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44
it accounts for only 1 per cent. of the total), yet it sometimes give rise
to puerperal pyrexia, that bugbear of obstetricians, and, when acute,
may cause abortion or premature labour. For every reason therefore
I have constantly endeavoured for years to track down and obtain
treatment for all such cases, even the mildest ones.
I have been able to collect a series of 14 cases of pyelitis which
have been under my supervision and been confined during the 18
months between September, 1934, and February, 1936. Of these 14
cases, 9 were young mothers, pregnant for the first time, the average
age being 24.
With regard to the condition of the urine, a trace of albumen was
found in 13 cases out of the 14, and, after further investigation by
a pathologist, pus and B. coli in large numbers. The symptoms
pointing to pyelitis were, pain on micturition in seven cases and pain
on one or other side of the abdomen in three. It is interesting, however,
that two of the remaining cases were absolutely symptomless and
attention was only drawn to the state of affairs when the patient was
found to have albuminuria combined with a very low blood pressure,
so that another cause for albuminuria than toxaemia had to be searched
for; pus and B. coli being eventually found. Yet both of these women
had severe attacks of pyelitis later in pregnancy, and had to be admitted
to New End Hospital for in-patient treatment, one of them developing
an attack of puerperal pyrexia subsequently. It would seem, therefore,
that further investigation should always be made when
albuminuria is unaccompanied by toxaemia symptoms and a raised
blood pressure. Incidentally, 10 out of the 14 cases had carious teeth.
With regard to treatment, two women were treated entirely at
New End Hospital, and a third by her own doctor to whom I had
referred her, as the pregnancy was too far advanced to do more than
administer alkalies. I sent the remaining 11 cases to Mr. Winsbury
White, the urologist, at St. Paul's Hospital, Covent Garden, who
undertook most thorough and painstaking investigation and treatment,
as far as possible. Pregnancy was not too far advanced in eight of
these patients, so that he was able to investigate the condition of their
urinary tracts and intravenous urograms showed a greater or less
degree of dilatation of the right ureter and renal pelvis and calyces in
seven cases. Cystitis was found to be present in five of these.