Volume 2
A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.
- Date:
- 1889
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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![liowever, is very much lessencKl by the following; considerations, wliich liave boon advanccnl by J^artcls, Schrocnler, Spicgelberg, Jiraxton Ilieks, Robert lianuis, Ingci-slev, Devilliers, Rcgnault, and others : Morbid renal albuminuria sometimes appears early in jiregnancv/ before any considerable elevation of intra-abdominal tension. Ingerslev found renal albuminuria, due to pregnancy, only in one primii)ara; on the other hand, in five multipane. lu the five cases of twin pregnancy and three cases of hydramnion, occurring in the 600 women e.xamincd, no albuminuria was present. In 67 cases of hydramnion collected by Levi.Sf)u albuminuria and anasarca were ])resent in only 2. Flaischlein^ has examined the urine in 28 cases of intra-abdominal tumors, and detected albumen in only 3 cases, tubc-ca.sts in 2. In the 3 ca.ses of albuminuria, ovarian cystomata, not of the largest size, were ])rcsent. Moricke’s conclusion, that albuminuria is much more frequent in labor than in pregnancy, is not fully establi.«hed by his own researches, inasmuch as a sufficient number of ante-partum urinary examinations were not made. Of 153 women during labor, Ingerslev detectal albu- minuria in 50. The development of the albuminuria, as already jiointed out by AVinckel, was favored by the long duration of labor. In 80.5 ]>er cent, of the cases the albuminuria disappeared Avithin forty-eight hours after jairturition. Ingerslev suggests the idea that labor itself may be sufficient to determine nephritis and albuminuria. But in the ca.><es cited by this ob.sorvcr adequate aute-partum examination of the urine Avas not carried out, aud the conclusion is only an hy]K)thcsis. Out of the 1000 j)reguant AA-omen Avhose urine Avas tested by Flaisch- lein, 537—295 primipane, 242 multipai'a>—Avere olxserA'ed during labor. Albuminuria A\as detwted in 93 cases—73 primiparre and 20 midtiparas —or in 25 per cent, of the primiparre and in 8 per cent, of the multiparre. Except in the cases of chronic nephritis and the kidney of ])regnaney the albuminuria disaj)peared soon after labor. These observations ren- der in a high degree probable the hypothesis that all affeetions of the kidneys characterized by albuminuria, hyaline and granular casts, and fatty degeneration of the renal epithelial elements may be caused by labor itself. In the eaasation of this albuminuria of labor it is not improbable that a reflex contraction of the renal arteries, and con.se- quent renal anremia, plays an important rOle. The jiolyuria after expulsion of the child and the ces.sation of uterine contractions is eA'idence of secondary relaxation of the renal arteries (Flaischlein). The di.sappearance of albuminuria after labor, as pointed out by Bartels, only indicates that ])regnancy is its cause. It does not proA’e that increa.sed intra-abdominal tension is the exclusive, or CA’en princi- ’ Loc. cit., p. 3S9. * Eobert Barnes; The Lancet, April 29, 186-5.](https://iiif.wellcomecollection.org/image/b24991028_0002_0026.jp2/full/800%2C/0/default.jpg)
