This is, besides, the opinion of Bartels, who says, " In cases in which pregnancy, confinement, and the puerperal state pass without unemic symptoms being developed, mpid recovery generally follows, with a com plete disappearance of the renal symptoms; but, as Litzmann adds, the passage into a chronic state is more frequent than in other forms of acute nephritis." Hoffmeier has often noted a corresponding alteration of the liver, and sees in this proof that nephritis depends upon an over-activity of the renal function, and in the fact that albuminuria is met often in twin pregnan cies. In 137 cases of nephritis, there were 9 cases of multiple pregnancy.
Nephritis during pregnancy may occur in two forms; acute parenchy matous—in this form chiefly do we have eclampsia (in 104 cases given above, in 89 renal symptoms declared themselves suddenly)—at other times a chronic form, characterized generally by a diminution of urine which may go on to complete suppression. The urine contains a considerable amount of albumin, and more or less casts. In 137 cases cited by Hoff meier, 46 presented this form, of which 31 had simple nephritis and 15 nephritis with eclampsia. It is in this form, as Litzmann and Georgi have shown, that one sees the disease develop a chronic inflammation of the kid neys. • Iloffmeier has found in 28 women, discharged living, 8 only could be considered cured, 5 were unknown and 15 were discharged still having symptoms of the disease.
'What is the conclusion to be drawn from all these theories? On which can we rely ? We believe it is impossible to adopt one exclusively, and it is alai) true that each of the authorities who have proposed these different theories would be obliged to confess that they could not explain all cases of albuminuria during pregnancy by it alone. 'The theory which attri butes albuminuria to a temporary or permanent renal lesion seems to us most rational, and yet it has happened to us, as to all authors, to make autopsies on eclampsic and albuminuric women, and never to have found either superficially or with the microscope any renal lesion. We think that Cassin is absolutely correct when he concludes in regard to these dif ferent theories in the following way: " Pregnancy produces a condition favorable to the passage of albumin into the urine, but the change of the blood, by pressure, or by its constitution, the influence of renal stea tosis, do not explain it, because leucomuria should be as frequent as the gravid state. They explain only the tendency to albuminuria. The fire
is ready, a spark is wanted to light it up--then, under the least pathologi cal influence, the renal trouble shows itself without always being the ex pression of the same lesion." Mohammed and Barnes have further demonstrated that the use of the sphygmograph in the puerperal state would give us warning of impending albuminuria,, and its frequent consequence, eclampsia. " The strong arterial tension which exists generally in the latter part of pregnancy is most marked in primiparte and constitutes a predisposition to albumin uria and eclampsia. One should fear, then, these two accidents. Where the lying-in period is normal, this high tension soon disappears, as we can prove at the second to the third day, in the tracing which corresponds t,o the milk fever. This tracing is very characteristic. Iet indicates a full pulse, soft, slightly dicrotic, beating 120, and is simply the vascular excita bility following the secretion of milk. it is analogous, according to Mo hammed, to the condition which exists in man during a state of alcoholism Afterward the pulse becomes gradually normal, also the temperature (100° to 101°) which accompanies this strong tension pulse. If it persists, it indicates some unfavorable complication which may predispose to al buminuria, i.e., a chill, which increases tension in the kidneys, constipa tion, which poisons the blood, unless indeed this increased arterial tension is not due to nervous excitability, which alone may suffice to cause it, as the author observed in a case aftar the use of chloroform and forceps." (Hypolitte. ) We cannot accept this comparison of Barnes, milk fever being, in our opinion, very rare, and its physiological appearance, as is seen from study and observation, and the thesis of Chantreuil, is accom panied by a pulse of about 100 to 104 and a temperature of about 98.2°. Should the pulse and temperature pass these limits, the puerperal period is no longer physiological but pathological, the woman is sick, and, if the high tension pulse exists as a prodroma of albuminuria (as it may, we admit, according to Mohammed and Barnes), it may also be met with in other conditions, particularly in any of the accidents which complicate a physiological lying-in period, and endanger seriously the woman's life.