Clinical findings in regard to the excretion of nitrogen (urea, ammonia, uric acid, etc.), the occurrence of acidosis, elevation of blood pressure, fever, diminished excretion, coma and convulsions, all point to toxæmia.
It is the minor disturbances, however, that the nurse will come in contact with most. They are nearly all toxæmic in origin, and a brief description of them must be given, together with suggestions for their management.
Salivation or Ptyalism.—In the majority of cases, saliva is not especially noticeable; but at times the secretion shows an enormous increase, and may even demand abortion. Patients will have saliva running constantly from the mouth. The amount may reach a pint or a quart a day, and the skin of the lower lip becomes greatly inflamed.
The only satisfactory treatment is a rigorous milk diet on the theory that the disturbance is an intoxication. In extreme cases abortion may be indicated.
Gingivitis.—The gums may become inflamed, spongy and hæmorrhagic during pregnancy, usually in patients of low vitality. If a generous diet and astringent mouth washes do not relieve the condition, the milk diet should be considered.
Toothache and Dental Decay.—The patient may be given hypophosphites, and the teeth should be put in good condition by a dentist.
Constipation has already been referred to. Strong cathartics should be avoided lest abortion follow.
Condylomata of pregnancy occur most frequently around the labia, perineum, and anus. They are wart-like growths that develop slowly or quickly and may remain discrete or cover the entire area with masses as small as beans or as large as cauliflowers, which in appearance they much resemble. The etiology is obscure, but they are generally associated with irritating vaginal discharges, such as an old gonorrhœa.
Treatment consists in stopping the discharge or neutralizing it, and in keeping the growths dry with a salicylic acid dusting powder. (See Therapeutic Index.)
Pruritus is often distressing. The itching may be limited to the genitals or appear on other parts of the body. It may be due to the irritation of local discharges or to a condition of the nervous system, arising from toxæmia. Astringent douches and protective ointments will relieve some cases.