PUERPERAL CONVULSIONS: The treatment of eelampsia or puerperal convulsions should whenever possible be begun in the pre-eclamptic stage, and should be directed to the prevention of this very dangerous complication of midwifery. It is seldom that the fits come on without warning in a patient who has been previously in good health, and the practitioner who is on the lookout and warns his pregnant patients to be on the lookout for the symptoms of toxxmia of pregnancy—headache, disturbance of vision and cedema especially if he makes a point of periodically examining their urine, will have no reason to consider his precautions a waste of energy if he is able to avert by suitable treatment an attack of this justly dreaded affection —threatening to the life of mother and child alike. The treatment of this pre-eclamptic condition is dealt with under Pregnancy, Disorders of of Pregnancy. It may be summed up here as strict confinement to bed, milk diet and saline purges. When the toxemic symptoms are very prominent, or when the treatment indicated fails to relieve them, I have seen excellent results after complete starvation for a few days, the patient being kept in bed, her bowels induced to act freely, and copious draughts of water given. After a few days of this regimen the urine often clears up and milk diet may be again begun.
Before actual convulsions have set in it is not uncommon to see pro dromal symptoms, which are a warning of imminent danger. The most common of these are—violent,headache, sudden loss of sight, pain in the epigastrium, often s.., severe as to lead to suspicion of a ruptured viscus or some similar abdominal catastrophe. When such symptoms are noted in a pregnant woman, a sample of the urine should be obtained at once, and if albumin be found present, as is usually the case, energetic measures should be taken without delay. These measures should have for their object the rapid elimination of the toxins which are causing the symptoms and are soon to cause even more serious ones. The patient should be put to bed, and warmth to the skin by blankets and hot-water bottles applied. It is probably a mistake to induce profuse sweating, as elimina tion of the toxins is not effected through the skin, and excessive loss of fluid in this way will only tend to increase their concentration in the blood.
At the same time there is a pretty general consent that external cold tends to increase the incidence of eclampsia, and it would therefore seem rational to apply external warmth with a view of preventing it. If the symptoms are severe it is wise to wash out the stomach either with the tube and plenty of warm water, or if that is not available by giving an emetic such as mustard and water in quantity, or by giving large draughts of water and tickling the fauces. When the stomach has been washed out, a purgative should be administered, and it does not matter much what purgative so long as it is sure to be effectual. Croton Oil (2 mins. rubbed up in a pat of butter) has a considerable vogue, but if that is not at hand an ounce of Castor Oil, with a few drops of brandy to disguise the flavour, or z ounce of Epsom Salt dissolved in lemonade may be given. If the stomach-tube has been used, the purgative may be poured down before it is withdrawn and allowed to remain in the stomach. Having thus attended to the upper end of the intestinal tract, the lower end of it is next attacked, and repeated enemata of water, in which a drachm to the pint of Sod. Bicarb. has been dissolved, are administered. The usual result is to bring away a con siderable quantity of scyhala, and the lavage should he continued until a free action of the bowel is obtained. If the symptoms are acute it is advisable to leave dr. of Chloral in solution in the rectum. tucking up the patient after these energetic procedures, a linseed poultice may be applied over her loins for the purpose of encouraging tl.e kidneys to act. Food, including milk, should be interdicted, but she may be encouraged to drink freely of plain water, or home-made lemonade with a teaspoonful of cream of tartar to the pint. If the symptoms subside under this treatment, and the urine increases in quantity with diminution in the amount of albumin, the patient may be put on milk diet and treated as for Toxiemia of Pregnancy (q.v.). If labour comes on, it usually terminates rapidly, but if the second stage is slow the forceps may be applied as soon as the os is dilated. If the symptoms grow worse in spite of treatment, the onset of convulsions may be regarded as inevit able, and treatment as for convulsions may be commenced without delay.