Glycosuria in Pregnancy
Boston Medical and Surgical Journal
previous infection. The very frequent acute processes occurring in the course of quiet chronic gonorrhea often can be quickly cleaned up under any treatment, even with internal use of the balsams alone. To sum up, the writer believes thoroughly that all cases of early acute gonorrhea except in the presence of some contra-indication (such as phimosis or acute folliculitis) do better under active irrigation which in itself much reduces the severity of the disease, and he believes that the "
... c " silver preparations used not alone but in combination with profuse bland irrigations accomplish definite results by germicidal action. By following out a routine based on this, varied to suit varying cases, we can effect a very rapid cure in a certain proportion of cases, a very considerable diminution of time of treatment required in the other cases, a very comfortable condition as to symptoms during the course of treatment and, by no means least, the most efficient limitation as yet possible of the area involved as well as of the duration, and hence the best chance for avoidance of complications and chronic processes. GLYCOSURIA IN PREGNANCY.* Physician to Out-Patients, Boston Lying-In Hospital; Assistant in Obstetrics, Harvard Medical School. Blot in 1856 found a physiological glycosuria in the urine of all women at the lying-in period, in all nursing women, and in a certain number of pregnant women. Sugar was present in amounts as high as 8 gr. per 1,000 cc. of urine. He did not state the kind of sugar found, and it was not until 1877 that Hofmeister demonstrated it to be lactose. Since that time many observers have noted the existence of glycosuria in this class of cases and have brought forward different theories to account for its presence. Brocard in 1898 found a temporary glycosuria in 60 out of 125 cases of pregnancy between the seventh and ninth months, the varieties of sugar being glucose and lactose. Marie des Bouvenes in 103 pregnant women out of 353 examinations found 109 positive glucose reactions, or about 40%. Commandeur and Porcher recently found glycosuria present in twenty cases just prior to delivery. Very frequently the proportion of sugar found was so small that ordinary methods of determination were not always delicate enough to demonstrate its presence. Brocard thought the glycosuria due to a disturbance of general nutrition. Charrin, his co-worker, suggested that the excess of fat in the liver of pregnant women might explain this tendency. Commandeur and Porcher in a recent article upon the subject maintain that the uncertainty of the physiology of the breast has been the difficulty in determining the cause. They state that from the experiments of Paul Bert in 1884. which they have since confirmed, it has been definitely proven that glucose, which is made in the liver, is transformed in the breast into lactose. This process increases as lactation appears. When there is an excess of glucose in the liver or when the breast is not ready for" action this excess of glucose is thrown into the blood and appears in the urine. Then there is a temporary glycosuria which may occur from various causes as fright, injuries, nervous conditions, creatinine and its bases febrile attacks, acute diseases, action of certain toxic substances, ingestion of saccharine foods, anesthetics, and others. Pathological glycosuria is due only to the condition known as diabetes mellitus. In this condition glucose is present in quantities from £ to 10%. The urine is increased in quantity and possesses various properties which are recognized as being associated with that disease. The relation of glycosuia to pregnancy is an interesting one and a number of cases of this condition have been collected. It has been possible to divide the cases into two classes: (1) Showing a temporary glycosuria during some part of the pregnancy where no other symptoms existed, where the glycosuria was small in amount and varied but little; and (2) Showing a glycosuria present where the amount was larger with a tendency to increase, and where other symptoms existed. Through the courtesy of Dr. Geo. M. Craigin of Boston and Dr. Ingalls of Hartford, Conn., we are able to report three recent cases of glycosuria in pregnancy and we desire to express our thanks to them here. (1) Case of Dr. George A. Craigin. Primípara; thirty ; family history negative. Always well, robust physique, accustomed to considerable exercise and a hearty eater. Last catamenia May 8. Urine examination negative up to Dec. 29. Urine examination,