ALBUMINURIA IN PREGNANCY


Having ascertained the condition, what shall we do? Diet is necessary at once-a milk diet with orange juice and plenty of water. Until the burning and urinary distress is relieved the patient should go to bed and stay there. In the early stages if nausea is distressing Dr. Royal of Iowa advocates 10 c.c. of the husbands blood injected into the buttocks. I have found this method splendid.


Pregnancy is a normal condition and one which every young married woman looks forward to with hope, it she has the correct attitude towards life.

We have all seen delicate girls marry and were doubtful about their strength to have children, but nature seems to join with the desire of the mother. The frail young woman broadens out during pregnancy and becomes a robust expectant, capable of withstanding the foetal development and delivery with case. It is only when nature is met by some with case.

It is only when nature is met by some previous defect, such as tuberculosis, pelvic deformity or a severe kidney involvement that it cannot step in and take charge of the case with complete satisfaction. Even in tuberculosis nature is not balked. I have seen several cases of advanced pulmonary tuberculosis where the young woman became pregnant and nature seemed to rob the germs of their victim. Often it is only a stay of execution, however, because after birth the germs are doubly active.

It is the doctors duty to keep a constant watch over the expectant mother as soon after conception as he is consulted. In fact it is nature or the rebellion of the body against the laws of nature which often send the young married woman to her doctor because of nausea. The doctor must then make a blood test, a urine test, examine the heart and lungs, and take the blood pressure. Sometimes this trying time for the young mother will be the warning for the doctor that all is not well. The frequent headaches, the rising blood pressure, and a trace of albumin in the urine should be sufficient evidence for him that he is not dealing with a blood condition brought about by pregnancy but that he is confronted with nephritis.

It is true there are a number of conditions which may produce albuminuria.

1. Physiological. A trace of albumin may be found and an entire absence of any other symptoms whatsoever. I have never met such a case, at least not in a pregnant woman.

2. Certain febrile conditions, such as scarlet fever, measles, or even influenza. In pregnancy this would be very dangerous both to mother and child.

3. Certain nervous affections, such as epilepsy, chorea, cerebral haemorrhage, or delirium tremens. Also exophthalmic goitre may produce an albuminuria. If the doctor has been consulted before the wedding these name conditions should be sufficient grounds for him to refuse to grant a clean bill of health and thus prevent the marriage until these nervous conditions are corrected.

4. Certain patients may have an interstitial nephritis producing albumin. To a certain extent this is physiological. It is physiological in this diseased and, while it complications the pregnancy very much, it does not have the grave significance that a true nephritis has. I have one woman with this condition whom I have cared for in five confinements, and she has had albumin during the whole pregnancy with all and yet had normal births.

5. There are also women who have married who have Brights disease-parenchymatous nephritis. These woman may become pregnant. These case should be checked, too, before they reach the altar by our state laws and the doctors examination.

6. A year ago I was consulted by a woman who was pregnant. I found she had secondary anaemia. She told me she had miscarried three time before because of the same condition. There was a trace of albumin in the urine but the blood picture was alarming. Haemoglobin was only 40 p.c. Strange to say, although she had taken quantities of iron both by mouth and hypodermically, Ferrum phos. 45M. changed the picture in there weeks. Alas, in her fifth month the contracted measles from her little son and again miscarried.

According to Bartlett there are other conditions causing albuminuria but we will not take them up now.

Whether the alkaline balance is lowered in the blood or whether certain toxins in the blood may be the sole cause, we meet these nephritis cases in pregnancy. It may come in any stage of the pregnancy, but my observation is that it is more apt to begin in the first three months. The hearts action is accelerated, the blood pressure rises, and the urine may cause burning and distress. It may also become scant and high colored. I may say that if there is a trace of albumin and none of these symptoms take place, then it is quite possible the condition is of long standing and the patient has established a tolerance, a tolerance which will see her through to a safe delivery.

My worst cases have been in the robust women of strong physique, often inclined to be fleshy, with red cheeks and strong bodies. They are frequently very nauseated in the early months and come to you with this distressing condition. Soon another condition is disturbing-frequency of urination and the burning on passing a small amount. This leads to an examination of the urine showing the albumin and the rising blood pressure, headache, and puffiness under the eyes are all characteristic.

Having ascertained the condition, what shall we do? Diet is necessary at once-a milk diet with orange juice and plenty of water. Until the burning and urinary distress is relieved the patient should go to bed and stay there. In the early stages if nausea is distressing Dr. Royal of Iowa advocates 10 c.c. of the husbands blood injected into the buttocks. I have found this method splendid. Not only does it stop the nauseas but it also checks the nephritis. Both the husband and wife are pleased with the spectacular method. One couple a year ago told how I used blood transfusion for them.

The next thing is the indicated remedy. This may be any remedy in the category. Look for the symptoms.

Belladonna is clearly indicated in the full-blooded type with increased tension, headache, red face, throbbing arteries, dilated pupils, and soreness in the bladder region.

Ferrum phos. is indicated where the pulse is not so throbbing. The patients is anaemic and the face while flushed is more florid. Often a history of a severe cold caused the trouble. The patient is chilly at 4 to 6 a.m. and worse on the right side by touch or a jar. I now use this remedy in high potency.

Merc. cur, has a great tenesmus of the bladder and often of the bowel too. The urine is hot and scanty, often with blood in it. There is a bloated appearance of the face, limbs and body.

Hamamelis is extremely useful if there is much blood. There are many varicose veins, also passive congestions, and great weakness and soreness. Use in 3 to 5 doses.

Eupatorium purp. has a burning and full feeling of the bladder, strangury, chills and pains run up the back, left-sided headache, and bone pains.

