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Hoffman records the case of a successful Cesarean section done ten minutes after death. The patient was a woman of thirty-six, in her eighth month of pregnancy, who was suddenly seized with eclampsia, which terminated fatally in ten hours. Ten minutes after her last respiration the Cesarean section was performed and a living male child delivered.
Ingleby describes a case of fibrous tumor of the uterus terminating fatally, but not until three weeks after delivery. Lusk mentions a case of pregnancy with fibrocystic tumor of the uterus occluding the cervix. At the appearance of symptoms of eclampsia version was performed and delivery effected, followed by postpartum hemorrhage.
He also advises large doses of magnesium sulphate. In such serious disturbances as eclampsia, it is not necessary to give a magnesium salt, which, it has been shown, can have unpleasant action on the nervous system. Sodium sulphate is as valuable and is not open to this danger.
This high nervous tension may overflow into other channels, into the vascular and excretory system, causing eclampsia; into the muscular system, causing chorea, or, expending itself in the brain, give rise to hysteria when mild or insanity when severe. But the vagi form a very ready channel for such overflow, and hence the frequency of sickness in pregnancy.
Vomiting is, however, a convulsion, and is thus the simplest form of a kind of manifestation to which the heightened nervous tension of pregnancy easily lends itself that finds its extreme pathological form in eclampsia.
Although he says he has found no bad action from ergot, either by the mouth or hypodermically in these eclamptic cases, it would seem inadvisable to use ergot, which may raise the blood pressure. He finds that pituitary extract "can cause dangerous rise of blood pressure." Irving believes that with proper preliminary preventive treatment most eclampsia is preventable.
The trouble with Angela's system, in addition to a weak heart, was that it was complicated at the time of her delivery by that peculiar manifestation of nervous distortion or convulsions known as eclampsia. In every two such terminations one mother also died, no matter what the anticipatory preparations were on the part of the most skilled surgeons.
If the urine is known to be free from albumin and casts, and there are no signs of impending eclampsia, the slow pulse is indicative of no serious trouble; but the urine should be carefully examined and a possible uremia or other cause of eclampsia carefully considered.
He finds that if a patient is past the eighth month, rupture of the membranes will usually bring a rapid fall of from 50 to 90 points in systolic pressure. Usually, of course, such rupture of the membranes will induce labor. He finds that the fluidextract of veratrum viride is valuable when eclampsia is in evidence or imminent.
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