This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
Convulsions may occur either during pregnancy or labour, and are of different kinds, requiring opposite treatment. One species is the consequence of great exhaustion, from a tedious labour, excessive fatigue, or profuse hemorrhage. This makes its attack without much warning, and generally alternates with fainting, or great feeling of depression of strength and debility, the muscles about the face and chest are chiefly affected, and the pulse is small, frequent and compressible, the face pale, the eyes sunk, the extremities cold. The fits succeed each other pretty quickly, and very soon terminate in a fatal fainting fit. Apparently it was this species of convulsion that destroyed Her Royal Highness the Princess Charlotte of Wales.
In all cases of this nature it should be our object to check the further operation of the exciting cause, by restraining hemorrhage, if present, or preventing any kind of exertion, and thus husband the strength which remains, or recruit it by cordials. Opiates will be of infinite service in conjunction with Ether and Camphor. Delivery is usually necessary.
Hysterical convulsions are more common during pregnancy than during labour. The species of puerperal convulsions most generally met with bears some likeness to Epileptic fits; and it is only by being aware of the different degrees of violence attending each, that at first sight we can distinguish them. A fit of puerperal convulsion is much more severe than one of Epilepsy, and a paroxysm of the former is usually so violent, that a woman who when in health was by no means strong, has been so convulsed as to shake the whole room, and to resist the coercive powers of many attendants. No force, indeed, can restrain a woman when in these convulsions. The distortion of her countenance is beyond conception.
Puerperal convulsions seldom happen before the sixth month, but may occur at any time between this period and the completion of labour. They may arise as the first symptom of labour, or after the labour is finished. This species of convulsion depends on the state of the womb, and has been observed to arise oftener during the first pregnancy than in any after one, particularly where the woman is unmarried.
The characteristics of puerperal convulsion are as follows: The paroxysms occur periodically like labour pains, so that there is a considerable space between them at first, but afterwards they become more frequent. They not only occur with the Labour pains, but in the intervals between; and whether there have been labour pains or not before they came on, we usually find the mouth of the womb somewhat dilated, and it is sure to become still more so from the •continuance of these convulsions. At length, if the woman is not relieved, and the convulsions continue without destroying life, the child is actually expelled by the contraction of the womb, which power is capable of expelling it even after death.
There are two cases of puerperal convulsion which are very distinct; one is a convulsion dependent on an irritable or excitable state of the nervous system; the other on a fulness of the brain. When convulsions arise from the latter cause, it is preceded by some symptoms, which, if watched, we can relieve; but if these symptoms are neglected, convulsions are very likely to follow. In a woman disposed to this complaint from such a cause, there will be a sense of great fulness in the head, giddiness in the advanced periods of pregnancy, drowsiness, and a sensation of weight when she stoops forward, imperfect vision, and atoms floating before the eyes. These symptoms strongly denote fulness of the vessels of the head, and, if allowed to continue, may lead to apoplexy or puerperal convulsions; but if early attended to may be removed, and premature labour prevented. Under such circumstances, the first step to be adopted is to protect the tongue from being injured in case of a fit coming on, by the introduction of a cork between the teeth, and then immediately to draw ten or twelve ounces of blood from the arm; or, if the patient is delicate, leeches or cupping glasses may be applied to the back of the neck and the temples.
After the bleeding the bowels may be opened by some mild purgative, which may be repeated every three or four mornings till the fulness is removed. At the same time the patient should abstain from stimulants and solid food.
When these precautionary measures have not been adopted, and convulsions have ensued, it has been customary to bleed largely from the arm, and to repeat the bleeding, if the symptoms were not relieved. As much as sixty ounces of blood have been taken from a woman in twenty-four hours, and, as is said, "with happy effect." Following up the bleeding with blisters at the back of the neck, and purgatives. Of late, however, medical opinions have been a good deal divided on this point. On the one side we have Drs. Churchill, Johnson, and Sinclair, Ramsbotham, Tyler Smith, and others, all strongly recommending bleeding. On the other hand, we have the late Sir J. Simpson, Dr. Braun, of Vienna, Dr. Barnes, Dr. Tanner, etc, all equally opposed to bleeding. Dr.. Tanner, in his last work on "Diseases of Pregnancy," says: "I have no hesitation in expressing a decided belief that bloodletting, as a general rule, without exerting any valuable effect on the symptoms, is calculated to produce irreparable mischief."
Several cases have been published lately, in which the patients have been treated with Chloroform instead of bleeding, and with complete success. Dr. J. Harris Ross gives a case of a patient aged 22 years. "She was lying on her bed, and had a flushed face and bounding pulse; and expected daily to be delivered of her first child. I was informed that the fit was sudden, and came on whilst sitting at tea; that she struck her head against the table in falling; that she had complained of headache all day; but had been about her household duties. She had most violent paroxysms of convulsions, which came on about every ten minutes, leaving her during the intervals perfectly unconscious.
In this case Chloroform was given, and the patient delivered while under its influence. She made a good recovery.
Dr. J. J. Phillips, Assistant Obstetric Physician to Guy's Hospital, gives several cases in which Chloroform was substituted for bleeding. He makes the following remarks in relation to the matter:
"That bleeding has no claim to be regarded as a remedy for puerperal convulsions; and that, in the majority of cases at least, if seen at an early period of the attack, it is unnecessary.
"That bleeding is often injurious by predisposing to various puerperal ailments, by retarding convalescence, and sometimes by increasing the violence of the paroxysms. Also, that the present diminished mortality is probably chiefly due to the less free depletion which is now practiced.
"That the chief reliance should be placed on Chloroform, which prevents the recurrence, or diminishes the violence of the paroxysms.
"That in mild cases it is sufficient to keep the patient very slightly under the influence of Chloroform in the intervals, more being given when indications of a fit are seen; but that in severe eases the patient should be kept for a time uninterruptedly under its influence.
"That if the convulsions have already produced much pulmonary congestion, it is beneficial to withdraw a few ounces of blood before administering Chloroform; and that generally it is advisable to lessen the tendency to cerebral congestion by the application of cold to the head."
If it is a case of convulsion depending upon irritation, a little blood may be taken from the temples by means of leeches. But the principal benefit will be obtained by the administration of sedatives. The Bromide of Potash, or Hydrate of Chloral, may be given in ten or fifteen grain doses every two or three hours. If these are not sufficient, Opium may be given, either by the mouth, or in injections.
Warm bathing, when it can be availed of, is of great benefit. Dr. Denman, who had much experience in Midwifery, strongly recommended warm bathing among the means for preventing convulsions in women previous to, or during their confinement. He states, that from its occasional use women will often find much benefit; and that it is one of the principal means which professional assistance is capable of affording for preventing puerperal convulsions, and for insuring an undisturbed labour. He also recommends a warm bath in labours rendered complex by convulsions, and this upon a long and extensive experience. He says, that when convulsions have continued or increased, notwithstanding copious bleeding, and the use of all other rational means, the patient may be put into the warm bath, in which she may remain for a considerable time if convulsions are suspended while she is in it. In instances where a warm bath could not be procured, or while it was preparing, he directed flannels wrung out of hot water to be applied over the whole of the abdomen.
The following mixture may be taken; a tablespoonful every two or three hours:
Ammoniated Tincture of Valerian........One Ounce.
Compound Tincture of Cardamoms.......One Ounce.
Syrup..............................................Half an Ounce.
Water sufficient to make.....................Half a Pint.
Fetid Spirit of Ammonia....................One Ounce.
Tincture of Castor............................Half an Ounce.
Cinnamon Water, sufficient to make.....Half a Pint.
A table spoonful every two or three hours.