- Email: [email protected]
Eclampsia and its conservative treatment
466
THE AMERICA~ JOCRNAL OE' OBS'TETRICS A?\D GY~ECOLOGY
and chloral are employed, the latter 1n doses of 4: grams, 10 to 15 gms. per day, given in milk, either by mouth or rectum. This may be alternated with morphine. Venesection is not to be forgotten. Lumbar puncture has a limited sphere of application. "Obstetrical treatment reduces itself to nothing or next to nothing.'' Like his teacher Couvelaire, Vignes feels that labor should be neither induced nor accelerated and one should hesitate to employ forceps or any other method of forcible extraction. He believes that either the classical or vaginal cesarean section, for toxemia alone, are useless since the very grave cases will die anyway and in the more favorable cases the patient can be cured by less drastic measures. R. E. WoBus.
Bear: Eclampsia and Its Conservative Treatment. Virginia Medical Monthly, 1921, xlvii, 487-491. After a review of the patholog·y, etiology, diagnosis and prognosis of eclampsia, the author discusses both the prophylactic and curative treatment of the disease. He does not recommend cesarean section unless the disease is complicated by a contracted pelvis or tumor formation. In his hands best results were obtained by venesection, morphia, catharsis and diaphoresis. Under such treatment the patient usually falls into labor promptly. When fair dilatation is accomplished, a bag is introduced or manual dilatation of the cervix done to hasten delivery. ,JoHN W. HARRIS.
Engelmann: Is the Therapy of the "Middle Lin.e" in Eclampsia Still Justifiable? Zentralblatt fiir Gynaekologie, 1920, xliv, 1113. Vo1hard has drawn a parallel between the pathologic anatomy of the kidney in trench nephritis and in eclampsia. Engelmann believes that a sharp distinction between eclampsia and eclamptic uremia is not always possible; the clinical entity termed eclampsia has no single etiology, but may be produced by different conditions and causes, of which the supposed pregnancy toxemia is one. It is not logical to omit from the classification of eclampsia those cases in which at autopsy the findings are characteristic, even though there have been no convulsions. The severity of the toxemia bears no relation to the number of these and yet the practical side of the question is that in statistics there is no distinction between light toxemia with say one convulsion and the very severe toxemias. A further question is the relation of eclampsia to nephritis. There is eclampsia following nephritis, true eclampsia, and the false eclamptic uremia. In certain clinics the differentiation may be made, but to the majority of practitioners blood chemistry is inaccessible. This is still more complicated by the fact that, according to Volhard, there is a transition from the false to the true uremia, which may occur during pregnancy. Cases that were definitely eclamptic clinically, do not always show characteristic results at section. '!'he recognized anatomical alterations are not specific for eclampsia. The kidney of eclampsia resembles that of Bright's disease. Barr ten years ago declared that the typical alterations in the liver were not pathognomonic for eclampsia. As true eclampsia should be known that form which we see in pre-
THE AMERICA~ JOCRNAL OE' OBS'TETRICS A?\D GY~ECOLOGY
and chloral are employed, the latter 1n doses of 4: grams, 10 to 15 gms. per day, given in milk, either by mouth or rectum. This may be alternated with morphine. Venesection is not to be forgotten. Lumbar puncture has a limited sphere of application. "Obstetrical treatment reduces itself to nothing or next to nothing.'' Like his teacher Couvelaire, Vignes feels that labor should be neither induced nor accelerated and one should hesitate to employ forceps or any other method of forcible extraction. He believes that either the classical or vaginal cesarean section, for toxemia alone, are useless since the very grave cases will die anyway and in the more favorable cases the patient can be cured by less drastic measures. R. E. WoBus.
Bear: Eclampsia and Its Conservative Treatment. Virginia Medical Monthly, 1921, xlvii, 487-491. After a review of the patholog·y, etiology, diagnosis and prognosis of eclampsia, the author discusses both the prophylactic and curative treatment of the disease. He does not recommend cesarean section unless the disease is complicated by a contracted pelvis or tumor formation. In his hands best results were obtained by venesection, morphia, catharsis and diaphoresis. Under such treatment the patient usually falls into labor promptly. When fair dilatation is accomplished, a bag is introduced or manual dilatation of the cervix done to hasten delivery. ,JoHN W. HARRIS.
Engelmann: Is the Therapy of the "Middle Lin.e" in Eclampsia Still Justifiable? Zentralblatt fiir Gynaekologie, 1920, xliv, 1113. Vo1hard has drawn a parallel between the pathologic anatomy of the kidney in trench nephritis and in eclampsia. Engelmann believes that a sharp distinction between eclampsia and eclamptic uremia is not always possible; the clinical entity termed eclampsia has no single etiology, but may be produced by different conditions and causes, of which the supposed pregnancy toxemia is one. It is not logical to omit from the classification of eclampsia those cases in which at autopsy the findings are characteristic, even though there have been no convulsions. The severity of the toxemia bears no relation to the number of these and yet the practical side of the question is that in statistics there is no distinction between light toxemia with say one convulsion and the very severe toxemias. A further question is the relation of eclampsia to nephritis. There is eclampsia following nephritis, true eclampsia, and the false eclamptic uremia. In certain clinics the differentiation may be made, but to the majority of practitioners blood chemistry is inaccessible. This is still more complicated by the fact that, according to Volhard, there is a transition from the false to the true uremia, which may occur during pregnancy. Cases that were definitely eclamptic clinically, do not always show characteristic results at section. '!'he recognized anatomical alterations are not specific for eclampsia. The kidney of eclampsia resembles that of Bright's disease. Barr ten years ago declared that the typical alterations in the liver were not pathognomonic for eclampsia. As true eclampsia should be known that form which we see in pre-