The following is a record of the cases of
Eclampsia which I have attended over a period of twenty
years, together with a suggestion as to the mode of
origin of the disease, some observations on treatment,and
a commentary on my analysis of 137 cases recently reported
in New Zealand.
The series of Eclampsias that occurs in a private
practice not largely of an obstetrical character is
naturally a small one; and it may reasonably be objected
that no general conclusions should be made from such limited
experience. Nevertheless, the actual experience of a small
number is extraordinarily instructive, and suggestive information can be gained by careful study of the details of a few cases perhaps more easily than from large statistics in
which detail is obscured by the mass of material, and personal contact is lacking.
My personal experience covers 15 cases in which
there has been a culmination of the disease in convulsions,
and a number of cases of pre- eclamptic toxaemia of varying
degrees of severity. I find I have preserved meagre notes
of 22 such, but that is only a fraction of the number actually seen. Perfection of recording in general practice is too difficult an ideal to attain.
It is opportune here to remark that a definition of
Eclampsia is not really easy. It is too closely associated
in our minds with fibs, and we regard fits as being a necessary feature. I am convinced that this is irrational and wrong. Convulsions are merely the terminal phase of a
toxaemia occurring in pregnant women, which presents any
other symptoms quite as essential and characteristic. It
would, I think, be just as reasonable to regard coma as a
disease entity, apart from the diabetes, or whatever else
is the cause; or to think of septic peritonitis as a disease,
apart from the perforation,or appendicitis producing it.
Further, the syndrome of Eclampsia is very varied.
Almost each individual common symptom of it may be absent in
a given case. The common symptoms are albuminuria, oedema,
headache, sensory disturbances, especially of sight, raised
blood pressure, and fits, occurring in pregnancy. But on
reference to my own cases, and to other recorded cases, I
find Eclampsia without albuminuria, Eclampsia without oedema,
Eclampsia without headache, Eclampsia without sensory disturbance, and even Eclampsia without fits. There remain only two constant features - pregnancy, and a blood pressure
which seems to have been found invariably raised whenever
it has been taken
