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It is curious to see how differently the run of cases occurs in the practice of the different reporters; thus, while Mad. Boivin had only 19 in 20,357 women, Mad. La Chapelle noted 61 in 38,000 cases; and while Granville met with 1 in 640, Cusack encountered 6 in 348. I know not how many labors I have witnessed, but I have met with as many convulsions as Braun saw in 24,000 labors, and perhaps nearly as many as Mad. La Chapelle found in 38,000. My private practice can bear no comparison, as to the number of labors, with that of Braun in the great Vienna Lying-in Hospital; the statistics, therefore, are of very little service in one's clinical business. If 172 cases occur in 103,000, or if 52 cases happen in 24,000, or 61 in 38,000, or 19 in 20,000, it is of little moment to the practising physician to know the grand total of labors and of convulsions; since, like Cusack, he may be doomed to treat 6 cases in 398 labors.

In the present state of the question, wherein much difference of opinion exists as to what is and what is not puerperal convulsion, or eclampsia, to tabulate the proportion of fatalities is of little advantage, since in such a table one party might prefer to include all sorts of convulsions happening to pregnant and puerperal women, whilst another party would strictly exclude everything not traceable to uramic or albuminuric causations. I shall, therefore, omit a statement of the results obtained by Dr. Braun. I may say, however, that, of 165 cases of convulsion stated by Churchill, 45, or more than 25 per cent. of them, were mortal.

In my own obstetric practice, commenced 43 years ago, I have met

with many cases, both in my private and in my consultation business. I have not kept a regular record of all the cases, but the following list will serve to show, at least, that I have had a considerable experience in these cases. I doubt not that the list does not comprise all the instances that I have witnessed, but I believe it to be a correct representation as far as it does go.

The following is the list, with names and results, of the cases I have observed:

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6. Fuller,
7. Farnham,

8. Emerick,

9. Eckert,

10. Orne,
11. Charnley,

12. Black,

13. Cambloss,

14. Hill,

15. Wilmer,

16. Rush,
17. Blight,
18. Tiers,
19. Lysle,

20. Boves,
21. Richie,

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26. Lea,

27. Gowan,
28. Taylor,

29. Esther,

30. Haines,

31. Johnson,

32. Waterman,
33. M'Cauley,
34. White,

35. Middleton,
36. Lyman,
37. Walter,

38. Armstrong,

39. Musgrave,
40. Brown,
41. Filbert,
42. Smith,
43. Tiers,

44. Callow,
45. McEwen,
46. Abel,

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22. Collom,

47. Sherman,

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Though the above list contains 49 names of which I find notes and memoranda, I am sure that I have lost the memorials of several other instances. In the above recited cases there were 36 recoveries and 13 deaths, or rather more than one death in every four cases. This result, discouraging as it may be, does not lessen my hope that the new light recently thrown on the etiology of childbed convulsions will enable our successors to lessen the ratio of fatalities to the number of cases, by the use of those precautions against the invasion that are so well

understood by many in the present day, and that would be far better understood by the world if care were taken to indoctrinate those monthly nurses, who have far better and more numerous opportunities to observe the state of pregnant women than those enjoyed by practitioners of midwifery. We, unhappily, too often become concerned in the cases only after a fatal blow has fallen on the victim, as certainly was the case in many of the above recited thirteen, whom I had no real opportunity to treat with reasonable expectations to cure them.

The disorder under consideration generally attacks suddenly, and so suddenly and unexpectedly, that like a flash of lightning or a clap of thunder in an unclouded sky, it produces a feeling of astonishment. In some instances it attacks the woman long before any signs of ap proaching labor are observed or expected. I have seen it occur at the 165th day of gestation, and at various periods from the 6th to the 9th month, and, in a few persons, after the complete delivery of the

woman.

As the larger proportion of the cases will occur to patients actually in labor, we do not commonly observe them to fall like people affected with the falling sickness or epileptic fits. The seizures are mostly noticed in patients lying in bed, which is, perhaps, a reason why eclampsia is deemed by some quite different from epilepsy. When the fit comes on long before any labor has begun, the patient may fall heavily to the floor, as I have witnessed, while conversing with the person concerning symptoms that I looked on as prodromes of the eclampsia.

