544 THE PHYSIOLOGY OF REPRODUCTION 



anabolic functions to perform in the building up of the foetal body, 

 e.g. in the synthesis of lecithin. 



(f.) Disturbances of Fat Metabolism in Pregnancy. The Excretion of 

 the Acetone Bodies. The " acetone bodies " aceto-acetic acid and 

 /3-oxybutyric acid are intermediate products of the oxidation of the 

 fatty acids. Acetone is formed from them by further decomposition. 

 They are formed normally, and very small amounts are excreted in 

 the urine of normal persons, while the bulk is further oxidised to C0 2 

 and H 2 0. Vicarelli l was the first to observe the presence of these 

 bodies in the urine of pregnant women. He attributed it to the 

 presence of a dead fostus, a conclusion which was disproved by Menu 

 and Mercier, 2 who found it to be present when the foatus was living, 

 but when the pregnancy was abnormal in other respects (albuminuria, 

 eclampsia). Stolz, 3 and later Bar, 4 found acetone also in a number of 

 normal pregnancies. In order to appreciate the findings and con- 

 clusions of the older observers it is necessary to remember that the 

 tests they had at their disposal were not very delicate and gave 

 positive results only when considerable amounts were present. A 

 second factor of importance in interpreting their findings is the diet. 

 In the normal organism the appearance of the acetone bodies in the 

 urine is related to the diet, in the sense that the excretion is greatly 

 increased when carbohydrates are withheld from the diet, and also of 

 course when no food at all is taken. This is supposed to be due to a 

 greatly increased formation of these substances when the liver has 

 lost its glycogen and has to draw upon fats and protein for the forma- 

 tion of carbohydrate. According to some authorities it is due to a' 

 deficient oxidation which allows these substances to escape in the urine 

 before they are burnt up. Forges and Novack 5 made the important 

 observation that in normal pregnant women the acetone bodies can 

 always be made to appear in the urine by keeping them for one day 

 on a special diet which does not lead to an increased excretion in 

 normal non-pregnant women. This diet was poor in carbohydrates 

 but by no means carbohydrate free. Conversely they could suppress 

 the excretion of these substances by adding carbohydrate to the diet. 

 With a more delicate test for the acetone bodies (Rothera's test) 

 Harding 6 has recently confirmecl these results. He makes the 



I Vicarelli, "Die Acetonurie wahrend der Schwangerschaft," Pragcr /< /. 

 Wo,-/iens<:/ir., 1893. 



- Menu and Mercier, Ihdletin de la Sw. fffObstetrique fie Pat-is, 1898. 



3 Stolz, "Die Acetonurie in der Schwangerschaft, Geburt tind im Wochen- 

 bett," Arck.f. (,'y>i., vol. Ixv., 1902. 



4 Bar, Lew/is de Pathologic Qbit&ricale, p. 822, 1907. 



' Forges and Novack, "TJber die Ursache der Acetonurie bei Schwangeren," 

 Bert. klin. Work., vol. xlviii., ii. r 1911. 



II Harding, tm: i-it. 





