That the blood-serum of celaniptics more toxic than normal cannot be proved; but, on the contrary, the blood serum of eclamptics produces, when in jected into animals, the same symptoms caused by normal serum.
Both blood-scrums produce dissolution of blood-corpuscles and liwmoglobinuria; both affect most powerfully when in jected continuously. Volhard (A1onats. f. Geburts. u. Gyniik., B. 5, H. 5, '97).
Certain substances injected directly into the fwtus or the amnion are rapidly- absorbed by the maternal or ganism, provided the fwtus is living, but much more rapidly from the fcetus than from—the amnion. From this it would seem that the fcetus secretes certain toxic substances into the blood and am niotic fluid. Secondly, if the fcetus be dead, substances injected into either am nion or fwtus do not seem to pass into the maternal circulation. This \vould seem to throw considerable light upon the various phenomena of eclampsia. and especially as showing that the death of the fcetus is followed by cessation of the convulsive seizure. Baron and Castaigne (Arch. de MCd. Exp6rimentale, Sept., '98).
A large coccus, round or oval in shape, and of remarkable individual mobility, believed to have a definite connection with the etiology of the disease. Found in the blood of forty-four eclamptics. Lewinowitsch (Centralb. f. No. 46, '99).
The systemic cell-activity in the pregnant woman is greatly increased.
Excrementitious material accumulates rapidly in the system, and at any time the balance between secretion and. ex cretion may become disturbed and a toxmmia or poisoning ensue. If this is apt to occur in a woman conceiving with normal or healthy excretory organs, all the more so is it likely to supervene in a woman who conceives in the presence of an organic disease of one or another of the excretory organs—especially the kidneys. Thus then we may witness eclampsia develop during the pregnancy of a woman with kidneys diseased from the start or in women in whom possibly there has never been a suspicion of renal impairment.
Eclainpsia is not common in women the subjects of chronic kidney disease before pregnancy.; where kidney symp toms arc present they usually develop suddenly; kidney-lesions may be ab sent ; albuminuria is in many cases the effect and not the cause. The kidneys are not the only excretory organs whose failure to perform elimination properly may produce eclampsia. Ptomaine poi soning should not be forgotten. J. 1'. Boyd (Albany- Med. Annals, Nov., '95).
Prognosis.—The prognosis in modern times has been greatly altered for the better. Whereas formerly the inaternal mortality ranged about 30 per cent., now aday-s there are series of cases recorded with as low a rate as 5 per cent. Some observers in a limited number of cases report no deaths. The fcetal mortality remains about 50 per cent.
In 52,328 cases of labor occurring within a period of 2 years there were 325 convulsions. The mortality- was 19.35 per cent. Among 248 patients who :survived the attacks, 54 subsequently developed other conditions; in 13 there were psychoses, generally ending in re covery; in 5 pneumonia, 3 pleurisy, and in 22 kidney trouble persisted. In 71.1
per cent. operative interference became necessary, including 108 forceps deliv eries, 19 versions, 13 operations to lessen the size of the child, 2 induced abortions, and 7 Cwsarean sections. Lohlein (Wi ener niedizin. Woch., Sept. 19, '91).
If the amount of urea in the blood is twice the normal, recovery is probable, while if it very nearly approach the physiological proportion the termination is generally fatal. This is also the case when the amount of the urea is five or six times the normal. More importance should be attached to the hepatic than to the renal lesions. Butte (Berne Mild. de l'Est, '93).
Series of 5000 labors in which there were 50 eases of eclampsia,-42 in pri iniparce. Twelve mothers died: 10 from eclampsia, 1 from nephritis, and 1 from sepsis. Geller (Centralb. f. Gynlik., 42, '94).
.1faternal mortality in eelampsia, 30 per cent.; fcetal mortality, 46.6 per cent. Tarnier (Annual, '96).
Series of 42,607 confinement eases 137 —0.321 per cent.—of which suffered from eclainpsia, 19 being already unconscious • and many others having had many fits before being admitted to the clinic. Of the mothers, 10'J-79.5 per cent.—were primiparai; 113 (97 I-parm) were not more than 30 years old. One only had had eclampsia in a previous (first) con finement (IV-para; Coesarean section). Twins are noted 12 times; hydro cephalus, hydramnion, a.nd low lateral placenta, 1 each; abnormal rotation. twice; abnormal pelves, 9 times; 3 breech eases. The attacks commenced before labor in 16.73 per cent., during it in 62.04 per cent., and after delivery in 21.16 per cent. of the cases; and while 53.17 per cent. had less than 5 fits, the average number of fits in 126 was S. Omitting the 34 children of 29 post-1)(1,1nm cases, of the remaining 115. 37-32.1 per eent.—were still-born, and 56--48.6 per cent.—were premature. In 50.7 per cent. of the whole, or 64.7 per cent. of the cases before delivery, empty ing the uterus ha.d a good effect. Of 27 deaths (19.7 per cent.), 17 only were due to eclampsia alone (12.4 per cent.). The mortality of multiparm per cent.) was greater than that of primip arm (21 = 19.2 per cent.). The relative mortality of cases commencing before, during, or after ehildbirth was 30.43 per cent., 18.82 per emit., and 13.79 per cent. The proportion of deaths is compara tively low, and with the fact shown that delivery without too active interference tends to stop the fits is sntlicient to warrant the adoption of conservative treatment for eelampsia. The practice of the Vienna clinic for many years has been a prophylactic milk diet for all albuminuric pregnant women: if this fail, the induction of labor by bougie or eolpeurynter. On the outbreak of eelamp sia liot baths, linden-tea, wet packing, chloroform, and delivery as soon as may be without incisions. Schreiber (Arch. f. Gyn., li, 335, '96).