The Kidneys, Skin

The Prospective Mother: A Handbook for Women During Pregnancy
by J. Morris Slemons

(Page 7 of 17)

The Kidneys. Any one may judge for herself whether or not the bowels are doing their work satisfactorily, but not so with the kidneys. For this purpose the urine must be examined by a physician. In spite of this fact, considerable responsibility rests upon the prospective mother, whose duty it is to collect the specimens properly - a detail that is apt to be neglected. It is impossible to urge too strongly the importance of saving, at regular intervals, all the urine passed in twenty-four hours, of protecting it from decomposition, and of sending a sample to the physician. The intervals may be longer at first, for the kidneys have very little extra work to do until the sixth month. Usually, therefore, it is a satisfactory plan to send a sample for analysis the first of each month during the early half of pregnancy; but during the latter half one should be sent the first and the fifteenth of each month.

To estimate the exact amount of urine passed in twenty-four hours and to protect it properly, in the first place, the vessel in which it will be collected should be carefully scalded out. As a further precaution against decomposition, add a teaspoonful of chloroform to the vessel, which should be kept covered, and not allowed to stand in a warm room. Unless these details are conscientiously observed, putrefaction may take place and vitiate the analysis the physician wishes to make. The precise amount of urine which the kidneys excrete in twenty-four hours will be determined as follows: At a convenient time, for example at 8 A.M., empty the bladder and throw the urine away; this marks the beginning of the observation. Subsequently, save all the urine passed during the day and night, and finally at 8 o'clock the next morning empty the bladder and add this urine to that previously collected. The total amount, thus collected, should be measured.

It is unnecessary to send all the urine to the physician; six ounces, somewhat less than half a pint, will be enough. But the physician should know what the total amount was found to be; therefore, a record of the measurement, the date, and the patient's name should accompany the sample. If limited to a single fact about the urine, it would be most helpful to know the amount passed during the twenty- four hours. In this way, as I have already pointed out, the patient herself may derive valuable information, for if the urine is scanty in amount - that is, less than a quart - she should drink more water.

Unscrupulous newspaper advertisements alarm people through incorrect statements about trouble with the kidneys. For example, they declare that a sediment in the urine is a sign of disease; but that is false. The mere act of cooling sometimes causes substances to crystallize out of perfectly normal urine. Or, putrefactive changes which frequently take place after the urine has stood for a time may cause some of its normal constituents to be precipitated. A sediment, either white, pink, or yellow, may indicate that the urine is too concentrated, and consequently means that the individual should drink water more freely; but it generally means nothing more serious. The really important abnormal constituents of the urine, namely, albumin and sugar, never form a sediment.

"Pain in the back" is a complaint frequently used to defraud the public. This symptom does not indicate Bright's disease. It is generally due to the muscles far away from the kidneys, with which, usually, the pain has nothing whatever to do. Similarly a desire to pass the urine frequently does not indicate any disturbance of kidney function, but is explained by the pressure of the enlarged womb against the bladder; it is a very annoying, yet a natural, result of pregnancy.

The Skin. The functions of the skin are at the very foundation of health. It protects the delicate structures which it covers, assists in the regulation of the temperature of the body, and excretes waste products. The excretory function of the skin is always active, but we are unconscious of this activity except on warm days and at times when we perspire freely. In the coldest weather, however, the body throws off what physiologists call the "insensible perspiration." The most important measures for the care of the skin are those intended to insure the activity of the sweat glands, namely, bathing and proper clothing. But before considering these measures, we will describe certain alterations in the skin which cannot escape the notice of the prospective mother, and which she is likely to misinterpret.

On account of the growth of the uterus the abdominal wall is stretched during pregnancy. To a certain degree the skin yields to the distention, but it finally cracks, and lines appear which are commonly called "pregnancy streaks." At first they are delicate and pink or blue in color; later they become white and more extensive.

The streaks indicate the situation of small breaks in the deeper layer of the skin, which is less elastic than the upper layer. They are not painful, and should never cause anxiety. Their size and number vary with the degree of abdominal distention, which in turn depends upon various factors, such as the size of the child and the quantity of amniotic fluid. Although these streaks are most frequently located upon the lower part of the abdomen, they may extend to the outer sides of the thighs; and occasionally appear over the breasts, since they too enlarge during pregnancy. Stretching of the skin, of course, is not confined to pregnancy; consequently, the same kind of streaks often appear in people who are growing stout.

Attempts to prevent or limit the pregnancy streaks prove futile. There is a common belief that they may be prevented by the use of vaselin, goose-grease, mutton-fat, or some one of a variety of lotions; but this teaching is not borne out by experience. None of these applications, however, are harmful, and there can be no objection to using them except that they cause needless soiling of the clothing. After the child is born the streaks fade of their own accord, though they rarely disappear entirely.

In certain localities the skin grows darker during pregnancy. We have already referred to the deepening of the color around the nipple as one of the signs of pregnancy; a similar but much less pronounced discoloration occurs about the navel, which also becomes shallow and may begin to pout in the latter months of pregnancy. About this time, with very few exceptions, there appears a more or less intense brown line which runs downward from the navel in the middle of the abdomen. Sometimes, though not very often, small dark areas, which have been called "liver spots," appear elsewhere over the body. The name is unfortunate, for the spots do not indicate a disorder of the liver.