In this case there is either abortion or premature labor, or labor at term; and this confinement may either lead to a favorable ending of the cere bral affection, or, on the contrary, may aggravate and hasten the death of mother and child. The following are, according to him, characteristic symptoms, which enable us to differentiate these two eclampsias.
In making a division so well marked Cohen goes much too far, but, without sharing his views, one must confess that eclampsia is far from being always the same in its characteristics, and, while preserving its gene ral characteristics, the attacks may vary in different women, or even in the same. How, on the one hand, can the attack, so frequent in some women, be explained, and so rare, on the contrary, in others? Why, in. some women, does labor come on after a few attacks, while in others, who have a great many attacks, labor does not come on ? Why does the child die so quickly in some cases, and in other c,ases survive so long .? Why do certain women die after 8 or 10 attacks, and others have 30, 40, 50, 60 or 100 attacks or even more, and still live, as has been shown by Pajot and Bailly ? These questions are so numerous that it is impossible t,o answer them definitely.
1st. Eclampsia is due to an Alteration of the Nerve antres and their Envelopes.—Supported by Marchal de Calvi in 1851, this theory has against it, as Hypolitte has observed, the results of autopsies, for the lesions met with do not, as a rule, exist in the spine, the medulla, or the tubercula quadrigemina, which, according to physiologists, are alone capable of producing the convulsions. Coindet and Odier, Grisolle, Hardy and Behier, Graves, Cahours, explain the encephalopathy by hydrocephalus; Owen, Rees,Traube, as cerebral oedema due to Bright's disease, and the experi ments of Munck (who injected water into the carotids, first having ligated. the ureters and jugular veins), seems to confirm this view. Otto, Bidder, performing these experiments, without ligating the uret,ers or jugulars, have shown that the increase of pressure did not produce the convulsions, and that there must be concomitant hydrcemia. It is on this fact that. Traube buses his theory of cerebral cedema with subsequent acute ana.-.' mia. To explain this cerebral (edema, Traube invokes first, the hydne mia shown to exist by Andra], Gavarret, Devilliers and Regnault; and secondly, an increase of the intra-vascular pressure, due to the cardiac hypertrophy of pregnant women, and the increased tension of the cerebral vessels, produced by the pressure of the uterus on the abdominal aorta at the end of gestation.
Hypolitte says, that there are certain forms of eclampsia, which seem at first sight to justify this theory. " Those, for instance, where the urine is diminished to 1500 grains per day. This urine is concentmted, and the dropsy (oedema) diminishes generally before the cerebral complications appear. Dropsy then spreads from the lower extremities to the bniin. This is the mechanical unemia of Jaccoud; but, as Hypolitte has observed, hydrocephalus, and (edema of the brain or its membranes, far from produc ing excitement or twitchings, seem, on the contrary, to produce weak ness. Convulsions are not the result, but paralysis." Nevertheless, Traube's theory, if it does not apply to all cases, may at least explain a great number, for it is supported by undoubted clinical facts, and we can not compare, as Hypolitte has done, the acute cedema of Traube to the chronic cedema of the paralytic.
2d. Eclampsia i8 due to a Cerebro-spinal Congestion.—Originated by Mauriceau, defended by Levret, Broussais, Blot, Peter, this theory is denied by Hypolitte, Testut, Depaul, who consider the cerebral conges tion and cerebral hemorrhage, which have been found on autopsies, the result and not the cause of convulsions. We -will see further on that the course of the temperature, very different in cerebral hemorrhage and in eclampsia, justifies the opinion of the latter authorities. But is not the eclampsia due to a rachidian hyperzemia, resulting from an irritation of the cerebro-spinal system, or the sensory terminal filaments ? This brings us to the third theory.
3d. Eclampsia is a Neurosis, by a reflex Irritation of the spinal System, whose Point of Origin resides in the Uterine Pains. —This is the opinion, formally upheld by Tissot, Cullen, Vogel, Sydenham, Sennert, Jacque mier, and revived by Dubois, Scanzoni, Axenfeld, Marshall Hall, Tyler Smith, Fleetwood Churchill, and refuted by Depaul, Bailly and Hypolitte.