These observations relate to convul sions antecedently to labour. We now proceed to the same disease during la bour.
It has sometimes happened that a wo man has died of the first convulsion ; but it happens much more frequently that a number come on in succession, arising either before or after delivery. The pa tient very rarely dies in the fit, though she (lie from convulsion ; she dies in the comatose state which succeeds to the fit ; and if we be suddenly called to a patient in this state, where we are unable to learn the circumstance of the case, and we evidently see there is a great fulness about the head, we should immediately open a vein, and draw blood largely, be ing regulated by the appearance of the body and what we are able to learn from those around. From twelve to twenty ounces may be the extent of the first bleeding; if the disease go on, and the os uteri do not admit of delivery from its not being in the least dilated, the convul sions not gone off, and the pulse in such a state as admits of it, we should bleed again, and again. Some practitioners have with the greatest advantage taken sixty (minces of blood in a day. A woman in this state will admit of divided bleed ings very largely. This takes off the pressure from the brain, made by the blood while in its vessels ; and also the chance of its being extravasated. This must be done immediately : then the head must be shaved, and a large blister ap plied over the whole cranium. The next means of relieving is getting the bowels into action as quickly as possible ; first by throwing up a soft soap solution in the form of injection, and then by giving a concentrated solution of some neutral salt with infusion of senna.
If it be a case of convulsions depend ing on irritation, we may certainly do something more by the use of opiates and here we must be limited in the quan tity of blood which may be taken away. The proportion must be small compared with that proper in plethora. Eight or ten ounces will be afull bleeding; and if it be necessary to take more, we may ap ply leeches to the temples, never ne.
glecting the bowels, which must be kept very open. It has been directed that the patient be put into a warm bath ; but experience contradicts its use ; the fits have been found to be more violent in it, and the patient is liable to bruise herself in it, and he otherwise much injured.
It is an extremely dangerous disease it is impossible for her brain to bear the violent pressure of her situation ; opium, in cases of irritation, is proper, and should be given to the greatest possible extent. With this we may join the affu
sion of cold water. This, when resolved on, must not be done by sprinkling% lit tle out of a basin upon the patient's face ; but we must have both a full and an emp ty pail, the patient's head being brought over the side of the bed ; and before the fit has come on, we may, as in other con vulsions, detect its approach, by attending to the intercostal muscles, the vibrations of which will warn us that no time is to be lost ; when we should immediately discharge the whole over the head at once. Whenever this complaint occurs at or near the time of labour, it is uni foWnly right to deliver ; to dilate the os uteri, and deliver immediately. We should deliver in all oases where it is practicable ; for this is the only cure for puerperal convulsions.
If convulsions occur some days after la bour, it should be treated as the same disease in other cases.
Rupture of the Uterus. This was former ly considered as a very rare occurrence, though it probably happened oftener than practitioners were aware of. We have many descriptions of sudden deaths in la bour, the symptoms of which exactly cor respond with those known to attend rup tured uterus. It may be divided into two kinds, spontaneous and accidental; the first happening most commonly in the cervix uteri, and the last in any part of the uterus.
Spontaneous rupture occurs suddenly and unexpectedly, and always without any warning, and for this reason, that It depends on the irregular action of the muscular fibres, and all muscular contrac tion is immediate. It most commonly happens, that when the head of the child is in the cervix uteri, the lowest segment of the uterus is received into the upper aperture of the pelvis, and the aperture of the pelvis without the uterus is oppo site to the bones of the head within the uterus ; the consequence is, that the ute rus is pressed firmly between the two forces from the pressure being applied in this situation, the longitudinal fibres can only contract from the pressed circle towards the fundus ; and upon this prin ciple it will not tear at the extremity, but will tear from the part so pressed upon ; the rent once made may run in any di rection.