Course and Duration.—Eclampsia, on account of the rapidity of its course and its gravity, should rank among the acute diseases. It is rare for it to last more than two days without ending in a cure, or in compli cations winch may lead to death; but the course of the disease may pre sent numerous varieties. First, the number of the attacks, which in some women are limited to two or three or even one, may reach in others to 100 (Rainy, Pajot) or 160 as Crettet observed. The intervals between the attacks are not fixed. and the attacks themselves, which are renewed with a sort of mathematical reralaritv, mav. on the other hand, be very irregular. At times. several attacks occur one after another, and a long interval passes without an attack. when they occur again with renewed violence. In some paients the attaok appears over, when. at the end of twelve, eighteen, twenty-four, forty-eight hours. a new attack appears. and this explains why certain authors have described the startling and very sharp forms, and those relatively slow. Paul Dubois goes farther when he says that one of the dangers of eclampsia, once declared during pregnancy, is that it will reappear until term. But this must be very rare, for where eclampsia, which occurs before term, ceases in a few days, it reappears no more even at the time of confinement, or else, as a rule, it induces premature labor. The attacks themselves present many varieties; sometimes few, with long intervals, or at other times slight and frequent. Often they have this character during labor. The latter ended, there is ate interval of repose, aild the attacks are renewed with a fatal result. At other times, instea,d of beginning with the uterine con tractions, the attacks come on before labor, cease when it begins; then labor is arrested, the attacks come on again; at other times there is an attack at each contraction.
Termination.—Eclampsia may end in cure, in d.eath, or in the develop ment of another disease, the result of the convulsions. Cure, however, is happily the most frequent termination, although the mortality is very great. When the case is going to end happily, one of the signs that is noticed after the cessation of the attack is the progressive diminution of the albumin which the urine contains, and its complete disappearance at the end of a time which may vary from several hours to several days. Gen erally it is in the first two or throe days that this disappearance is noticed, and, at the same time, the urine, which was almost wholly suppressed during the attack, and likewise cloudy, takes on again, little by little, its normal quantity and appearance. Then consciousness gradually returns, but it is not rare to see it remain for some time, sluggish and troubled. It is the same with memory and disturbances of vision, but generally all complications cease in the fortnight after confinement, and the patients recover their health almost entirely, save a feeling of feebleness and fatigue, which may last much longer.
Unfortunately it is not always so, and death is too often the end of eclampsia. At least statistics go to show it: General Mortality qf Eelampsia.—Lachapelle and Romberg, 50 per cent.; Devilliers and Regnault, 55 per cent.; Brummerstadt, 37 per cent.; Dohrn, 29 per cent.; yerriman, 22 per cent. Churchill, 27 per cent.; Lever, 28 per cent.; Collins, 16 per cent.; Ramsbotham, 16 per cent.; Murphy, 24 per cent.; Blot, 35.5 per cent.; Wieger, 30 per cent.
According to Kiwisch, one-third of the women attacked by eclampsia die during the convulsive period, and one-third of those who survive are carried off by secondary puerperal complications. In 318 cases collected by Wieger there were 96 deaths. In 60 the CA11180 was as follows: 41 women died from eclampsia, and 19'from complications.
Death may occur in different ways. 1st. Death may come on before, during or after confinement, and then it is due, either to the attacks themselves or to the consequences of the attack, or to the sequeltv.
When death comes on before labor, it is either during the attack, and although rarely, it has been observed by Baudelocque, Kiwisch, Prestat, Depaul; or else, and this is the rule, it may come on during the period of coma. Ordinarily, after a certain number of attacks, labor comes on, and then, indeed, death may take place either during labor in an attack, or after labor in another attack, or, as a rule, during coma. Pulmonary complications are very common, and may carry off the patient; also pul monary cedema, congestion or apoplexy; death, even, may result from cerebral apoplexy or paralysis produced by congestienowhich in turn re sults from disturbances of respiration and circulation. or by extra-asations into the cranial cavity, which may be either serous or bloody.
Litzmann and Bratin attribute the cause of death either ummie poisoning, i.e. , to the toxic influence of the blood on the nervous system, or to secondary lesions of the brain or lnngs. The apoplexies into the cranial cavity or tissue of the brain have been noted by Chaussier, Vel peau, Meniere, Larcher, Dues, Prestat, Bailly, Depaul, Charpentier, and Moles, who has in his thesis collected five to six cases. Blot and Molas have noted hemorrhages in the liver. These hemorrhages are not surpris ing, for since Blot noted the frequency of hemorrhages in connection with albuminuria, all authors have noted similar cases.
Hamilton, Baudelocque, Miguel, Scanzoni, Cazeaux have reported cases of rupture of the uterus during an eclampsic attack; and Bailly has seen death in one case due to the swelling of the tongue, produced by blood ex travasation into the organ, the result of the deep bites inflicted during the convulsions. In these cases, death is no less rapid, and, in general, the women die in twelve or twenty-four hours or more after the last attack.