When the end of the attack approaches, the skin, which was dry, be comes covered with perspiration more or less abundant, the respirations become a little longer, more regular, the convulsions diminish in violence and frequency, first in the body and limbs, then in the face, the livid ap pearance disappears gradually, lastly in the face, where it may remain for snme time. The attack ends generally with a deep inspiration, followed by a slow and prolonged expiration. The ,patient sinks back in bed in a state of coma or stupor more or less pronounced. Whether there be one eclampsic attack or several, never does the patient regain her normal condition immediately after the attack, but she remains, for a given length of time, in a comatose state, with loss of intelligence and sensibility. But it is understood that this condition or state is less pronounced and long as the attacks are less violent, or as they have been few in number, and, finally, the further apart the attacks have been.
Generally, after the first attack, coma and stupor do not persist a long time. In a few minutes the breathing, which was noisy, becomes calm and regular. The patient, quiet and motionless, moves frequently in bed, opens her eyes, looks vaguely about her, withont knowing where she is, or why she is kept there, nor does she recognize those about her. Little by little consciousness returns, sensibility reappears, and, when the pa tient is spoken to, she tries to reply, and is not able to do so, on account of the mental disturbance which exists, and also on account of difficulty of articulation caused by the swelling and sensibility of the tongue. Slowly consciousness returns, but memory is still at fault, so much so that the patient has forgotten her pregnancy, her address or her name, and it is only after several hours that consciousness is more completely re stored, but memory returns only at the end of twenty-four to thirty-six hours or even more. At times, it is true, when there is only one attack, a normal condition is regained sooner, but this is rare, and usually the first attack is soon followed by another or several. The new attacks may be separated by shorter or longer intervals, and then, in the first instance, they come upon the woman when she is in the coma following the first attack; or, secondly, the woman may have regained consciousness, and have come out of her comatose state before the return of convulsions. Each new attack is preceded by a new period of excitement, and the scene is gone over again, with a severity proportionate to the number of the at tacks. As these attacks are renewed, the coma becomes more and more profound, and, in cases where they are renewed again and again, the patient passes from a comatose state into new attacks, and vice versa to the last.
But the attacks themselves vary in intensity. At times one or two vio lent attacks are followed by a lighter one, then there follows a more vio lent one. Sometimes two or three attacks follow each other in quick succession, then after an interval of half an hour or several hours; then the attacks are renewed with greater frequency and intensity. Sometimes the attacks come at regular intervals, five to ten minutes, every half hour, or every hour; at other times without regularity; at other times still, they are repeated with such violence and intensity that they do not in termit at all, but are continuous, and we believe these to be the cases, cited by certain authors, in which the attacks lasted ten to fifteen min utes, as in Tarnier's case. The tonic period is obscured by the incessant clonic convulsion, and this will explain the error into which these ob servers have fallen, when they give such a long duration to an eclampsic attack. The coma is always proportionate to the severity of the attack, and, when they are numerous, the woman, if she recovers, is always a longer time in coming out of the coma than when the attacks are few in number, and the interval between them long. On the other hand, if the attacks are long actd repeated, the coma is profound and persistent. It is often only at the end of twelve, twenty-four or thirty-six hours that the patient becomes conscious of what is going on about her.
The patient may be roused from her stupor for a moment, her eyes open, but shut again at once, the few words which can be drawn from her are incoherent, the movements, if any, are mechanical, and she soon relapses into the comatose state. The memory is the last to return, and this rarely takes place until three or fbur days have passed, the patient being only partially conscious of what is going Oil about her. As for the attacks, the patients are not at all conscious of them, and manifest some surprise at finding themselves in bed, and know nothing of their confine ment, which, as we shall see, may lutve taken place during the convul sion; and when they find themselves in the hospital, they ask why and how they have been brought there. When. on the contrary, they die, the coma becomes more marked, the breathing becomes stertorous, con sciousness and sensibility is entirely abolished, and death takes place, either in a new attack or before the patient becomes conscious. In some cases, the coma is interrupted by a certain amount of excitement, by cries; it would seem that the patient was going into another attack, but this is aborted, and she passes into a stupor which may yield in its turn or end in death.