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I have tears in my eyes and I am furious at the doctors who both stood there and did nothing!

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My prediction for the next few episodes....Mary and Matthew are drifting apart, and he has been so kind to Edith and interested in her writing. I think the writing is on the wall.

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Treatment

At the end of the 19th century and into the beginning of the 20th century, two very diverse approaches were used in the treatment of eclampsia. According to Chesley, physicians in Germany and the Netherlands advocated for aggressive management (e.g., prompt abdominal or vaginal cesarean section), but the associated maternal mortality rates were extremely high. As a result, a more conservative management gained popularity and was widely used up until the 1930's (Chesley, 1978; Chesley, 1984). Physician pioneers of this conservative method included Tweedy of Dublin and Stroganoff of Russia (Speert, 1958).

Tweedy's rationale for conservative management (as cited in Speert, 1958) was rooted in the belief that hastening of labor and delivery increased the occurrence of convulsions through the induction of reflex stimulation. Physicians were to abstain from vaginal examinations, abdominal palpation, massage of the kidneys, cold blasts of air, and the dilatation of the cervix in an effort to mitigate the risk of reflex stimulation. In contrast, his management plan revolved around patient sedation and included large doses of morphine. However, if a patient went into labor, he believed that the application of forceps was permissible given that the os would safely permit their application (Speert).

Because convulsions disrupted the functions of the heart, lungs, kidneys, and liver, Stroganoff'd main objective was to eliminate convulsions (Speert, 1958). He treated the eclampsia, ignored the pregnancy, and waited for natural onset of labor. All examinations and treatments were performed under light anesthesia and sensory stimuli were reduced by keeping the patient's room dark and quiet (Chesley, 1984). Morphine and chloral hydrate were administered to keep patients sedated and to decrease frequency of convulsions. To restore respiratory function, oxygen was administered. To restore cardiac function, digitalis was administered if the pulse was found to be rapid and weak after a seizure (Chesley, 1984; Speert). Labor was to progress naturally and once a woman's cervix had dilated to six centimeters, the membranes were artificially ruptured (Chesley, 1984).

In addition to the diverse approaches to manage preeclampsia-eclampsia in the 20th century, the use of magnesium sulfate was introduced. Although a mainstay of current treatment, it was not until 1906 that Horn first used magnesium sulfate to manage preeclampsia-eclampsia (Chesley, 1984). During the 1920's the parenteral use of magnesium sulfate in the treatment of preeclampsia-eclampsia was popularized by Lazard and Dorsett (Chesley, 1984), for Dr. Lazard's work (as cited in Gabbe, 1996) demonstrated that treatment with intravenous magnesium sulfate was both efficacious and safe.

Since the 1960's few alterations have been made in the management of preeclampsia. Such consistency can be observed by studying the obstetrical textbooks used to educate students within the healthcare fields. Routine prenatal care (e.g., routine blood pressure measurement, urinalysis, maternal weight) remained a hallmark surveillance method since early signs and symptoms of preeclampsia may not be readily recognized by pregnant women. Once diagnosed with preeclampsia, management consistently included hospitalization, frequent blood pressure measurement and weighing, urinalysis, bed rest, fetal surveillance, and assessment of maternal headache, blurry vision, and epigastric pain. With fulminating preeclampsia or the development of eclampsia, magnesium sulfate and antihypertensives were administered over the later part of the 20th century to prophylactically prevent or manage convulsions and acute hypertension, respectively. Ultimately, the decision to proceed with a vaginal delivery or cesarean section depended on a myriad of factors, including gestational age, condition of the cervix, and maternal and fetal condition (Eastman & Hellman, 1966; Hibbard, 1988; Pritchard & MacDonald, 1976).

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I think they all deserve some kind of award for the death scene, though. That was one of the most heartbreaking scenes I've ever seen on a screen. And then in the servants' hall when they got the news ... their faces. Just heartbreaking.

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The whole "must be stoic" thing is grating on my nerves. Fall apart for goodness sake!

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