True Albuminuria Gravidarum.
Albuminuria is far from being a rare disease, at least so the following statistics show: Dumas, who has collected all these statistics, gives 1 in 5 or 6.
As to age, Deviniers and Regnault have fixed upon from 17 to 38 years, or from 17 to 30 years, as the period when the disease is most often seen. Bailly, on the contrary, attaches only a secondary importance to age. It is necessary, however, to take into account these statistics and those furnished by Peter, which seem to indicate that albuminuria is more common in young women than in older ones.
Among 113 women, of which 27 were suffering from albuminuria, Peter found: Ought we not here to refer it to pritniparity rather than to age, since it is more common as the women are younger? The influence of primiparity is, indeed, indisputable, and it is aclmowl edged by all authorities, thus: Rare during the first months, albuminuria is noticed above all after the sixth month and during labor. There have been reported, however, a number of eases of early albuminuria. These have been observed by: We have seen a c,ase at six months and a half in a multipara who had • shown it in two previous pregnancies, one of which was complicated with eclampsia.
What are the causes of albuminuria in pregnancy ? The causes which, theoretically, produce albuminuria may be reduced to three: 1. Alteration in the blood, super-albuminous. 2. Excess of intra-vascular tension, (the hydraemic state of pregnant women.) 3. Temporary or permanent disorder of the kidneys.
1st. Super-Albuminous Blood. —This theory is based on the experiments of Cl. Bernard, who produced albuminuria by injecting into the veins a certain quantity of albuminous liquid; on the experiments of Schiff, of Stokvis, who showed that the development of artificial albuminuria is de pendent upon the molecular state of the albumin injected; on the influ ence of exclusive albuminous diet. (Cl. Bernard, Bareswell, Brown &guard, Tesaier, Hammond). Gubler has proposed the following theory: " During pregnancy the mother's blood should furnish the fcetus with material for nutrition, but only in a soluble and diffusible form, since there is no communication between the fcetal and maternal surfaces of the cotyledons of the placenta.
"There are, in consequence, various forms of albumin which are called upon to nourish the new being, and during this.time, the maternal organ ism must provide for a double waste by absorbing more, by a more strict economy of the proteid elements, or indeed by these two causes together.
A greater quantity of these materials must be found ready at hand. It is enough that by virtue of a simple change in the mode of respiratory combustion the ternary substances should be consumed, and that the albu minoid materials escaping the catalytic action of the liver, the direct changes in the capillaries should be entirely reserved for the Hie of plas tic alimentation.
"Now, by this new way of working, a system badly regulated or new may go beyond the mark, and the albumin becomes relatively excessive for the wants of the two organisms grafted one on the other.
"This is the easier, since the albumin which has passed through the fcetus without being employed in its development comes back loaded with waste material, since respiration is not yet established in the latter, whose urine normally contains albumin, as in batrachians, and never contains urea. Besides, this albumin, as a whole, has returned into the circulation of the mother, seeing that the renal secretion, not appearing outside, is nearly suppressed during intra-uterine life. Albuminuria in pregnant women thus implies an over-production of albuminoid substances, considering the wants of the two organisms.
" At times the mother produces too much, sometimes the fcetus does not consume enough; at other times the two causes join in producing the result.
"If these products increase with weight and dimensions, one may con clude that the albuminuria is produced by organic disorders in the mother. If an albuminuric mother gives birth to a weak, sickly child, there ia ground for assuming the want of development of the latter as having occasioned an excess of albumin in the blood and in the urine." As Hypolitte remarks, if this theory is admitted, albuminuria should be met almost constantly in pregnancy, but it is not, and, what is more, this theory does not explain the albuminuria of the first months when the nutrition of the fcetus is very slight. Finally, the sudden disappearance of albuminuria after confinement in some cases could not be thus ex plained; and again, children who are born of women suffering.from albu minuria do not appear much more sickly than others. Thus: Showing, in a total of 56 children, 39 were of an average weight or above, and 17 only below.