If, however, the state of the os uteri forbids our interfering with art, we must be content to follow out that plan of antiphlogistic treatment which has been just laid down, bearing in mind, that in proportion as we reduce the power of the circulation we increase the disposition of the os uteri to dilate, and, as Baudelocque justly observes, “while we wait the favourable moment for operating, we should only employ those means which we could use after delivery, if the convulsions should continue.” (Op. cit. § 1110.)
By the time that the medicine has begun to operate, a considerable change will usually be observed in all the symptoms—the violence of the convulsions abates, the coma is less profound, and if the child be not yet born, the process of labour much more speedy and favourable; but if we find that the convulsions assume a tetanic character, and that the uterus actively participates in this state of spasmodic rigidity, we must not expect any very favourable change until delivery is effected; and there will be little chance for the child of its being born alive for reasons already mentioned. Under such circumstances, which are fortunately of rare occurrence, it will be our duty to perforate rather than run the risk of losing the mother as well as her child; but before proceeding to this extremity we must satisfy our minds that the state of the os uteri forbids the forceps, and that, from the tetanic action of the uterus, there is little chance of its farther dilatation.
“It does not always happen that the convulsions cease upon the termination of the labour; on the contrary, they often continue after the birth of the child, and sometimes increase in violence, and at length produce death. If, however, the intervals between the fits become longer, a more favourable prognosis may be formed, but it will be expedient to continue our exertions in relieving the symptoms.” (Merriman’s Synopsis.)
The after treatment will be little more than a continuation of that which has been described during the attack, only in a much milder form: the head must be kept cool by a proper lotion, and the bowels sufficiently open by gentle laxatives; a little gruel, with or without milk, may be given occasionally; and if the child be alive, it should by all means be applied early to the breast, in order to establish a flow of milk as soon as possible. Where the breasts have been very flaccid, and there were little or no signs of milk, we have now and then applied a sinapism over them with very good effect, for the mammary excitement thus produced has been attended with a copious lochial discharge, which has evidently produced much relief.
Apoplectic species. Dr. Dewees has described a species of convulsions by the term “apoplectic,” but it is perhaps questionable how far he is correct in calling them “puerperal convulsions;” for, from the cases which have come under our own notice, the disease has been nothing else than genuine apoplexy occurring in the pregnant, parturient, or puerperal state: he justly observes, that “it may be brought on by causes independent of pregnancy, though this process may with propriety be regarded as an exciting cause; for it sometimes takes place when this process is at its height, but is no otherwise accessary to this end, than increasing by its efforts the determination of blood to the head.” (Op. cit. § 1238.)
The treatment will in no respect differ from that of the genuine puerperal convulsions, except that, as the danger is still greater, so, if possible, must the treatment be more prompt; indeed, it can scarcely be said that there is a convulsion, for there is merely loss of motion with insensibility. It is fortunately of rare occurrence, as the patient seldom recovers.
Anæmic convulsions. The next form of epiplectic puerperal convulsions is the anæmic form, where, in consequence of serious loss of blood or debility otherwise induced, the due balance of the nervous system has been disturbed, and irregular and convulsive actions have been the result.
We have already shown that cerebral congestion is favourable to that state of irritability, which, by the help of any exciting cause, may easily pass into a state of epilepsy; an opposite condition, viz. that of exhaustion, is capable of acting in a similar way, and thus confirms Dr. Cullen’s assertion, “that there are certain powers of collapse, which, in effect, prove stimulants and produce epilepsy.”
“That there are such powers which may be termed indirect stimulants, I conclude from hence, that several of the causes of epilepsy are such as frequently produce syncope, which, we suppose, always to depend upon causes weakening the energy of the brain.” “The first to be mentioned, which I suppose to be of this kind, is hæmorrhage, whether spontaneous or artificial. That the same hæmorrhage which produces syncope, often at the same time produces epilepsy, is well known; and from many experiments and observations it appears, that hæmorrhages occurring to such a degree as to prove mortal, seldom do so without first producing epilepsy.” (Op. cit.) It is a well-known fact, that when once a state of exhaustion or collapse has been carried beyond a certain point, the irritability of the nervous system increases in proportion: the due balance of its various actions becomes more and more unsteady; their equilibrium is disturbed by the slightest impressions, and losing the state of well-adjusted repose which belongs to health, they continually vibrate between the extremes of excitement or collapse, which seldom fail to produce some serious derangement.
“The symptoms of reaction from loss of blood,” says Dr. Marshall Hall, “accurately resemble those of power in the system, and of morbidly increased action of the encephalon; and, from these causes, the case is very apt to be mistaken and mistreated by the farther abstraction of blood. The result of this treatment is, in itself, again apt farther to mislead us; for all the previous symptoms are promptly and completely relieved, and this relief, in its turn, again suggests the renewed use of the lancet. In this manner the last blood-letting may prove suddenly and unexpectedly fatal.”