SIMPLE CEDEMA.
Causes.—The first chief cause consists in the changes of the blood, particularly if there is a local or general congestion, a febrile state, severe or slight. Age and child-bearing have no influence, but it is not the same with privation, fatigue, moral influences, living in unhealthy dwellings, dampness—in a word, all the causes which exert a depressing influence on the pregnant woman. Sometimes, however, one sees cedema in a woman in a robust condition.
But to these general causes are added influences which we call local and mechanical. Among them, the activity of a new life which stimulates the uterus, the determination of a considerable amount of blood which this new state exacts, are the powerful causes of the dis turbance of the circulation. They may wonderfully modify the lower portions of the body and induce congestion or stasis, of which they may become the seat.
It is through the development of the uterus, whose influence is felt in the last month of pregnancy; the inclination of the uterus, which explains sufficiently the preference of the infiltration to the limb on the corresponding side; the form, the direction of the foetal part, the form of the pelvic cavity and its unusual size, which allows communica tion more or less direct between the uterus and the blood vessels; the resistance of the abdominafwall; the development and height of the uterus, which impedes the expansion of the thorax; the large size of the fcetus; the increased distension of the uterus by twin pregnancy, hydramnion, tumors of the foetus, tumors of the uterus or pelvis, abdominal tumors, prolonged standing in certain occupations; filially, predisposition in certain individuals to varices. Such are the main causes of simple oedema.
Prodhomme, together with Andral and Gavarret, Becquerel and Rodier, Regnauld and Devilliers, considered the alteration of the blood as the predisposing cause (diminution of albumin); but it must play, like these last, a great role in the influence of the mechanical obstacles to the circulation; the serous infiltration which complicates these condi tions is only, according to him, the result of a local plethora. He tells
us that the influence of the uterus on the neighboring organs is shown again by this fact, established by Depaul, that when the Coesarean operation is performed, one almost always finds a varying quantity of serum in the peritoneal cavity. It is the same .in supra-pubic oedema, which he has shown is present in case of twin pregnancy.
ffdenta combined with Diseases of central Organs.—Aside from simple oedemas, we find 4:edemas or anasarcas with affections of the central organs of the circulation and of respiration. In this condition, the organic causes of the disturbance of the circulation, and the con sequent infiltration of serum, increases again all those conditions which the puerperal state in women developes. If dropsy does not exist before the pregnancy; it will develop almost certainly in its course, and if it had already shown itself beforehand, it will increase considerably more in simple oedema. This is the case, particularly where the serous cavities are invaded, and then we have ascites, pleurisy with effusion, percarditis; at times even the dropsy will commence in these cavities. It is understood, moreover, that these are dropsies which induce serious complications for mother and child (symptoms of asphyxia, premature expulsion of the foetus, etc.).
(Edema complicated by Albuminuria.—In this case, oedema is on:y an accompanying symptom, and it is the albuminuria which constitutes the disease.
Symptoms and Course.—It is in general during the last three months of pregnancy that oedema commences to show itself; however, when it is dependent oa a general cause, it may commence with pregnancy, or during the third or fourth month (Cazeaux); and while it shows itself most often during pregnancy, it may only appear after confinement. Its course may be acute or clu-onie, slow, and acccording to 'Anti), Thierry, Schindler, there are three degrees.