Convulsionsare to be looked upon as very serious indications of derangement, during either pregnancy or labor, and are frequently followed by fatal results to both mother and child. They may be of several different kinds,epileptic,hysteric, orcataleptic, though the epileptic form is most common. They often occur during pregnancy, but not usually before the seventh month, though occasionally met with much earlier. According to observations it appears that there is not above one case of convulsions in six hundred deliveries.
The principal cause of this disease appears to be the strong sympathy between the womb and other organs, owing to which they are continually disturbed by the changes it undergoes. Certain temperaments also dispose to it, particularly the lymphatic, and also dropsy, rickets, and other diseases. Strong moral impressions may also have a predisposing effect, such as sudden frights, joy or anger, and also acute pain, or the dread of it.
In most cases, and particularly during pregnancy, the convulsions are preceded, and indicated, by severe headache, and spasm at the stomach, with dimness of sight, bright sparks before the eyes, buzzing in the ears, and partial difficulty in speaking. Occasionally however the fit comes on quite suddenly, without any warning whatever.
There are few exhibitions of suffering more frightful than one of these attacks, and none that call formore prompt and decided action. In general females are perfectly helpless when one is attacked in this way, and instead of being able and disposed to render proper assistance, they either run away alarmed, or fall into hysterics themselves. It is however of the utmost consequence that the sufferer should be attended to instantly, and therefore every female should know what to do in such an emergency, at least till better aid can arrive.
At the first commencement of convulsions the features become gradually fixed, the eyes are expanded and distorted, the breath is drawn with difficulty, and all consciousness appears to cease. The body then begins to twitch, the mouth opens, usually on one side, the tongue protrudes, the head turns on one side, and the blood rushes to it and the face in great quantities. In a short time the jaws close again with great force, and the tongue is bitten if proper care has not been taken to prevent it. At last the eyes began to twinkle, the mouth moves as if the patient were muttering, and the nostrils expand; the arms are thrust straight down by the sides of the body, with the hands firmly closed; the legs are stiffened straight out, and the body is bent back like a bow. In short every muscle is affected with spasms, which are sometimes fearfully violent, and may endure for a considerable time. When they subside, the fit gradually terminates and passes off. During the whole time the breathing is difficult, the mouth froths very much, and the heart palpitates quickly, but irregularly. When the spasm is over the patient falls into a perfect stupor, during which she remains unconscious, but with all the limbs soft and moveable, except the fingers, which appear to grasp. The jaws generally remain closed, and so do theeyes, but they may be easily opened, and will sometimes remain open; the breathing becomes powerful and loud, and the pulse beats with rapidity. At last slight motions are observed, and consciousness gradually returns, but the memory is generally gone for some time. This state of stupor usually lasts from ten minutes to half an hour, but has been known to continue for many hours, or even a whole day. The spasm seldom continues more than from one to ten minutes, though it has lasted for an hour or more.
These convulsions might be mistaken for ordinary hysteria by those not acquainted with the difference. In hysteria however the female moves about and struggles more; she also cries out, and retains both sensibility and consciousness, so perfectly even sometimes that she requests those around to hold her, which is never the case in convulsions.
During the stupor it might be supposed, by any one not aware of the previous fit, that the patient was suffering from apoplexy, or intoxication, the appearance being so similar to that exhibited in those states. This shows the necessity for careful inquiries as to what has previously occurred.
During pregnancy convulsions generally cause abortion, either by bringing on uterine contractions or by causing the death of the child. Some few patients have suffered from them however, and yet gone their full time, but this must never be expected. A gradual extinction of the vital spark, during the stupor is the ordinary termination, though sudden death is not unfrequent, during the fit. Gradual recovery is occasionally witnessed, but seldom without partial loss of memory, or some other affliction. Madame Lachapelle says thatone-halfof thefemales attacked with convulsions die, and of their children many more.
There is no doubt but that thetendencyto this fearful affliction may be very much lessened in many females, by proper attention to diet and regimen. Those who are of a full habit, and disposed to headache, and rush of blood to the head, should live low, and carefully avoid everything of a heating or stimulating character, and also every kind of excitement or agitation. The bowels should be kept free, and the skin well rubbed and kept warm, and the head cool.
Treatment.—While the patient is in the fit, care must be taken that she does not fall off the bed, or bite her tongue, to prevent which the jaws must be kept apart, by putting something between, as a piece of soft wood, or the handle of a spoon covered with cloth, or even a knotted napkin. The face should be sprinkled with cold water, and the whole body well chafed, particularly the hands and feet, which should also be made warm as soon as possible. As soon as the spasm is over it is customary to bleed, either at the arm, or by leeches to the temples and behind the ears. Mustard poultices should also be applied to the feet, and inside the thighs, and an enema should be given of warm water and a table-spoonful of salt. Ice, or cold water, should be applied to the head constantly, and if possible the body should be immersed in a hot bath, which will, in many instances, bring the patient round immediately without any other treatment. The bladder should be also looked to, as well as the bowels, and if necessary the catheter should be used. As soon as she can swallow a few drops of laudanum may be given, or a little ether, but not a full dose by any means.
The propriety of bleeding, even in these cases, is denied by many, and I am almost inclined to think myself, that a prompt and persevering use of the other remedies mentioned, would be fully as successful without it. At all events, the fearful mortality in spite of it proves that it has not much power, and may well raise a doubt of its utility.
Convulsions however are so fearful and violent, that few practitioners can resist the temptation to bleed, because it seems so well calculated to give prompt relief; and besides it has popular prejudice in its favor. Some authors however assert that it makes the danger greater of paralysis, and loss of memory, afterwards.
When convulsions occur during pregnancy they seldom cease entirely till the uterus is emptied of its contents. It is therefore necessary to bring on labor, and terminate it as soon as possible, after the parts are in a proper condition. When they occur during labor it must also be finished in the shortest time possible, to afford the best chance of saving the child, and also because no treatment will prevent the attack while the patient remains undelivered. All means of bringing on dilatation of the mouth of the womb, mentioned in the article onRigidity, may be resorted to, exceptingErgot, which should never be used in these cases.
M. Chailly tells us, that in thirteen cases of convulsionsninewere first pregnancies, andsevenof the females were dropsical. Onlyonewas attacked during pregnancy,tenwhile in labor, andtwoafter. Onlytwodied, andtenof the children.
It is worthy of remark that where pregnant females have had convulsions, apparently from living too high, the children have also had them after delivery.