1st. Slow Chronic Form, Fird always, the swelling begins in the lower extremities. It is noticed, toward evening, that there is cedema about the malleoli, which disappears after rest and the horizontal position, to reappear when the woman remains up for a certain length of time. As the pregnancy advances, the infiltration extends, reaches the feet, legs, knees and thighs, aud no longer disappears com pletely during the night. The skin becomes dull, pale, is now insen sible to, and pits on, pressure. This increase in size of the lower extremities is accompanied by loss of motion more or less marked. Sometimes it is utterly impossible to stand, on account of the vague pains and weight, and finally-, the (edema rising still higher, ends by involving the genital organs, and becomes a considerable inconvenience.
In the second degree, the cedema continues its ascent, involves in its turn the abdominal wall, forms above the pubes a tumor, quite a large cushion, then reaches the upper extremities, the face, eye-lids, involving thus all the cellular tissue under the skin, and giving to the woman a peculiar appearance. But while, according to Lauth, it remains still limited or nearly so in the cellular tissue under the skin, according to Schindler, the peritoneum is involved generally in its turn by an effusion more or less abundant. The cedema, carried to this extent, threatens the woman with serious complications. As evinced by the feeling of extreme tension, of general heaviness, they experience vague pains in all the limbs; the respiration becomes difficult, anxious, oppressed, and symptoms of asphyxia and syncope manifest themselves, and next appear disturbances of digestion and diarrhcea. The urine is diminished, of a deep red color, sonietimes albuminous; the pulse is small, feeble, and soft. There is a cardiac bruit transmitted into the carotids; but won derful as it may seem, fever is the exception. It is not rare in this case, in view of the condition of the woman, to see the pregnancy interrupted, and the patient confined prematurely and spontaneously, usually at the end of the eighth month. Carried to this extent, the ceclema may dis appear after confinement (Lasserre, Lauth), but, in certain cases, it is not so, and the dropsy continues to increase, and the disease passes into the third stage, that is to say, the effusion spreads into the great serous e,avities of the abdomen, thorax, and skull, and death results quickly. We may add that these (edemas, so extensive, are most commonly compli cated by albuminuria, and that eclampsia comes in its turn to add its deadly influence to the troubles experienced by the woman. already so severe.
The third degree is accompanied always, contrary to the first two. by a true rise of temperature, is characterized by effusion in the serous cavi ties; it may originate only after confinements, or show itself already dur ing pregrnancy, and one may understand without difficulty the danger which it brings with it, both for the mother and child. Such is the common course of cedema, in pregnant women, but it is not always so.
Second Form, some cases it takes a course truly acute, and is then generally accompanied by some fever.
It is, moreover, in these grave cases that one meets with infiltration in the upper extremities and in the serous cavities. But as Prodhomme remarks, "while the effusion in the serous cavities generally only advances according as the infiltration rises from the lower to the upper parts, the visceral cedema, so to speak, more independent of the state of general infiltration, sometimes waits to form until the latter has attained a con siderable degree, sometimes declares itself when the infiltration of the lower extremities is scarcely marked. Then they may appear rapidly, presenting in their progress the characters of the metastatic serous con gestion which Lasserre has noted in the recently confined woman. It is then that we see arise pulmonary cedema, pleuritic pericardial effusions, se rous effusion into the cranial cavity, cerebral cedema, and finally death." Of all the serous cavities, that which is most often and first involved is the abdominal cavity, and ascites is one of the varieties comparatively frequent in the dropsies of pregnant women. Cazeaux claims that hydram nios, hydrorrhcea and ascites are only varieties of the intra-abdominal serous effusion. We cannot accept this opinion. Hydrorrhcea and hydramnios are special diseases, as we hope to show, and although it is true that hydramnios coincides often with ascites, there are a number of cases in which ascites exists alone, without the complication of hydramnios, showing thus the possible independence of these two dropsies. (Edema only arises secondarily, that is to say, when the disease has reached a certain stage; while ascites, except in case it depends upon some disease of the liver, never shows itself unless the cedema becomes general, or at least has taken a serious form or in some manner an acute. We will return to it in the study of hydrorrhcea and hydramnion in the chapter on the diseases of the ovum. We confine ourselves here to the study of ascites during pregnancy.