2d. Death may be caused by complic,ations which are frequent in eclainp sia, but they are not all of the same gravity; and, if some are the imme diate cause of death, others may be only a predisposing cause, and such are hemorrhages in general. Aside from the blood extravasations, such as sub-arachnoid or cerebral or hepatic hemorrhages, or pulmonary apo plexies, which we have noted, Blot has called attention to a hemorrhagic tendency which eclampsic and albuminuric women have, a tendency which shows itself in epistaxis, otorrhagia, hematemesis, hematuria, but, above all, uterine hemorrhage, which comes on during the third stage of labor, and to which he attaches great importance, and which has been since observed by other authors. If these hemorrhages, indeed, are not serious in themselves, they weaken, exhaust the woman, and predispose her thus to puerperal complication& Authors are agreed in establishing the frequency with which puerperal complications follow eclampsia, and Blot has shown that these complica tions are the more grave and serious as hemorrhages have been severe. In 28 cases of albuminuria, with or without eclampsia, Blot has observed 15 cases with hemorrhages, more or less abundant, with 6 deaths.
These complications may be arranged under five heads: 1st. Women may suffer from puerperal complications (Blot, Depaul, Braun, Devilliers and Regnault, Litzmann, Krassnig, Dohrn, Grenser, Cazeaux). These accidents are classic, i.e., pe4tonitis, metro-peritonitis, phlebitis, lymphan gitis, etc. 2d. Women Tnay die from meningeal complications, (Cazeaux, Pelissier). 3d. The albuminuria was dependent upon Bright's disease, chronic or acute, which becomes increased, in passing into a chronic state, and may kill the patient. (Hoffmeier, Miiricke). 4th and 5th. Eclampsia may end in paralysis, or puerperal mania, which will be treated of in a chapter devoted to that subject.
We will only say here, that mania is much more frequent than paralysis, since Wieger saw 10 cases in 140; Grenser 4 in 19 cases; Braiin 5 in 44 cases, and Simpson much more frequently still.
Pathological .Anatomy. —The lesions which are found on autopsies of patients who die of eclampsia are so numerous and varied, that one might well ask, Is there a pathological anatomy of this disease ? The lesions are found in the brain, lungs and kidneys, but it is impossible, at present, to find one lesion which is characteristic of the disease, or constantly pres ent. The kidney lesions may be often wanting, so it is not to be won dered at that so many theories are advanced. The lesions themselves are in no respect constant, and in a great many cases, general congestion is only present to explain the convulsions.
On referring to different authors, we find that Lachapelle, Cruveilhier, Baudelocque, Ramsbotham, Velpeau, Scanzoni, Cazeaux, Kiwisch, Jac quemier, in a number of autopsies have found no appreciable lesion, it may be in the brain or adnexa. The following lesions have been dem onstrated by others: Braun, in 10 autopsies, 1 case of meningeal apoplexy, 10 cases of slim mia and cedema of the brain and its envelopes.
Krassnig in 9 autopsies, 6 cases of anwmia and interstitial serous effu sions, 1 case of congestion, 1 case of meningeal apoplexy; 1 case nothing was found. Devilliers and Regnault, Lever, Hardy, Collins, Mac Clintock, Ramsbotham, Kiwisch, Grenser, Martin, found in 42 autopsies: Hyperm mia, 10; aneemia, 4; normal, 4; serous effusion of irachnoid, 7; serous effusion in ventricles, 5; apoplexies, 12.
Depaul, Blot, Bailly, Mercier, Charpentier, have found cerebral hem orrhages; Mola,s hemorrhages into the arachnoid.
Helm, Kiwisch, Braun, congestion of the membranes and meningeal apoplexy.
Bloilo, serous effusion into the spinal cavity.
Braun found the brain and its membranes sometimes anaemic or nor mal, sometimes congested.
The arachnoid and ventricles sometimes contain fluid. The eye, in spite of amaurosis, may be normal, or the aqueous humor may be in creased (Cucuel, Abellle, Crocq, Collard, Marchal); sometimes there may be hemorrhages in the retina (Turcq); the blood is slightly coagulable, and has a violet color. In the lungs there is always cedema, and emphy sema may or may not be present, as Bar hits stated. Usually they are congested and contain apoplexies. Dolmas has shown that serum exists in the pleAral cavity. The spleen and liver are more or less con gested. Blot, Molaa, have found hemorrhages. The changes that are most often met with are those in the kidneys, but, Bailly to the contrary, they are not constant, and if it is true that, in a certain number of cases, the, lesions have escaped observation on account of the insufficient means employed in the search, the microscope is not always able to find them; and although we think that there is an almost constant relation between albuminuria and eclampsia, we believe that in many cases the renal lesions are very slight, and sometimes they cannot be finuid by the most careful research, because they do not exist. When the renal lesions do exist they may be met with in the three forms described by Frerichs.
First Degree. Commencing Hypercemia and Exudation.—The surface of the kidney is smooth, the capsule is easily removed, the venous plexuses are dilated and gorged with dark blood ; the cortex is reddish-brown, soft and friable. On cutting through this substance, a gelatinous bloody fluid oozes out which infiltrates the substance of the kidney. The pynt mids are congested. The mucous membrane of the calyx and infundibu lum is swollen, covered with congested vessels and contains a bloody fluid. Exeept for the hypertemia, the substance of the kidney does not appear very much diseased. Sometimes hemorrhages are found coming from the glomeruli, again from the vascular plexus, the uriniferous tubules, or even from the veins spread over the cortex. The epithelium of these tubules is not yet very much alt,ered, but it is easily detached. The tubules are filled with an exudation, or fluid in the form of c,asts, trans parent, bloody, constituting fibrinous casts.