much importance attached to severe frontal or unilateral headache, associated with insomnia, as one of the earliest symptoms of eclampsia. F. B. Earle (Illus. Med. Jour., Mar., 1900).
The number of seizures are variable, as many as one hundred and twenty-five in the twenty-fonr hours have been noted. The duration of the seizures is from about thirty seconds to a minute, and in the intervals the woman is scious; or else the first seizure merges into coma and ends in death. Generally, after delivery of the fcetus the convul sions cease. Rarely eclampsia develops after delivery.
in the course of four and a half years, among 44SO cases of childbirth, the pro portion of eases of eclampsia was 4.9 per thousand. Of the 44SO, 23S3 were pri iniparm and 2097 multipart-le; 16 of the:se cases of eclampsia were primiparm, and 6 multiparte; that is, equal to 72.7 per cent. of primiparm to 27.3 per cent. of multiparm. Braun found the percentage of primiparte S6.3; Lohlein, S3.4; Schauta, S2.6; V. WinckeI, 76.S; and Olshausen, 74 per cent. Women attacked with eclampsia were, for the most part, young. The first convulsive seizure oc curred before labor in 2 cases, during labor in 15, and after labor in 5 cases. The extent of the discrepancy as to ante partum eclampsia is well brought out by the following figures: Lohlein gives 4.7 per cent.; Strumpf, 7.4; v. Rosthorn, 9.1; Schauta, 14; v. Winckel, 23; Braun, 24; and Olshausen, 40 per cent.
The convulsions ended at the termina tion of labor in S of the 22 cases. The duration of the convulsions was, on the average, one minute. The severity of an eclamptic seizure is only to be meas ured by its influence on the respiration and the action of the heart. There was albmninuria in the whole of the cases. Knapp (Monats. f. Geburts. u. Gyniik., B. 3, May and June, '96).
_Nature frequently teaches us the line of action—spontaneous abortion occur ring and the eclampsia ceasing.
Inasmuch as convulsive attacks may persist after delivery, or even in rare cases may appear for the first time after delivery is completed, the plan of hurry ing on labor with the object of checking the attacks must necessarily be often completely inefficacious. We may, there fore, conclude that it is not in the evacuation of the uterus that the cure for celampsia is to be sought. The toxic condition of the blood dominates every thing else, and it is on the degree of toxicity, which is so difficult to de termine, that the prognosis of the disease depends. Maygrier (Jour. de .M6d. de
Paris, ..-kug. 8, '97).
The victims of nephritis who become pregnant rarely go to term, but abort a dead fcetus, the result of interstitial alter ations in the placenta.
Etiology and Pathology.—Modern be lief teaches that eclampsia is the result of a toxmmia. The acceptance of this broad term has done much toward the adoption of a rational method of treat ment. The definitions which for long prevailed in medical literature simply complicated the topic. Thus the view that eclampsia depended on pressure of the gravid uterus on the renal ves sels, while negated by the fact that such pressure exercised by ovarian and fibroid growths was unaccompanied by eclampsia, and, further, that the gravid uterus, when risen above the pelvic brim, exerted no such mechanical interfer ence with the kidneys, led the mind of the observer far astray from a strong presumptive etiological factor, which is deficient excretion of toxic products em anating not alone from the kidneys, but also from the liver.
The eclampsia symptom-complex is de pendent on a peculiar irritation change in the psychomotor centres of the cere bral cortex (subcortical centres). This zone develops dnring gestation on an existing disposition, which may be either congenital or acquired. (Mlin chener med. Woch., No. 5, '91).
Puerperal eclampsia originates from a, renal insufficiency causing a high arterial pressure, this again reacting on the mo tor areas of the brain, producing the characteristic epileptiform manifesta. lions in the parts of the body presided over by the centres which are subject to the abnormal blood-pressure. R. Max well-Trotter (Brit. Med. Jour., May 9, Though the pathogenesis of eclampsia is unsettled, it belongs solely to the preg nant or puerperal state. It is not apo plectic, epileptic, or hysterical in char acter. It depends upon toxaemia due to overproduction of toxins and under elimination by the emunetories. These toxins probably have their origin in the ingesta, in intestinal putrefaction, in fcetal metabolism—one or all—and there is co-existing sluggishness, impairment, or suspension of elimination. When the prodromes of eclampsia appear, the kid ney should be interrogated as to its functions and all symptoms carefully watched. W. W. Potter (Amer. Jour. Obst., Nov., '97).