Such is the ordinary aspect of the eclamptic, during the tonic period, which is thus characterized by rigidity, immobility, and insensibility of the patient, with impeded respiration, all coming on suddenly and unex pectedly. It is not always so, however, and with Many patients, as Bailly has shown, the attack is preceded by a very short period of excitement, during which the patient, instead of stretching her arms along her body, raises them over her face, as if she wished to defend herself from an im aginary enemy. The tonic contractions come on secondarily. This ex aggerated tonic state of the muscles lasts generally for fifteen to twenty seconds, and then begins the third period of clonic convulsions.
Third Period.—This general muscular rigidity is followed by shakings and twitchings, which agitate incessantly, and in turn, all the muscles of the face, body and limbs. As in the tonic convulsions, it is in the face that they begin, to reach finally the body and limbs. The face, also, is horribly disfigured, the jaws open and shut, cutting the tongue, which bleeds more and more, swells, and thus contributes to increase the hin drance to respiration. It is, indeed, in the clonic convulsions, that respi ration, suspended during tonic convulsions, reappears, but it is irregular, noisy and whistling, and is accompanied, at each expiration, by expulsion of a froth more or leas bloody, sometimes even, when the tongue is very much cut, by almost pure blood. •Generally, the shaking of the body and limbs makes itself apparent by slight twitchings, which pass off, and occur without the patients changing much in position. This is not always so, however, and in certain cases, as soon as the clonic convulsion comes on, they are very much excited, throw themselves from right to left, so that it is difficult at times to hold or restrain them. During this period, the cutaneous and visceral congestion increases, and the face is blue, red, livid, seems as swollen as that of a drowned person who has been long in the water. Sub-conjunctival hemorrhages take place, and, on account of contractions of the diaphragm, or the muscles of the abdomen, as Jacque mier, Depaul and Bailly believe, or even on account of intestinal contrac tions, as Lachapelle and Tyler Smith and we are disposed to believe, ab dominal evacuations frequently occur. Evacuations of urine are not very frequent, owing to the small amount of urine in the bladder of eclamptie patients. Vomiting is rare, and we have seen it generally in patients
who have inhaled chloroform.
This period of clonic revulsions is longer than the tonic period, but we have not seen it extend over one or two minutes. Bailly, who has given one to five minutes as the limit, appears to go too far; likewise, Tarnier, who has seen the attack prolonged twenty minut,es by the watch. Ordinarily we would yield to the testimony of such a conscientious and careful observer as Tarnier, but we believe that he has taken the case of a woman in whom the attacks followed each other so quickly that there was no intermission, and therefore the limit we have fixed upon for the duration of the attacks seems to be the rule.
If we consider the congested and asphyxiated condition of the patient during a tonic and clonic convulsion, we e,an not understand how, when respiration is so impeded, the patient could long survive such a condition of things.
While the limbs and body are so shaken by convulsive twitchings, the face, which was drawn to one side, returns to the middle line, but is still carried from one tale to another by muscular twitchings. The twitching of the eyelids is still present, and also the movement of the eyes. Res piration, for a while suspended, returns, but accelerated, and becomes more and more blowing and whistling. It is irregular, the muscles of in spiration and expiration taking part in the clonic convulsion which in volves the whole system.
Tyler Smith states dud the muscles of the larynx share in this spas modic contraction, and it is the closure of the glottis that is the cause of the bruit produced in respiration. Asphyxia is the consequence of the suspension or diminution of the blood-producing process. Hence the bluish-black discoloration of the face, the swelling of the neck and face, the enlargement of the jugulars, and the violent beating of the carotids. He thinks also that the heart participates in the convulsion, and this would explain why the lividity and turgescence is not always limited to the face, but may extend sometimes all over the body.
At the beginning of the attack, Cazeaux says, the pulse is full and strong, but we have, on the contrary, seen it always rapid and feeble, so feeble that it is sometimes difficult to count it; but, remarkable enough, however feeble, we have always seen it increase in cases in which vene section has been practised, as in Depaul's clinic.