1. Choleraic Eclampsia.—It is always joined to acute yellow atrophy of the liver, to typhoid icterus, to premia and to puerperal diseases. It is always accompanied by fever, and the diagnosis ought always to be based on the diminished size of the liver, made out by percussion.
2. Hysteria.—The convulsions of hysteria come on during very difficult labors. The urine never contains albumin. Consciousness is always pre served, if not wholly, at least very appreciably; sensibility may be lessened, but preserved. Hysterical convulsions are always accompanied by other phenomena—globus hystericus, oppression, dyspncea, etc., but there are neither " tonic nor clonic " convulsions. During the attack, there is a tendency to loss of consciousness, but there is no coma after the attacks, which end usually by the passage of clear urine, limpid, not albuminous. These attacks do not interfere with the course of pregnancy.
3. Epilepsy.—The convulsions are chronic; they come on during preg nancy, at intervals of several days or weeks, but very rarely several times in the same day. There is no albumin in the urine. The attacks are often preceded by an " aura epileptica." Epilepsy is, moreover, charac terized by insensibility, and it is not rare to see consciousness return very quickly and rapidly after the attack. Further, in epilepsy, reflex sensibility coincides with loss of consciousness from the beginning to the end of the attack. But it is the disease which most nearly resembles eclampsia, for in epilepsy the attacks have a period of tonic and clonic spasm, and also of coma; but the prodromata, and the absence of albumin in the urine, are the diagnostic peculiarities. We may add that, except the aura, epi lepsy never presents the prodromata which are seen in eclampsia, and that the infiltration which is so frequently found in albuminuria and °clamp sia is never present in epilepsy.
4. When the woman is comatose, the diagnosis must be made between coma of epilepsy, apoplexy, cerebral hemorrhage, and the coma of alcohol ism.
(A). Coma of is very difficult, if one has no information, to make a diagnosis between coma of epilepsy and that of eclampsia. The examination of the urine may remove all doubt; besides, the coma of eclampsia always lasts longer, is more persistent than that of epilepsy. Whilein the latter consciousness may be recovered completely, in eclamp sia consciousness comes back only slowly, at first incompletely, and the patient remains more or less time in a state of discomfort, which does not exist in epilepsy. Memory comes back much more slowly, and the
persistence of disturbances of one or more of the senses are often noticed— hearing or sight. Finally, it is not rare to see mania, paralysis, etc., fol low eclampsia, which does not happen in epilepsy.
(B). Cerebral hemorrhage is accompanied by hemiplegia, no albumi nuria.
(C). Coma of drunkenness (alcoholism) is diagnosticated by the odor of the breath, and by the nature of the vomited material which is noted in these cases. There is no albuminuria.
(D). But with epilepsy, which is the disease most commonly confounded with eclampsia, lead poisoning must be mentioned. The latter is accom panied by nervous phenomena similar t,o those of puerperal eclampsia; attacks of convulsions, coma, albuminuria like that of nephritic albumi nuria; but, as Depaul says, who has observed a remarkable case, the coma is not as deep—the loss of consciousness exists, but insensibility is not completely lost. The eyelids and the lips twitch, and there are convul sive movements, but the head retnains fixed, the other muscles of the face are not convulsed, and the tonic and clonic spasm are incomplete. Fur ther, the lead line of the gums aids the diagnosis, whicll is furthermore assisted by the information drawn from the patient. In Depaul's case, the autopsy revealed the presence in the bmin of fifteen grains of lead. In this c,ase the diagnosis was facilitated by the absence of infiltration, and also the absence of albumin in the urine.
We only mention here meningitis and chorea, which are distinguished by such characteristics that an attentive physician cannot be mistaken; The application of the thermometer to eclampsia gives to-day a much greater precision in the diagnosis, which is remarkably facilitated by the study of the temperature. Thus, in eclampsia the temperature rises gradually and rapidly from the beginning of the attack, and it continues to rise even after death. (109.2°4 In urwmia, the temperature falls from the beginning, and continues to fall gradually until death, when it May descend even to 98° F. In some cases, however, the temperature stays high at the beginning, but always falls the following day.