“The patient, after the fit, can for the most part be roused to attention or will frequently become coherent so soon as she recovers from the fatigue or exhaustion occasioned by her violent struggles; and though she may lie apparently stupid, she will nevertheless sometimes talk or indistinctly mutter. After the convulsion has passed over, she will often open her eyes and vacantly look about, and then, as if suddenly seized by a sense of shame, will sink lower in the bed, and attempt to hide her head in the clothes.” (Dewees’s Compend. Syst. of Midwifery, § 1240.)
When sufficiently recovered to be capable of swallowing, she should sip some cold water, or what is still better, take a dose of spiritus ammoniæ fœtidus in water; this soon produces copious eructations from the stomach, which are followed with much relief. Where there is a disposition to vomiting, and other evidences of a deranged stomach, it should be encouraged by some warm water, chamomile tea, &c. The bowels are almost always in an unhealthy state, which frequently produces much irritation, and in plethoric habits so much tendency to cerebral congestion as to endanger even an attack of the epileptic convulsions. One or two doses of a pretty brisk purgative should, therefore, be given, and if there be still heat or pain of head, a bleeding may be required.
Under ordinary circumstances hysterical convulsions are by no means dangerous, and beyond a little fatigue and exhaustion, the patient recovers from them almost immediately.
CHAPTER XII.
PLACENTAL PRESENTATION, OR PLACENTA PRÆVIA.
History.—Dr. Rigby’s division of hæmorrhages before labour into accidental and unavoidable.—Causes.—Symptoms.—Treatment.—Plug.—Turning.—Partial presentation of the placenta.—Treatment.
There are few dangers connected with the practice of midwifery which are more deservedly dreaded, and which are wont to come more unexpectedly, both to the patient as well as to the practitioner, than that species of hæmorrhage which occurs in cases where the placenta is implanted either centrally or partially over the os uteri. Well has a celebrated teacher observed, that “there is no error in nature to be compared with this, for the very action which she uses to bring the child into the world is that by which she destroys both it and its mother.” (Naegelé, MS. Lectures.) In other words, where there is this peculiar situation of the placenta it becomes gradually detached, either in proportion as the cervix expands during the latter months of pregnancy, or as the os uteri dilates with commencing labour, and is thus unavoidably attended with a profuse discharge of blood, which generally increases as the dilatation proceeds.
The peculiar feature of this species of hæmorrhage, necessarily accompanying the commencement of every labour where the placenta is implanted over the os uteri, was first fully described in this country in 1775, by the late Dr. Rigby, in his classical Essay on the Uterine Hæmorrhage which precedes the Delivery of the full-grown Fœtus, a work which has been justly looked upon, both in England and the Continent, as the great source to which we are indebted for our practical knowledge in the management of these dangerous cases.