108 OBSTETRICS. 



The attendant symptoms are, a turgid purple condition of the 

 face ; convulsive movements of the face and whole body ; foaming 

 at the mouth ; repeated and sudden closure of the under jaw, by 

 which the tongue is often dreadfully bitten ; the respiration is at first 

 irregular, and being forced through the closed teeth, and the foam at 

 the mouth has a peculiar hissing sound which, once heard, can 

 never be mistaken ; the pulse is quick, full, and hard at the begin- 

 ning, but afterwards becomes small and scarcely perceptible ; the 

 urine and faeces are often discharged involuntarily. 



This fit lasts for a time varying from five minutes to half an hour, 

 and then gradually subsides ; the pulse often becoming calm, and 

 the patient conscious ; or she may remain in a state of complete 

 coma with sibilant or stertorous breathing ; the more profound the 

 coma, the greater the danger. 



The calm is generally short in duration, being often followed by 

 a recurrence of repeated paroxysms and intervals. 



Puerperal convulsions may come on either before, during, or after 

 labour. When they occur before labour, uterine contraction is very 

 apt to come on synchronously with the fit, and the child is born dead. 

 When they occur during labour, the latter runs nearly its natural 

 course, and the fits are synchronous with the pains though not re- 

 curring with each. When they occur after labour, they generally 

 take place from two to four hours after the child is born, and are 

 attributable to some injury received by the brain and nervous sysem 

 during the parturient effort. 



The causes are generally a loaded state of the stomach or bowels; 

 intemperance in eating or drinking ; fright ; and in most cases, an 

 accumulation of blood in the brain during the violent expulsive 

 efforts. Primiparse are more frequently attacked than multiparce. 



Treatment. — The first indication is to protect the brain from the 

 effects of an accumulation of blood. This should be done by taking 

 away blood, in a full stream, from the arm, or temporal artery, and 

 repeating it if the paroxysm continuue. This may be followed by 

 cups or leeches to the temples and back of the neck ; there is great 

 tolerance of bloodletting in this disease. 



A strong purgative should next be given, (such as calomel and 

 jalap,) and its operation assisted by stimulating enemata. It has 

 also been recommended to combine tartar emetic with the purge, or 

 to give it alone, in divided doses, after the bowels are moved. The 

 head should be shaved, and cold applications made to it. 



In regard to the use of opium, most practitioners are in favour of 

 it when judiciously used. If it be given in the commencement of 

 the attack, when the patient should be bled, it can only hasten the 

 fatal result. But if the fits continue, especially after delivery, with 

 signs of great irritation and exhaustion, it may be given with the 

 hope of deriving benefit, remembering that depletion should always 

 be premised. 



