In confirmation of the above statement I will report the history of a very interesting case. Mrs. B, multipara, called "me in to attend her during the progress of labor. I did not have the care of her case during her pregnancy, and therefore could not give her the necessary preliminary treatment and attention. She gave birth to twins with nothing abnormal until convulsions came on. This patient subsequently became pregnant again, and, profiting by my former experience, I instituted a strict watch over her case. At first urinary examination was negative, but later on as pregnancy advanced albumin appeared in the urine. Edema of the feet and ankles came on. The condition grew worse until the cedema involved the entire lower extremities. From the seventh month until after labor came on she could not rest in the recumbent position. She was so fearfully swollen that she could only rest in a large arm chair with pillows about her. She was in a most pitiable condition and life was truly a burden to her. She was almost totally helpless. I do not believe that I have ever seen such oedema during pregnancy. She was almost entirely waterlogged and presented the picture of a most unfavorable prognosis. I was expecting to be called at any moment to find her writhing in convulsions. I had placed her under strict surveillance, having her on the necessary medicinal treatment and confined to a strict regimen. To my surprise, I was rewarded for my trouble and care by having her pass through her labor without a convulsive symptom. She had a comparatively easy time, but gave birth to one of the most horrible monsters that was ever con. ceived in the imagination of the Grecian mythologists, the mythical cyclops,-one eye in center of forehead, of the variety of cyclops-arrhynchus or cyclocephalus medium fissure of upper lip pre-auricula appendages, cerebral deformity and absence of olfactory proboscis. This monster lived a few hours before it ceased to breathe, After labor this patient rapidly returned to her normal condition. This case furnishes a most striking illustration of the good result, to mother at any rate, of the proper care and management during preg nancy. Had she not received such care she would most assuredly have died either before, during, or after labor.

I must now be pardoned for illustrating with one more case before closing this paper, proving that while it may be true that albuminuria does not always produce eclampsia, yet acute nephritis with albuminuria will sometimes cause the death of the fœtus in utero, and, by its subsequent maceration and decomposition, produce sapræmia. Mrs. P., primipara, progressed favorably until the fourth month when urinary examination revealed the presence of albumin. She advanced to the fifth month when pain and uterine contraction announced an impending abortive or premature labor. She was delivered of a macerated decomposed foetus, and afterwards exhibited all the usual symptoms and presented the clinical history of a welldefined case of puerperal sepsis of the saprophytic variety. Curettement followed by daily intra-uterine irrigation, with vigorous stimulative treatment brought her through the storm almost a total wreck. While this patient did not have eclampsia, as might have been expected from the great amount of toxæmia present, she presented the other most serious complications of pregnancy, death of foetus, premature birth and sepsis.

Experience is the master hand that serves us in guiding these unfortunate women safely through their puerperium. Preg. nancy in its normal physiological state does not furnish us with such experience. Many pass safely through their pregnancy without any trouble, and never consult the doctor until the pangs of labor force them to cry out for help. The savage, that untutored child of the forest worshiping only at the shrine of nature, make their beds upon some mossy bank beneath the star-decked canopy of heaven, where they can breathe in the ozone so graciously borne to them by the balmy zephyrs that gently sway the towering pines' magnetic needles, rarely ever suffer the experiences, or meet with the difficulties so often encountered by their less fortunate sisters, who recognize only the dictates of fashion and blindly worship at its shrine. Such is the penalty of civilization!

SOME PATHOLOGIC CONDITIONS OF THE PERIOD

OF GESTATION.

By T. H. Frazer, M. D., Mobile, Ala.

Professor of Physiology, Hygiene and Dermatology, Medical College of Alabama.

In the vast majority of cases gestation pursues a physiologic course, and is accompanied by few, if any, untoward symptoms. But in no other condition does the physiologic merge so easily into the pathologic state. The slightest irregularity often suffices to effect this change. And here let me say, by way of explanation, that while I shall not (with possibly one exception), discuss those pathologic conditions, due to diseases which existed before the period of gestation, yet I would have you bear in mind that the division line between health and disease often depends upon these disIn fact all organs should be interrogated at the beginning of this period, and accurate data thus obtained should be so tabulated in the mind of the physician, as to be of invaluable aid in the time of threatened danger.

eases.

