Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    (liiots in 21. Flaisclilcin' examined the nrine of 1000 ])resnant women, and detected albuminuria in 2(>, or in 2.(5 per cent. In 5 eases it was due to vesical catarrh, in 2 eases to antecedent chronic nephritis; in 3 wises the albuminuria was transient. Out of 200 cases in the Guv’s Hosiiital Charity,^ albuminuria was discovered in 4, and 2 of these were probably cjL«es of chronic Bright’s disease. Out of 422 cases in Bellevue Hospital,* albuminuria was found in 22. Other investigators have estimated the proportion of pregnant women whose urine contains albumen at 20, and even 30, per cent. The results of the re.searches of Ingci-slev and Flaisehlein are especially worthy of credenee on account of the large number of eases and the accuracy of the methods of chemical analysis. Mention has already been made of physiological albuminuria^ as an occasional phenomenon under certain conditions in the coui*se of ]ireg- nancy. The small quantity of albumen, the absence of tube-easts and renal epithelium, the transient character of the appearance, and the absence of all symptonis pointing to renal disturbance, are diagnostic criteria commonly sufficient to distinguish this jihenomenon from albu- minuria due to functional or organic disease of the kidnevs. In the light of Ingerslev’s and Flaischlein’s observation the a.ssertion by Behm® that pregnancy is invariably accompanial by albuminuria is plainly erroneous. Etiology.—Pregnancy sustains with relative frequency a necessary relation to various forms of nephritis. A certain type of renal disease is observed only during gestation, and all the varieties of chronic Bright’s disease are, as a rule, aggravated by the condition. The nature of this causal nexus, however, is still verA’ obscure, notwithstanding the ])atient investigation of numerous observers from the days of Raver® (1840) and Ijcvcr^ (1842) up to the present. The subject is of vital importance, since the treatment of the condition itself and its chief symptom, eclampsia, depends almost exclusively upon the views entertained as to causation. Not one of the numerous theories which have been urgeil from time to time is in itself adequately explanatory of the renal complications inci- dent to pregnancy. However, those theories are seldom contradictory jiropositions, and it is frequently the case that more than one etiological factor is in active operation. 1. The most ancient theory is that the albuminuria and kidney dis- orders are due to mechanical pressure of the renal blood-vessels, espe- cially the veins, by the gravid uterus. Passive hypenemia of the ’ Zeiluchr. f. Orb. u. Gr/n., Bd. viii. p. 358. ’ Galabin’s Midwifery, p. 272. • Elliott: Obstci. Clinic, N. S., 1868, p. 7. * Leiilte: Virchoida ArrMr, Bd. Ixxii. p. 145. ^ Monaischr. f. Gcb., Bd. .xviii., Sup., p. 19. ’ Guy’s Ifoepilal Reports, 2d Series, 1842. “ Train des Maladies dcs Reins.