PRIMIPARTTY.
This is, without doubt, the most frequent predisposing cause. Most authors will agree in this. Thus 161 multipara3 against 522 rimiparin, or 3.22 primipara3 to 1 multi para.
This proportion would be too low for Madame Lachapelle, who puts it as high as 7 primipara3 to 1 multipara. Usually women who have had eclampsia in their first confinement, are secured from having it in subse quent confinements, but it is not always so, for Collins, Devilliers, Schwartz, Johns, Braiin, Dewees, Ramsbotham, Litzmann, have reported cases.
This is not surprising. If we admit the relation of albnminuria to eclamp sia, albuminuria does not always appear in subsequent confinements, and the women escape eclampsia; if, on the contrary, albuminuria does reap pear, nothing is more natural than to have eclampsia also. This explains cases apparently irregular, in which the first pregnancy, being compli cated by eclampsia, a second is passed without any accidents, which, how ever, appeared in a subsequent pregnancy. Cases are seen in which a woman escapes eclampsia in her first confinement, and has it in her second, third, fourth and even the eleventh, as Dumont has stated.
Distension of the Uterns.—Along with primiparity, which acts, accord ing to many, through the great resistance of the uterine fibres, must be placed excessive distension of the uterus dependent upon the large size of the child, twin pregnancies, hydramnios; finally, different cause,s whose action is much less evident, i.e., erosions, fright, indigestion, and retention of urine.
The Length of Labor.—Labor may be prolonged by the causes given above, by mechanical causes, deformed pelvis, uterine and abdominal tumors. The influence of the length of labor in the production of eclamp sia is undisputed. But eclampsia, we have seen, is produced often dur ing pregnancy, and, when labor comes on in these cases, it was gener ally rapid, unless there was some mechanical obstacle; and one of the proofs that eclampsia is not always connected with labor, is, that there are a great many cases in which eclampsia, coming on during pregnancy.
has not brought about confinement, which only takes place latter. Most often the child dies, the eclampsia ceases, and the woman is delivered later of a dead child, changes in which are the more pronounced the greater the length of time between its death and its expulsion. We have had one case in our Clinic. The woman was confined eight days later; and to this case we can add those of Lever, Litzmann, Wegscheider, Lachapelle, Boer, Braun, Lauer, Mauer, Rodenstein, Baschwitz; and finally, Simon,Devilliers and Regnault, Blot and Wieger, have cited eases in which the eclampsia came on during pregnancy, did not bring about labor, and in which the women were delivered later of living children. In each of these cases the eclampsia was reproduced neither during labor nor after confinement.
What are then the determining causes of eclampsia? We must remem ber here all the e,auses we mentioned under albuminuria, i.e., alteration of the blood, increase of blood pressure and renal lesions, etc., but if those theories account for albuminuria, they do not suffice to show why eclamp sia occurs in certain cases, and why it is wanting in others, and so the aim has been to discover the true cause of eclampsia; hence the new theories which Bailly classifies under the following heads: Eclampsia is due: 1. To a structural change in the nerve centres and their envelopes; 2. A cerebro-spinal congestion; 3. Eclampsia is a neurosis, caused by a reflex irritation of the spinal system, originating in uterine pain; 4. To a gen eral or cerebral anzemia; 5. To a condition of the blood which renders this fluid less ready to stimulate regularly the nerve centres (uramia, ammontemia, urintemia.) Depaul and Hypolitte have endorsed these divisions of Badly. All of them we think are open to objections more or less grave. As Cazeaux has stated, all these causes may act in producing an irritation Qf the nerve centres, and Scanzoni has already tried to show that this convulsive attack is due to an excitation, an irritation of the peripheral nerves, and of those of the spine or bluin.