At the close of the preceding chapter on the complications of pregnancy, brief mention was made of blood-pressure as a possible source of anxiety. This chapter will be devoted to a further discussion of the subjects of toxemia, eclampsia, convulsions, and especially blood-pressure—in connection with other leading symptoms of these serious complications of pregnancy.

TOXIC SYMPTOMS

In a former chapter we learned that the developing child nearly doubled its weight in the last two months of pregnancy. As the child grows, its metabolic waste matter is greatly increased, while all these poisonous substances must finally be eliminated by the mother. Now, the mother's waste matter is of itself considerably increased; and so, if the kidneys, the liver, and the skin are already over-taxed in their work of normal elimination—if they are already doing their full quota of work—we can readily see that the additional waste matter of the unborn child will throw much extra work on the already overworked eliminative organs, and this results in a condition of toxemia. Certain symptoms accompany this state of constitutional poisoning or auto-intoxication—the chief of which are:

1. Headache.
2. Dizziness.
3. Blurring of the vision.
4. Swelling of the feet and hands, or puffiness of the face.
5. Diminished urine.
6. Vomiting.
7. High blood-pressure.
8. Albumin and casts in the urine.

Any one of these symptoms may or may not indicate toxemia; but it should be reported at once to the attending physician. In the presence of one or more of these symptoms an expectant mother is always safe, while awaiting the physician's advice, in carrying out the following program:

1. Drink more water or lemonade.
2. Take a mild cathartic.
3. Avoid eating much meat and other highly protein foods.

CONVULSIONS OF PREGNANCY

This serious complication of the last weeks of pregnancy demands immediate attention. They may almost invariably be avoided if the blood-pressure and the urine are studiously watched during the latter part of the expectant period.

If you are unable to get your physician at once, the following treatment should be administered immediately.

1. A hot colonic flushing (See Appendix).

2. A hot bath followed by the hot blanket pack (See Appendix).

3. One drop of croton oil on a bit of sugar may be placed on the back of the tongue.

4. Chloroform may be administered, provided a competent nurse or other medical person is present.

The appearance of convulsions which have been preceded by one or more of the symptoms noted under the head of "toxemia," indicates that the patient has become so profoundly intoxicated and poisoned by the accumulating toxins, that the lives of both mother and child are jeopardized by threatened eclampsia. At such a time, the attending physician will immediately set about to bring on labor, and thus seek to empty the uterus at the earliest possible moment.

CARDINAL SYMPTOMS OF TOXICITY

Since toxemia (eclampsia) is one of the complications of pregnancy most to be dreaded, it is fortunate that it almost invariably exhibits early danger signals which, if recognized and heeded, would enable the patient and physician to initiate proper measures to avert danger and escape the threatened disaster. The presence of this toxic danger is indicated by the persistent presence of the following three symptoms:

1. Persistent, dull headache.
2. Presence of casts in the urine.
3. Persistent high blood-pressure, with tendency to increase.

Of course, albumin will probably appear in the urine along with the casts, but it is the continued appearance of the casts that is of more importance as a danger signal. Albumin is quite common in the urine of the expectant mother, but casts—long continued—suggest trouble. Headache as an indicator of toxemia is of special significance when coupled with the other two cardinal symptoms of eclampsia—urinary casts and increasing high blood-pressure. Therefore, the necessity for frequent urinary tests and blood-pressure examinations during the last weeks of pregnancy—especially, if the patient has suffered from headaches and has been running albumin in the urine.

HIGH BLOOD-PRESSURE

Blood-pressure is a term used to indicate the actual pressure of the blood stream against the walls of the blood vessels. The blood-pressure machine tells us the same story about our circulatory mechanism, that a steam gauge does about a high-pressure boiler (See Fig. 4). The normal blood-pressure varies according to the age of the patient. For instance, the normal pressure of a young person, say up to twenty years of age, runs from 100 to 120 millimeters of mercury; and then, as the age advances, the blood-pressure increases in direct ratio; for every two years additional age the blood-pressure increases about one point—one millimeter.

