It is usually considered important to persist in giving small amounts of practically any article of food that the patient fancies, in order to encourage her in the belief that she can take nourishment and also to accustom her stomach to receive and retain food. Olives and nuts are particularly valuable for this purpose and are often kept on the patient’s bedside table where she can reach them and nibble on them at will. Ice cold fruits and fruit juices are useful, while strained apple sauce, ice cold, is very valuable as a starting point from which a more generous diet may be gradually developed. All foods should be very cold except broths, which should be very hot. The dietary is gradually increased to six small meals daily from which fats and proteids are omitted.
In more severe cases, or if the patient does not improve, an injection of 300 cubic centimetres of fresh 5 per cent. solution of glucose is given under each breast daily, and sometimes a mild sweat-bath, given with blankets and lasting twenty minutes. (See page [197] for sweat-bath.)
In very severe cases when the patient is unable to retain anything taken by mouth; loses weight and strength; when possibly the urine decreases in amount and contains acetone bodies and ammonia, the situation is serious and the treatment is more drastic. All effort to give fluid by mouth is abandoned and in addition to the sub-mammary injection of glucose solution, a colonic irrigation of one and a half to two gallons of sodium bicarbonate solution (from 2% to 5%) at 110° F., is given once daily by the drip method. The daily hot pack is continued; a mustard leaf is applied to the abdomen if necessary to relieve the pain and nausea; glucose solution may be given intravenously and also a nutritive enema, three times daily, consisting of a raw egg, four ounces of peptonized milk and one-half ounce of whiskey.
The method employed at the Toronto General Hospital in treating patients suffering from toxemic vomiting is outlined as follows by Dr. J. G. Gallie: “The patient is given as much as she is able to drink. A nutrient enema is given three or four times daily, consisting of six ounces of a 10 per cent. solution of glucose in saline. Bromide and chloral may have to be added to the last nutrient in the evening. A simple enema is given each morning. Nutrients are discontinued when the urine becomes free of acetone bodies. In more severe cases, where fluid cannot be taken by mouth, it may be supplied interstitially or intravenously, a 5 per cent. solution of glucose being used. When vomiting ceases, and solid food can be taken, the feeding is begun very carefully with small quantities of carbohydrates. Lactose is added where possible to any fluid taken. Frequent small meals are then instituted—six between 7 a.m. and 10.30 p.m., thus reducing to the smallest space of time the period of starvation during the twenty-four hours. Protein may be added to the diet when nausea is under control, but fat should be left out for some time.”
Such a course of treatment, quite evidently, is designed to relieve a toxic condition, in which increased elimination is important, and to quiet an irritable nervous system.
As the patient with toxemic vomiting is often very uncomfortable because of a bad taste and dryness of her mouth, some kind of a mouth wash which she finds refreshing should be used frequently. And since a degree of toxicity which is capable of producing such a condition as is described above will almost inevitably produce nervous symptoms, as well, the nurse’s attitude toward her patient must always be one of sympathy, encouragement and optimism.
When the patient’s condition is so desperate that pregnancy is terminated, with the hope of saving her life, ether or nitrous oxide gas, or both, is used as an anesthetic rather than chloroform, which of itself tends to produce a liver necrosis.
Pre-eclamptic Toxemia is the most common of all the toxemias of pregnancy, occurring several times in every hundred pregnancies. It develops more frequently among women who are pregnant for the first time than among those who have borne children, and one attack usually confers an immunity against a recurrence.
As pre-eclamptic toxemia usually responds to treatment, but if neglected, frequently ends in the much more serious disease of eclampsia, the imperative need of supervision and care during pregnancy are once more borne in upon us.
Symptoms. Pre-eclamptic toxemia seldom appears before the second half of pregnancy, usually not until after the sixth or seventh month, and the symptoms vary widely in severity. They may range from headache and nausea, so slight as to cause the patient little or no inconvenience, to coma and death.