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last month of pregnancy the anasarca was so extensive that she was obliged to recline much of the time. The urine was scanty, but never showed blood nor hyaline casts. Occasionally she had slight attacks of dizziness, and if she made special efforts to move quickly there was some dyspnoea. Her labor came on at the full term and was normal in every way. The anasarca passed off in about six days; and on the twentieth day after delivery no albumen was to be found in the urine. Her recovery was complete in four weeks, and she has enjoyed good health until the present, a period of more than ten years.
CASE II. Mrs. G. P. was in her second pregnancy. During the second month she had some nausea which soon subsided. During the fifth month she was not usually well, and at its close I was consulted. There was puffiness of the eyelids and face and the urine was slightly albuminous. At the middle of the sixth month the albumen was about one-sixth, and several hyaline casts were found; the urine was scanty and the specific gravity, 1014. At the beginning of the seventh month there was œdema of the ankles and anasarca with dyspnoea. The albumen measured nearly one-half. At the middle of the seventh month labor came on and she was delivered of a child in six hours, that survived some ten hours. Very few hyaline-casts, and no blood-cells were found in her case up to the time of her delivery.
During the first week after labor the urine was scanty; there was troublesome dyspnoea and the pulse was quick and feeble; her strength then began to rally, and her convalescence was slow but steady. In two weeks the anasarca had passed off, and in four weeks there was neither dyspnoea nor oedema of the ankles. No traces of the hyaline-casts were observed after the end of the fourth week, and but one before then, and no albumen after the eighth week. Six months have elapsed since her confinement and she is now in comparatively good health.
CASE III. Mrs. H., primipara, aged nineteen years; short, stout-built, very healthy from childhood; was seven months advanced in pregnancy when I first saw her. She said she had felt well till within two days; but about a week before she
perceived herself "bloating all over." She was suffering from headache and dizziness, and said she felt "very sleepy." The urine was scanty and heavily loaded with albumen. It was not tested microscopically. In about twenty-four hours after this convulsions ensued, and soon coma supervened. She was delivered with forceps of a dead foetus; but in about forty hours after the convulsions appeared, death had ended the fearful scene.
CASE IV. Mrs. K., multipara, thirty-five years of age, had been pregnant eight and one-half months. She had been in feeble health for two years. I found her pale and feeble; considerable anasarca existed, and she was suffering extremely from dyspnoea; her urine was scanty and heavily loaded with albumen, with some hyaline-casts. Her history pointed to the existence of albuminuria at the time of conception, and she seemed to be on the verge of the grave. She was delivered some fifteen days prematurely, after a rapid and easy labor. The anasarca and oedema entirely subsided in about two months; very little albumen was to be found, and the hyalinecasts were absent. No effort was made to nurse the infant, and the breast gave but little trouble. In less than three months she attended somewhat to household affairs. She then removed from my neighborhood; but I have learned that her health was delicate for a time, when "Bright's disease came on," and after several months of suffering she died from its effects.
The indications for treatment will depend on the causes of the disease and the symptoms presenting at a given time. If debility and blood-impoverishment or perversion are prominent symptoms at any stage of the disease, and if it will be tolerated by the stomach, the following should be given: R.— Tinct. Ferri chloridi, zvi.; glycerini, zv.; salicini, zij.; Aquæ ad., ziv. M. ft. mist. Sig. A teaspoonful in a wine-glass of water an hour after meals.
The solution of sulphate of quinia in dose grs. ij.—grs. iij. may sometimes be substituted for the salicini.
If the skin be inactive the warm alkaline sponge-bath should be used: vapor and hot-air baths are also indicated in
these cases. The Turkish bath also has its important use in some of these cases. Jaborandi in small, continued doses, is often of immense importance in the condition under consideration, and seldom produces the prostration of the large but infrequent dose of that agent; sometimes, however, the larger doses will be required. When oedema of the lower extremities exists, or anasarca, great benefit has been found from the use of Martin's long, light, elastic bandage, by applying it from the foot to the body. It gives great support to the limb, while it excites a free exosmose of the the serum, and thereby invites thither the fluids from the superior portions of the body.
