« ForrigeFortsæt »
speedy relief. Dr. Scudder says, in the Eclectic Medical Fournal, 1882, p. 238: "The indication for chlorate of potash, is a peculiar fetor like an offensive lochia."
In obstetric practice we sometimes have to treat tedious and protracted labor. The patient suffering more and longer than is usual in parturition. Such cases cause friends to become uneasy and apprehensive of danger to the child, also to the mother. Puerperal fever and all its dreadful consequences are threatened, warning the physician to provide every available means to escape any unpleasant results. Well-directed professional skill, either medicinal or instrumental, adequate to the demand is imperative.
The suffering may be relieved by the administration of the following, namely: R.-Saturated solution of chloral hydrate in glycerine, and aromatic extract aa. O. S. Sig. teaspoonful every hour. It will procure rest, render the patient less sensitive to pain and allow labor to progress without so greatly taxing her powers.
The case of Mrs. F., primipara, November, 1879, furnishes an example worthy of notice. She had been in labor several hours; the pains, occurring at irregular intervals, were short and ineffectual. The vertex presented; the os uteri sufficiently dilated, was feverish and sensitive; the membranes ruptured and the genitals were scarcely moist. The patient was restless and seemed careless as to the consequences of her confinement. Her condition called loudly for assistance. The aromatic chloral mixture referred to, given in teaspoonful doses every hour, soon calmed the nervous excitement and she went into a sound sleep. The pains became strong and intermittent, the labor progressed well to completion in a few hours, while the lady was yet asleep. When she awoke her infant was dressed and in her grandmother's lap. So great was her joy, she grasped hold of me and exclaimed: "God bless you, Doctor; my babe was born and I did not know it."
It is difficult to estimate the degree of relief enjoyed by the lying-in woman under such circumstances. The contrast between a continuous endurance of keenly-excruciating pain, and being transported into a season of refreshing sleep, is suf
ficient to prompt such expressions of gratitude. When we find the perineum partially ruptured and it does not readily heal, it may be caused to granulate and unite, by painting the rent with the saturated solutions of chloral hydrate in glycerine, and potassium chlorate in pure water, mixed in equal portions. This is a favorite prescription of mine, in the pathologic condition known as "nursing sore mouth." It should be applied with a camel's hair pencil, to the ulcers and raw surfaces, or by washing the mouth with the mixture as often as necessary. The remedy may be given in drachm-doses each three or four hours, which will induce sleep and otherwise add to the comfort of the patient. The fetor arising from the aphthous condition is corrected and the burning, scalding pain is completely subdued by careful and thorough use of these means. Of course, we get the stimulant and hypnotic effect of hydrate of chloral in the uses made of it; yet as a prophylactic it acts antiseptically. Thus M. Duitrieff, in a dissertation published at St. Petersburg, tested the effect of chloral-hydrate, both clinically and experimentally. By infection with putrefying matter (put into wounds), he produced unhealthy ulcerating surfaces. Some of these were left to the efforts of the system, and some were dressed with a two per cent. solution of chloral-hydrate. The ulcers treated became healthy and cicatrised before the others did. Dr. Dunglison says: "It has been supposed that something like putrefaction may occur in the living body." To this condition Piorry has given the name, "Typhohæmia." The description applies to puerperal patients suffering from the septic fevers; hence we use our two favorite remedies. The indications for hydrate of chloral are putrid emanations from the patient and a condition of irritable unrest.
ALBUMINURIA COMPLICATING PREGNANCY.
By C. EDWIN MILES, M. D., Boston Highlands, Mass.
It is now a fact well established that albuminuria is a frequent complication of pregnancy; but how frequent has not been accurately ascertained, so variable have been the statistics of eminent authorities. Some place it as high as 40 per cent. (Bartel), and others (Hofmier) as low as 2.74 per cent. The careful observer, however, will regard these estimates as the very extremes of the matter. And it will be understood that the percentages quoted refer to cases of simple albuminuria, and not to acute or chronic parenchymatous nephritis. In discussing this point Bartel asserts that only one case of acute nephritis occurs to from twenty-five to fifty of albuminuria. But so frequently does albuminuria occur in pregnancy that the caution has been suggested that when albumen has been found in the urine of a woman during the period of her liability to childbearing, it is well to keep in mind the possibility of her pregnancy.
