It is a disease depending on the uterus, and brought on by the labour pains; or, if arising before them, is of itself capable of expelling the child, if the woman sur vive long enough. It occurs in all pre sentations; sometimes with the first child, and sometimes with those born after wards. It resembles hysteria, as well as epilepsy; but is more violent than either. No force can restrain a woman when in these convulsions, be the same woman naturally ever so weak. The distortion of tie countenance again is beyond any thing that can be conceived: in regard to deformity, surpassing any thing the ima gination of the most extravagant painter ever furnished ; nothing bears any re semblance to the progress of this disease ; the rapidity with which the eyes open and shut, the sudden twirlings of the mouth, are altogether frightful, dreadful, and inconceivable.
These convulsions are by no means ex ternal only ; respiration is first affected with a hissing, and catching. The patient stretches herself out, and immediately the convulsion begins. The next symp tom which arises comes on after the con vulsive motions have continued in their utmost violence for a time ; the woman foams at the mouth, and snores like an apoplectic patient, indicating great ful ness about the brain. These symptoms are succeeded by a comatose sleep, out of which she awakes astonished, on being told what has happened, not in the least aware that she has been in a 'fit : and then she will fall into another fit, out of which she will again recover as before. It rarely happens that the understanding is taken away in this disease until it has been repeated several times. In the fit the skin becomes dark and purple, prov ing that the circulation through the lungs is not free, which purple colour leaves the woman gradually after the fit is, gone ; and it is not only the external parts of the muscles of respiration that are affected here, but the uterus also. This is known by introducing the hand; when the con vulsions come on, the uterus will con tract, but with a tremulous undetermined sort of force, perfectly different from what it does at any other time.
There are two cases of puerperal con vulsions which are very distinct : one is a convulsion dependant on some organic affection of the brain ; the other on an irri table state of the nervous system. Where puerperal convulsion arises from the former, but more especially from fulness of vessels, or extravasation, it is always preceded by some symptoms, which, if watched, will enable us to relieve, if the patient send in time, which however is rarely done.
In a patient strongly disposed to this complaint, there will be a sense of great fulness in the region of the brain, which amounts even to pressure, giddiness in the latter periods of pregnancy, dizziness in the head, and a sensation of weight when the head stoops forward, which gives her the idea that she shall not be able to raise it again ; imperfect vision ; bodies dancing before the eyes, some times dark, at others luminous. This
state of the eye denotes fulness of the vessels of the head more surely than any other symptom, and if allowed to conti nue, will lead to extravasation and puer peral convulsion. The disturbed vision is a very strong symptom, and must never be passed over. If attended to early, even though symptoms of the complaint be present, still it may, by timely assidui ty on our part, be prevented from ending in premature labour.
Here repeated bleeding and purgatives are all in all ; the sole object being to take off stimuli. After bleeding, and be fore any aperient is given by the mouth, we should give a solution of soft soap in warm water as an injection ; it is the quickest as well as the surest means ; then a purgative mixture, with manna and Epsom salts. By these means, that is, by bleeding, purging, and the absti nence of all solid food and wine, no more blood is made ; what the patient has is diminished, and she gets gradually bet ter.
When convulsion arises from a general irritable state of nerves, it is difficult to distinguish the disease before it becomes established. It is most frequent in large towns, and in those women who lead the most indolent life; hence it is found in the first circles of fashion, in preference to the others; and there is one grand cir cumstance which has great influence in its production, that is, a woman's being with child when she should not. Being obliged to live in a state of seclusion from society for some months, perhaps she re flects and broods over every thing which relates to her situation, and which gives her pain. She recollects she is not to enjoy the society of the babe she has borne, but on the contrary will be obliged perhaps to pa rl with it for ever. She is afraid of her situation being known, and that she shall be considered an outcast in society. In this way she will brood in so litude, till at last the mere irritation of la bour may be sufficient to excite puerpe ral convulsion. The difference between this kind of puerperal convulsions and the other, does not probably exist in any thing visible : it is not possible to tell the difference exactly; but just as it is com ing on, the woman will complain sudden ly of a violent pain in her head, or sto mach, which is expressed in the same way by all women : they all say they can not survive the pain it' it return. The mode of treatment will not essentially va ry from that already mentioned. Our plan, however, should be less active, and opiates may be allowed to succeed it.