LITHIASIS IN PREGNANCY
Journal of the American Medical Association
When honored by an invitation to contribute a paper to the proceedings of the Obstetrical Section of the American Medical Association, I was anxious to select a topic which, while possessing some novelty and belonging to the wider domain of General Medicine, might be useful and pertinent to the subjects within the province of this department. It is some years since first I observed the frequent manifestations of certain symptoms during pregnancy, and their subsequent persistence, that could be
... nce, that could be explained most satisfactorily by ascribing them to the influence of the lithic acid diathesis. Additional observation and reflection having satisfied me that the association was more than coincidental, I have concluded to submit my speculations to the consid¬ eration of this Section. That many observers have noticed the association of lithiasis with pregnancy is beyond question, but I am not aware of any attempt to present the facts and inferences in continuity. It is not so evident, either, that the profession generally has recognized the affiliation or the tendency which the phenomena of gestation have to develop this dyscrasia. My intention is to review the characteristics of lithiasis, their analogous manifestations in preg¬ nancy with the physiological processes in the lastmentioned which favor their development, and thus I shall endeavor to establish a definite relation be¬ tween the two conditions. For the sake of continuity I will briefly recapitu¬ late a few generally recognized principles concerning lithiasis. It is a diathesis associated with the pres¬ ence of an excess of lithic, or uric acid in the sys¬ tem, and made manifest by very varied phenomena, affecting almost every structure and function. Uric acid is derived from the proteid tissues and from the albuminous or nitrogenous foods. The manner of the formation of uric acid is a subject as yet involved in much obscurity, but it is generally conceded that, when it exceeds the normal quantity, marked disturb¬ ance of the structure or the functions of one or more important organs is the result. Primarily or second-arily the liver, stomach, kidneys, nervous system, liings, and the blood are severally or collectively in¬ volved, although in many instances no departure from the normal condition can be detected in some one or more of these factors. Lithiasis is intimately associated with those important excrementitious sub¬ stances, urea and the urates, which result from and, other things being equal, represent in constant pro¬ portions the constructive and the destructive cellchanges of the system. The intermediate link between the presence of uric acid and the manifestations of lithiasis is the deposition of the former in the affected tissues or of the salts produced by its combination with some of the inorganic elements, notably that with sodium. The resulting disturbance of the func¬ tions or the nutrition of the invaded organs produces the symptoms of the diathesis, and verily their name is legion. The specific gravity and the alkalinity of the blood is diminished and the excrementitious matters, espe¬ cially the uric acid and the urates, are increased in quantity, the alkalinity of the blood is less than nor¬ mal and the fibrin is increased. The objective symp¬ toms of anoemia also are frequently present and, naturally, they are associated with a reduction of the red corpuscles. The results of these abnormal con¬ ditions of the blood are very numerous, eczema, pru¬ ritus, phlebitis, neuralgia, myalgia, cedema and dropsy being prominent among the many. In the vascular system the arterial tension is increased and cardiac hypertrophy, simple or complicated, is a frequent consequence. Palpitation, irregularity of action, syncope and other diseased cardiac conditions are often present. It is reasonable to suppose that respiration is in¬ volved in an important manner, as uric acid is the result of arrested oxidation of the nitrogenous ele¬ ments which otherwise are convertible into the easily eliminated urea. The most frequent examples of disturbance of the respiration are dyspnoea, irritable cough and hiccough. The connection between lithiasis and the digestive system is close, and its manifestations are marked and frequent. Without dwelling upon the causal in¬ fluence of gastric acidity and imperfect digestion, we must notice their frequency in lithiasis. The various actions and secretions are deranged, producing mor¬ bid appetite, gastralgia acid and other eructations, nausea, vomiting, irritative diarrhcea or constipation, tympanites, hoemorrhoids, and several other symp¬ toms.