Volume 3

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    nor after having begun the use of the anajsthctic is it to be continued if the pulse becomes small and weak. jMorphia is a remedy which has been regarded with very great ftivor bv some. In this country Dr. Clarke^ of Oswego has especially advo- cated it. He directs giving to the eclamptic patient at once a hypo- dermic of one grain and a half; the dose is repeated after two hours if another paroxysm occurs, and if the patient be in labor another dose is given at the end of eight hours. Most practitioners do not employ such heroic doses. Zweifel regards the morphia treatment as especially adapted to cases where the attacks occur at long intervals. It or chloral would be used in preference to chloroform in eclamp- tic attacks occurring after labor. Professional attention to veratruin viride in the treatment of eclampsia was first directed by Fearn of Brooklyn in 1871, and since then testimony to its value has been given by many American practitioners, more especially in the South and West. One of the most recent contributions to the subject is by Jewett,^ and the. following are his directions as to dose, mode of administration, etc.; he uses the fluid extract of veratruin viride as prepared by Squibb, and he rejects administration by the mouth: “ The average dose should be from ten to twenty minims. The smaller dose repeated in half an hour will doubtless suffice in the majority of cases. A^et I have usually preferred to place the patient at once fully under the influence of the drug. The guide to the dosage is the frequency of the pulse. Experience seems to justify the statement that no convulsion will occur while the patient is sufficiently under veratrum to hold the cardiac pulsations below sixty to the minute. The average time required to develop the full effect of a single sub- cutaneous injection is thirty minutes. If the desired result is not attained after that interval, the injection should be repeated in the .same or smaller amount as may be required. Five-minim doses at longer intervals will suffice to maintain the diminished pulse-rate. I have rarely rejieated the drug, however, after the circulation has been once brought profoundly under its effects, the total dosage seldom exceeding twenty to thirty minims of the fluid extract.” The value of pilocarpine has been attested by numerous practitioners. The remedy is administered by hypodermic injection ; some have em- ployed one-third or one-half a grain at a time, while others one-sixth at intervals of two hours. Zweifel does not seem to attach much value to it, and, as others have done, warns against its use in threat- ened pulmonary oedema. Hot baths have been especially commended by Breus, and the results in his hands were very satisfactory. Inha- lation of oxygen has been employed, but not with striking success: • American Journal of Ohxlelri.es, 1880. * 2'ransaclions of the American Gynecological Society, vol. xii.