386 DYSTOCIA. 



those viscera which contain a muscular membrane are also seized. 

 Thus the pharynx, the oesophagus, the stomach, the intestines, the 

 bladder, the uterus itself, the heart, and especially the diaphragm, are 

 at times violently tormented by them. 



Hysteria, epilepsy, catalepsy, and the convulsions produced by 

 some material lesion, such as a phlegmasia, or any disease of the 

 encephalon or its meninges, or of the general nervous system, ap- 

 pear pretty frequently, and sometimes become aggravated during the 

 course of pregnancy: but it is to be observed that the three first rarely 

 manifest themselves during labor. Moreover, in these cases the dis- 

 ease is complicated by the state of gestation, and that is not what is 

 generally understood by the convulsions of pregnant women. 



888. Puerperal convulsions, also called apoplectic convulsions, 

 hysterical apoplexy, milk apoplexy, sympathetic apoplexy, eclamp- 

 sia of labor, differ from other diseases, in that they are evidently con- 

 nected with the state of pregnancy, which they complicate. 



889. Their proximate cause is always located in the brain, and, 

 consequently, I do not perceive the use of dividing them into sym- 

 pathetic and idiopathic convulsions. This proximate cause doubt- 

 less, is an irritation, or stimulus, which reacts upon the whole ner- 

 vous system, but whose nature appears to be extremely variable: 

 sometimes it is a precedently irritated point in the brain which in- 

 vites the fluids into that organ, which thus becomes a centre of 

 fluxion; sometimes, on the contrary, the fluids themselves, by being 

 determined towards the brain in too large quantity, produce a state 

 of congestion therein, and in consequence thereof, a convulsive re- 

 action. In this, as in the other case, the remote causes are very 

 numerous. There are predisposing and determining causes. Al- 

 though eclampsia is observed at all seasons, at every age, in all 

 classes of society, and under all temperatures, it is, notwithstanding, 

 true to say, that strong persons, those who are plethoric, of a dry 

 fibre, very animated countenance, short neck,* abundantly and fre- 

 quently regulated, nervous, delicate, irritable, subject to nervousness, 

 and young women in the first pregnancy, are more liable to them 

 than others. 



Air that is impure, charged with odors, and too rarely renewed; 

 the summer heats, too high an artificial temperature, anger, grief, 



* In Dr. Collins' cases, amounting to 16,654 labors, there were 30 cases of con- 

 vulsions. Five of the women died. 



In all the cases of convulsions that have come under my notice, the women 

 were small,' thin, with long necks. I have seen only one fatal case. It has been 

 ray good fortune to have met with few samples of this dreadful malady. — M. 



