The principles of management for the attack are (1) to empty the uterus, on the theory that the disease is a toxæmia of gestational origin, (2) to eliminate the poison, and (3) to control the convulsions. The albumin in the urine and other eclamptic symptoms demand urgent attention in prophylaxis. For the pre-eclamptic period (see Albuminuria of Pregnancy, p. 77) a rigid milk diet is indicated. The bowels, kidneys, skin and blood vessels must all be brought into service. In the full blooded patient, venesection may be done and after drawing off ten or twelve ounces of blood, an equal amount of normal saline may be poured into the same vein. [Illustration: Fig. 106.—Flexed dorsal position with feet on the table. (American Text Book.)] Subcutaneous transfusion or the submammary introduction of saline solution may be done. The skin is stimulated by hot wet packs and the bowels by saline cathartics and frequent irrigation of the colon. During the attack, the patient must be kept from injuring herself. A spoon wrapped in gauze or a small, long roller bandage should be slipped between the teeth to keep the tongue from injury. The clothing must be loosened or removed. No food, but only water is given by mouth, until the patient is conscious. The convulsions are controlled by morphine, chloral, or both. Morphine sulphate, ¼ gr. is given hypodermically, followed in an hour by 30 gr. of chloral by mouth. Two hours later the morphine is repeated and six hours after the first dose of chloral, it is repeated. In this method (Stroganoff’s), four doses of chloral and six of morphine are given in twenty-four hours. That is all. When the stomach will not retain the chloral it may be given by rectum in milk. If a general anæsthetic is used, it should not be chloroform, but ether. [Illustration: Fig. 107.—The Sims position. (Kelly.)] The labor, if begun, should be expedited by forceps, or version and extraction. Bleeding during delivery should be looked upon as desirable. If more rapid measures of delivery seem demanded and obstacles exist, such as pelvic contraction, imperfect dilatation, or the prospect of a prolonged first stage, Cæsarean section or forcible delivery (accouchment forcé) may be attempted. If the labor has not begun, when the convulsion occurs and a quick delivery by the normal passage does not seem feasible, then the Cæsarean operation may be the best treatment. CHAPTER XVI THE ABNORMAL PUERPERIUM The practice of obstetrics has many features that are very gratifying to the nurse and physician.