Second Degree. Exudat ion and commencing fatty Degeneration.—It is characterized by a dull, yellow color of the cortex, by vascular striae, by red spots and by the size of the kidney, the weight of which is above the normal. Then the' kidney is softer, more friable, opaque and dull, its surface is sometimes smooth, sometimes granular, covered with little eleva tions of the size of a poppy seed, an appearance which is due to the fact that the tubules, whose walls reach the surface of the kidney, are distended with fluid.
The capsule of the kidney may with difficulty be separated. The pyra mids are dark red, the mucous membrane of the infundibulum issa dirty red, the glomeruli are covered with fine granular material, and in places there are areas of fatty degeneration. Between the glomeruli and the capsule lies a thick bed of solid, granular matter, in which fat globules are found and sometimes cholesterine. When the disease is more ad vanced, the interior of the epithelial cells, filled with fat globules, becomes cloudy. Finally, by the increase in granules, the cells themselves become disorganized, and then the epithelial cells themselves undergo fatty de generation.
Third Degree. Atrophy. —The kidneys may have returned to their nor mal size, or even smaller, the capsule has a dirty white color, it is thick at certain points, and closely united to the cortex, and can with difficulty be detached without bringing away with it portions of the kidney. The surface of the kidney has lost its polish, is rough and nodular, studded with deep depressions or furrows, which divide it into lobes. The color of the surface of the kidney is dirty brown, the depressed portions seem like cicatrices, and are generally pale. They have at times a bluish black color, due to old extravasated blood. Generally, some parts of the organ retain their normal color. The friability which the kidney presented in the preceding stage gives way to a hardness like leather. On section the cortex has more or less completely disappeared. The uriniferous tubules are destroyed and the Malpighian capsules retracted, aft,er the oblitera tion of their vascular coat. There remains no more of the destroyed uri niferous tubules than the ba,sement substance, which in its turn becomes wrinkled and shrivelled. When, in the first two conditions, a part of the exudation has passed into the interstitial tissue, it becomes organized, more or less completely, into a tissue which surrounds the tubules and capsules of Malpighi, and, contracting like cicatricial tissue, become& one of the chief causes of atrophy. The atrophy of the pyramids of Mal
pighi and of Ferrini, is less than is found in the cortex. There is found at their base, scattered between the straight tubules, fine granulations which compress them, and separate them one from the other. The calices are usually enlarged, their mucous surfaces are thick and studded with varicose vessels, which give them a bluish gray color. The mass of fatty matter about the kidney diminishes when the atrophy of the organ begins (Braun). But it is rare that this third stage is found in women who die of eclampsia. The first two stages are most commonly met with.
Diagnoliis.—The diagnosis of eclampsia may be difficult or not, depend ing on the stage or period of the disease in which we see it. It is, how ever, particularly during the period of convulsion and of coma that we are liable to be in error; for often, the patient is seen by the physician, suddenly, before he has gained any information in regard to the case, and it may sometimes be very difficult t,o reach a diagnosis at once. The first point which ought to arouse the suspicion of the physician is the fact of pregnancy. Convulsions come on generally in the sixth or seventh month, Le., when the positive signs of pregnancy have existed for a long time. It is easy, hence, to determine pregnancy with certainty. The urine should be examined at once for the presence or absence of albu min, and albuminuria once determined, the probability is that the convul sions, if there are any, are true eclamptic convulsions, and that the coma may be the result of the convulsions. There are, however, a certain num ber of morbid states independent of albuminuria, which may produce convulsions, followed by coma, either during pregnancy, labor or the puerperal state, which may lead to error. We will review them rapidly.
It is Braun who has gone extensively into the diagnosis, but as Bailly remarks, he has gone much too far, when he has tried to establish the differential diagnosis of eclampsia, with the convulsions which may come on in poisoning by mercury, copper, silver, arsenious acid, hydrocyanic acid; by the use of the preparations of hemlock, belladonna, tobacco, strych nine, etc., and even poisoning from snake bite. Only lead poisoning could lead really to error. We will limit ourselves here to those diseases which present phenomena like those of eclampsia, either during the period of convulsions or coma.