Introduction, History, Controversies, and Definitions

Several German authors, such as von Siebold, Knapp, Kossmann, Fasbender, Fisher, and Bernhart have written on the history of eclampsia, but all too often they did not document their sources and made errors that live on in second-, third-, and nth-hand reviews. Bernhart wrote that eclampsia was mentioned in the ancient Egyptian, Chinese, Indian, and Greek medical literature. One of the oldest sources that he cited, without specific reference, was the Kahun (Petrie) papyrus dating from about 2200 BC. Eclampsia was not differentiated from epilepsy until 1739, and the distinction was not generally accepted for another century. Merriman discussed dystocia convulsive but 25 years later his countryman Churchill, in his Theory and Practice of Midwifery (1856), classified gestational convulsions as hysteric, epileptic, and apoplectic. Classifications of the hypertensive disorders in pregnancy are of relatively recent origin. Women with prodromal signs of gestational or puerperal convulsions were designated as having threatening or imminent eclampsia, but a specific name of the condition was long delayed. During much of the latter half of the 19th century, eclampsia was thought to be uremic Bright's disease and women with proteinuria and edema were thought to have nephritis, although a few authors simply called it “albuminuria,” a term that persisted for many years in England. Until the 1990s, literature regarding measurement of blood pressure in pregnancy was quite confusing. There was no unanimity regarding the preferable posture for testing the subject, and most important which Korotkoff sound, K4 or K5, was the appropriate measurement of diastolic pressure in pregnant women.