In estimating the frequency with which albuminuria complicates pregnancy, it should be kept in mind that the disease may precede that state. This would eliminate pregnancy as a cause in such instances. Indeed it cannot be accurately stated just how great a proportion of such cases exist. It the present state of medical knowledge it is not always possible to distinguish those cases which arise during the pregnant state from those which existed unrecognised previous to the period of conception. It is a fact, however, that albuminuria is seldom discovered before the fifth or sixth month of pregnancy, and also that the attack, as a rule is of temporary duration. These facts strongly indicate that it is of recent origin, and probably has its rise, in a very great majority of the cases, after conception. The complication is most likely to arise in the primiparæ, although it is not uncommon in the multiparæ.
The symptoms are not constant; but when puffiness of the eyelids and face, or general anasarca are observed, especially if accompanied with dizziness and headache, and dimness of
vision, with scantiness of the urine, a careful examination should be instituted at once to ascertain whether albumen be not present in the renal secretion. If it be not found on the first test, and yet the symptoms mentioned continue, repetitions of the test should be made at brief intervals.
Albumen is almost certain to be found accompanying the preceding symptoms; and if they become aggravated, the existence of blood- and pus-corpuscles, hyaline-casts and epithelial cells will most likely be revealed in the urine under the microscope, and Bright's disease thus fully demonstrated.
It is to be remembered, nevertheless, that there are certain modifications in the acute parenchymatous nephritis of pregnancy that are not common to its ordinary occurrence, such as the suddenness of its development, even in those previously seeming to be in perfect health. Edema may be absent, while the uremic symptoms are far more frequent than in nephritis generally; albumen is found in larger quantity than usual, and hyaline-casts are very scanty, as a rule.
The pathological conditions of this disease, when complicating pregnancy, are similar to those found in it generally.
The prognosis of the disease, when complicating pregnancy, is always more or less grave. If the attack be recent, it is far more hopeful than if it has existed for a length of time. Such attacks as have preceded pregnancy are exceedingly precarious. It always increases the liability to abortion when it complicates early pregnancy, and provokes the tendency to premature labor in its later stages. That it predisposes to eclampsia is generally conceded at the present day. Hence, though no serious results have arisen from its presence in so many instances, it can only be a source of concern to the patient and her friends during her period of gestation and at the time of parturition, and also as regards her ultimate recovery, although she passes through those conditions without serious accident. While, therefore, great caution should be exercised not to create undue anxiety on the part of the patient in regard to her condition, judicious watchfulness should be used by those having her case in charge.
The causes of albuminuria complicating pregnancy are nu
merous, and not always apparent. Indeed, in many instances, so rapidly does this condition pass away after parturition that they seem to be trifling and evanescent in their nature. In other cases, however, the disease invades the system so stealthily and progresses so persistently, and again it manifests itself so suddenly, and prostrates so profoundly, as to point to most energetic causes for the phenomena witnessed.
The pregnant condition necessitates an increased supply of albumen in the blood for the nutrition of the foetus. An altered state of that fluid is thereby produced. It is by no means improbable that this condition of the blood renders its albumen more liable to be poured out through the kidneys. Then the pressure of the gravid uterus constantly increasing on the renal vessels tends to produce a congestion of the venous circulation of the kidneys, and hence the flow of albumen into the urine. Again, the nervous system of the pregnant woman is supersensitive, and its influence on the circulation of the blood, through the vasomotor nerves, must favor an hyperemia of the kidneys. Now all of these conditions obviously render the pregnant woman susceptible to every exciting cause-such as sudden cold, obstructed action of the skin, and attacks of such acute diseases as are liable to induce acute parenchymatous nephritis.
If albuminuria exists previous to the time of conception, the conditions producing ordinary Bright's disease will then be regarded as its cause. Some authorities argue that eclampsia is a cause rather than a consequence of the albuminuria of pregnancy.
It may be well to briefly review the clinical history of this disease, and the following cases are typical of some of the forms which it assumes:
CASE I. Mrs. P. was pregnant for the second time, and maintained her usual good health till near the close of the seventh month, when she found her strength flagging a little, and noticed some puffness of the eyelids and face. At the latter part of the eighth month anasarca was marked, and my attention was called to her condition. I found her urine albuminous, but without any casts or blood-cells. During the