In general, when the attack begins, the woman is first seen to fix her open eyes and stare as if intently looking at some object. If spoken to she takes no notice of the speaker, but in a little while slowly and with a solemn motion turns her head towards the right shoulder very far round and then backwards, after which the facemuscles, then those of the shoulders, the arms, the trunk, and lastly, those of the lower limbs are violently and rapidly jerked. The eyeballs are uprolled so as to hide the cornea. The respiration is high but not very frequent, though it soon grows irregular and disordered, being attended with a quantity of foamy mucus and saliva. At first the mouth is open and the teeth quite separated by spasm in the depressor muscles of the jaw. I have always observed the tongue to be a little protruded-in a little while the jaws begin to champ or open and shut on the still protruded tongue, which is badly bitten, and bleeds so freely that the mucus and saliva of the mouth and lungs becomes reddened and flies with a hissing sound, through the closed jaws, which at last become firmly shut by a spasm so severe and so

long, that it is difficult to withdraw from their bite a tooth-brush handle or stick that may have been used to keep the tongue from being dangerously cut or bruised. This champing with the teeth on the bleeding and blackened tongue, the flecks of bloody foam that dabble her person and dress; the dishevelled hair; the purple, swollen and brutified appearance that has come on the face of the most beautiful woman, giving to it an expression scarcely human; the appearance of approaching dissolution seen in her blackening countenance; in the lessened frequency and violence of the convulsive jerkings, and finally, a long protracted groan blended with râle and hissing—make it altogether the most pitiable and terrifying of spectacles. When at length the body lies still, one looks at it doubtful whether it be living or dead. The purple stains of the cyanosis soon fade before a coming paleness like that of death-the pulse is gone-the lungs are still-the victim motionless and without consciousness-we doubt if she will breathe again-yet faintly, slowly, irregularly the diaphragm begins again to draw the vital air down into the recesses of the lungs-the heart impels a feeble current into the pulmonary artery, where the lifegiving oxygen combines with and brightens it: slowly it is transferred to the systemic heart by which it is sent forwards on its mission of resurrection of the brain. The innervations clear away this black darkness, and in a little while the now gentle breathings are followed by a moment of sleep, from which she wakes conscious and speaking to surrounding friends.

Under the dreadful circumstances of this disorder, one reflection ought obviously to strike the mind of the medical attendant; it is, that if the woman were not pregnant, she would not be assailed by the disease; and the inference very justly follows; namely, the pregnancy ought to be terminated in order to put a stop to the malady. For whether the assault has depended remotely on mere pressure on the great vessels, on uræmia, or on that more metaphysical state called sympathy of the brain and womb, we shall enjoy a far better prospect of rescuing the woman if she can be delivered, than we shall if the womb remains unemptied.

But can we deliver-ought we to deliver-when and how shall we deliver the woman? We can deliver if the womb is dilated or dilatable. We ought to deliver, provided we find that the discordant operations of the womb and constitution are likely to fail of promptly bringing the child into the world; for, although the womb sometimes acts with great power during convulsion, and is successfully aided by the violent, irregular, and spasmodic constriction of the abdominal muscles and other accessory forces of parturition, it also happens that

the child, in some other instances, makes no progress at all, and the convulsions, returning at short intervals, afford but small prospect of escape for the patient, inasmuch as they will be likely to continue until the pregnancy is brought to a close by the delivery of the entire

ovum.

It is, therefore, always desirable that the patient should enjoy the benefit of as early an accouchement as possible, but it must never be forgotten that the attempt to effect it must be regulated, entirely, by the fitness of the parts for the operation. There can be no excuse for forcing the hand into an undilatable os uteri, under any circumstances; and if the medical attendant be ever so anxious to give his patient every possible chance of safety, he will not be excusable, if, on that account, he rather adds to, than diminishes the risks of her frightful disorder, by intempestive violence in the introduction of hist hand. It is true to say, that "anceps melius quam nullum remedium;" but let not this trite aphorism lead us to the commission of positive mischief, under the impression that we are about to employ a doubtful remedy. Happily for us, however, delivery is not the only resource to which we can appeal in our anxious wish to put an end to the danger and distress of the scene before us.

What are the circumstances of the case? The patient has, perhaps, complained of severe pain in the head; she is under the excitement of labor; she is heated; the pulse is hard, full, and bounding, and greatly accelerated. On a sudden, the muscles of the whole body become convulsed, and the patient writhes, and every feature and every gesture are horribly distorted; the respiration is attended with a hissing noise, and bloody froth issues with violence from betwixt the teeth, which are rapidly opened and closed by spasm, wounding the tongue, and giving rise to the peculiar hissing sound above mentioned. The eyes are rolled upwards, or moved in opposite directions; and after a greater or less duration of the paroxysm, the patient sinks into a stertorous sleep, or profound coma, from which she is roused only by a renewal of the convulsive movements, or to mutter in the intervals incoherent or inarticulate sounds. Here, then, we have the proofs, as they are also the results, of a preternatural development of the innervating functions of the brain and spinal marrow, caused or maintained not by uræmia alone, but by an undue momentum of the cerebral circulation. The remedy is, first, to moderate the excitement by venesection and evacuants, and, second, to remove the cause by delivery. By the abstraction of blood, we can weaken the force of the circulation of the whole system; we can make the heart beat gently, and cause it to send the blood in a milder current into the

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