200 'I'he Philippine Journal of Science 1917 



the average period of pregnancy was 5.7 months; the average 

 interval from the beginning of the attack until admission to the 

 hospital v^as only 10.5 hours, a substantiating fact that the foe- 

 tuses are killed early in the first stage of the disease. Tvs^o cases 

 in w^hich dilatation and extraction were performed died, one of 

 pneumonia twenty-seven days later and the other of uraemia nine 

 days later. The latter patient had passed a normal amount of 

 urine for four days and was on full diet for two days, when she 

 developed such a severe case of ursemia that all our efforts failed 

 to save her. All the other cases made uneventful recoveries. 



In the cases in which dilatation and extraction were performed, 

 the whole operation did not take more than fifteen minutes for 

 any one case. No anaesthesia was necessary, as the patients were 

 in the partially comatose state seen so frequently in cholera. 

 Also, as the tissues were very lax, the cervix uteri was very 

 easily dilated, and the shock to the mother was practically nil. 

 The foetuses with one exception were dead when removed and 

 showed no signs of maceration. The amniotic fluid was almost 

 normal in amount, and the after-delivery bleeding was always 

 very scant, except in the case of the birth of the live foetus, in 

 which it was slight. The procedure in the last-mentioned case 

 was resorted to because abortion was in progress, and if not 

 speedily terminated, the patient would have died. 



The mortality of these 11 cases was 18 per cent, which is about 

 the same obtained in the nonpregnant cases in this hospital (19 

 per cent) , thus giving the pregnant patient the same chance for 

 recovery as the nonpregnant. This procedure prevented the 

 mortality of 45 per cent, which was obtained in the pregnant 

 cases not treated in this manner. The average period of re- 

 covery was 8.7 days, which, although not as low as the average 

 7.3 days that was obtained in those cases that did not abort, is 

 lower than the average in those cases that did abort without 

 this procedure, which was 9.6 days. 



Nichols (12) prefers not to interfere with the pregnant con- 

 dition of cholera patients on the grounds that they are not 

 strong enough to withstand the shock. This is very true at 

 times if the interference is not resorted to until the patient is 

 in an extremely serious condition, as I have seen on three oc- 

 casions. Basil (1) states that he cannot follow the advice of 

 some of the continental authorities who advocate emptying the 

 uterus in all cases. This seems to be unwise, as there is a class 

 of patients who will recover without this procedure. During 



