PUERPERAL CONVULSIONS.
Epileptic convulsions with cerebral congestion.—Causes.—Symptoms.—Tetanic species.—Diagnosis of labour during convulsions.—Prophylactic treatment.—Treatment.—Bleeding.—Purgatives.—Apoplectic species.—Anæmic convulsions.—Symptoms.—Treatment.—Hysterical convulsions.—Symptoms.
Women are liable, both before, during, and after labour to attacks of convulsions, not only of variable intensity, but differing considerably in point of character. We shall consider them under three separate heads, viz. epileptic convulsions with cerebral congestion; epileptic convulsions from collapse or anæmia; and hysterical convulsions. Other species have been enumerated by authors, but they are either varieties of, or intimately connected with, those of the first species.
No author has more distinctly pointed out the fact that epilepsy may arise from diametrically opposite causes than Dr. Cullen; a circumstance which, in a practical point of view, is of the greatest importance. “The occasional causes,” says he, “may, I think, be properly referred to two general heads; the first, being those which seem to act by directly stimulating and exciting the energies of the brain, and the second, of those which seem to act by weakening the same.” “A certain fulness and tension of the vessels of the brain is necessary to the support of its ordinary and constant energy in the distribution of the nervous power” (Practice of Physic;) and hence it may be inferred that, on the one hand, an over-distention, and, on the other, a collapsed state of these vessels, will be liable to be attended with so much cerebral disturbance as to produce epilepsy.
Epileptic convulsions with cerebral congestion. Epileptic convulsions connected with pregnancy or parturition, and which are preceded and attended with cerebral congestion, alone deserve, strictly speaking, the name of Eclampsia parturientium (which, in fact, signifies nothing more than the epilepsy of parturient females,) being peculiar to this condition; whereas, the anæmic and hysterical convulsions may occur at any other time quite independent of the pregnant or parturient state.
The term “puerperal convulsions” is employed in a much more vague and extended sense, and applies generally to every sort of convulsive affection which may occur at this period, and as such, it therefore, forms the title of the present chapter.
Causes. The exciting cause of eclampsia parturientium is the irritation arising from the presence of the child in the uterus or passages, or from a state of irritation thus produced, continuing to exist after labour. The predisposing causes are, general plethora, the pressure of the gravid uterus upon the abdominal aorta, the contractions of that organ during labour, by which a large quantity of the blood circulating in its spongy parietes is driven into the rest of the system, constipation, deranged bowels, retention of urine, previous injuries of the head or cerebral disease, and much mental excitement, early youth: also “in persons of hereditary predisposition, spare habit, irritable temperament, high mental refinement, and in whom the excitability of the nervous, and subsequently the sanguiferous system is called forth by causes apparently trivial.” (Facts and cases in Obstetric Medicine, by I. T. Ingleby, p. 5.)
Symptoms. From the above-mentioned list of causes it will be evident, that these convulsions will be invariably attended and preceded by symptoms of strong determination of blood to the head. Previous to the attack the patient has “drowsiness, a sense of weight in the head, especially in stooping; beating and pain in the head; redness of the conjunctiva; numbness of the hands; flushing of the face, and twitching of its muscles; irregular and slow pulse; ringing in the ears, heat in the scalp, transient but frequent attacks of vertigo, with muscæ volitantes, or temporary blindness; derangement of the auditory nerve; embarrassment of mind and speech; an unsteady gait; constipation and œdematous swellings.” (Ingleby, op. cit. p. 12.)
As the attack approaches, the patient frequently complains of a peculiar dragging pain and sense of oppression about the præcordia, which comes on and again abates at short intervals, and is attended with much restlessness and anxiety: this is followed by intense pain, which usually attacks the back of the head, and upon the accession of which the præcordial affection apparently ceases; the pulse now becomes smaller and more contracted. If the convulsions do not make their appearance by this time, and the headach continues one or more hours, a slight degree of coma supervenes, the patient loses her consciousness more and more, and wanders now and then; after a time she becomes restless and evidently uneasy, the eye becomes fixed and staring, the countenance changes, and the outbreak of convulsive movements follows.
Sometimes the premonitory symptoms are much less marked; indeed, in some cases, there is scarcely a sign to warn us of the impending danger; in the midst of a conversation the patient becomes suddenly silent, and, on looking to see the cause, we find the expression altered, the muscles of the face are twitching, the features beginning to be distorted, and the next moment she falls down in general convulsions.