Eclampsia historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Importance of Historical Perspective
The importance of historical perspective lies in the fact that our current understanding of pathophysiology, classifications and management strategies is influenced by past hypotheses and scientific contributions, which have also shaped our current practice trends. [1]
Origin
The term is derived from Greek and refers to a flash, a term used by Hippocrates to designate a fever of sudden onset.[2]
Historical Perspective
Over time various theories and treatments based on those theories have been proposed.
Ancient Times
Theories
- THEORY OF FOUR HUMORS
- WET AND DRY THEORY
- Women’s skin was considered wet, porous, and soft and it was thought that she could accumulate lots of moisture which resulted in an overabundance of fluids and led to illness. [4]
- WANDERING WOMB THEORY
- Hippocrates believed that dried up uterus wandered the body in search of moisture, and as it wandered the body, it could wreak havoc upon the liver, spleen, lungs, and head, leading to disease.
Treatments Offered
Treatment directed towards the restoration of internal equilibrium by mechanisms that increased elimination of excess fluids and could consist of:
- Altered diets
- Purging
- Blood-letting
Middle Ages
During the middle ages, between 400 CE and 700 CE, scientific progress, especially medical, came to a standstill as the Christians were opposed to human science and dissection. many medical schools were closed, such as at Athens and Alexandria. Hence, the main focus was on the compilation and rewriting. Later, the Christian influence began to decline and new theories emerged. In 1619, the word "eclampsia" first appeared in Varandaeus' treatise on gynecology.[5]
Theories
- DOMINANT HUMOR THEORY
- One theory that emerged suggested that one humor dominated the other humors and controlled an individual's physical and emotional characteristics, and was responsible for the signs and symptoms of eclampsia.
- MAURICEAU'S THEORY
- In 17th century, when medicine gained momentum again, Francois Mauriceau helped establish obstetrics as a specialty. He was the first to systematically describe eclampsia,[6] and to note that primigravidas were at a greater risk for convulsions compared to multigravidas. He attributed convulsions to either suppressed lochia flow which could lead to inflammation, pain in the head, convulsions, suffocation, and death, or intrauterine fetal death which could lead to foul-smelling humors and predispose a woman to convulsions.
Treatments Offered
Increasing Christian beliefs greatly influenced treatments which consisted of charms, amulets, prayers. However, as time passed treatments offered in ancients times were again practiced, such as phlebotomies.
18th and 19th Century
Theories
- In the 18th century, Bossier de Sauvages discerned eclampsia from epilepsy and believed that convulsions transpired due to nature trying to free the morbid elements from the organism. [7][1]
- In the 19th century physicians continued to propose more theories. Dr Thomas Denman(1821) in his work entitled "Introduction to the Practice of Midwifery", concentrated on labours affected by convulsions. He attributed convulsions to specific customs and behaviours analogous to living in big cities and towns but also noted that the largest risk came from the uterus. According to him, expansion of the uterus during pregnancy placed considerable pressure on the descending blood vessels, resulting in regurgitation of blood in the head and overload of cerebral blood vessels resulted in convulsions.[1]
- Dr William Tyler Smith(1849) in his work, “Parturition and the Principles and Practice of Obstetrics” challenged Denman's notion of cerebral congestion. He speculated that pregnancy was a state of increased fullness in Circulation. Dr Smith pointed out that if cerebral congestion was the rationale for seizures more cases would be anticipated during the second stage of labor as contractions during the second stage would interfere the most with the circulation of blood. He proposed other rationales such as:
- mechanical or emotional stimulus applied to the spinal cord
- variations in the wind, temperature, other atmospheric alterations
- bloodletting
- irritation of the uterus, uterine passages, intestinal canal, and the stomach
- the toxic elements
- SMITH'S THEORY OF TOXIC ELEMENTS: Dr Smith speculated that the health of the pregnant woman depended on the exponential increase in the elimination of the waste elements, such as secretion of the bowels, and debris from the maternal and fetal system. Failure to eliminate such wastes could result in "toxemia", in which morbid elements accumulate in the system and could irritate the nervous system.
Treatments Offered
References
- ↑ 1.0 1.1 1.2 Bell MJ (2010). "A historical overview of preeclampsia-eclampsia". J Obstet Gynecol Neonatal Nurs. 39 (5): 510–8. doi:10.1111/j.1552-6909.2010.01172.x. PMC 2951301. PMID 20919997.
- ↑ Chesley LC. Hypertensive Disorders in Pregnancy, in Williams Obstetrics, 14th Edition. Appleton Century Crofts, New York (1971), page 700.
- ↑ Demand N. Birth, death, and motherhood in classical Greece. Baltimore, MD: The John Hopkins University Press; 1994. [Google Scholar]
- ↑ Green MH. Unpublished doctoral dissertation. Princeton University; 1985. The transmission of ancient theories of female physiology and disease through the early Middle Ages.
- ↑ Ong,2004
- ↑ McMillen (2003)
- ↑ temkin,1917