Albuminnria is no less fatal to the fcetns than to the mother, and even excluding eclampsia, which has an extremely bad prognosis for the child, albuminuria is none the less one of the causes which threatens seriously the life of the child. On the one hand, indeed, it may die from the dis ease itself, and again, albuminuria being a frequent cause of abortion and premature labor, it compromises certainly the life of the child, or subjects it to all those untoward circumstances in which the child finds itself when born before term.
Blot reports 6 eases of premature labor. Rayer, Barker, Hubert de Louvain admit the frequency of abortion and premature labor. The same is true of Bratin, 80 per cent. Hoffmeier in 45 cases of nephritis has only seen 15 cases go to term, 13 premature labors, 17 abortions; aud in 33 cases of simple nephritis, 20 children died, 13 lived; in 104 cases of nephritis with eclampsia 62 children died, 46 lived, i.e., in a total of 137 cases, 82 children died, 61 lived.
Finally, albuminuria, aside from post-partum hemorrhage, predisposes the patient to puerperal complications, (peritonitis, septiclemia, puerperal mania, etc.,) and we readily see the importance of treatment.
Trealinent.—Considering the number of causes of albuminuria and the different theories which have been given to it, one can understand, as Ganeau de Mussy has said, how absurd it would be to seek for a uni form treatment for albuminuria; but it is not at all the same of the al buminuria of pregnancy. This, indeed, presents peculiar characteristics, by the fact that it is intimately dependent upon pregnancy, by its fre quent relation to eclampsia, by the influence which it exercises on the child; by those circumstances, in a word, under which it is produced. The increase in the quantity of blood, the alterations in the pregnant woman, the changes which take place in the circulation, the particular tendency to congestion which the woman presents during gestation, seem, a priori, to indicate the direction this treatment should take.
Diminish, combat, suppress, if you can, this tendency to renal conges tion, bring the blood into its normal condition; these are the two great indications which should govern our treatment of albuminuria gravidarum.
Venesection fills better than any other treatment the first indication, and here wo agree with Peter, our teacher and friend. We cannot go as far as he does, in admitting that the greater frequency of complications, and of eclampsia, in the last thirty years, depends on the fact that vene section in pregnant women has been lost sight of. But it cannot be de
nied that venesection, in a great many cases, renders wonderful service, say 4500 grains, and, as we have already said, we have seen Beau derive exoel lent results from it. We prefer general blood-letting to local (leeches, eupping,) which do not appear to us without inConveniences, in cedemat ous and greatly swollen women. Should we make use of it in every case ? No, for if bleeding has its advantages, it also has its disadvantages, and it may, in certain women, even when it is moderate, cause a feeble state which cannot be without danger *to mother and child. Venesection, in deed, withdraws blood-globules from the pregnant woman who has less than the normal amount. Finally, there are cases where it is impossible to use it. We have at this moment a case in mind. The woman in ques tion is pregnant for the fourth time, and, beside a slight amount of albu men, has hemorrhages, dependent, probably, on a faulty insertion of the placenta.
The patient has been pregnant for eight and one-half months, and has already had, at intervals of forty-eight hours, two hemorrhages, slight it is true, but dependent upon placenta prfevia. In presence of the possibil ity of a future severe hemorrhage, we do not dare to weaken the patient by blood-letting, inasmuch as these two spontaneous hemorrhages have not led to any amelioration of the condition of the patient.
Further, before bleeding, we should always make use of purgatives, in a repeated and constant manner. We try to obtain, by means of purga tives, a serous intestinal discharge, which withdraws from the woman a larger quantity of serum, leaving behind the blood-globules, and therefore we prefer the saline purgatives, sulphate of soda, sulpho-vinate of soda, Seidlitz powders, Carlsbad salts, mineral purgatives, Seidlitz, Birminstoff, Pullna, Hunyadi Janos, and they are employed by us every day in doses of a glass, or at least every other day; in a word, we try to produce a revul sive effect on the intestine. But, in turn, we discard all revulsives ap plied to the skin, in particular sinapcsms and blisters; for several times we have seen gangrenous patches produced where they had been applied, and this should not surprise us when we consider the changes of nutri tion in the cedematous, infiltrated, and distended tissue.