[119] _Praeger medizinische Wochenschrift_, 1892 n. 17.
[120] _Zeitschrift für Geburtshülfe_, bd. 16, n. 2.
It is usually impossible to differentiate in pregnancy a lighting up of an old nephritis from a toxemia. Where there is a history of nephritis before the pregnancy, this often clears up the diagnosis. Nephritis is likely to manifest itself in pregnancy earlier than toxemia; albuminuric retinitis is commoner in nephritis, but these facts are no real help in differentiation.
The position of the uterus may be a cause of nephritis, according to the _American Text-Book of Obstetrics_; but De Lee and others hold that the growing womb cannot possibly be a cause. Many other origins have been suggested, but without sufficient proof.
The treatment of the nephritides of pregnancy is that described in chap. xiii for eclamptic symptoms. When albuminuric retinitis occurs, the medical tendency is to empty the uterus. All text-books counsel this procedure, but they give no convincing reasons for the advice. If the child is viable the therapeutic abortion might be done when necessary; if the child is not viable the operation is, of course, not licit. In the nephritis of pregnancy it is not certain that emptying the uterus artificially, with the entailed shock, is the best method of treatment; but, as a rule, nephritis is made worse by pregnancy, and the irritation lessens with the termination of gestation in some cases, but not in true chronic nephritis. Eclampsia is more toxic than nephritis, and the treatment may differ in important details: it certainly is doubtful that artificial abortion in eclampsia is the method of choice at present. I saw a case of albuminuric retinitis ten years ago, which could not have been worse. The woman was in the seventh month of gestation; she was nearly blind and half comatose. The albumin in her urine _always_ was so great that it would not fully precipitate in a centrifuge tube, and every field under the microscope was covered with large casts in such enormous quantities that they were felted together. Yet the woman was carried on to term by Dr. Joseph O'Malley and delivered of a fully developed child. She since has had two other children at term who are perfectly healthy, and she herself could pass a life insurance examination. This is, of course, only one case, and it is exceptional; but it is impossible to say what will happen in any particular case--whether it will go on to death or recovery.