nothing left but the final scene." He politely, though decidedly, opposed it. Said I: "Doctor, with the highest respect for you, I shall do it." I knew that the confidence of the family in me was unlimited. I had brought this patient into the world twenty-three years before. I opened a vein in the arm, making a large orifice. As the flow of blood increased, the pulse became more regular and fuller. I kept the fingers constantly applied to the opposite radial artery. The pulse continued to improve until the loss of twentyfour ounces seemed to have accomplished all that was necessary, when the flow was arrested. I continued by the bedside of my patient from this hour until the following evening, noting the recurrence of but one convulsion, at 4 A. M., and giving only a few inhalations of chloroform and one hypodermic injection of a quarter of a grain of sulphate of morphia, when her intelligence began gradually to return. She made a good recovery.

In this, as in the previous case, without venesection, death must have inevitably resulted.

In a conversation with the patient some weeks afterward, she informed me that she had no recollection of anything connected with her labor except an indistinct idea that she saw me as I entered the room when I was first called, which accounts for her frequent answer, throughout the first part of the day of attack, "I am very comfortable." Although my paper has already taxed your patience, I desire to report one additional

case:

Mrs. K., primipara, aged thirty-one, upon rising from bed one March morning at 2 A. M., for the purpose of urination, fell from the vessel to the floor, in a convulsion. A homeopathist was called, and, after leaving some remedy, left (evidently not recognizing the true state of the case), to be summoned again after another convulsion. The patient remained unconscious, with occasional spasms, until 8 A. M., when I was sent for and assumed charge of the case. I found a somewhat plethoric woman, compactly built, and profoundly insensible, having been comatose since four o'clock that morning. Bloody saliva was oozing from the mouth, the complexion was becoming cyanotic, there was loud and labored respiration, and, as near as could be calculated, the

patient was within three weeks of the completion of her term. She had had four convulsions since the attack, and the pulse was very irregular as to frequency and quite firm. I believed that the patient would die if I ventured to try morphia and chloroform without first letting blood. I opened a vein, having decided to lessen the circulation to the extent of relieving the overloaded brain and heart. After thirty ounces of blood had been taken, the pulse steadily became slower and fuller, and the skin, instead of presenting a purplish congestion, was clear and nearly natural in appearance, with a total change in the character of the respiratory movements. I had chloroform ready, and, as soon as deglutition was possible, I gave the usual dose of chloral and bromide of potassium. Not succeeding well by the mouth, I gave these remedies per rectum at reasonable intervals throughout the day. I kept the morphia in reserve in case of another convulsion. Chloroform was given but once. An examination per vaginam gave no indications of the beginning of labor. Upon catheterization, I obtained only two ounces of urine.

My notes say: "In less than an ounce of urine a teaspoonful of albumen was found." Rochelle salts were given by enema during the following twenty-four hours, until free movements of the bowels were obtained. During the afternoon of the day of the attack, while I was temporarily absent, the bandage on the arm became loosened and more blood was lost. After thirty-six

hours had elapsed, consciousness returned, but vision did not. She would direct her eyes toward the place from which a sound came, but said that she could not see the person addressing her. I now endeavored to reduce the quantity of albumen in the urine and to increase the renal secretion, before parturition should add to her danger. Saline laxatives, acetate of potash, digitalis, and slop-diet, with diurnal examinations of the urine by testing and measurement, constituted the programme for six and a half days, when, after she had been down stairs for the day, every symptom being satisfactory, and while sitting upon the sofa, the amniotic liquid began to pass away, with no pain. On this day, the discharge of urine was quite copious, and the quantity of albumen was small. I saw her soon after the amniotic discharge began. A vaginal examination failed to reveal any immediate signs of labor. I left her, with directions to be sent for when pain or any

unpleasant symptom came on.

At 4.30 the next morning, I was sent for, and found her in pain, with a slight "show."

Pains continued to moderately increase during the day. She was cheerful and free from headache. Toward evening, the os uteri was found to be dilating satisfactorily, when she suddenly became restless and said: "I feel as I did once before. Oh, my head!" I gave her twenty grains each of chloral and bromide of potassium, and made her inhale chloroform. As the pulse was quite firm, notwithstanding the treatment for the past six days, I determined upon another loss of blood if, in connection with the chloral, etc., a hypodermic injection of morphia should fail to ward off another convulsion. The effect of the venesection was almost magical; and nothing further occurred to interrupt or mar the progress of the labor, which terminated at 2.30 the following morning. A speedy convalescence followed.

