This theory of Peter has lately been urged by Moricke: " The stasis of the blood is the cause and origin, for the'most part, of nephritis in preg nant women. This stasis acts in two ways: first, causing, as Peter says, a renal hyperiemia; second, alterations in the blood. We know, from modern research, that want or lack of oxygen is the cause which produces fatty degeneration of the kidneys. The intra-abdominal pressure being increased during pregnancy (aside from the direct pressure exercised by the gravid uterus on the renal vessels), produces an obstacle to the return of venous blood to the kidneys. The circulation is not increased in the kidneys, but diminished notably; a less number of red globules pass in a given time than in the normal state. (These red corpuscles are, on ac count of the pregnant state, leas numerous). Consequently, the quantity of oxygen which is taken from these globules by the tissues is diminished in amount. There results, then, disturbances of nutrition and fatty de generation. Would this condition of the blood predispose also to inflam matory changes? This seems probable, according to Nasse, who says: " up to the present, the uterine lymphatics have not been studied in pregnant animals, but it is very possible that they may play some part in renal inflammation, and even the change in the blood in pregnancy is analogous, in a general way, to that which exists in cases of renal inflam mation." Bailly rejects this explanation, for he thinks that serous-polytemia is a theoretical rather than a real state of the blood, and, although certain eclampsic women are pale and anemic, others, apparently strong and vig orous, are none the less victims of the disease.
3rd. Temporary or Permanent Kidney Disease. —In other words, Can pregnancy become the cause of renal lesions? We have seen that Nasse and Maricke incline to the affirmative, although they admit this only hypothetically. Rumberg goes farther and says that albuminuria cannot exist without a kidney lesion. The filtration of al bumin is only explainable by some modification in the permeability of the membranes, and, even as Robert has shown by his statistics that Bright's disease is much more common in pregnant women during the period of sexual activity, 011ivier arrives at the same results, and concludes that in a good many cases pregnancy may cause or hasten Bright's disease.
We find, then, that the theory of renal lesions as a cause of albuminu ria gravidarum, a theory first stated by Bayer and sustained by Gregory Christison, Addison, Johnson in Digland, by Imbert Gourbeyre, Cohen, Blot, Cazeaux, Devilliers, Regnault, Bach,Gubler, Becquerel and Vernois, Lorrain, Jaccoud, Wieger, and modified by Peter and Petit in France, defended also by Litzmann,. Frerichs, Braun, Schattin and Rosenstein, is generally accepted.
But opinions differ as to the frequency of these alterations. While Bailly admits that albuminuria is very common, particularly in the acute form, in pregnant women, Blot, Abeille, Barker, Braun, Bamberger, Hoff meier, Moricke,.Hypolitte, recognize the renal lesions, but consider them much less common, and add that the renal lesions may, sometimes, ante date the pregnancy, and at other times depend. upon other causes than
those of pregnancy. Bartels, Spiegelberg and Schroeder claim that the changes in the kidney during pregnancy are analogous, not to say identi cal, to those in the liver, and admit, with Dickinson, that the kidney during pregnancy may undergo a fatty degeneration. There exists a puerperal kidney as well as a cardiac kidney, the first being more dan gerous than the second.
Olshaueen acknowledges the kidney lesion, but the primary lesion he considers a catarrh of the bladder, the other only being a secondary lesion. The inflammation is transmitted to the uterus, thence to the kidneys secondarily.
Cassin has revived the opinion of Bouchard, and refers to this interest ing fact: " When albuminous urine is boiled, add Tanret's reagent, or picric acid, albumin coagulates, and this coagulation may take place in two ways: "Either the urine remains opalescent or milky, or it may separate out, and the albumin presents a solid mass in the liquid (this mass may be solid or lumpy or as fine as sand). Each of these conditions has a distinct significance. The finely coagulated albumin represents a transient albu: minuria, such as one observes in severe fevers, alcoholism. The retrac tile coagulum, on the other hand, indicates a renal lesion, provided we are certain that the urine contains neither blood nor pus." Cassin, in 47 albuminuric women in labor, has found in 31 cases the urine opalescent in appearance, and 16 times the albumin was precipi tated in lumps. In the 31 cases, the albumin disappeared in forty-eight hours; of the 16 cases, in six the albuminuria was slight, in ten the albu minuria persisted, in seven the urine contained cells and a great number of granular casts, identical to those which line the tubules. In the ten in which the albuminuria was retractile, 4 had puerperal complications. The observations were taken on 124 women: The figures of the ninth month represent the total, because the exami .nations of the previous months were continued.
Cassin, taking the different opinions of authorities, shows that they may be reduced to three: 1st. A chemical condition of the blood. 2d. Change in pressure. 3d. Conditions of the kistological elements of the kidneys. But he denies, or at least accepts only partially, the first two theories, and accepts the idea of fatty degeneration of the kidney. " It is sufficient to realize that the liver and kidney are organs which cooperate with each other, in order to infer that changes which pregnancy produces in the latter organ would take an important part in the pathology of albuminuria." Hoffmeier, who believes in the theory of the kidney lesions, has made a careful study of them, and found in 5000 confinements in Schroeder's clinic, from Sept,ember 1st, 1867, to April 1st, 1878, 137 cases of nephritis, of which 104 were complicated by eclampsia--2 per cent. He has col lected them in the following table: From this table we see that nephritis does not compromise the life of mother and child solely on account of the possible complication of eclampsia, but that the form in which it presents itself ought to be given serious consideration.