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TREATMENT OF FEBRILE ABORTION 231PRINCIPLES FOR THE REATMEN OF FEBRILE ABORTION
THE author advocates an expectin altitude in the reaiment
of this aliment and emphasietes that permanent defervescen e speedit occurs with the ovum o the remainder of the ovum in the uterus mostly durin the firSt two dctys. Ver raret after the
The anser of haemorrhase o in to expectins rectiment i notconsiderable Among 276 cases there ere ni 2 instances of haemorrhase hic compelle an interruption of the waitins reat-ment. .e. 10 . and oni a single casei death rom haemorrhage. He furthe writeS: The mos important observation howeve with whicli the wattingtreaiment has provide us is that biistite ova o thei remainders may be Ven spontaneousi expelled. As resard this in the first place I an repor from the materia o m clinic that ut o 276 cases realed on a attins basis. 178 6q. V., were expelle spontaneously. The figures communicate resardin thisi lxauthors Vary considerably accordininto the patience of the doctor, and fluctuatebetwee 3 and 73 . The alter figure hows o hat extent thepowers of Nature may be trusted o deat illi miscarriase. The liopeos spontaneous expulsio ma be stili further considerabi increased hen the powers of Nature re strensthene by Strons ecbolics: quinine, bove ali has prove essective in m clinic, hein administere in 3 forms, per os intravenousi an intramuscularly, ach
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232 TREATMENT OF FEBRILE ABORTION
placentas in One-hal of the cases only here mali remnant of miscarrias were retaine di it fati completely. Finalty he formulates the folio ingrave principies: l. Anyone havin opportunit for bacteriological examinationis the vagina contenis hould effect it. I the stio a pure culture ora predominant quantit of Strepto occi, particulari haemolytical, clearinu hould notis undertaken or liould ni be carried ut hen the streptococci ave disappeared that is the bacteriolo- uical potnt of vie in the treaimentis severis miscarriase. 2. Thos who cannot or illiso make a bacteriological examination hould refrain fro clearance in the laveris stas an onlyeffect it Cor 5 day after defervescence oneraliould nodi ait for morethan ydays for deferveScence. 3. Spontaneous expulsion houldiemimed at in ali cases illi theassistance of quinine.
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INDUCTION OF LABOUR B QUIN INE 233 INDUCTION OF LABOUR BY QUIN INE AND PITUITRIN
P. Walson, in the chair, a communication was read by r. F.
I. Bromne on the inductionis labouri quinine an pituitrin Thespecther referred to the researches of Oliver, Schaber Dale, and Blair Bel in connexion illi the discover of quinin and of iis effect in
producin uterine contractions an to the investigations ostris.
Hause 5 Meyer Stein iover, an Cron, and of B. P. Mareonon iis employmen in the inductionis labour. In 1922 areontiad published the resulis obtaine in a series of 195 cases in 90 per
that is a litile ove 90 per cent. Al the fallures occurre in cases
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23 INDUCTION OF LABOURAE QUIN INE
where premature induction had been attempted. ith resar to thetim inhen to stari and complete labour, countinifrom therars doseo quinine, the time taken ill the onset os labour averase twentynine ours: the veras duration Diabour a Sixteen ours. In premature cases the veras time ahenuit the onset os labour,asthirty-nine hours the veras durationis labour hein nine hours. In spite of the numerous objections that had been ursed against theus o pituitrin the ni unpleasant incident the speake had experience were two cases of tetani contractio of the uterus, in both cases the spasm was effectivel controited by chloroform but in onecas the child was stiliborn while twenty-sico the patient had suffere hom purulent vagina discliarses, ni three howed a riseo temperatur in the puerperium, and in no caSe was this prolonsedint a second day. In Mur cases the child had been stiliborn in only
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QUIN INE IN XYTOCIC TREAT MENT 235 QUIN INE IN XYTOCIC TREATMENT
LA QUININE DANS LA MEDICATION OCYTOCIQUE
Obstetricia of the Paris Hospitals
