As Depaul observes with reason, if one admits, with the advocates of this theory, the irritation of the nerves of the uterus or pelvic cavity, by the increased growth of the uterus, or the action of the parturient state, " Why are not all primiparte eclampsic, since in them the uterus is en larged for the first tizne ? Why are not all rachitic cases eclampsic? We have already seen that this last cause is more rare than we generally be lieved. That all these conditions may predispose to eclampsia, I grant; but there must be other causes added to produce convulsions. It is this other cause that I look for in this theory and do not find; and further, How explain an eclampsia which may occur during the puerperal state, when the irritation of the uterine nerves is not present? If the Marshall Hall theory is rightly established, it must still fall to the ground, since this author pretends that no lesion of the brain or cerebellum can give rise to convulsions if the spine is secure from irritation. And so Tyler Smith believes convulsions to be due to a reflex irritation of the spine through the nerves of the uterus. I would answer him even as I have Axenfeld in regard to his theory.
"I do not see what can be the cause of this irritation of the nerves of the uterus, when I remember that eclampsia may be developed before the beginning of labor, or even of the puerperal state. Some interesting ex periments have lately been made on this reflex power, but every time that the convulsive movements were produced, they were partial and not general, aside from the fact that, where a like result has been reached, the point of origin is known, and ono can localize the irritation on such or such point of the organism. Is it the same with eclampsia? What is this pretended irritation of the nerves of the uterus? Are not all women in a like situation? Labor produces in all very severe pains; the cervix itself is irritated where we aim at the induction of premature labor; and yet, is it common to produce eclampsic attacks? It is not then in the uterus that we must look for the causes of this accident, because, although, sometimes we see convulsions following on a severe pain, how many times under other circumstances, do we see the disease develop before the be ginning of labor, or even after delivery.
"Further still, much has been said about the accumulation of fEeces in the rectum, of foreign bodies in the intestine, of worms, of emotions, etc. But I will not expatiate on this poinL I do not think that simple sympathetic phenomena can be invoked to explain the etiology of eclampsia, and I reject as well the neurosis, by the reflex action on the cerebro spinal system, as the neurosis essential to the acute stage." (Depaul.) 4. General or cerebral Anomia is the Cause of Eclampsia.—Accorcling to Fournier, Traube, See, the phenomena of eclampsia (urremic eclamp sia, i.e., blood poisoning) are analogical, from the point of view of the particular mode of their production, with the pathological process, which Kussmaul, Tenner and others, assign to epilepsy. By the altered state of the blood, there is produced an irritation of the vaso-motor nerves of the cerebral arteries; these arteries contracting, there result, either con vulsions from oligemia of the cord, or coma from oligemia of the brain.
Testut, who is an advocate of the reflex action, admits that it produces anremia of the brain. " Instead of being arrested in the cells of the sen sory and motor columns of the cord, the irritation from the uterus is car ried quickly toward the vessels of the mesophalon, and causes the elements of its muscular tissue to contract, and anEemia of this portion of the brain resulting, the conditions are evoked on which stress has been laid by Kussmaul and Tenner for the development of epileptic attacks."
Before considering the last cause of eclampsia, the poisoned state of the blood, it is necessary here to return to tho " renal theory," the theory which we have spoken of in detail, in the chapter devoted to the study of albuminuria. Let us remember only that, while certain authors de clare that there is no eclanipsia without albuminuria, and no albuminuria without a renal lesion, others, whose authority is no less, do not share this view, and that the latter oppose to the first the relatively numer ous cases where there has occurred eclampsia without albuminuria. These cases have been multiplied during the last years; and it will be sufficient to refer to 141 cases, which we have taken from the literature on the subject, and if some of the cases may be doubted, the greater number offer well-authenticated characteristics. Renal lesion is not, therefore, constant in eclampsia. Also certain authors have gone still further, and have declared, that it was not only not albuminuria which produced eclampsia, but eclampsia which predisposed the patient to albuminuria. Blot and Depaul have already noted the increase of albumin during the at tacks, and often also, albuminuria, which did not exist before the con Tuhions has shown itself, and disappeared with them. This they call nervous albuminuria, and three possible causes are assigned to it: lesion of the renal nerves, those of the splanchnic, and the floor of the fourth ventricle. The experiments of Wittich, of Herman, of Ludwig, of Stokvis, have only confirmed those of Cl. Bernard as to lesions of the floor of the fourth ventricle being sufficient to produce albuminuria; and Paul Dubois has said in his clinical lessons: " Since numerous experi ments have proved that lesions of certain portions of the nervous system may suddenly produce various disturbances in the urinary secretions, it is not impossible that albuminuria may not be the cause of eclampsia, but the result of the same lesion which causes the nervous affections." Hamon has shown albuminuria to be a neurosis of the central nervous system, cerebro-spinal and ganglionic. Tessier, to the renal alterations and to those of albuminuria of the blood, adds the influence of the central nervous system or the nerves which preside over the urinary secretion. But as Ilypolitte rightly observes, the neuroses are of all affections those which are most rarely accompanied by albuminuria. This fact is particu larly true of epilepsy, the most serious of all; and Hypolitte, who tries to explain these facts, supposes as an hypothesis, that eclampsia might lead to albuminuria, "first, from the nervous troubles which are of the same es 'Bence as it is by acting directly on the kidneys, then by the blood changes and the pseudo-asphyxia which immediately results, by preventing the intra-capillary combustion from taking place." This opinion is not sustained to-day, and Depaul, not considering it too radical, hastens to add: " If albuminuria does not certainly lead to eclampsia, I do not believe either in the necessary production of albumi nuria by eclampsia, but I consider these two symptoms, as dependent upon the changes which pregnancy produces in the composition of the blood." Let us add, finally, that if albuminuria may be wanting in eclampsia, it is the same in anasarca and in cedema, and that in a still greater pro portion. Thus the absence of cedema has been noted: In 27 cases, by Blot 13 times; in 62, by Wieger 10; in 44, by Braun 9; in 133, by Depau114.