Gambar halaman

If we

point in the management of this disease. It is the cathartic that clears the blood and thus relieves the bead and the kidneys. But it is unfortunately true that, if nothing else be done, the patient may die before the cathartic can have time to operate. could find some means of suspending the convulsions for a time, the cathartics would effect a cure. There is no question at all that bleeding is a means by which the convulsions can, for a time at least, be suspended; and I may say that this is capable of suspending almost any condition. The older physicians were in the habit of bleeding for almost everything; and probably all present know that venesection is capable of arresting a violent attack of neuralgia ; but, the next day, the neuralgia will be worse than it had been before. I have no doubt that venesection was one of the most valuable remedial agents against eclampsia in former times, as it has the power of suspending the convulsions, giving an opportunity for the action of cathartic medicines; and thus, also, time was gained for emptying the uterus and effecting a permanent cure. Now the question is, Have we any means by which to suspend the convulsions more quickly and better than by bleeding ? There are, in the list of therapeutic measures, many things of value which we have been reproached for having cast aside ; but we have abandoned these measures, only because we think we have found something that is better. We do not deny the value of the old agents, but we prefer the new as being more efficient. Now we find that the free administration of ether will suspend puerperal convulsions even more effectually than will bleeding. The same is true of chloroform ; but convulsions will follow the first blood-letting, and they will also occur after the cessation of chloroform-inhalation. According to my experience, however, so long as the patient continues to inhale the anæsthetic, the conyulsions will not return. I always advise beginning the use of the anæsthetic as soon as there is deep snoring and a restlessness which indicates threatening convulsions ; and, while in this condition, the patient should not be allowed to come from under its influence until a free movement of the bowels has been obtained or until the uterus has been emptied. Failure is often due to our not continuing the administration of the anæsthetic long enough.

Dr. Colvin has mentioned a case in which the convulsions tended to return with regularity after the lapse of a certain num

ber of minutes. All have observed this peculiarity in the convulsions of the puerperal state. The intervals may be half an hour, or forty minutes; and, after having observed this in the course of two or three convulsions, we expect a return about so often, and it seems at each convulsion that the patient must die. In such a case I have remained by the patient as long as four hours, holding a sponge containing the anæsthetic over the face, and by that time, the calomel and croton oil having taken effect, I would remove the sponge. The uterus was emptied the next day, and no more convulsions occurred. I have spoken earnestly upon this subject, and I desire to say that I consider blood-letting an exceedingly valuable agent to suspend the convulsions; but I believe the real means of cure to be the cathartic, and I insist that suspension of the convulsions can be effected more quickly and better by the use of ether than by blood-letting.

DR. C. G. POMEROY, of Wayne County.-I shall detain the Association but one moment, but I can not help expressing my views on the important question involved in the subject under discussion. During the reading of Dr. Colvin's valuable paper, and the remarks made by Dr. Moore, I have been thinking of my experience in years past regarding the treatment of albuminuria. All who have reached middle life have seen the lancet used, and have also seen the other measures commonly employed for the relief of puerperal convulsions. I wish, in this connection, to relate the history of a case of the most frightful convulsions that have come under my observation. I was away from home one evening, a distance of seven miles, to see an old lady; and, when about to leave the house, her daughter, twenty-six years of age, a vigorous woman who had been married but three years, said she wished that I would examine her feet. I found her limbs much swollen, and, as she was soon to be confined, I told her she must rest her feet, assume the recumbent posture, and that it would probably be necessary for her to take a cathartic. She placed her hands on the abdomen and said she had pains, and afterward she vomited. I remained with her until two o'clock in the morning. The patient threw up everything taken into the stomach, and it was only after some hours that the vomiting ceased. I had scarcely reached home in the morning, when a messenger came and said that the patient had had a fit just after I left the house. When I returned,

