Toxemia of pregnancy with vomiting : its toxic manifestations, its relation to eclamptic toxemia, acute yellow atrophy and experimental necrosis of the liver / by Ellice McDonald.

  • McDonald, Ellice, 1876-1955.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Toxemia of pregnancy with vomiting : its toxic manifestations, its relation to eclamptic toxemia, acute yellow atrophy and experimental necrosis of the liver / by Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    stained. Face was drawn, tense and anxious, with prominent eyes and photophobia ; the patient was restless and querulous. The odor of acetone from the breath was distinctly evident on entering the room. There was slight jaundice. There was a marked limitation of field of vision. Patient complained of pain in the epigastrium and in the region of the lower part of the esophagus. Tempera- ture was 990 and pulse 140, thready and of extremely high tension. Heart was slightly enlarged and showed a mitral stenosis; lungs were negative. Abdomen was flaccid and no pain nor tender- ness was appreciable on palpation; no enlargement of the liver could be made out and no tenderness on pressure could be elicited. Vaginal examination revealed a soft, congested vagina and soft cervix, which was firmly closed. Uterus was soft, about the size of a two-months pregnancy, markedly retroverted, but mobile and capable of replacement. Appendages were free and negative and no vaginal discharge was present. Urine was scant, of high specific gravity and showed a large amount of albumin, one-fifth by bulk, with granular and hyaline casts in very large numbers. Leucin and tyrosin were also present microscopically. The treatment begun at this time consisted of large rectal salines as often as they could be retained, predigested food by the bowel in the form of peptonized milk, predigested beef, etc. Chloretone, grs. v, was given every four hours to control irritability of the stomach and restlessness of the patient. Patient improved slowly during the first week and, at the end of that time, vomiting was only occasional. Easily digested food, as light cereals, broth, etc., were well taken. Celestin Vichy was retained often to the amount of two liters daily. As the irritability of the stomach improved small doses of extract of ergot and strychnia were given with the aim of aiding involution of the uterus. This involution, however, did not progress. The urine increased in amount and albumen lessened, although granular casts were still present. The jaundice still per- sisted. There was no vaginal discharge; pain was less and still referred to the epigastrium. Temperature was 98°-99° and pulse was 108-120. This condition continued until five weeks after the first curet- tage. Vomiting still continued in a mild form, although it was absent once for two days. Jaundice disappeared at the end of the third week. Nutrition improved. An annoying complication, an