The aetiology of pre-eclampsia, 1945-1953.

XUE QING WU, CONSULTANT, YAO YAO CAI, RESIDENT, WEI TING XIA, RESIDENT AND MJ QUINN, VISITING SCHOLAR, FIRST AFFILIATED HOSPITAL, MEDICAL UNIVERSITY OF WENZHOU, WENZHOU, CHINA ....................................................................................................................................................................... A Tremain Hertig (1904– 1990) was a professor of pathology at Harvard Medical School who was the first to describe the ‘narrowing of uterine arterioles’ in pre-eclampsia in 1945. In his original report (and in almost every report since), there is a partial or complete ‘halo of hyalinised (“empty”) cells’ around the injured vessels that corresponds to the site of a ‘halo of injured nerves’ in many gynaecological syndromes (Figure 1A, B; Hertig Clinics, 1945;4:602–13). In 1953, John Sophian (1894–1975), who later became an obstetrician at St Mary’s Hospital for Women, Plaistow, discovered uterorenal autonomic pathways in rabbits. He observed immediate blanching of the kidneys after inflating balloons in rabbit uteri, and, that persistent distension led to acute renal failure, whereas prior renal denervation abolished the effect (J Obstet Gynaecol Br Emp 1955;62:37–47). In 1948, in the same laboratory, Josep Trueta (1897–1977), a Catalan surgeon who became Professor of Orthopaedics in Oxford, described the ‘Oxford shunt’, where crush injuries to animal limbs resulted in the diversion of renal blood flow from the cortex to the medulla, with subsequent hypertension and proteinuria (Proc R Soc Med 1948;41:339–42).