It may seem strange to some why one or more fatal cases under the same plan of treatment are not reported. It affords me great pleasure to be able to state that I have never seen a fatal case which occurred, in the experience of either my father or myself, during the forty years of my midwifery practice, strange as the fact may seem; and, while I do not wish to be understood as asserting that every case, in which the course of treatment I have indicated is carried out, will recover; yet I believe, if this treatment be pursued before consciousness is abolished between the seizures (and usually it is not between the first two), and before the peculiar cardiac action that I have described presents itself, that every case will recover; and I believe that a very large majority of cases will recover under this treatment, even after these grave symptoms have become developed.

I am sure no one can properly charge me with undue haste in arriving at the conclusions which have irresistibly forced themselves upon me; for, notwithstanding my father's success in the treatment of puerperal convulsions by blood-letting, for fifty-eight years, together with my own earlier experience, I approached my belief after, in some cases, an unjustifiable delay in resorting to venesection, and after carefully subjecting all other methods of treatment to the severest test.

This paper is presented as an epitome of the cases of puerperal eclampsia which have occurred in the practice of two physicians, during an aggregate period of seventy years. While I do not in the main object to the radical change of fashion as regards venesection in the treatment of a large majority of diseases, yet I shall ever plead for the lancet as the sheet-anchor in the treatment of "the convulsions of pregnant and parturient women."

In conclusion, I desire to present the following suggestions: First. When engaged to attend a case in midwifery, insist upon seeing the patient two months (if so much time is to intervene before labor is expected) before parturition.

Second. Carefully test the urine at times during this period. Third. If there be much cephalalgia, with or without œdema, and if this be more or less constant, whether the urine be albuminous or not, resort to venesection, taking sufficient blood to relieve the head-symptoms.

Fourth. Warn the patient against all articles likely to unduly tax the digestive apparatus.

Fifth. Insist that the bowels be kept in a soluble condition, especially if there be a tendency to torpidity.

Sixth. When the first professional introduction to the patient is at the beginning of parturition, and the symptoms as described in the third suggestion are present, the treatment there suggested is imperatively demanded; and, should the pains seem inefficient, a hypodermic injection of gr. to gr. ss. of sulph. morphia is an important adjuvant.

DISCUSSION.

DR. E. M. MOORE.-The paper read by Dr. Colvin is of a somewhat remarkable character, and I think that some criticisms should be made upon it. The extraordinary experience of Dr. Colvin certainly does not correspond to that of his contemporaries. My own experience extends back to the time when bleeding was the fashion; and I have certainly seen puerperal cases in which this treatment did not give relief, but perhaps this was because a sufficient quantity of blood was not withdrawn, as the author has stated, although the bleeding had been quite free. I can not help believing that the elimination from the blood of the poison that is incident to the condition known as albuminuria constitutes the real means of cure of the parturient woman; and it must not be forgotten that, in connection with blood-letting, it had been the universal custom to use a cathartic at once. I believe the author has not mentioned, as a means of producing catharsis, the placing of dry calomel upon the tongue, followed immediately by croton oil, so as to be sure of obtaining a profound action upon the bowels.

DR. COLVIN remarked that the method mentioned by Dr. Moore was practiced by his father, and that cathartics were used in some of the cases which he had reported.

DR. MOORE.-I can not help thinking that the true treatment of albuminuria consists in the use of cathartics, and especially of saline cathartics. I know very well that some of my friends do not agree with me in this opinion, and I do not expect that my views will be accepted by all present at this meeting. I am speaking, of course, of cases of albuminuria which are susceptible of cure, and not of the organic changes which commonly occur in Bright's diseases. I know that there are cases of albuminuria which may recover and which are entirely independent of the parturient state. We also know that the albuminuria of the parturient condition usually disappears when the uterus is empty; but this is not always true, as patients sometimes have convulsions after the expulsion of the uterine contents. Nevertheless, it seems to me that the habit which prevails in the profession of adding to the other treatment of eclampsia the giving of a cathartic, is the most important