We can naturally, therefore, speak of conditions that affect the pregnant state as:

1st. Those conditions that result from diseases, which existed before the inception of pregnancy.

2nd. Those conditions that result from the pregnant state itself, and are not due to extraneous causes.

I shall deal only with the latter division, and, in order not to consume too much of your time, I shall confine what I have to say to the consideration of only three complications of pregnancy, viz: (1) Pernicious vomiting; (2) Toxemia; (3) Abortion. The three conditions selected as a text could be named the essential diseases of the period of gestation, inasmuch as they might be said to exist only during this period. The intelligent practitioner feels secure when called to treat any one of these important conditions, if he knows exactly what to expect from the lungs, the heart and the kidneys. Though he may

*Read before the Medical Association of the State of Alabama, April, 1903.

not be able to avert impending disaster, yet he has the su preme satisfaction of knowing that he can employ rational rather than empirical treatment.

With these introductory remarks, I shall now invite your attention to the conditions in the order named. The last, from its importance, will receive most attention, and I trust that what is said will provoke such a discussion as to elicit the best and most accurate information from the experience of those present.

PERNICIOUS VOMITING OF PREGNANCY.

Hyperemesis gravidarum (pernicious vomiting of preg nancy), is excessive aud persistent vomiting, attended by marked diminution cf nutrition during the pregnant state.

Three degrees are usually described. The first degree or stage is observed when vomiting is persistent, but some food is appropriated; the second degree when no food is retained long enough for digestion to take place, and is attended by rapid inanition and fever; the third degree when cerebral symptoms, such as delirium, coma, etc., occur.

The pathology of this disorder is not constant. Some of the theories of its causation may be mentioned. Kaltenback claims that it is a neurosis or hysteria. Hedra holds to the toxic theory, while many others claim that it is due to the close anatomical relation, in the medulla oblongata, of the special center of vomiting and the center that presides over the generative organs. When by enlargement of the uterus, the generative center is irritated, that of emesis is also stimu. lated, causing the stomach to contract and to expell its contents.

Some observers claim that it is a purely reflex or referred phenomenon, which is thus explained: The uterus by its enlargement irritates the motor and sympathetic filaments which in turn affect the vagi and cause stomachic disturbance.

In most cases the exciting cause cannot be discovered. Some contend that hyperemesis gravidarum is invariably ac companied by some pathologic condition that may yet be discovered and demonstrated, if looked for, on post mortem.

Many morbid conditions of the tissues of the uterus or adnexa, as well as abnormal positions of the uterus, are said to be responsible for this serious condition of pregnancy.

The treatment is divided into local and constitutional, both of which are unsatisfactory. Among some of the more important and beneficial remedial measures may be mentioned gastric lavage with saline solution, giving the patient charcoal afterwards; faridization of the vagi before and after meals; blisters over the cervical vertebræ. Horizontal posture, purgatives and baths are beneficial. Saline transfusion or hypodermoclysis is highly vaunted by Bacon, who says that induction of abortion is never indicated; at the stage when safe and efficient it is not necessary, and in extreme cases it adds greatly to the dangers and rarely stops vomiting. I invite an expression of opinion on this point from the Association.

Copeman claims that dilitation of the cervix with steel dilators is very efficient. Packing the cervix with gauze will also benefit or relieve this I do not advise also painting the cervix with iodine or nitrate of silver.

Of the internal medicinal remedies, cocaine, orexin tannate, oxalate of cerium and chloretone are of the first importance. Cocaine gr. 1, and monobromated camphor gr. 3, in capsules are often effectual. (Dudley). Other less important remedies are too numerous to mention. Emptying the uterus is the "dernier" resort, and should be resorted to sooner than is usually done. When emaciation is marked and fever begins, then induction of abortion is urgently indicated, or becomes imperative. The frequency of death after the procedure is due to waiting too long; the patient's vitality being so low sepsis is favored, which sooner or later ends her existence.

TOXÆMIA OF PREGNANCY.

When poisonous substances, resulting from physiologic metabolism, are retained in the blood of a pregnant woman, thereby producing auto-intoxication, we have a condition known as "toxæmia of pregnancy." This toxæmia is so often accompanied by changes in the liver and kidneys as to almost induce one to believe that a true toxæmia cannot exist inde