should the premoni tory symptoms be aggravated elimina tion of urea is defective, as shown by the recognized tests. Insufficiency on the part of the kidneys may be determined by measuring the amount of urine passed in the twenty-four hours. Vascular ten sion is apt to be increased except in women of an anmmic type; cedema, as a rule, accompanies organic renal dis ease.
The symptomatology of the eclamptic seizure is characteristic. The wide-open eyes, fixed in vacant stare; the contracted pupils, the rapidly opening and closing lids, the clonic convulsions. These symp toms accompany, ordinarily, the first seizures. The heart's action becomes ir regular, the face is cyanosed, the breath ing stertorous. Soon the convulsions be come tonic in character; the eyes are fixed; opisthotonos may set in.