Recurrent toxemia of pregnancy

Abstract

r HE purpose of this paper is to call attention to some preliminary -r studies of certain cases of toxemia of pregnaney. I believe from this study that it is possible to regroup certain toxemias of pregnancy cases in a manner which is of great clinical importance, particularly in relation to prognosis. Recently facilities have become available through the opening of the new Boston Lying-in Hospital for the proper study of such cases, and since this proper study involves a period of considerable length, it is not yet possible to give any results from the work done there. I simply attempt now to furnish t,he evidence so far as it goes that led up to a feeling for the need of studying toxemics along a definite scheme and from the angle here presented. The chief material from which the idea sprang in. the order in which it became of interest, was from three sources: First, the study, several years ago and for another purpose, of 400 consecutive toxemics from the records of the Boston Lying-in Hospital. Second, the study of forty odd cases of toxemia from my own private records, and third, the study, within the last nine months, of the records and autopsies of two cases of toxemia dying at the Boston Lying-in Hospital during my service. In addition to these three main sources there have been sundry observations on other cases of toxemia seen in hospital which have tended to stimulate an interest in this phase of the problem. I will now take up the three main sources and attempt to give you briefly the ideas derived from each source. 1. From. the study of the records of 400 consecutive toxemics, made primarily for the purpose of determining the relation of toxemia to uterine sepsis, certain other questions, aside from the main point, arose,-many of these having to do mit,h the question of treatment of toxemics and not of importance to the matter in hand. Certain other questions arose, however, which. were profoundly interesting and somewhat irritating which sowed the original seed of the ideas here offered. The first was that at once it became evident from the records that over and over again it was impossible to demonstrate satisfac.lorily whether one was dealin g with chronic nephritis complicating pregnancy, or whether one was dealing with a so-called toxemia of pregnancy. About one-fourth of the 400 cases were toxemias with .*Presented as a thesis for admission to Fellowship at the Thirty-sixth Annual Weeting of the American Association of Obstetricians, Gynecologists and Abodminal 13urgeons, Philadelphia, Pa., September 19-21. 1923.