The actual symptoms of puerperal confusions are indeed scarcely to be distinguished from those common to epilepsy itself. They are thus described by Churchill. (*System of Midwifery, Phila., 1864, p. 473 ‘During the attack the face is swollen,, of a dark- red or violent color, and distorted by spasmodic contractions; the eyes are agitated, the tongue protruded, and the under jaw repeatedly closed with force, so as to wound the tongue. A quantity of froth is ejected from the mouth; which is generally drawn more to one side of the face that to the other. The muscles of he body are directions, and with such force that it is sometimes difficult keep the patient in bed. The respiration is at first irregular, and being forced through the closed teeth and the foam at the mouth, has a peculiar hissing sound it subsequently becomes nearly suspended. The pulse is quick, and at the beginning full and hard, but afterwards small and imperceptible. The body participate in the purple color of the face. The urine and feces are often passed involuntarily. This terrible paroxysm, however, is not of very long duration. After a period varying from five minutes to half an hour, other convulsive movements become less violent, and gradually subside; the countenance is less distorted, and assumes a more natural and placid appearance;the eyelids close the respiration becomes more regular, through still sibilant, and the circulation is restored, the pulse becoming more perceptible, though still very walk; the patient rests quietly in bed, and the paroxysm has terminated for the time.
During the interval, the patient condition is very variable. She may partially recover consciousness, so as to recognize persons around her, and to be aware of something extraordinary having happened, without knowing what, and without being able to express herself clearly. In other cases, the return of intelligence (without recollection) may be complete until the approach of the next fit, accompanied with great weakness, headache, and confusion. In the more unfavorable case, s the patients remain in a state of total insensibility, almost approaching to coma or asphyxia, with sibilant or stertorous breathing, a nd without muscular motion, or with a restless throwing about the body and extremities. This fit is however of not very long duration; it may be half an hour, or two hours, but sooner or later the paroxysms return to be succeeded by an interval which in its torn gives place to a paroxysm.
Under the head of eclampsia parturientium, puerperal convulsions are thus described by Romberg. (*Diseases of the Nervous System, II p. 187) The convulsions coming under this denomination break out suddenly, and the patient is at once deprived of consciousness. The face and neck swell, and become red and livid. The carotid and temporal arteries pulsate violently, and the jugular veins swell; the eyelids are distended the eyeballs are elevated or stare rigidly and their vessels are congest, or they roll the grinding teeth, causing it to bleed, and bloody froth issues from stretched. and again contact with lightning like rapidity. The whole trunk is a one time rigid, immovable, drawn backwards to tone side; so violent that patient can scarcely be restrained. The muscles of respiration, and especially the diaphragm, are implicate; there is danger 0f suffocation. Vomiting supervenes, and urine and excrements escape involuntarily. The temperature is raised the face drops with perspiration. The pulse is very frequent, full and strong, or weak and hard. The abdomen is tympanitic; the uterus is hard, and this hardness increases as of the as convulsions are renewed.
These attacks are more apt to occur in primiparae; although they are by go means confined to them. Some women even have the misfortune to be seized with them at each succeeding pregnancy; in different individuals these attacks terminate differently; some remain in a state of half stupor and great exhaustion for hour for days. and for a long time, and eventually recover. In some cases the patient continues comatose, gradually passes into a state resembling apoplexy, and dies. In these cases the danger is said to be reader during the last months of pregnancy than during and after parturition. When the convulsions are originally associated with profound sopor and stertorous breathing, they are said to prove almost invariably fatal under the Allopathic treatment. Plethoric and robust women are in greater danger than weak and hysterical subjects. And when the intervals are very short between the paroxysms, or become imperceptible, death is at hand.
Dr. Hodge (*Disease peculiar to Women, p.126 states, that ‘after much anxious experience and reflection, it is evident to my mind that thee is no essential pathological difference between the usual form of puerperal confusions, and those which occur in the non-parturient state in hysterical women. I have seen so many cases t the later, precisely similar, as regards their phenomena at the time and after the attack to those of the former; and so many of the puerperal form resembling those of the hysteric as to the precursory, attendant and consecutive symptoms, that I must believe that pathologically they are virtually the same. The only real difference is the degree of congestion; this being comparatively trifling in. the unimpregnated state, very great during gestation, and still more so during labor. The engorgement in this case arises from the almost universal plethoric state of pregnant women, which during labor is enhanced, particularly as regards the brain, by the ‘pain and he bearing down efforts; these include of course the holding of the breath, the temporary suspension of respiration, and the consequent passive congestion in the lungs, right side of the heart, the brain, &c. hence the danger and fatality of puerperal convulsions. The original nervous irritation is aggravated by this congestion, so that effusion, so that effusion of serum or blood may insure, and the patient become comatose and die.
When this affection appears in. the last months of pregnancy, the infant almost always perishes; but it may be saved when the convulsions appear during parturition in these cases the fits will usually be found synchronous with the uterine contractions, that is each pain is attended by a convulsions. But if there have been to no pains before the fits come on, the os uteri most frequently begins to dilate; in all cases of puerperal convulsions of this kind, that is during parturition, the condition of the os uteri, as dilated, dilating, or as rigid, will afford important indications as to the course to be pursuaded rigid, will afford important indications as to the course to be pursued and the remedies to be employed. In connection with these convulsions the uterine contractions are usually feeble and irregular, sometimes, they either pass into the spasms or alternate with them. In some instances according to Leadam, the opening of the os is the signs for the manifestation of convulsive action, each parturient effort being accompanied by a convulsions in others, every paroxysm seems to cause a firm, spasmodic contraction of the os, and so interferes with and delays the progress of the labor. The convulsions sometimes continue at intervals until the birth, which therefore, is an event looked forward of with great anxiety and it has happened that labor has proceeded, even to the expulsion of the child and secundines, without the surrounding attentions being aware of it, in consequence of the convulsions so obscuring the parturient efforts that there was no outward manifestation of the labor. This shows the duty of ascertaining without doubt the actual condition of the uterus by a proper and timely examination. If delivery, whether it be at the full time or not, be inevitable, and if tin spite of application of appropriate remedies, the convulsions continue or increase, then it will be a matter of serous consideration whether the birth of the child can be expedited by manual or instrumental interference with safety to the mother. The soon the child is born, the sooner may we reckon on the probable cessation of the conflations, and the safety of the mother; although they do not always terminate when that desirable object is accomplished.
The proper course to be pursued, under the different conditions of Convulsions in Parturition will now be indicated.
First. Ascertain by examination, if any loaded condition of the rectum, or of the bladder, offer any impediment to the progress of the labors or predispose to the convulsions.
Second. Remove any such obstructions by the use of enema syringe or catheter.
Third. Administer the similar remedy, according to the indications given at the close of the chapter, either one of those mentioned or any other which may be more Homoeopathic to the case.
Fourth. Should the convulsions not be relieve, it will be necessary to induce artificial delivery, as soon s the os uteri is found to be sufficiently dilated or dilatable.
