It has been our privilege during the last thirty years at the New York Lying-In Hospital to study and in part to treat 879 cases of toxemia of pregnancy of the convulsive type, commonly known as eclampsia. These cases have consecutively occurred in a series of 152,248 confinements in the combined indoor and outdoor services. Included, there are 414 cases with convulsions beginning before labor; seventy-four cases in which the time of onset was not definitely noted but the majority of which evidently began ante partum; 118 cases in which convulsions began during labor; 234 cases in which convulsions began during the puerperium; twenty-three cases in which the patients died undelivered shortly after being admitted in a moribund condition, and sixteen in which the patients were discharged undelivered, pregnancy continuing.During this time our conception of the control and treatment of the disease has varied greatly. The pendulum of procedure has swung back and forth, and while we may be still far from a scientific treatment based on an accurate etiology, we at least have come to believe that the eclamptic patient is as much a medical as an obstetric problem, and with the accompanying corollary, that obstetric intervention should be for obstetric indications only, and not for the convulsions.We feel that we must remain content for the present with this principle of treatment, even though we also find statistically that the sooner the woman comes to delivery after the first convulsion the better are her chances for recovery. In a previous study of this point it was noted that out of seventy cases observed, thirty deaths occurred where delivery averaged 11.2 hours after the first convulsion ; while forty recoveries took place with an average delivery 7.3 hours after the first convulsion. In 106 cases, there was no further convulsion in sixty-nine after delivery. Could we but promptly relieve the woman of her pregnancy without the slightest addition of shock or trauma, it would be ideal ; but no matter how dexterous we may be, this is impossible.Along such lines, vaginal and abdominal cesarean section have been proposed and highly advocated by certain authorities. Our results in delivery of eclamp¬ tic patients by abdominal cesarean section have not been encouraging. In fifty-four patients so delivered, twelve mothers died, a mortality of 22 per cent; while in a series of forty-two delivered by vaginal cesarean section, eight died, a mortality of 19 per cent, practically the same as by all other methods. Where we seem to have gained in controlling the eclampsia by prompt cesarean delivery we have equally lost by introducing the additional operative mortality.Some fifteen or twenty years ago, according to the reports of a certain group of men in and about Cincinnati, all that it was necessary to do for eclamp¬ sia was to give full doses of veratrum viride. This treatment was entirely disappointing in our experiences with it. We have seen at times a large number of eclamptic patients subject to certain routine treatment f...
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