These are only a few of the remedies you may need. It the blood pressure goes down, headache stops, and the pulse slows, do not be alarmed if the albumin is not all gone. When delivery time comes take the blood pressure, give the indicated remedy, and watch your patient.

DISCUSSION

DR. GRIMMER: This was good paper and concise. Of course, as Dr. Bowie stated, those remedies mentioned are not the only remedies we have, but they are high type.

It is a pity that the expectant mother cannot have more homoeopathic physicians like Dr. Bowie to take care of her. She would go through easier and have none of the consequence of bad drugging, and, what is more, the children that come into the world under homoeopathic care have gone a long step forward to better health and to health that will go on to future generations.

I am throughly convinced that if we could have three generations of homoeopathic treatment we could eradicate most of the tuberculosis and cancer in the race. That is a pretty startling statement, but I believe it is true, because we see that we can do in just one generation with careful homoeopathic prescription.

The doctor thought I would take issue with him on some questions of potencies versus tinctures. You might think it strange, but I have used tinctures quite a few times to very good advantage. I think all of our men have at some time. Even Dr. Hahnemann himself cured the poor old washerman with tincture of Bryonia, and very well. If your remedy is indicated, you can give anything from tincture to the DM. potency and get results. It is true that as we get along in our work we can select better whether the case will he more applicable to the tincture or more applicable to the potency. We do not need to be divided any longer on the potency question. It is the question of the one remedy the counts.

I would like to mention another not mentioned, and that is Phosphorus. It is a wonderful remedy in many forms of Brights disease and albuminuria. The extreme thirst for ice-cold water is one of the things that will lead to Phosphorus, and you quickly have to differentiate from some of the other remedies.

As the doctor said, we must individualize and get the remedy best suited for each individual case if we get the ideal homoeopathic remedy.

DR. DIXON: Phosphoric acid did yeomen service for me in a good many albumin cases.

Dr. Bowie mentioned in his paper that some people carry albumin through a long life without any bad symptoms. I have a man, now well up in his seventies, who, when he was twenty-five years of age, was refused life insurance because of a trace of albumin in his urine, which he has had all his life. I have been the family doctor for forty years, and that man has not had a severe illness in all that time, only little acute things like a cold or a touch of rheumatism.

I met him on the street, not over a week ago, and shook hands with him. I do not believe I had been him for seven years, although we live in the same town. I said, “George have you got the albumin in your urine still?

He said, “I dont know. I have quit looking for it.”

DR. STEVENS: I think Apis ought to be put in that list of remedies. It is very useful sometimes with the intense swelling and albuminuria.

DR. HAYES: Dr. Erastus E.Case, years ago, told me that albuminuria of pregnancy which exhibited copious, sour, pale, slightly cloudy urine and sour smelling, would need only Merc. cor. I have verified that many times.

DR. DIXON: I recall a homoeopathic doctor in one of our state societies making a statement once in a discussion of a case-this was a lady doctor-“I have used Merc. cur. and Phosphorus acid in alternation all my life, and I have never lost a case.”

I think I have made that statement at these meetings before but it is laughable.

DR. MOORE: Some of the old, old things are mighty good things. Some of the old, old ideas are mighty poor ones, The idea that we can put into the stomach a substance that a system is needing and that the system will take that up, as iron, for instance, is rather a poor idea that came from a long way back and continues today.

Of course, in the case you spoke of, where the iron had been given, perhaps different forms of iron, it might have been useful, but never would have been useful because they had iron, nor was the Phos. useful before it had iron. The Ferrum phos. in this case was useful because of its stimulative action. It might just as well have been a remedy without anything of that sort at all.

I am glad to have Dr. Bowie bring the idea of the crude drug being used, because I came from the crude drug crowd not long ago, and all of the people belonged to the crude drug up to the time of the Hahnemann, as far as I Know. All of the drugs that were given upto his time were given in material dose, although discrimination between the action of a large dose and of a small dose goes back to Hippocrates.

DR. HUBBARD: I would like to add a word for the frequency with which I have been able to help albuminuria, not only in pregnancy but other cases, with Lycopodium, and in pregnancy sometimes with Arsenicum or with Cuprum ars.

DR. BOND: Speaking of Eupatorium perfoliatum and Eupatorium purpureum, there are some doctors who feel that Eupatorium purpureum has greater action then Eupatorium perfoliatum. I would like to hear some discussion of the difference between the action of the two remedies.

DR. GRIMMER: Well, they are quite similar in action. I think perhaps the purpureum is more apt to correspond to more chronic forms of disease than the perfoliatum, which corresponds more to the acute, especially “flu” and rheumatic states. I think perhaps you can state the difference pretty logically in the fact that the purpureum is more apt to be related to chronic conditions.

DR. BOWIE: Of course, as I stated, there are many remedies that are useful in albuminuria. Any remedy may be the remedy. I have found Helonias very successful, especially following pregnancy. It is one of the most valuable remedies in albuminuria that I know of, following pregnancy, but not so useful before delivery.

I believe you spoke of the old school. Dr. Winter, whom some of you may know, as I believe he was a member of this society, is a very old gentleman living in Nebraska and once had a great experience. A hotel mans wife had albuminuria and was waited on by two doctors, visiting her four of five times a week, both of them. They finally decided it would be necessary to use mechanical means to bring about delivery of the child.

Her husband got on the train and went down to Dr. Winter and told him about the case and the doctor gave him Merc. cor. and Belladonna in alternation. He said he didnt know what the complete symptoms were, so just alternated. The patient kept getting better and better, and the doctors were examining the urine every day and found it improving. They called the husband up and said, “We believe it is safe to let her go on.” Their medicine was going in the stove.

R C Bowie