ALBUMINURIA OF LABOR.
Under this name, we understand not only albuminuria recognized dur ing labor, but, according to Hypolitte, Peter, Dumas, Cassin, albuminuria of the two or three days which immediately precede labor. It appears essentially dependent on this act, begins and ends with it, and its duration and intensity are often proportionate to the duration of labor. Petit has shown that if Peter's theory can fully explain all the particulars of album inuria of pregnancy, it is not so in albuminuria of labor, and, whilst adopt ing in great part the ideas of his teacher, he thus modifies Peter's theory: "A priori one would think that expulsive efforts alone are capable of congesting the kidney enough to cause filtration of the urine, but if we consider what takes place in the part of the abdominal circulation during dilatation, we will easily realize that this organ must undergo, at the same time with each uterine contraction, a certain degree of hyperremia, capable also, although in a less degree, of producing the same result. The uterine vessels, arteries and veins, acquire an extreme development during pregnancy; the uterine circulation is interrupted more or less com pletely in the uterine walls during a uterine contraction. The enormous quantity of blood brought continuously by the utero-ovarian arteries ceases at each uterine pain, to find a free flow through the uterus. There results then, by a mechanism somewhat analogous to that of the hydraulic ram, an increased pressure in the portion of these arteries which remain pelme able and also in the trunks from which they spring.
"The utero-ovarian arteries arise from the antero-lateral part of the ab dominal aorta, a short distance from the origin of the renal arteries, and at times they arise from the renal arteries themselves. It is then in the lat ter, as well as in the kidney, that this increased pressure is felt soonest and strongest. But while it shuts off the passage of arterial blood toward the uterus, each uterine contraction presses out in some way the engorged uterine blood, and accelerates the return utero-ovarian circulation: again, the abnormal distension of the trunks to which these veins lead, i.e., the
part of the inferior vena cava, near the opening of the emulgent veins, or some of the emulgent veins themselves, hinders the course of the blood which returns to the kidneys; and venous stasis in the organs results, i.e., a condition favorable to the production of albuminuria. If these views are correct, uterine contraction exerts a pressure toward the kidney from two sides at once: through the arteries by increasing arterial tension, through the veins, by increasing venous pressure; and we perceive how this arterial tension, persisting for a long time, determines the passage of albumin into the mine; above all if we admit with Peter that there exists physiologically, by the fact of pregnancy alone, a functional hypera3mia of the kidney.
Finally, Peter believes that the abdominal muscles have a part in this pressure. As to the notable increase in the albumin which he has de monstrated in the first urine passed after the birth of the fcetus, Petit explains this by the fact that, " accustomed to work during pregnancy, under a gradually increasing pressure, of which they are suddenly de prived, the kinneys find themselves exposed to an intense congestion." of labor is much more frequent thau that of pregnancy, and it has been met with by Blot 1 in 5; Petit 1 in 4.8; Hypolitte 1 in 4.23; Litzmann 40.78 per cent. Moricke 37. per cent.
Age and primiparity play an important part: thus Cassin has found, in 427 cases, 197 primiparEe, e7 or 34 per cent; 250 multiparEe, 42 or 16 per cent.
In our opinion this table is not of greai value, because it is in positive contradiction to facts daily observed.
Presentations in R 0.P. would give, if one refers to the tables of Cassin, a duration of labor much greater in multiparte than in primiparte, but the contrary is true. Indeed, intervention is more frequent in primiparm than in multiparty; but even taking into account this intervention, the duration of labor is not comparable in the two cases. It is the same of dystocia, of which Cassin does not describe the nature.