she was in her fourth or fifth convulsion, which was the most frightful I had ever seen. I bled her immediately, until I was of the impression, from the character of the pulse and the appearance of the face, that a sufficient quantity of blood had been withdrawn. I then ruptured the membranes and gave calomel, and sent for croton oil. Dr. McIntire was called in consultation, and we, with the assistance of a young physician, gave chloroform until 4 P. M., when the child was born, the woman having been unconscious from the time of the first convulsion. The patient was put to bed and soon bad a movement of the bowels, passing an enormous quantity of green tomatoes and green corn not properly masticated and not at all digested. The night before, she had thrown up what were supposed to be green pickles. Five or six ounces of urine were withdrawn, and the patient was left in charge of the young physician, who had instructions to give chloroform in case the convulsions should return. The next day, the young physician said the woman had had a convulsion regularly every hour during the night. He was asked if he gave chloroform, and replied that he had tried to do so, but, as the patient struggled, he abandoned the attempt. Arriving at the patient's bedside, I found that she had continued to have convulsions and was unconscious; but the convulsions were less severe than before. An enema was followed by another evacuation of an enormous quantity of green corn and tomatoes. The next morning, the patient was on the way to permanent recovery.

In another case, I gave chloroform for twenty-four hours, preventing convulsions except for a few moments when the anæsthetic was withdrawn. The patient began to recover after an evacuation of the bowels had been secured. I believe, with Dr. Moore, that the most efficient means for controlling puerperal convulsions is to secure a prompt and free action of the bowels.

Dr. B. L. HOVEY, of Monroe County.- Probably most of the gentlemen present have years ago practiced venesection and used cathartics in puerperal eclampsia, and more recently have employed chloroform and cathartics. It has also been the practice to empty the uterus ; and I believe that by this means we can best control the convulsions. In the first two cases which I attended as a young man, the patients went on to recovery after delivery of the child ; in one case, chloroform baving first been resorted to, and, in the other, venesection having been performed twice. Cathartics were also administered. While I agree with what Dr. Colvin and Dr. Moore have said, I still believe in emptying the uterus, as the essential means of promoting recovery.

Dr. W. H. THYER, of Kings County.-I wish to say a word with regard to another means for controlling puerperal eclampsia. I fully believe in the principles enunciated by Dr. Moore. Of course, the first step to be taken is to relieve the kidneys, and to move the bowels by a cathartic. But, in order to gain the time in which to do this, I believe in the use of ether. There is another remedy, however, which some of the profession in Brooklyn found to be very efficient, and that is the veratrum viride, in drachm-doses of Norwood's tincture. This agent will reduce the circulation rapidly and permanently, without any ill effects. It should be repeated as often and continued as long as may be indicated by the character of the pulse. By this means, the pulse is speedily reduced to a normal rate, and while it is kept there the convulsions will not recur. Permanent relief can be secured after emptying the uterus and securing a free evacuation of the bowels.

DR. COLVIN.-In my paper I have simply stated certain facts, without insisting upon any theoretical views which I may entertain with regard to the mode of relief in the treatment of puerperal convulsions. If, for instance, we were to discuss the subject of scarlet fever or rheumatism, the views of every one would probably remain unchanged. There is one point, however, that seems to have been lost sight of in the discussion, which is, that in every serious case of puerperal eclampsia there is irregularity and rapidity of the pulse; and, until these conditions are controlled, we can not save the patient. I have insisted, in my paper, on the necessity of proper regulation of the diet. In one case, I ga patient advice as to diet, but she afterward had a convulsion; and, when an emetic was given, she vomited a large quantity of turnips. The convulsions then ceased. Had the veratrum viride or a cathartic been given, the patient would have retained the turnips long enough to have endangered life. The condition of the pulse is the indication for bleeding; and we should not hesitate on account of the apparently weak condition of the patient. I approve of emptying the uterus; but it may also be necessary, as it was in one of the cases reported, to resort to venesection.

Dr. John CRONYN, of Erie County.- I can not agree with Dr. Colvin in the statement that our views would probably remain unchanged, notwithstanding discussion on this or on other subjects. I have been much pleased to listen to the paper which Dr. Colvin has read, and it is my opinion that the lives of many women have been saved by the old mode of treatment by the use of venesection and cathartics. Formerly the condition under discussion was spoken of as apoplectic, epileptic, and hysterical ; but it was undoubtedly the same as that recognized at the present time as albuminuria ; and the treatment then adopted, and now too much neglected, has saved life.

« SebelumnyaLanjutkan »