The average pregnant woman starts in her pregnancy with a blood-pressure of say, 125 millimeters, but as pressure symptoms increase, and as constipation manifests itself, and as the circulating fluids are further burdened with the toxins which are eliminated from the child, the blood-pressure normally increases to about 140 mm., and later, possibly to 150 mm. If the pressure goes no higher, we are not alarmed, for we have come to recognize a blood-pressure of 140 as about the normal pressure of the pregnant woman.

There are a number of factors which enter into the raising of the blood-pressure. For instance, at any time during the pregnancy, if the eliminative organs of the mother are doing inefficient work, if she falls a victim to a torpid liver, diseased kidneys, decreased skin elimination, or sluggish bowels, then, with the added and extra excretions from the child, there is superimposed upon the mother far more than the normal amount of eliminative work—and then, because of improper and incomplete elimination, the blood-pressure is increasingly raised.

ECLAMPSIA PREVENTED

This whole subject can best be illustrated by relating a story, the actual experience of Mrs. A. This patient came to the office with a history of Bright's disease (albumin and casts in the urine), and chronic appendicitis. While treating her for the kidney condition, preparatory to an operation for the removal of the troublesome appendix—in the very midst of this treatment—she became pregnant, and great indeed was our dismay. We entertained little hope of getting both the mother and child safely through. Frequent examination of urine was instituted, the albumin did not increase and the blood-pressure remained at normal—about 124 mm. She paid weekly or bi-weekly visits to the office and carefully followed the regime outlined. She drank abundantly of water and strictly followed the dietary prescribed. Weeks and months passed uneventful, until we approached the last six weeks of pregnancy, and then we found to our surprise one day that the blood-pressure had made a sudden jump up to 175 mm., while the urine revealed the presence of numerous casts and albumin—in the meantime the albumin had entirely disappeared. There were also other urinary findings which showed that the liver was not doing its share in the work of burning up certain poisons.

In her home we began the following program: Every day we had her placed in a bathtub of hot water, keeping cold cloths upon her brow, face and neck, and then, by increasing the temperature of the bath, we produced a very profuse perspiration. She was taken out of this bath and wrapped in blankets, thus continuing the sweat. All meat, baked beans, and such foods as macaroni and other articles containing a high per cent of protein were largely eliminated from her diet. At times she did not even eat bread. Her chief diet was fruit, vegetables, and simple salads, and yet the albumin and casts continued to increase in the urine and the blood-pressure climbed up to 190 mm.

As we approached the last two weeks of pregnancy, this little woman was taken to the hospital and systematic daily treatment with sweating procedures was begun. Among other things, she had a daily electric light bath. After each of these baths she was wrapped in blankets and the sweating continued for some time. Careful estimations of albumin were made daily and the blood-pressure findings noted three times a day. During the last week of pregnancy she lived on oranges and grapes. Day by day she was watched until the eventful hour arrived. She went into the delivery room and gave birth to a perfectly normal child. The albumin and casts quickly cleared up, the blood-pressure lowered, and today the little woman is a fond mother of a beautiful baby boy.

It is hard to estimate what might have taken place had not her elimination been stimulated. The blood-pressure was our guide. Had the albumin (without casts) appeared in the latter weeks of pregnancy with a blood-pressure of 140 or 150 mm., we would not have become excited, for the reason that in every normal pregnancy there is often present a trace of albumin in the latter weeks; but when the blood-pressure jumped to 170 or 190, then we knew that toxemia—eclampsia—convulsions—were imminent. So we have in recent years, come to look upon the blood-pressure as an exceedingly important factor—as an infallible indicator of approaching trouble—as a red signal light at the precipice or the point of danger; and it not only warns us of the danger, but it tells us about how near the boilers are to the bursting point. The glassy eye, the headache, the full bounding pulse and the blurring of vision, are all symptoms accompanying this high blood-pressure, so that in these enlightened days no practitioner can count himself worthy the name, or in any way fit to carry a pregnant woman through the months of waiting, unless he sees, appreciates, and understands the value of blood-pressure findings in pregnancy.