reinfor in uterine contractions Some have sed it,ith conviction, thers illi the idea that the were sivinina harmiessmedicament So as to satisf the patient an her familY. In reality, quinine has an action But iis resulis are, bove allislse linked, with iis absorption It omelimes happens that a quinine tablet is vomite absolutet intactis long time aster avin beens allo ed. Furthermore, hen the quinine reaches the intestines, it absorptio varies accordin to the individual so much so that iis proportio in the blood is subjectrio variation. The concentratio ofquinin in the blood is hisher in mea and anaemi people, as Actonystio ed. Accordin to this author, hen the concentrationis quinine in the loo reaches t in l50.000, it reinforces uterine contrHctionS. Finalty just as,ith other xyloci medicamenis, the previΟus inteo the tonus musti taken into consideration. Clinia facta. - Ecboli actiori . The question hether quinin can produce abortio has been very much discussed Thi potnt is of particula importanc in malariat countries Among the authors ho have trealed the subject Burdel
l 874 musti mentioned Burde declares that he is convinced of the
non-ctbortive actionis quinine, a more by toppin the malarialiaver, this medicament contributes, fanythins, topreventins Abortion. Other doctors have see cases in hicli the administrationis quinine determine abortionis premature delivery either producins at thesam time Severe intoxicatio phenomena, o without nyra com- panyins phenomena Finalty Tarnier and other authors have reported Clear cases of abortio after infestioni moderate doses of quinine,
and the explain these facts by a kind of diosyncrasy.
I have sed quinine illi succes in the formi suppositories.
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236 QUIN INE IN XYTOCIC TREATMENT
It is true that sucii accelerations os labour may appen pontan- eousty in the present case howeve it Seems that quinin improved the contraction, o that it produce a Stronge contraction hichbrought o the complete flexion of the head folio ins hic therotatio an descent of the head were completed. These facts are not constant Schwaab ho ever specthyos a Constant action, and Cordes, who sed quinine to remove the Vula remainsafter abortion, says that he neve had to perform An more curetting. These are the optimisi os quinine.
The folio in are acie figures hich mahe it possibi clearly to
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Mrs A. figures in his cat ory, even though forceps ere applied becnus Asterquinine, Satisfactor contraction appeare form moment.
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238 QUININE IN OXYTOCIC TREATMENT
was successsul in resisterins by internat hysterography the contractiono Six omen ho ad alien quinine found that the actionis his medicament varie ver much It omelimes distincti reinforces, and Sometimescit has no action linteuer, a bet in to the methodo introduction. Contractum is exceptional aster the se of quinin is it occurs atall. Instances of contractur have been found oni exceptionali in women Tassius, ho Sed quinine, Speciali durin the periosos dilatation has not ad ne case of continuous contractur in 19qcases we must howeversoint ut two caSes observed by Beaupencireε. in whicli, after administrationis quinin Sulphate, the uterus remained
However inquinin is sed intravenousi or intramuscularly the result are Ome hat different accordinaeto Muschallikq. his author obtaine remarkable resulis: 93.5 of successcin 2 cases He re- commend the se of quinin in his format ali stases of delivery, hut especiali a the momentis expulsionis the after-birth He tried the bove mentione injectio in incases and dre the folio insconclusions no anser eitheroo mollier o child Tinnitus, visualdisturbance, sensationifieat, bitteruast in mouth, are phenomenctwhicli must notis taken into account. The inconvenience of the method resides more in the frequenc of spasmodi contractions Andili impossibilit to regulate them though the life of the child has neve been in anser in the cases studie by the author The bestresulis have been obtainestat the besinnins of the delivery Stachosch'.
rner, have been able by intravenous injection to increas the strensi of the contractions and even to star delivery O thecontrary, Hinselmann usin intravenous method in the case fabortionaad 2 expulsion and 12 fallures. This hows that, pari rom the cases here there is a Strongconcentration o quinin in the blood such ascis producedi intra-
venous injections it is exceptionant observe uterine contra ture.
