This may, possibly, be the case also with the hippuric acid, as the few analyses yet made show great differences in amount. Again, it remains to be seen whether, in some persons, more of the nitrogen does not pass off by the lungs (as ammonia), than in other persons; if this turn out to be the case, no regularity of diet, exercise, &c., could render the urea the same in two persons of equal age, sex, and weight. Altogether it would seem probable, that if two individuals, of the same sex, age, and weight, took precisely the same food, exercise, rest, and were subjected in all points to the same conditions, the urinary excretion would not be equal. SECTION XXII. MENSTRUATION. Beigel1 has made some rather imperfect observations on this point. In two women the following amounts were found: If the result in these two women can be taken as the rule, which is very doubtful, the amount of urea is lessened during but increases after, menstruation. I am not aware of any other analyses. SECTION XXIII. PREGNANCY. The urine of pregnant women was said by Lubansky2 to be less acid than usual; Lehmanns finds, however, that when first passed it is equally acid, but has a greater tendency to become alkaline than the urine of non-pregnant women. Hofle1 has not, however, found even this to be the case. Towards the latter end of pregnancy, the urine becomes more watery; all the solids diminish in amount, except, according to Böcker, the volatile salts and extractives. The earthy phosphate was said by Carus and Lehmann to be especially diminished. Böcker's analyses do not show this to any great extent; but Hollmann confirms Lehmann's statement. The following table, from Böcker's analyses, gives the most complete statement of the urine of pregnancy yet made. Urine of a Pregnant Woman in perfect health. Urine of 24 hours; in cubic centimeters and grammes. During this period, the weight of the woman increased about 5400 grammes. One Kilogramme of Body-weight excreted. Urea. At end of 8th week 29.85 1-11 0.408 0.018 0.0031 0.471 0.029 0.213 0.004 0.0040 0.320 0.025 0:379 Uric acid. The most noticeable fact brought out by this is the great diminution in the urea. It fell from 0.408 grammes to the kilogramme, which may be considered a healthy amount, to 1 Wagner's Handworterbuch der Phys., op. cit. 2 Böcker, Rheininche Monatschrift für prak. Aertze, May, 1848, p. 129. 0.154 grammes. The uric acid was also lessened. The earthy phosphates were scarcely altered. An analysis, by Hollmann, was made of the urine of a woman, aged thirty-one years, who had had four children, and who was in the thirty-fifth week of pregnancy. The singular deficiency of "extractives" in the first analysis is worthy of note. The amount gradually increased. The urea in this case was apparently not lessened, but the phosphoric acid was decidedly so. In twenty-four hours there were excreted in grammes Mosler has made twelve observations on the twenty-four hours' urine of pregnant women, the mean of which is as follows: These analyses do not show any diminution either in th ur ea or phosphoric acid. Blot has found sugar in the urine of pregnancy, as in that of 1 Einige Untersuchungen über Blut u. Harn. der Schwangeren. Inaug. Diss. Wurzburg, 1854. In Scherer's Report on Pathol. Chem., Canstatt's Jahresb. 1854, p. 187. 2 Comptes Rendus, 1856, ii, No. 14. suckling. This is denied by Wiederhold and Leconte (Schmidt's Jahrb., 1858, No. 1, p. 14); for a discussion on this subject I refer to the chapter on "Suckling." Ranke1 examined the water, solids, chlorine, urea, and uric acid in a woman, twenty-five years old, confined with her first child. From a comparison of five days before the birth, and six days afterwards (beginning with the second day), it would seem that before labour the excretion was very regular, and was normal as to quantity, the mean being in twenty-four hours after the birth, all the above urinary ingredients were very much lessened for a day, and then increased, so as to very much surpass the excretion before the birth. Taking the five days (4-9) after birth, the mean excretion in each twenty-four hours was The water and urea were thus increased, especially the water, while the uric acid was almost unaltered, and the chlorine was lessened. The increase in the urea may be connected either with the rapid disintegration of the uterine textures (as suggested by Ranke), or, perhaps, with a slight pyrexia occurring during the first week. All these analyses can be merely considered as so many facts, which future observations must confirm and connect together, but which are not at present susceptible of being used to explain the metamorphoses in pregnancy.2 Much attention was directed some years ago to the formation of a white scum, or thick pellicle, which appears in the urine of pregnant women, when kept for thirty or forty hours, and to which the term kyestein was applied.3 1 Ausscheidung der Harnsaure, p. 20. 2 Comparative analyses of the blood and urine of a pregnant woman with dropsy and albuminuria have been made by Harley and Gegenbam. (See chap. v.) 3 For the voluminous literature on this point, see Hofle, Chem. und Mikroscop. am Krankenbette, 1st edit., appendix, p. 149. The last and best paper is by Elliott (New York Journal, Sept., 1856). He describes the appearances in 153 cases of pregnancy. It was supposed that this substance was in part composed of casein, derived from the mammary gland; but this does not appear to be the case. The so-called kyestein is not of constant or determined composition, but consists of triple phosphate, derived from decomposition of the urea, bladder mucus, fat, infusoria, and fungus-growths, mixed with the organic matter of vaginal discharges. Very similar appearances are found, less frequently, in the anæmic urine of non-pregnant women, and sometimes in the urine of men. As already said, according to Blot,' when the breasts begin to enlarge during pregnancy, sugar appears in the urine, and continues during the whole period. No other diabetic symptoms attend this state. (On this subject, see page 107.) When albuminuria and dropsy occur in pregnancy, the amount of urea is very much lessened. Harley and Gegenbaur 2 have made comparative analyses of the blood and urine of a woman, aged thirty-six, who, in the thirty-third and thirty-fifth weeks of pregnancy, had general dropsy and albuminuria, but improved before delivery, and got perfectly well afterwards. The blood was found in the first two analyses to be very watery (826 and 829 parts per 1000), and to be poor in albumen (54 and 60-6 parts per 1000) and in blood-cells (103.5 and 96 parts per 1000). The soluble salts were in excess. The fibrine was in normal amount. Subsequently the blood became much richer in albumen and red cells; indeed, quite normal. The urine had the following composition in twenty-four hours, in c.c. and grammes: The increase of the urea and the "extractives," and the decrease of the albumen, coincidently with the improved condition of the blood, are very well seen. The quantity of the 1 Scherer's Report on Phys. Chem., Canstatt's Jahresb. for 1856, p. 160. 2 Scanzoni, Beitrage zur Geburtskunde. |