LESIONS OF THE SECRETIONS AND THE EXCRETIONS. Ptyalism.
Excessive salivation, or ptyalism, is not, in pregnant women, as rare or insignificant a symptom as Cazeaux seems .to think. Besides the inconvenience and discorafort which it brings upon the pregnant woman, it weakens her considerably, interrupts assimilation, induces a certain amount of depression, which leads to emaciation and a tired feeling, sometimes very marked. It is true, the health of the woman is not, in general, seriously undermined; but ptyalism none the less merits the at tention of the physician. Sometimes it may be accompanied by vomiting, sometimes, on the contrary, it may exist alone. Slight in some women, in others it becomes very abundant, even in the night, and deprives the patient of a certain amount of sleep. According to Cazeaux, it may be a temporary affair, in general of slight duration. The cases of serious and abundant salivation we have had do not allow us to share this opinion. In 7 cases the ptyalism began, so to speak, with pregnancy (3 times in the same woman), and persisted after the pregnancy, once 15 days, once 18 days,twice for 2 to 3 weeks, and 3 times in the same woman for 3 to 4 months after labor. Cazeanx himself has had similar cases.
Unfortunately, the means of treating the disease are of little avail. Astringent gargles, sugar, ice, have usually failed. That which has the most power, and still its power is limited, is the use of bitter sub stances, quassia, dry bitter orange peel, (of which the patient can keep a small piece alwa3rs in the mouth,) brandy, used as a gargle several times a day. We have never, as Cazeaux, seen ptyalism cease toward the end of pregnancy, but have seen it, on tho contrary, persist even to the end of that pregnancy, and appear again in the same woman in three suc cessive pregnancies.
Gingivitis of Pregnancy.
This disease is characterized by a redness, a congestion of the gums on both maxilhe, a puffiness which covers a part of each tooth, and forms thus a pad, more often on the anterior of both maxillre as far as the molar teeth. This pad of gums bleeds easily, the teeth become loose, shaky, and may, later on, fall out of their sockets. Then results a difficulty
in mastication which becomes the more painful as the lesion is more pronounced.
Pinard in 73 women, of whom 43 were multiparre and 32 primiparre, found it 31 times in primiparie and 14 times in multiparre. Multiparre are, then, more liable to this disease than primiparre. Former pregnancies and bad general condition appear to play an important part in the course. Gingivitis, as a rule, continues through pregnancy and only disappears a month or two after confinement. It persists, sometimes, longer in women who nurse. We have at present under observation a yotuig woman in the seventh month of her pregnancy, who presents not only this gingivitis, but a true gingival tumor of the size of an almond, situated near the left canine tooth. The tumor is a bloody, fungoid tumor, which resists all treatment. Tincture of iodine, glycerol of tannin, chlorate of potash, rec ommended by Pinard, have failed ; chromic acid alone relieved the patient, but did not produce a cure, which will probably occur after confinement. The following solution, chloral and alcohol equal parts, advised by Pittard, has failed completely.
Excretion of Urine.
The secretion of urine during pregnancy is the same as in the non pregnant state. It is neither increased nor diminished. But it is not the same with the excretion, which suffers marked modifications. At times there is retention, sometimes incontinence, and finally an incessant desire to urinat,e, occurring at different periods of pregnancy. These troubles may be referred to various causes, and in regard to incontinence, in particular, it may be observed in two distinct conditions. Sometimes it may succeed, or, better, accompany retention—that is to say, an incon tinence by distension; on the other hand, there may be no retention; but, in multiparte in particular, the vesical sphincter has lost some of its tonicity, and in walking, coughing, laughing, lifting, such women eject a small amount of water, which the bladder, having 4ost its retentive power, is unable to hold. There may be a true inflammation of the blad der, cystitis, pains, Malaise, frequent micturition.