The following combination, which is original with Dr. H. I. Bowditch, of Boston, will be of great service in many cases of irritable heart and dyspnoea: R.-Digitalis, pulv., grs., X.; Colchici Rad., pulv., grs., xx.; sodæ bicarbonatis, grs., xl. M. Ft. pill No. xx. Sig. One three times a day.
The propriety of the inducing of premature labor in desperate cases where all other means have failed, if there is a reasonable certainty that the albuminuria did not exist previous to pregnancy, is worthy of consideration. When the risks are considered that are taken in abdominal surgery for the preservation of the life of woman, certainly it should not be sacrificed when threatened by the albuminuria of pregnancy, if it is probable that it can be saved, and only so saved by the induction of premature labor.
An important factor in the treatment of this disease is a proper attention to the diet of the patient, making it simple but nutritious to the fullest extent. Milk-some would say: skimmed milk-and the white of egg should be among the staple articles of food. So, too, the beef-juices and the games -if they are digested well-are to be fed with an unstinted hand. The malts, and particularly Maltine, serve an excellent purpose in the treatment of these cases. Fruits are not to be proscribed if desired and well tolerated by the stomach.
(D) OTOLOGY, OPHTHALMOLOGY AND
HENRY K. STRATFORD, M. D., Chairman; JOHN L. FURBER, M. D., Acting Secretary.
By HENRY K. STRATFORD, M. D.
The courtesy, if not the over-confidence, of President Howe, has led him to form this Section with its present staff of officers, We, as his chosen lieutenants and associates, have no other duty in the matter than to do our part to justify his action. He is too able a man, too prominent in our ranks, too worthy a practitioner and instructor, for us to regard the task which he sets except as a tribute to our fidelity, and something which it is a matter alike of honor and pride to execute.
It has not been the practice for the men who assume to be par excellence" the scientific physicians," to acknowledge any merit to those not of their number. If we discover or invent a new method or improvement in surgery, any better form of practice, any better remedy or mode of pharmaceutic preparation, it is the old-time practice of Old-School Medicine, not yet reformed, to ignore and deny. If, however, it cannot be crushed out by this sitting down upon it, those men have no scruples of conscience at pretending to have made the discovery or improvement themselves, and in some mean way cast opprobrium upon the individuals who had anticipated them. It has been so in Electro-Therapeutics, in Materia Medica, and in matters of practice. A man as scholarly, as worthy in many respects as Oliver Wendell Holmes, has not been able, when writing about Eclectics, to be candid, or to speak quite the truth. We do well to bear this in mind and quietly to bide our time.
The field assigned to this Section has been one the literature of which is less abundant than that of other departments. The principal information has been garnered by specialists,
and their observations have received little attention from the great body of practitioners. Yet the importance of these topics cannot be questioned. The great number of our population suffering from partial deafness, and so to a very great degree shut out from the society of their fellow-beings, require the aid of science and art to afford them whatever aid is in our power. The varied disorders that induce difficulty of hearing should be catalogued, their pathology and treatment explained, and the ways by which to obviate their effects made known. Living as we do in a country where coryza is common, which so often degenerate into laryngeal inflammation and permanently affect the tympanic cavity, and where nervous impairment is too common, and sundry other complaints well known in surgical practice, we can perceive that otic pathology and therapeutics ought to be diligently studied.
The United States and Germany have produced most of the recent literature of Otology. The field is far from being circumscribed. The surgical operations upon the tympanic membrane, Eustachian tube, etc., are no insignificant matter. The views of surgeons in regard to them do not always agree, but are often totally adverse to each other. Some never incise the membrane; some cut only for the removal of pus; others do it, also, to evacuate superfluous mucus from the tympanic cavity; others, more daring, open the tympanum for the remedying of the consequences of pestiferous catarrh, or of inflammations, such as adhesions of the membranes and tension of the tensor tympani, etc. These facts show us that we ought to understand the subject very thoroughly, and that we have enough to do if we would master it.
Morbid growths within the ear will be another important topic. The cancerous disorders, polypus, bony enlargements, ulcerations, and the like, are met with frequently enough to create great anxiety on the part of the medical attendant. The causes of such affections should be explained and proper treatment suggested.
The various causes of deafness ought to receive attention. A considerable percentage of children are born mutes, unable to learn to speak because of deafness. Articulate speech is the