Symptoms.—Although eclampsia sometimes developes suddenly and sharply, surprising the patient as an epileptic attack, this is not the rule,and, most commonly, the attacks come on after a prodromic stage, but the pro dromata themselves present certain differences, occasionally being faint, at other time,s they come on just before the attack. They are cephalalgia, disturbances of vision, epigastric pain, dyspncea, vomiting, insomnia, ver tigo and excitement.
Among the slight prodromata must be noted insomnia, or, on the con trary, deep sleep, excitement, vertigo; the latter may be accompanied with a dullness of the intellect, more or less marked. The patient seems sim ply to exist, scarcely interesting herself in things about her, answering questions more or less correctly. She seems to live in a sort of trance, a physical and moral apathy. She complains of vertigo, transient dimness of vision, and, above all, of head-ache more or less severe, situated gener ally in the back part of the head, rarely in the occiput, sometimes in the temporal region. This head-ache, which is at first transient, and appears only occasionally, becomes day by day more persistent, more fixed, more •intense, and finally continuous, and 'when the attack is near at hand the head-ache becomes so intense as to be unbearable. Then vomiting appears, which may be bilious or stercoraceous, and may reappear suddenly in some women who have been free from it for some time.
Next appear the prodromata which indicate that the attack is immi nent, i.e., disturbances of vision, epigastric pain with or without dyspncea. The disturbances of vision, although being an indication of an impending attack, may come on beforehand, but then, usually, they are not well marked. They accompany then the head-ache, and are confined to a little disturbance of sight, and fatigue, which prevent the patient from read ing or amusing herself. But when they come just before the attack, they are more marked, and the disturbances of vision are observed, i.e., am blyopia, diplopia, and even complete blindness. At the same time, the head-ache becomes more marked, and the patient goes into a state of pro found stupor, which had been slight up to this time. To the disturbances of vision are often added a sharp epigastric pain, sometimes so violent that the patient cries out. This pain, this epigastric oppression, may accompany dyspncea, although this sometimes precedes the epigastric .pain.
Epigastric pain, disturbances of vision and dyspncea, are the three symptoms which announce the onset of eclampsia, and which may pre cede it by a few hours, but sometimes come on only a few minutes before the attack.
In spite of the disturbances of vision, the ocular media remain trans parent, excepting a little congestion of the ocular conjunctiva. on a level with the oculo-palpebral fold, but it is only after an attack that we find retinal lesions, hemorrhages and congestion, which often, however, may be wanting.
Wieger claims that the frequency of the prodromata is not the same, according as the eclampsia occurs before, during or after confinement. Eclampsia of pregnancy will have prodromata in 40 per cent. of the cases; that of labor in 30 per cent., and that of the puerperal state in 20 per cent
Attacks of eclampsia are not all alike, and if, in most cases, the move ments are not increased, and do not require a great amount of power to restrain the patient, at other times, on the other hand, the patient is greatly excited, so that we can, with difficulty, prevent her from falling or throwing herself out of bed.
The attack finally comes on and may be divided into three periods: 1. The period of invasion; 2. The period of tonic convulsions; 3. The period of clonic convulsions.
1. The Period of Invasion.—All at once the eyes become fixed, there follows a moment of quiet, and the attack begins by convulsive movements of the face, which is contracted in a thousand ways and makes horrible contortions. The eyelids fall and rise through rapid twitchiugs, and the eyes, drawn by the convulsive movement of their muscles, roll in their orbits, drawn sometimes one way, sometimes another. The pupil is dilated, • immovable, insensible to light, the ocular conjunctiva is insensible to stimulation and to light, and finally the eye, drawn upward by the levator muscles, partly disappears behind the upper lid, leaving in view only the lower segment of the sclerotic, and a very small part of the pupil. It lastly remains fixed on that side of the orbit toward which the commissure of the lips is drawn. These aro not slow in taking part in the convul sions; the mouth, more or less distorted, deviates strongly to the left side, as a rule, and the head being rotated, the face to the left side rotates back again to the right shoulder, and finally, it is directed to the left; the alae of the nose, strongly pinched and contracted, draw down, and _ towards the lower part of the nostril& 2. Period of Tonic Convulsions.—From the head, the convulsions extend to the muscles of the neck, of the body, and the limbs, which are greatly contracted. The extensor muscles of the neck and trunk produce a curve of the spine, with the concavity turned backward, and the patient, raised up by the contraction, only rests on the bed by the head and lower limbs, in a true state of opisthotonos, the whole body being rigid. At the same time, the arms are stretched and rigid, undergoing a marked movement of pronation, while the fists are closed, and the thumbs turned into the palm of the hands, which cannot be opened. The diaphragm, the muscles of the thorax, take their turn. Respiration is suspended, and the face, instead of the livid pallor which it has presented, becomes red, swollen and tumefied, as in asphyxia. At the same time, the mus cles at the base of the tongue contract, the tongue projects out of the half open mouth, the jaws rise and fall spasmodically; the tongue is bitten and cut by the teeth, and the blood mixing with the saliva, forms a bloody froth which dribbles out of the mouth. The muscles of the larnyx, throat, pharynx, contract violently, and when respiration becomes re-established, it is noisy and whistling. At the same time, there is absolute loss of sensibility and intelligence, ao that the patient may be pinched and pricked without being conscious of it.