XII, B, 4 



Lowell: Treatment of Cholera Patients 



199 



Williams (19) states that in nearly every instance the disease 

 causes uterine contractions, resulting from the toxins in the 

 blood. Expecting then a similar change in the pregnant uterus, 

 a high percentage of abortions is sure to occur, and as it has 

 been shown that they occur mostly in the second stage of the 

 disease, the foetus-killing factor must necessarily act very early 

 in the first stage before the patient becomes pulseless, and so if, 

 on admission, the foetus is dead and any assistance is to be 

 rendered to the mother, it must be given as early as possible, in 

 order to cause the absorption of a minimum amount of foetal 

 toxins and also to cause the exhaustion of the smallest possible 

 amount of energy in the delivery of the foetus. 



In the latter part of 1916 the cholera admissions increased, 

 and the pregnant cases were frequently examined to ascertain if 

 the foetus was dead or if abortion was in progress. If either of 

 these two conditions was present, then such assistance was 

 given as indicated by the severity of the cases (Table IV) . 



Table IV. — Eleven cases in ivhich dilatation of the cervix uteri or dilatation 

 and extraction were performed. 



Cholera 

 case No. 



6159 



6170 

 6189 

 6197 

 68S2 

 6345 



6S81 

 6395 

 6439 

 6418 



6443 



Agre. 



21 



23 



80 

 26 

 30 

 30 



18 

 20 

 24 

 21 



25 



Inter- 

 val be- 

 tween 

 attack 



and 

 admis- 

 sion. 



Hours. 

 4 



7 



36 



8 



8 



12 



18 



4 

 7 



5 

 12 



Pulse on 

 admission. 



Present .. 



...do ... 

 ..-do... 

 Absent . 

 Present. 

 Absent . 



Present- 

 Absent". 

 Present- 

 Absent - 



Present- 



Urination 

 on admis- 

 sion. 



Manner of treat- 

 ment. 



I 



Absent . 



-do. 

 -do. 

 .do. 

 -do. 

 -do. 



Present- 

 Absent - 

 .— do- 

 .-.do-.- 



.do. 



Dilatation and 



extraction. 



do -■-.-. 



do — . 



Dilatation 



do 



Dilatation and 



extraction. 



do 



do- -. 



Dilatation 



Dilatation and 



extraction. 

 Dilatation --. 



Month 



Recov- 



of preg- 



ered 



nancy 



in— 





Days. 



7 



7 



6 



7 



7 



10 



4 



6 



6 



9 



7 





• 8 



5 



7 





3 



10 



8 



9 



5 



12 



Died of 



Pneumonia 

 29 days af- 

 ter. 



Uraemia 12 

 days later. 



'Foetus was alive when born. 



The above 11 cases of pregnant cholera women, in which ten 

 of the foetuses were dead, were aided either by dilatation of the 

 cervix uteri alone or by dilatation and extraction of the foetus. 

 All were in a very serious condition. In 7 of these, dilatation 

 and extraction were performed. The average age was 24 years ; 



