The clinical significance of glycosuria in pregnant women / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1909
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Licence: In copyright

Credit: The clinical significance of glycosuria in pregnant women / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and is usually associated with premature mammary activity, d'lius, Ludwig noted it in 4(5 per cent, of 82 women in the last weeks of pregnancy, wliile in 10 per cent, more of his patients lactose alter- nated, with glucose. Commandeur and I’orcher found lactosuria in 30 consecutive cases, altliough in 8 instances it was associated with glycosuria. In the latter event they believe that the condition is due to the fact that the breasts are not sufhciently active to convert into lactose all of the glucose which is brought to them l)y the blood, as they hold that such a transformation usually occurs as soon as the breasts begin to function. Moreover, they consider that both they and Bert have adduced experimental evidence in su'fiport of such a transformation by finding that the urine of recently delivered goats, whose breasts had been amputated just before conception, contains considerable quantities of glucose in place of the lactose which is usually present. In 22 of the 24 cases in which sugar was present during pregnancy in the urine of 3000 consecutive patients in my service, it is probable that we had to do with lactosuria, as in none of them was the presence of sugar demonstrated prior to the last six weeks of pregnancy and usually only during the two weeks immediately preceding delivery. Moreover, only lactose was found in the cases in which the nature of the sugar was differentiated. On the other hand, Case I clearly shows that lactosuria does not occur exclusively in the last weeks of pregnancy, as in this instance milk sugar was definitely demonstrated during the course of the seventh month, and doubtless many similar cases have occurred in the experience of others. In consideration of the facts just adduced, I feel that one is justi- fied in stating that moderate degrees of lactosuria occurring either during pregnancy or the puerperium may be regarded as physiologi- cal and, therefore, of no prognostic significance. The practical im- portance of the condition lies in the fact that an incautious observer may confound it with glycosuria and, believing that the latter is indicative of the existence of diabetes, may express a sombre prog- nosis, which is usually not justifiable. Transient Glycosuria. Leaving out of consideration the minute amounts of glucose which have been shown by the observ’^ations of Briicke, Ivanoff, Abeles, Pavy, Luther, Moritz, Lemaire, and others to be present in the urine of normal men and women, certain authors also state that appreciable quantities of glucose may be demonstrated in the urine during the second half of pregnancy and particularly during its last few weeks. The following authors make varying statements concerning its incidence: Keim, 10 percent.; Ludwig, 12 per cent.; Ney, 16.6 per cent.; Commandeur and Porcher, 26 per cent.; Charrin, 40 per cent.; Bar, 43 per cent.; Brocard, 45 per cent.; Leduc, 60 per cent.; Saldmi, 66 per cent; while Rudaux holds that its presence is practically universal, and Brocard and Bar state