There are four indications for prophy laxis in regard to the kidney in preg nancy: 1. urine of all pregnant women should be regularly examined es pecially after the sixth month. Exami nation of the urine should be chemically for albumin, sugar, and total solids, and microscopically for casts. It is of the most importance to obtain an approxi mate idea, at least, regarding the amount of urea -xcreted in twenty-four hours. 2. The formation of toxins is best prevented by careful regulation of diet and by an abundance of pure air. Pregnant women should not eat too much meat, and that only once a day. Lamb, mutton, fish, and oysters are best for them, with raw or cooked fruit, and with the lighter fresh vegetables in moderation. Graham or whole wheat bread and all cereals are also helpful. Spirits should be inter dicted during pregnancy. 3. The gravid uterus makes quite enough pressure upon the kidney without the added weight of heavy skirts, tight bands, and a laced-in corset. The clothing should be light and suspended from the shoul ders. All of the limbs should be pro tected by flannel undergarments, except in the hottest weather. Multiparm are often helped by a bandage. 4. To pro mote excretion by the skin, frequent baths are necessary. A proper evacua tion of the bowels is the most important duty that the future mother has to per form. Cascara sagrada, either as fluid extract or as the aromatic trade prepa ration, daily doses of compound-licorice powder, sulphur and cream of tartar, saline mineral waters, small doses of colocynth and podophyllum are all use ful. A glass of milk in the morning purges some patients, though it consti pates others. If there be beginning signs of renal incompetence, saline diuretics, Spiritus mtheris co., infusion of digitalis, if the arterial tension be not too high, will be found useful in increas ing kidney secretion. Large quantities of fluid—such as alkaline mineral waters, milk, bitter vegetable infusions, or even of ordinary water—will prove of service. Mercuric chloride—to increase the flow of urine, to diminish the oedema, and to improve nutrition—should be given for a long time in doses of at least '/.,„ grain three times a day.
In this manner 80 per cent. of the pa tients who are in danger from renal fail ure and faulty metabolism may be tided over until they are safely delivered. James L. Kortright (Brooklyn Med. Jour., Apr., '99).
A woman having a heart lesion which is compensated should not be prevented from marrying. Abortion should not be induced on a woman with heart disease unless very serious symptoms are pres ent. Premature labor should seldom or never be induced on account of heart dis ease. Mitral stenosis is the most serious heart lesion during pregnancy and labor; aortic stenosis comes next; then, prob ably, aortic incompetency. Mitral insuffi ciency is the least serious lesion. A. H. Wright (Amer. Med. Quarterly, Sept., '99).
Where true nephritis exists before or begins in pregnancy, the disease, as a rule, is a more serious matter than in the no-n-pregnant state, and the prognosis is unfavorable. In the case of chronic nephritis, an acute exacerbation is usually induced. The patient may die from kidney-failure, and urmmia is very apt to occur. Only in a small percentage of cases are the phenomena of eclampsia noted, as has been pointed out by Ea ling and Leyfert.
As regards the influence on the course of pregnancy, the tendency to premature emptying of the uterus is to be particu larly noted. According to P. Miller, it occurs in more than 40 per cent. of cases. It is attributed to various causes, viz.: hmmorrhages into the placenta, causing infarcts and destruction of portions of the chorionic villi, or separation of the placenta. The foetus may die as a result
of the accumulation of toxic material in the system, and this is an important cause of the premature expulsion. The foetal mortality is very high. Hofmeier noted that the fwtus died in twenty out of twenty-three cases of nephritis. Braun has estimated the mortality at SO per cent. J. C. Webster (Jour. Amer. Med. Assoc., Apr. 21, 1900).
Notes of 13 cases in which cardiac disease has complicated labor. Among these there are 3 cases of aortic stenosis. 1 of which terminated in premature labor and 2 in labor at full term. The mother made a full recovery and 2 of the children lived. The remaining cases were those of mitral disease, in which the degree of incompetency varied, as did also the condition of the heart muscle. In sonic of the cases tiara} stenosis was present, and 2 eases were complicated by tricuspid incompetence as well. Most of these patients went to full term. There was 1 death from cardiac failure. One patient had high fever, which fell after the bowels had been thoroughly moved, the patient dis charging a large quantity of very of fensive faeces. Another patient after labor was seized by a rapidly increasing and most threatening anaemia, from which she made a very gradual recovery. Jardine (Jour. of Obstet. of the British Empire, April, 1902).
Constitutional disease at the inception of pregnancy may also be a very trouble some disturbance to that condition. This may consist in syphilis, tuberculosis, pro found anwmia, or any wasting or in tensely infectious disease which in itself is a severe drain upon the vital forces. Pregnancy is often interrupted under such conditions.
If it should continue to term the child may be dead at birth or so poorly nour ished that death may occur without a very prolonged struggle.
Artificial abortion is only indicated when there is endocarditis with wdem atous swelling, well-advanced tuberculo sis, nephritis, uterine disease, deformed pelvis which would necessitate Caesarean section, or uncontrollable vomiting. After the necessity for artificial abor tion has been established, the operation should be resorted to at the earliest possible moment to protect the patient.
The attending physician should always call in consultation some colleague. The following technique has never failed nor has ever caused untoward results: A metallic curved catheter, with a lumen of about 2 millimetres, is introduced into the uterus as far as the fundus. This is absolutely imperative, for it brings the instrument in the immediate neighborhood of the embryo. About a drachm of tincture of iodine is injected through the catheter. The vagina is tamponed to prevent the iodine, which may partly trickle down, from irritating the vaginal mucosa. About three days thereafter a little blood is passed, and the abortion results in the nature of an ordinary menstruation. This may not occur if the catheter has not reached the fundus. In that case the operation is again performed. The entire procedure is so little exciting to the patient that she may go about immediately and need not necessarily go to bed. This is the case when the menses have ceased only for some days, or, at most, a few weeks. The advantages of the iodine are that it percolates through the tissues rapidly, killing the foetus, at the same time pre venting sepsis by its strongly-antiseptie nature. Besides, the tincture of iodine stimulates the uterus to contract, caus ing the expulsion of the tumor. (See also ABORTION, volume i.) Oehlschliiger (Centralb. f. Gyniik., July 7, 1900).