Puerperal Eclampsia.

H. S. LOWRANCE, M. D., CHEBANSE, ILLINOIS

On November 26, 1907, I was called to attend the Rev.— at his home. The minister, with his family, had very recently settled in our place, and in order to "get settled" as soon as they could, they had worked very hard. The minister was in bed suffering from bad headache and sick stomach, and he said to me, "Get me well quick, and don't use any morphine, for my wife is expecting to be confined and I must not be here in bed when she is sick, for I am uneasy about her and want you to attend her." After prescribing for him, the wife was called into the room and I found her to be a Dane, aged twenty-nine, and the mother of four children, and she had been expecting to be confined any time for three weeks. She was quite stout and large and weighed about 180 pounds.

After questioning her carefully regarding her previous confinements, excretory organs and matter pertaining to confinement, she assured me she was all right, but complained that she had been having much headache of late. I at once became suspicious and secured a sample of her urine for examination. I tested the urine for albumen but could detect only a slight trace.

That night, at two o'clock a. m., I received word to "Come over at once as Mrs. W— was having a chill and was very nervous, restless, could not stay in bed and was having some pains." Reaching the house quickly I found her walking the floor and shaking. Upon inquiry, was told she was not having labor pains, but an aching pain across the abdomen. She was very nervous. I requested her two attending neighbor women, who had been called in, to assist her to bed and prepare her for a vaginal examination, and while they were doing this and chatting with each other, I was scrubbing my hands when one of the attending women called, "Doctor, come here quick." I found the patient oil the bed with her head turned to the 'Left side, face purple and turgid, eye balls turned and fixed, and eye lids batting and snapping. Breathing labored but not stertorous, and the body jerked in spasms and finally became rigid, and she became unconscious. During this convulsion, which lasted some time, the bowels and bladder both moved unconsciously, although they had moved some two hours before, so I was told.

After the paroxysms had passed, I made a vaginal examination. The external os was with difficulty found, and it was in the posterior portion of the vagina and upon the left side, and closed tight. No dilatation at all.

Fearing more attacks I gave her hypodermically, thirty drops of Lloyds sp. gelsemium. I waited thirty minutes and seeing no improvement gave thirty drops more. She went into an easy sleep; slept for two hours and awoke in a dazed condition, which lasted all night, but she had no more convulsive movements.

I began giving her, as soon as I could, saline laxative and diuretin, and had splendid results. She became rational and felt good. I congratulated myself on her good condition. She was given the above remedies right along during the day.

Two days after this, about six p. m. I was called again in great haste. Responding promptly I found her in a harder convulsion than before, and not having any veratrum, I again used Lloyds sp. gelsemium hypodermically as before. The convulsive movements ceased, after I had given the second dose; I made a vaginal examination at this time, and found the external os tightly closed as before.

She remained in a somewhat semiconscious condition for two days. All this time the child in utero was living and moving about freely. Realizing the seriousness of the case, and the parties being new in our village, I suggested counsel, but the counsel did not suggest anything more than that which was being done at this time.

A week later she felt so well that one evening she got up from bed, was pulled to the supper table in a rocking chair. She ate a fair supper, chatted with the family for a few minutes after eating, said she was tired, and was pulled in the rocking chair back to the bed. Immediately she went into another convulsion and had then four hard, severe attacks all about thirty minutes to one hour part before we could control the seizures.

We used sp. gelsemium and we used it in dram doses too, with but little if any, effect. We used specific veratrum also, with the same results. We then used chloroform and two of Abbott's H-M-C tablets, full strength, thirty minutes apart, and I assure you we got results, for she slept eight hours good, and two hours more, dozing, and awoke in a fairly good condition. During all these days, frequent examinations of the urine had failed to show any special or appreciable amount of albumen and the specific gravity ran from 10-18 to 10-22.

I kept her upon diuretics and (lave her May apple as an hepatic stimulant and also the saline laxative. On December 20th, she went into labor property and was delivered of a fifteen pound boy, and did not have any more signs of convulsions. She was in labor about four hours and had what is called on ordinary labor, except there was a very profuse postpartum hemorrhage coming on two hours after, but was without much trouble finally controlled.

In all my obstetrical experience, and it has been considerable, there are very few cases that do not show albumen in the urine. I have seen it stated that there is always albumen in the urine in case-, of eclampsia, but I state positively this is incorrect, for our counsel and myself both tested samples of this patient's urine at different times and we did not find any.

If there is ever a time on earth which tries a doctor's mind, heart, body, brain and soul and makes him grow old quickly, and for which he never receives proper remuneration, it is a severe attack of eclampsia or a severe post-partum hemorrhage.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.