XXXII.

Case of Puerperal Convulsions.

By S. D. HAND, M. D.

March 21, 1870.-Mrs. M., aged about twenty-six, gave birth to her first child, after a labor of twelve hours, moderate in severity, and complicated with no untoward circumstances.

One hour after the birth, the patient being comfortable, and the placenta having passed away, all circumstances being favorable, I returned to my office.

After six or eight hours had elapsed, I was summoned, as the patient was in convulsions, and the friends thought her dying. Found her entirely conscious, having recovered from the first paroxysm which, I was informed, continued about fifteen minutes. Patient complained of pain, and a feeling of pressure in the head, extending over the entire head, with a confused feeling, partial loss of memory, etc. The face was flushed, heat in the head and face, but no general increased heat, the pulse wiry and increased in frequency, dryness in the mouth, with some thirst, but no pain except in the head. I administered belladonna", removed all persons from the room except the attendant, admitted plenty of fresh air, and awaited the results.

In about half an hour from the end of the first paroxysm, another, moderate in severity, occurred, which I witnessed. The only premonitory symptoms that I observed was slight chilliness, with a little nausea, and twitching of the muscles of the face. These symptoms were soon followed by a rapid convulsed movement of the muscles of the body and limbs, dilated pupils, difficult breathing, etc., which continued with slight intermissions for fifteen minutes.

When these convulsive movements ceased, the patient passed into a state of stupor, from which she could not be aroused for about fifteen minutes, when consciousness was recovered; complained of pain and pressure in the head, with nausea and faintness. I repeated the dose of belladonna.

After remaining conscious about ten minutes, the paroxysm

returned with greater severity than before, accompanied with strong efforts to vomit. From this paroxysm, which continued about the same length of time as before, she did not fully recover conscionsness, but appeared exhausted, and in not more than fifteen minutes. the convulsions recurred, violent as ever, and as long continued.

From the next paroxysm the patient did not recover any degree of consciousness except a mere ability to swallow. At this stage the case seemed to me to be growing desperate, and although I thought belladonna covered the symptoms very well, concluded to discontinue it, and try a remedy with which I had hitherto had no experience in similar cases. Accordingly administered one drop of the mother tincture of veratrum viride.

The next attack occurred soon after the administration of the medicine, and did not differ much in severity and continuance from the two preceding ones. In the interval between this and the fol lowing one, the patient did not arouse from the stupor, but breathed easier, had less redness of the face, and no return of the nausea.

The next paroxysm, which was the last one, was comparatively very light, and did not continue more than five minutes. No efforts were made to arouse her except to give veratrum viride. After sleeping half an hour, became conscious, complaining only of weariness and a slight headache.

The convalesence was slow, but very favorable, having slight headaches and nausea for ten or twelve days, after which, health was good as usual. The child was small, but well formed and healthy, and for his special benefit she had an abundant flow of milk.

A little previous history may throw some light upon this case. For a year or two previous to pregnancy, I had occasionally treated her for prolapsus, leucorrhica, general debility, loss of appetite, coldness of the extremeties, and a low condition of the vital forces generally. Under homeopathic treatment her health became greatly improved, so that for three months before the commencement of pregnancy, had heard nothing from her, except the enjoyment of perfect health. But during nearly the whole period of gestation, the system was greatly disturbed, and the sufferings more severe than I have ever known in any case. These consisted of severe vomiting, constant nausea, with burning pain in the stomach, entire inability to retain food, except a very small quantity of thin gruel or beef broth, and these would often excite protracted vomiting. Added to these were a constant pressure and confused feeling in the head, with

paroxysms of intense burning pain, prostration of strength, and coldness of the extremities, dryness of the mouth without much thirst.

These symptoms continued with slight intermissions, until about the end of the eighth month, when they gradually subsided, and for the last three or four weeks the patient was comfortable.

Among the remedies administered during this time, none of which gave but slight relief, were arsenicum, ipecacuanha, belladonna, pulsatilla, and lobelia, the last of which relieved the nausea more than either of the other remedies. I gave these in the mother tincture, and in the third, sixth and thirtieth attenuations.

With this brief, imperfect statement, I leave the case with the profession, hoping and believing that in some of these terrible cases of puerperal convulsions, so trying to the physician, and so often fatal, the veratrum viride may be found to be a remedial agent of greater value than any hitherto employed.

Some queries suggest themselves to my mind:

First. Would the veratrum viride have relieved the distressing symptoms during the period of gestation?

Second. Would the veratrum viride have acted thus promptly in any of the high attenuations? These and other points will probably be settled by further investigation of this important remedy.

XXXIII.

Case of Threatened Puerperal Convulsions.

By JAMES C. HARRINGTON, M. D.

September 13.-Was called to visit Mrs. D., aged thirty-two. It was the seventh day after the second confinement. Found the patient suffering from severe after-pains. Upon an examination ascertained the following symptoms:

Severe, cutting, paroxysmal, bearing-down pains through the uterine region; excessive tenderness across the bowels, seeming to involve the uterine appendages and the whole of the entoneum. Not much febrile excitement, but considerable thirst; eyes expressive of great anxiety; sharp, lancinating pains in the head, particularly in the frontal and temporal regions; bowels constipated.

Prescribed belladonna' and aconite', from eight to ten drops, in two glasses half-full of water each, to be taken two teaspoonsful every half-hour in alternation. Then put half a grain of sulphate of morphine in eight teaspoonsful of aqua pura, and gave the patient two teaspoonsful, it then being about fifteen minutes since the other medicine had been taken. Left directions with the nurse to administer the morphine every two hours until sleep was induced; also directed the application of cloths, wrung from hot water, to be placed across the abdomen, and changed every ten or twenty minutes.

The day following, found the patient very much better. The aconite and belladonna had been taken as directed, and only two doses of the morphine were administered.

Prepared a fresh supply of the same remedies, and lengthened the intervals to an hour, to be continued alternately until the next visit, and prohibited the further use of the morphine. Ordered an enema of tepid water, with an addition of a little salt, to be given in sufficient quantities, and often enough to produce a movement of the bowels.

The third day found the patient had passed the night very comfortably; there had been a movement of the bowels; the pulse eighty-two, and the patient considered herself almost well.

Whether this case would have resulted in puerperal convulsions or not, of course I am unable to say; but with the presentation of the foregoing symptoms, and the favorable circumstances under which they appeared for the production of this dreadful disease, impressed me with the opinion that I could reasonably, expect convulsions if medication had been much longer delayed. The above described treatment resulted in a speedy and perfect recovery.