Capillary circulation in eclampsia

528

THE

XMERICXN

JOCRNAL

OF

OBSTETWCS

AND

Gl?NECOLOGP

All but The duration in the reported ea2ees was from one hour to over three days. one case cleared up immediately after delivery or after the last convnlsion, hence the prognosis as to vision in these patients is favor’able. J. I?. GREENHILL Hinseimann, Archiv

fiir

~etteko~e~, GynCikologie~

and Silberbach: 1923, cxvi, 443.

Capillary

~ircnlat~on

in

Eclampsia.

,This is a minutely d8etaile.d report of observations and conclusions incident to the study of the digital capillary circulation in IS eehmptics. In 16 eases, a In every patient, the authors found prapkic time-recording device was wed, period5 of capillary stasis, in compa,rison with 80 per cent of previously observed ilcalthy nonpregnant women who showed none, and 40 per cent of heabhy pregnant momen who showed none. RAII~AY SP~~LMAN. sitzgibbon: Journa.1

elationship of Obstetrics and

of Eclampsia Gynaeeology

to t&e Other of the British

Toxetias Empire,

of Pregnancy. 1922, xxix, 402.

Xlyperemesis, accidental hemorrhage, neuritis, the aibuminuria of pregnancy and The various names are applie#d eclampsia are all classed Ias toxemia,s of pregnancy. ro the dominant symptom but vomiting, par&s, hemorrha.ge and convulsions are ail symptoms of one and the same disease. Albuminuria is the only universal symptom and tkis v,aries greatly in intensity. The a,ge occurrence in e’clampsia seems younger than in the other toxemias. ,~-lbuminuri~a of pregnancy and eclampsia are both more common in the primigravida. Toxemias tend to produce symptoms earlie r in multipa,rae than in primagravidae. When a primigravida develops toxemia the tendency to convulsions stands in proportion to her youth. Accidental hemorrhage occurs usually in the multipara and may be asso’ciated ~211 convulsions or other toxic symptoms. Headaches occur in 25 per cent of toxemia, hemorrhage and eclampsia. Edema and decrea.sed urinary sacretioa are usually in direct proportion to the albuminuria. The pathologie,d findings in toxemia, oelampsin and hemorrhage are identical. &. subacute nephritis is common to all. ‘The causes of toxemia may be summed up as an extra demand on the elimina;tive organs and the failure of these organs to keep pace with the demand. Pregnancy requires a certain reserve power in the &ninative or-an5 with decreased eliminative power5 develop toxemia b * I%tients o5,rly in pregnancy. Overeating, neglect, constipatio,n and a rapid gain in weight arc all common symptoms in tmamic women. The maintenance of regu!ar bowea action avoids toxic accumulation and delays excretory &compensation. The treatment ‘of the toxemiasi of pregnancy a5 carried out at the Rotunda is based entirely on elimination and varies only with the immediate urgency o’f the Starvation, purgation and diuresis are elmployed in all cases. Labor symptoms. is induced only after the failure of medical trea,tment. Where! vomiting is a pronounced symptom, nothing is given by mouth and fluid5 ,are supplied by submammary infusion and enemata. Morphine help5 in this type of cases. The routine in eclampsia includes stomach lavage and catharsis, lo’ng continued colonia irrigations every five’ hours, and the eliminative measures employed in all toxemias. dll unconscious patients are kept continually on the side and the respiratory passages must be kept free of mucous. Morphine though employed freely some time ago is no longer used routinely in all caees. Lla,bor i,a not interfered with until the fetal head reaches the perineum. The methods advocated or their modifications are t!m only ones as yet capable of showing a mortality in &lamp&s of less than ‘ten per cent. H. W. SHUTTER.