HAPPILY both for the doctor and his patients this disease is of rare occurrence.
It is a violent convulsion, epileptiform in character, followed by coma, occurring during the latter months of gestation, and during and after labor. Although it is a condition of great peril to both mother and child much can be done in the way of prevention alleviation, and cure.
Many are the causes which in the past have been assigned for this malady but later research narrows them to two or three. All causes sooner or later refer to a functional or pathological derangement of the kidneys. Is it pressure of the gravid uterus upon these organs?.
Is it pressure of the gravid uterus upon the solar plexus, thus interfering with the renal nerve-supply? For the renal plexus receives a large part of its nerve fibres from the solar plexus.
Is it some peculiar position of the foetus in utero?.
Is it the non-elimination of the uric acid-thus constituting uremia? Is it albuminuria? The fact that albumen is so constant a factor would lead us to think so. For fifty years albumen has been associated with this disease as its cause and has been so attributed by many noted authors.
But the other fact that eclampsia occurs in cases where little or no albumen is present makes us look for still other causes.
I think we shall find them, as my friend Dr. Tooker once suggested, in the peculiar nervous tendency of certain expectant women.
Some have attributed it to anaemia, especially cerebral anaemia; but the gestating woman is a good feeder, and if eclampsia occurred where long nausea and vomiting had been of daily occurrence, and the system been depleted, we might then regard it as a cause.
That renal insufficiency through pressure upon these organs may be the cause receives color from the fact that eclampsia occurs, in make and twin pregnancies and in persons of contracted pelvis. The male child being on an average larger than the female, for in one hundred cases each of consecutive male and of consecutive female births I found a difference n weight in favor of the male of from one-quarter to one-third of a pound on the average.
That it occurs in primiparae and especially to elderly primiparae is evidence in the same direction, for the first distension of the abdomen cause more resistance and pressure-and when these abdominal parietes have settled down to mature life without distension, as in the elderly primiparae, the resistance is still greater.
That these attacks are due to pressure, in part at least, is supported by the fact that prompt delivery of the child-thus removing this pressure-prevents, in so large a number of cases, a recurrence of the convulsions.
If we are correct in the premise that pressure is a prime cause then we can deduce our prophylactic hints.
HINTS.
1. Easy habits of dress, discarding the corset and the bands about the waist, thus relieving the tension here.
2. A semi-prone position in sleep, the abdomen resting upon the couch and not upon the kidneys.
3. Daily massage of the abdominal parietes using warm sweet oil in the process.
4. In the rare cases where peripheral irritation causes the convulsions-remove as far as possible all sources of irritation. These with a proper affiliation of remedies like Arsenicum and Apis will prevent the final troubles in a large majority of cases.
SYMPTOMS.
Among the first symptoms noticed are-a puffiness under the eyes-specks or cobwebs before the eyes-sounds in the ears, swelling of the feet, ankles and also of the wrists.
These symptoms should lead to an immediate examination of the urine and if we find albumen present in any considerable quantities, we should immediately commence our preventive treatment. Our armamentarium is full, complete, and effective to combat this state of things.
My friend, Dr. Tooker, the eminent professor, and author, once met me and said he had case which promised convulsions at labor, having all the symptoms which precede eclampsia. He urged me to respond promptly if I were called to his aid. A proper affiliation, however, of the remedies in his skilful hands prevented, and he told me latter that she passed through the ordeal of labor-safely.
Perhaps no agent is os valuable at the time of the convulsions as chloroform wisely administered. It has held many a case in check while the true remedium was doing its curative work.
Perhaps Bell. and Opium are the most commonly indicated remedies.
It seems strange that two remedies so diametrically opposed to each other should be so happily and uniformly efficient in this disease.
SOME CONSULTATION CASES.
Dr. S.N. Snider called me in a case of eclampsia. He had delivered the case and hoped that this would terminate the convulsions as it so frequently does-but they continued, and were of a violent and alarming character. Chloroform held them in check while the Bell. was doing its work. This case made a good recovery.
Prof. Tooker called me in another case which was sprung upon him without his previous knowledge of the threatening.
The lady was in a series of frequently recurring convulsions when I arrived. It was a primipara past thirty years, with a breech presentation, the breech having been for some time impacted in the straits.
Some convulsions occurred after the delivery, but under Dr. Tooker’s skilful handling of the remedies she made a full though tardy recovery. Later she moved west, had another child, and died of puerperal convulsions.
Some months ago I was hastily summoned to an adjoining State. Here I found a lady, 37 years old, seven months along in her first pregnancy, and having had frequent convulsions for some weeks.
There was evident and increasing harm to the sensorium from the long continued strain. After getting a history of the case, I advised an immediate termination of he gestation as the only course offering any hope of relief. In this view the two physicians in charge and also the family acquiesced. At 11.30 P.M. I commenced by dilating the os, using, first, no index- finger and then two index-finger back to back. Soon I had sufficient dilation for the application of the forceps. The labor terminated successfully in three and a half hours.
The lady had no more convulsions, regained consciousness, and the doctors in charge wrote me three days latter that they had strong hopes of her recovery. She died about two weeks later, as I afterwards learned. And right here let me say that if this renal disturbance is from pressure of the gravid uterus, we have a right to expect relief when that pressure is removed; but if the convulsions arise from an old Bright’s disease, the prognosis is very doubtful.
MY OWN CASES.
In my own practice I have had but four cases with two deaths in thirty years-a practice covering between three and four thousand cases. The statistics and authors would lead us to expect one in but five hundred cases, but my experience has been much less.
I think that by early recognition of the danger and a proper use of our Homoeopathic remedies, I have been able to prevent several cases.
1. My first one occurred about twenty years ago, in the case of Mrs. H., primipara.
The convulsions recurred every thirty minutes. After the second I sent for Dr. S.P. Hedges in counsel. He being, the messenger brought Dr. M. The lady was delivered with instruments, when the convulsions ceased, not to return, and she made a good recovery. The convulsions did not return at subsequent labors. She is at the head of a beautiful family to-day.
2. Mrs. S., from another city, was placed under my care, expecting to be confined in six weeks. She was a primipara, nearly 30 years old. Her eyes were puffy; her hands and limbs were swollen; there were specks before the eyes; also sounds in the ears, occasional vertigo, and frequent micturition.
Asking the husband to call at my office, I had an opportunity to tell him of the danger, and that he must be prepared for trouble, explaining to him as definitely as possible what the dangers were. When within two weeks of her expectation, I was hastily summoned to find her in convulsions of the worst type. They continued at frequent intervals for about eight hours, when, with a violent convulsions, the trouble ended in death. She was unconscious from the time she was taken, never rallying a moment.
My nephew, A. Grosvenor Thome, assisted me in caring for the case.
3. I was called to Mrs. P., aged 3 years, who had lost all her children a year previously with diphtheria. She had it in a severe form herself, losing some features of her face by blood- poisoning, as her doctors affirmed. The diphtheria probably left a kidney disease, which fatally complicated her gestation, fro when about eight months along she was taken with eclampsia, and died in a convulsion the next day. My son, Dr. Lorenzo N. Grosvenor, was with me in the case.
Whether this case should be regarded purely as a case of puerperal eclampsia or as a sequela of diphtheria is a question.
4. Mrs. S., December, 1892, a German, primipara, large and strong, and 24 years old. When the confinement engagement was made there was some indication of kidney trouble, but the family, being poor, objected to what they called unnecessary visits.
