Toxemias of Pregnancy *

An analysis has been made of the records of all patients who have entered the New Haven Hospital since 1921 with complications of pregnancy usually classified under the term toxemia. Of this group those who suffered only from vomiting in the early months of pregnancy have been excluded, together with a few who received the diagnosis of toxemia, but had such scanty records that the nature of their illnesses could not be determined. To the list of accepted toxemias have been added patients who came to the medical service with vascular and renal disorders that appeared to have originated in or followed pregnancy toxemias. The number of this latter group in which there may be doubt concerning the relation of the disease to pregnancy toxemias is extremely small. Finally, 36 patients are included who developed pyelitis during pregnancy and, before or immediately after the termination of pregnancy, exhibited hypertension, edema, or both. Altogether, the whole series comprises 351 patients. The present paper presents a summary of some of the salient features of these cases. Detailed studies of certain groups have already been pEublished. It has been pointed out that pyelitis complicating pregnancy is a major etiologic factor in the production of toxemias.24 Evidence for this view has been derived from both clinical and pathologic studies. Altogether 42 cases with outspoken pyelitis (or its endresult, pyelonephrosis) were discovered among patients who had received the diagnosis of toxemia of pregnancy. To these should be added the 36 mentioned above, who, while suffering from pyelitis during pregnancy, developed hypertension or edema. In the review of autopsy material33 it was demonstrated that besides pyelitis, a great variety of vascular or renal diseases may act as predisposing causes for toxemias. Pregnancy apparently contributes only a distinctive coloration and an explosive character to these conditions. In both these reports it was shown that the usual clinical classifications of toxemias have little significance. This was further emphasized in an analysis of so-called eclamptic toxemias.23 Eclampsia, which was