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is that eclampsia is due to toxæmia.” The first attempts to combat the onset of eclampsia consisted in the use of drugs and other active therapeutic measures, and it was frequently said that if only calomel and salines were more freely administered during pregnancy this dreaded condition would be less likely to occur. A clearer conception of its origin has led us to see that a more rational and not less effectual proceeding is to eliminate the original source of the toxins. We have now reached a stage when it is said that supervision and care, puerperal eclampsia ought not to occur in obstetric practice.” To ensure this, further care is required than mere regulation of the diet : periodical use of the urinometer, purinometer, and other tests are demanded. The time has gone by when the obstetric physician engaged for a case felt he had fulfilled his whole duty if he registered the expected date of confinement, and then left the patient to herself till summoned by the nurse at some time, not too early, after the commencement of labour.
Clinical experience has shown that such toxæmia as leads to eclampsia is best avoided by a diet consisting largely of milk, and free from meat, tea, coffee, and other purincontaining substances. With milk, white bread, butter, and cheese as a basis, there is no difficulty in maintaining the nitrogenous equilibrium, while the addition of most fruits and vegetables affords plenty of scope for variety. treme cases milk may form the sole means of subsistence, and that without detriment, as demonstrated by Church and many others. The recent investigations, however, of Van Noorden on diet in nephritis indicate the possibility of rena) irritation by large quantities of milk; the amount should, therefore, not exceed one pint in the twenty-four hours ; small quantities of white bread and butter being used if further nourishment is required. The injurious effects of water in large quantity must also be remembered.
Not only may eclampsia be avoided by diet on these lines, but also many of the minor disorders and discomforts of pregnancy formerly regarded as inevitably associated with that state. The morbid conditions attributed by various
authorities in whole or in part to auto-intoxication include constipation, diarrhea, hyperemesis, anorexia, ptyalism, leucorrhea, albuminuria, nephritis, headache, neuritis, chorea, abortion, mental depression, insomnia, anæmia, and glycosuria. We should be optimistic indeed if we expected to banish all these disturbances by diet and other hygienic means, especially if conception has already occurred; yet experience has shown that their frequency may be greatly reduced.
It is always necessary to combat the popular idea that a much larger amount of food is required than in ordinary health. Certainly if an absolute minimum were previously taken, a slight increase would be necessary for the proper development of the fætus, but the daily addition of half an ounce would be ample provision for this purpose. So few, however, if any, take regularly such an absolute minimum, that no increase is called for. Indeed, in many cases the amount habitually taken can be diminished with benefit both to mother and child. It is not so much, however, in the total quantity of food taken as in the number of different occasions on which it is taken that women most frequently go wrong, and suffer in consequence; no food, not even milk, should be allowed at any time other than the regular meals. Indeed, every precaution should be adopted to ensure the healthy working of the digestive system. Errors in the manner of taking food, such as insufficient mastication, often vitiate the results of a carefully-arranged dietary. The so-called "
longings ” of pregnancy are now largely relics of the past. When they occur, careful investigation is required in case the condition is due to a deficient supply of some necessary constituent of a healthy dietary, such as salt or nitrogenous food; sometimes the craving, especially if it be for anything sour, indicates a natural instinct to control the vomiting incidental to the early months by an acid, and supplies a useful indication for medicinal treatment. In the majority of cases these longings are morbid, and may be explained either by an improper dietary or as due to
auto-suggestion prompted by popular tradition; they occur chiefly among the uneducated and in first pregnancies. Such morbid cravings should never be gratified, but call for judicious treatment.
Alcohol is generally harmful. It is true that it forms an important ingredient in Prochownik's dietary, while in rare cases of deficient nutrition and incapacity for assimilation a sound wine taken during a limited period does increase the digestive power; yet it is seldom called for, and must usually be forbidden. Its potentiality for evil in the form of hyperemesis and post partum hæmorrhage has often been recognised ; recently further possibilities of mischief have been foreshadowed by its detection in the tissues of the foetus. Nicloux has even proved that alcohol given to a pregnant woman one hour before delivery can be found in the blood of the umbilical cord.
Not only the course of pregnancy, but of labour itself, and also the puerperium, may be much modified by the diet adopted; it has long been known that habitual indulgence in alcohol exerts an unfavourable influence. More recently it has been noticed that when meat is excluded from the dietary, labour is in every way easier; the tissues, as well as the muscles, are healthier; consequently such complications as lacerations of the cervix and perineum are reduced to a minimum. Partly for this reason, and partly owing to the increased natural resistance, puerperal infection is less likely to occur. In aseptic midwifery there is more than one factor involved; the general health of the patient requires attention, as well as the hands of the attendants. It is wofully disappointing, when every precaution has been taken by the obstetrician himself, to find that, after all, a septic condition is developing owing to abnormal activity of the bacillus coli or some other parasite of the mother. Observations such as these are confirmed by investigators in other provinces ; thus the experiments are well known in which it was found that dogs fed on septic offal suffered from autosepsis when their bones and periostea were injured, while those fed on healthy food escaped sepsis, similar precautions being taken in both
cases to prevent sepsis ab extero. Again, Surgeon-Major Seaman has recorded a series of comparative observations in the Spanish-American and Russo-Japanese wars. While describing the American army as “in a state bordering on collapse at the end of the war,” he states that the Japanese, fed on a practically fruitarian dietary, are “in superb physical condition” when brought back to the base hospital after severe wounds. His investigations led him to the conclusion that the great difference was due to the diet. Several surgeons have recorded marked improvement in the results of surgical operations when the patient had previously been placed on a fruitarian diet.
Some of the systems of diet that have been described involve much denial. The purin-free diet, however, is one . that appeals to a large number of women, and as it is seldom necessary to cut off all purin-containing foods, a satisfactory modus operandi can generally be arrived at; for instance, small quantities of China tea can often be permitted. Yet, even if the most stringent precautions must be observed, little difficulty is experienced : women are notoriously selfsacrificing, and during pregnancy will submit to considerable hardship if they are assured it is for the good of their offspring. We must spare no pains to guide them towards this. end.
RECURRENT FEVER, ASSOCIATED WITH
LYMPHADENOMA. A Contribution to the Study of Fever in Lymphadenoma,
with special reference to Seventeen Reported Cases of Terminal Recurrent Fever in Lymphadenoma and Sarcomatous Disease. By H. BATTY SHAW, M.D. (Edin
burgh Medical Journal, December, 1901). Notes on the Fever of Hodgkin's Disease ; Recurrent (Rück
fall) Fever; Ebstein's Disease. By J. H. MUSSER, M.D. (Transactions of the Association of American Physicians,
1901). A Case of Lymphadenoma associated with Recurrent Fever.
By HENRY T. BEWLEY, M.D., and ALFRED J. SCOTT, F.R.C.S.I. (Transactions of the Royal Academy of Medicine in Ireland, Vol. XXI., 1903).
DR. BATTY SHAW and DR. MUSSER both give a summary of the literature of this condition, the chief feature of which is the association of successive periods of fever, separated by apyrexial intervals, with enlargement of the spleen and lymph glands. In the cases quoted these recurrent attacks of fever have been terminal events in the course of Hodgkin's disease, lymphadenoma, or sarcoma. But they have also been noted in carcinoma, and rarely in cases of tuberculosis. The case published by Ebstein, which, though not the first recorded, was the first to call prominent attention to the condition, may be briefly summarised from Dr. Musser's account :-The patient, a man, aged nineteen, first complained in June, 1886, of malaise, headache, loss of appetite, and intermittent pain in the right side of the abdomen. In September of the same year the temperature records began.