re.ality, there is only here a misunderstanding, and the difference of opinion is not as great as would seem at first sight. We consider eclamp sia as closely allied to albuminuria. Now all authors agree on this point: that the albuminuria of labor is more frequent than the albuminuria of pregnancy, that it is at the same time more serious. It is not remarka ble then that eclampsia shows itself more frequently during labor. But, on the other hand, under the name of albuminuria of labor, authorities generally mean that which appears during the two or three days before labor, days which correspond .to the period which Millet calls the period of secret labor, and these days belong as much t,o pregnancy as to labor.
'As a rule, further, labor comes on at the end of a certain number of eclampsic attacks; and lastly, delivery does not always suppress these at tacks, which are then seen to return either in greater or less numbers than before delivery. Hence the differences of opinion. Group the attacks together, and the eclampsia of labor becomes the much more fre quent. If we separate, on the contrary, the three periods distinctly, Bailly gets nearer to the truth, which appears to us to be the division which we have given—Labor, pregnancy, puerperal state.
This seems to be the result of the various statistics in the following table, which we have taken from Wieger.
Thus, in a total of 455 cases of eclampsia, 109 occurred before labor, 236 during labor and 110 after the birth of the child.
Jacquemier found 99 cases during labor,. 53 cases during pregnancy, 45 cases after labor. Depaul confines himself to cases before and after labor, and in 133 cases there were 106 cases before labor, and 77 after labor. Of the 77 cases, in 9 only did the attacks appear first after labor, with out giving any signs of eclampsia before labor.
In 62 cases there were attacks before labor which continued after. In 11 cases the attacks, which existed before and during labor, were not pro duced after labor. The other cases refer to women brought to the Clinic, without information concerning the possible attacks before labor. The following then are the figures: In 133 cases attacks before labor, 106; after labor, 77; first eommenc ing after labor 9; ceasing after labor, 11; before, during, and after labor, 62.
It is rare before the sixth month; although Danyau has seen a case in the sixth week; Bach in the sixth week; Prestat in the second week; Morel d'Argentan in the fourth month; Carville in the fifth month; Charpentier in the fifth month; Cohen fifth and sixth month; Deviltiers and Regnault sixth month. The rule is that eclampsia manifests itself from the seventh to the ninth month, particularly a few days before labor.
As to the appearance of eclampsia after delivery, as a rule, tbe attacks are only the prolengation of those which existed during pregnancy, but even then the attacks may be immediate or a few hours after confine ment. We have seen one case in which the attacks came on after a lapse of twenty-four hours. When the attacks come on for the first time after labor, they may be at a greater or less interval after labor. Wieger in 44 cases has noted the following in regard to commencement: At the end of 4 hours, 8; 12 hours, 2; 24 hours, 1; 48 hours, 3; 4 days, 2; 10 days, 1. The invasion may, however, be much more slow. Thus: Ramsbotham has seen it 7, 9, 10, 18 days after labor; Ducheck at 10 and 14 days after labor. The women remained hemiplegic.
Cazeaux has seen it 8, 10, 12 days after labor; Charpentier at 17 and 19 days; Tissier at 17 days; Bailly at 29 days; Simpson at 8 weeks. (Died.) In 1872, we analyzed 133 cases collected in the Clinic by Dr. De Soyre, and these are the figures for the time of pregnancy at which the attacks showed themselves.
Causes.—A great fact governing all causes of eclampsia, is the almost constant presence of albumin in the urine of the patient. Excepting, - indeed, a certain number of cases of albuminuria, which we cited above, albumin is always found in the urine of eclamptic cases, and these cases are too few in number, compared with the others, not to be taken as ex ceptiens, and still, as Cazeaux says, all are not absolutely authentic.
The quantity of albumin found in the urine increases a great deal dur ing the attack, and diminishes usually afterward.
Aside from this great primary cause, authors have noted the following: Manner of Living.—Young mothers are more subject to it than others, but, as Wieger observes, poverty may contribute to it, particularly grief, and the more so as the primipara3 are young mothers.
Epidemics. —This inference is admitted by Wieger, Mende and Man sell, who base their judgment on. the frequency of eclampsia at certain times, as observed by authors; but the epidemic influence of eclampsia seems to me to belong in the. same category as the influence of seasons and imitation.
Age. —This does not appear to have any great influence as a cause, although it is between twenty and thirty years that eclampsia is most frequent, but this is not surprising, since it is at this age that women are more likely to become pregnant.
In 148 cases, Wieger found 37 cases from 15 to 20; 63 cases from 20 to 25; 26 c,ases from 25 to 30; 20 cases from 30 to 40, and 2 cases from 40 to 46.