William Frederick Gardener
1897 The Lancet  
I WAS called on Dac. 6th, 1896, at 4.45 P.M., to see a woman who had engaged me to attend her in her confinenent about that date (Dec. 8th to 15th). She was forty-one years of age, and this was her first pregnancy. On arrival I found her dressed and seeming very dull. It was said that she had been complaining of "her head " &nd suddenly went off into some kind of fit, her features being convulsed and blackened. The case seeming like puerperal eclampsia she was at once removed to bed. A
more » ... to bed. A soap-and-water enema had been given in the morning which had acted slightly. At 5.15 the patient was seized with a second fit, in all respects typical of puerperal eclampsia. Three grains of calomel were placed on the back of the tongue and followed by 20 grains each of amoral hydrate and bromide of potassium. Most of the calomel was swallowed and the whole of the mixture. At 5.50 a third convulsion occurred which was cut ;short by administration of chloroform vapour. At 6.50 another fit was similarly treated, the inhalation of chloroform being prolonged for the purpose of making a vaginal examination. The os was found to be dilated to the diameter of a little less than half an inch. At 8 o'clock lio gr. pilocarpine hydrochlorate was injected sub-'sutaneousiy. In response to repeated inquiries the patient complained of sickness. At 8.45 and 9.32 the liits recarred. By 9 P.M. the os had dilated very slightly. At 10.30 the patient commenced to moan, her eyes opened, and lateral nystagmus became visible with turning of the head and eyes to the left. A few whiffs of chloroform removed all these symptoms and staved off another convulsion, as in this way the previous ones had commenced. At 11.5 P.M. and E2.55 A,M. the nystagmus returning convulsions were again prevented by a prophylactic use of chloroform. Every three hours a nutrient enema of b aef-tea and milk was administered containing twenty grains each of bromide of potassium and chloral hydrate. At 9.15 P.M. urine had been passed into the bed and at 10.45 P.M. the bowels had commenced to act. At 2.25 A.M. on Dec. 7th a convulsive attack again seized the patient, the first not prevented since 9.32 the previous evening. At 4.25 A.M. the temperature was 103° and the pulse was 108. At 10.20 the temperature was 100° and the pulse 118. At 12.30 P.M. the first specimen of urine was obtained, being drawn off by catheter ; it was" porter--coloured" and yielded five-sixths albumin. In consultation with Mr. Soltau Eccles, of Norwood, it was decided to leave the case to nature unless there should be any return of the convulsive seizures. The pains were then becoming fairly regular and the os was very slowly dilating. There were no more fits. The mixture of bromide of potassium and chloral hydrate was given in small enemata of milk and beef tea every four hours. The pupils remained contracted, and the patient complained occasionally of great pain in the head, but the nystagmus and twitching of the muscles were absent and the bowels acted freely and often. By 4 o'clock the amount of albumin present had diminished to one-sixth, lessening slightly towards evening. At 11 o'clock the foetus was born without any very strong pains. It was stillborn, and had apparently been dead some days. At 2 A.M. on Dec. 8th the temperature had fallen to 99 4°, and at 8 o'clock to 972°. From this date to Dec. 19th there was considerable variation of temperature from 97° to 102°. The urine contained from one-tenth to one-eighth albumin up to this date, then slowly cleared off, till early in January only a very faint trace remained. Very severe headaches were present during the whole time, for which a variety of drugs were tried, ammonium chloride giving the best results. A mixture of acid tartrate of potash and digitalis was given for some weeks, with 40 gr. of pulv. jalapse co. at night. The great interest in this case was the extraordinary ease with which the fits were arrested by chloroform inhalation. One hundred grains each of chloral hydrate and potassium bromide were retained by the mouth and rectum.
doi:10.1016/s0140-6736(01)57478-4 fatcat:nz5ced5ri5ev3hbuandwet4g3y