I reatly seems that quinine acta directi on me muscular bre of the uterus without passin through the nervous system. Rurdinowskisettied his potnt to whicli Minoi, returned very recently ShO ingi particula that atropin does no modisy iis action. Besides this a factis a senera character Not long ago, Brodyshowed that the actionis quinine n the muscula fibre in generalca eastly be made evidenti the striated muscle an he a that it
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QUIN INE IN XYTOCI TREAT MENT 239
decreases the heiulit of the contractio an especiali diminishes theeffecti contractins excitations while maintaining the rhythm. The actio os relaborcement of the uteriri contractio is more constant in animal than in omen. Accordininto Actori, experiment- ally, quinin increases the contractions of the uterus hicli has been
removed, and this happens both as resard the longitudina and the circula fibreS. Accordin to 'Ramoto, quinin inhibit the non-gravi uterus, an stimulates the gravi uterus hecause the distentio of the fibres has rendere them sensitive to any kind of stimulant. There is disapreement acto me effectis quin in on the tonus of
the uterus Accordin to uresnowSkm experimenta researches, quinine produces a considerable increas of the tonus and his graphics Hre qui te characteristic But the actioni quinin is no sufficiently tetani tote danserous to the foetus However, is ver Stronidosesare sed uterine tetanus may be started. EXperimentin On nimais, Acton Mund that aratrons contraction determine a toni Spasm, butthis dos is very nea the one hichris toxic for the subjeci. Attentio must e rawn to the fac that the doses used in these VBriou eXperiment were conSiderable we Saw, in human practice, that the reinforcemen is far romaein constant, and that contrac
wil eve so further an say that it was my impression that quin-ine in ordinar doses hastens the delivery by orkin against thecontracture The las of m cases in hicli quinin was successsul ere hos of omen hos labour a no progressins, ho ad ea contractions bulpainful intervals Under the influence of quinine, the ain hecam more frequent, hile thewdisappeared durins the intervals This is ni an impression hic need clinica an experimenta verification, ut Iciliould not be astonished i these facts were graphicatly translated by an unlevellins .lowering of the tonus, riseo the contractio cone. Inversely, in the cases here labour drassedo in to ea contractions and laebi tonus I found that quinine Stoppe the contractions. Quinin is also inactive hemit is used too SΟΟn when contractilit is stili,eah Rubsamen λη. The actionis quinine has been discussed not a resard the uterus alone and Gubter a te to a that quinin sulphat whicli hasbeen considered in turmas excitin Asent, a sedative, ct tonic, and narcoticishouldnot deserve ali these contradictor epitheis . Turre tini/ recenti recalle that: Quintne has been considere in turn ASStimulant, then a a depressant of the heari . This actioni quinin and of iis isomer quinidine on the hearthas
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been studied very thoroughi durin the last months It is known that quinine diminishes fibrillations a weli a the excitabilit of the myo- cardium and the excitabilit of the accelerator sympatheti nerves. So that a Turrettini faid in the bove-mentioned article quinine hasiis place in ali the manifestations o cardiac hyper-excitabilio It is probable that in the doses sed by us in obstetric practice, quinine
acta in the fame manne o the uterus, thus deservinscit old descriptionis anti-Spasmodic. Another interestins fac is tole dra n rom cardia therapeutics: quinin acts oninis the cardia musci possesses a certain degre ofresistance. The Same seem tote the case illi the uterus and the
histor of rs de M ... hic me related above undoubtedi proves this Generalty quinin does no accelerate the labour os a uterus whic has good contractions eithe it has no actioni it delay the labour These are mali facta frequently observabieci the uoubie istisen to observe the circumstances of uterine contractioni g.