In epilepsy,' under the influence of an attack, the temperature rises slightly, but the highest point is 101.4°—the rule is 100.2°. The attack ended, the temperature falls, only to rise again at the beginning of a new attack. In epilepsy, the temperature curve is the same as that in puer peral eclampsia; it rises gradually, stops, and descends graduany after the attacks. It is then by the previous history, and above all by the absence of albuminuria, that the diagnosis is made. But when the epileptic attack presents the two periods, convulsive and meningitic, described by Dela siauve and Bourneville, at the beginning there is an elevation of temper ature, then a depression, which is succeeded by a sudden elevation to 104° to 105.3°.
In hysteria and hystero-epilepsy the tpmperature rises during the at tacks, but where the attack is over, it descends again gradually to the normal.
In lead poisoning the temperature follows the same course as in epilep sy, moreover the pulse is tricotic. In cerebral disturbances the tempera ture does not rise.
Cerebro-spinal Meningitis.—The pulse is slow, and the temperature pre sents morning remissions and evening exacerbations. Finally, in the coma tose period of cerebral hemorrhage, there is an initial lowering of the temperature, and then a much greater elevation as the disease is going to end fatally.
Grebrai Concussion.—There is always a lowering of the temperature.
It is not necessary to quote a large number of statistics of the mortality of women in the puerperal state to establish the seriousness of this disease. We must, in order to make our prognosis, seek, in the circumstances which accompany eclampsia, or in which it is produced, the elements for our prognosis, and finally determine what may be the consequences for mother and child. We think•that eclampsia shows itself in this oqler of frequency: 1st. During labor. 2d. During preg nancy. 3d. During the puerperal state. Is eclampsia equally serious during these three periods, or is it more serious during one than during another ? First of all, it is a fact admitted by all authorities that de,ath rarely takes place during the attack, and that it is, generally, during the coma tose period or in consequence of puerperal complications that the fatal issue manifests itself.
Contrary to the opinion of Cazes,ux and Ramsbotham, who consider eclampsia more fatal when it occurs during the puerperal state, Depaul and Mme. Lachapelle believe the mortality greater when the convub3ions
oc,cur during pregnancy or labor. Here are the statistics of Wieger: Wieger hence agrees with Depaul. If the mortality of eclampsic women before and at term be compared, we find: . .
Beyond this last number, which varied from 50 to 100 or 160, accord ing to Bailly, Cretet and Depaul, we can ma,ke no statement, the number of cases being too small; the patients of Bailly and Pajot were cured.
We say, therefore, that the number of the attacks has a marked influ ence, because the mortality is increased with the number of the attacks; and since it has been proved that the number of the attacks is far from be ing proportional t,o the renal lesion, one is forced to a,dmit that the at tacks themselves have some influence.
The information derived from the thermometer ought to be a help in making a prognosis. But it is not the maximum temperature which ought to guide us, although it has some importance. (All the women, indeed, who have died, have had a temperature as high as 105.4° or higher, except two. In women who have been cured, the temperature has re mained below 105.4° except two, in which cases the temperature reached this point). It is the course of the temperature which enables us to make the following propositions: 1. Whenever the temperature, after having followed the ordinary course, i.e., elevated, which is usual in puerperal eclampsia, falls slowly and gradually, a favorable prognosis may be given. 2. If, on the contrary, the temperature continues, and gradu ally increases and becomes very high, 105° to 106°, an unfavorable prog nosis can be given, for, in these cases, the eclamptic attack usually ter minates in death.
The liyinenee of Eclampsia on the Course of Preputncy, and conse quently on the Fa3tus.—Thia influence is gloomy, and in the great major ity of cases, women attacked with epileptiform convulsions are confined preraaturely. (Depaul.) Cohen has gone too far in affirming that he ha,s never found albumin in the urine of any pregnant woman, unless the pregnancy was interrupted in its regular course. Blot has proved how exaggerated this opinion is, by showing that in the albuminuric women examined by him, 34 went to term, 7 only had premature labors. But in those cases, it was a question of albuminmia and not of eclampsia, which has a differently marked influence.