PUERPERAL RHEUMATISM.
As early as 1866 and 1867, Lorain stated, in a communication made to the Medical Society of the Hospitals, that "there exists in pregnant women a morbid state of the genito-urinary passages, which may pre dispose to attacks of arthritis, analogous to blenorrhagic arthritis. There is a certain amount of urethritis as well as of cervicitis and vaginitis. The urethral pus, as well as the pus which escaes from the cervix and bathes the vagina, is the natural result of pregnancy. There is always disease of the genito-urinary organs in the pregnant woman. Genital rheumatism is, thus, as little surprising in her case as in that of a man who has just had the sound passed." Lorain's ideas have been reasserted by two of his pupils, in their in augural theses. Vach6e gives the name of iiro-genital rheumatism to this form of rheumatism, and states that it may occur in four forms: 1. As hydrarthrosis; 2. Rheumatism, proper; 3. The form characterized by vague pains; 4. The nodular form.
Vaille, in 1867, takes a broader view than Cruveilhier, who considers the rheumatism of pregnant women to be akin to puerperal rheumatism proper (i.e., the rheumatism which is developed a few days before or after labor), and adds to this class, menstruation, which he considers to be a sort of miniature puerperal state, and lactation. He describes two varieties of puerperal rheumatism—muscular rheumatism and articular rheuma tism. Under the term muscular rheumatism he describes tetany or con tracture of narsing women, and ordinary muscular rheumatism, which seems to have nothing special about it, excepting its causative relation to the puerperal state. The conclusions he arrives at are the follovring: 1. There is a rheumatism peculiar to the puerperal state, developed under its influence and modified by it. This rheumatism is, perhaps, eonitantly accompanied by leucorrhceal or other dinharges, and is, therefore, analogous to blenorrhagic rheumatism. This is Lorain's geni
tal rheumatism.
2. Puerperal rheumatism attacks the same organs as ordinary rheu matism. It may be muscular or articular and may provoke other arthritic diseases, cardiac affections, meningitis, ophthalmia, etythemata, etc.
3. During pregnancy it tends to follow the subacute course of gon orrhoeal rheumatism. It is prone to produce hydrarthrosis, and may, rarelyi end in suppuration or white swelling.
4. Immediately after labor, particularly when epidemic influences are prevalent, articular rheumatisms of exceptional gravity may be devel oped, and are remarkable for their tendency to suppurate and to pro duce articular changes.
5. Endocarditis may develop, sometimes, in the puerperal state, even when there is no joint trouble.
Braunberger, in 1870, stated that the puerperal state is only one of the phases of Lorain's genital state, and that the rheumatoid symptoms of pregnancy are localized in the joints and synovial sheaths, with or without the coincidence of cardiac affection& This local trouble is tenacious, re bellious, aggravated ad time elapses after conception, and is not improved or cured until after parturition. These joint troubles of pregnancy have a special stamp. They are quite analogous to gonorrhceal arthritis.
Peter does not so absolutely admit the influence of these causes. "He thinks that everything is an exciting cause of rheumatism, as well cold, which is a general traumatism, as a contusion which is a local one; as well urethral gonorrhcea as uterine gonorrhcea; as well pregnancy as parturi tion." Tison, in 1879, admits that pregnancy acts in two ways: 1. By the profound changes which conception produces in the general condition and in the woman's health; 2. By the discharges which exist in most