" The pregnant woman, affected by eclampsia, is urina3mic. It is be cau.se all the elements of the urine have accumulated in her blood, that she is a prey to the complic,ation known as eclampsia. There occurs a great and complex disturbance of innervation, of which convulsions are only a symptom. There may be convulsions, coma or delirium, but always with a predominance of convulsions, and it seems beat to designate the combination of symptoms by the term puerperal urimemia.' The analysis of the urine shows, without a doubt, that the woman excretes daily a greater quantity of urea. Quinquaud has shown that during preg nancy, and on its account, a woman excretes daily one and a half times more urea than in the non-pregnant condition. If she excretes twice as much urea in twenty-four hours, she ought to do more work—i.e., more blood passes through the kidney, and there is an increased functional hy perEemia. As a result of more blood, there is greater pressure; if greater vascular pressure exists, then possible filtration of the serum of the blood, nay even the blood itself—a phenomenon which is called incorrectly albuminuria, but it is serumuria." Now how does this serumuria, physiologicEd when it is of slight amount, becoming greatly increased, ir ritate, poison the organism, and cause eclampsic attacks? One can, by the aid of the examination of the urine, judge of the state of the kidney. The more serum there is, the more the kidney is inert, so that the integrity of the kidney is in inverse proportion to the amount of albumin contained in the urine. With the microscope, the exact state of the kidney can be made out, by means of the presence of casts, granular and hyaline. These latter show that, at certain points, where this des quamation has taken place, the kidney is totally useless, so far as secre tion of urine is concerned. It is only a passive organ, through which the serum filters, as it would through a filter paper. It is necessary, there fore, to look for serum in the urine; if it exists there, to examine the state of the nervous system for premonitory signs of eclampsia. There is not present as yet eclampsia, but only a tendency toward urintemia. There is not only an accumulation of urea, but the accumulation of all the constituents of the urine.
Very exact analysis of tlae urine shows an accumulation of all the ma terials of the urine in the blood of a woman inclined towards urintemia. In a first observation, in place of 6 parts of extractive matters in 15,000 grains of urine, Quinquaud found 21 parts, i.e., 3+ times more urea in the blood. These figures agree exactly with a second observation which gives 19.2 in place of 6 parts; a third gives 18.3. This makes three times more extractive material. I do not know of anything more convincing, and we need not say that it is only creatintemia (Schottin and Hoppe), but all the urinary extractives are present, that is to say, urintemia. The pregnant woman no longer forms urine, no longer selects decomposed ele ments which are the urine; they remain and accumulate in the blood, and therefore she is diseased.
Contrary to Quinquaud, Hypolitte has not found urea increased in the blood of pregnant women, but diminished; and finally he says, that in cer tain patients suffering from oligemia or anuria, as in cases of hysteria, or of retroversion of the gravid uterus, accompanied by compression of the bladder and oligemia, eclampsia is not observed.
Hypohtte gives in the following table the examination of the urine of eclamptic women: From this table it results that urea is rather diminished than increased during pregnancy, and that it varies with the process employed. Thus between Yvon's and Liebig's methods, there may be a difference, varying between 15 to 75 grains. What do all these theories prove ? which is true ? It is at the present time impossible to say.
It cannot be doubted, says Fournier, " that it seems rational to attri bute these phenomena, obs3rved during life, to an alteration in the blood. This alteration is not doubted; it does not consist in the retention of one principle alone, but the alteration is still poorly understood." Lately, practical researches in regard to the temperature in eclampsia have shown that all these theories are useless. It was in France that the first authentic researches on the temperature in eclampsia were published, and Winckel is in error when, with the fairness and fidelity which charac terizes the Germans, he tries to appropriate the credit of this discovery, (but this does not surprise us). " The French authors," says Winckel, " naturally do not recognize my works." This important work confines itself to the following phrase, which is found in the " Clinical observations on the Pathology of Labor," 1869, Rostock, which he has reproduced in his second edition. " The temperature rises very considerably at each new attack. It may go as high as 104.5° F." From 1874 to 1875 and 1876, in these observations and studies, he published various observations on eclampsia, in which he notes the temperature before the attack, but not during, and he takes it again only after two days, to find that it has risen to 105° F., under the influence of a new disease. It was only then in 1879, i.e., when he must haveoknown of the French works for a long time, that he really began the study of the subject. This does not sur prise us, for this appropriative method does not confine itself to scien tific subjects.
It was in France, in the Faculty at Strasburg, that the first observations cm the temperature in convulsions were made. It is to Kien, a pupil of Hirtz, that they are due. For, although Quincque had, in Germany, in 1869, taken the temperature in eclampsia in a careful manner, he had drawn no conclusions, and confined himself to a simple statement; and the proof of this is, that Wunderlich, whose work appeared in 1871, col lected all the thermometric observations acquired in medicine, and left aside entirely the course of the temperature in puerperal eclampsia.
In 1869, at the suggestion of Charcot, his teacher, Bourneville under took the study of the course of the temperature in diseases of the nervous system, and in 1871 to 1875, pursuing these studies, he arrived at the fol lowing conclusions, based on 13 personal observations and 4 of Budin's.