Percy Boulton
1883 The Lancet  
PHYSICIAN TO THE SAMARITAN FREE AND QUEEN CHARLOTTE S HOSPITALS. ON Sept. 21st I was asked to see A. 0 -, who had been delivered the day previously of triplets, and was in strong convulsions. Excepting its plurality, the labour had been normal. The large single placenta bad come away naturally, and the uterus contracted well without any excessive hæmorrhage. The patient was with difficulty kept in bed during the fits by two women in attendance, and in spite of a clothes-peg, which had been used
more » ... which had been used as a gag, she had bitten her tongue badly. She was pale, unconscious, foaming at the mouth, the pupils were dilated, the skin cool, and the legs much swollen. I was told that before the fits she had complained of severe headache, and that she had passed very little urine. In addition to the increased arterial tension during pregnancy, the enormous size of the uterus during triple pregnancy causes pressure on the large abdominal vessels, on the bladder, thereby diminishing its capacity, and to some extent on the ureters, preventing free escape of urine into the bladder-all tending to renal congestion and ursemic eclampsia. This patient, however, had no symptoms of convulsions till after confinement, whenthepre-existing pressure had been removed, and therefore it was a question whether the fits were uraemic or not. The swollen extremities showed that although direct pressure had been removed, the circulation had not recovered
doi:10.1016/s0140-6736(02)37269-6 fatcat:kw6jb4meobgqhc77isolrbjb6u