PUERPERAL ECLAMPSIA 541 



vulsions, and the related pernicious vomiting of pregnancy. Acute 

 yellow atrophy of the liver belongs in tiie same categor}', although 

 often occurring independent of pregnancy. 



ECLAMPSIA" 



In many respects eclampsia resembles uremia; so much so, indeed, 

 that Frerichs and others have referred to eclampsia as "puerperal 

 uremia." Considering it as a simple uremia occurring in pregnancy, 

 uremia and eclampsia have in common the constant occurrence of 

 renal disturbance with albuminuria and decreased elimination of urea, 

 and also violent convulsions and profound coma terminating in death. 

 On the other hand, eclampsia differs greatly from uremia in the ana- 

 tomical changes observed in the organs of the body other than the 

 kidneys; these are of such a nature that in some cases it becomes diffi- 

 cult to distinguish eclampsia from acute yellow atrophy of the liver, ^* 

 while in other cases the picture resembles that of a profound bacterial 

 intoxication, so that numerous authors have urged that eclampsia is 

 the result of a bacterial infection. At the present time the cause of 

 puerperal eclampsia is quite unknown, but there is a decided ten- 

 dency to assume that poisonous substances are developed in the pla- 

 centa or fetus, or are formed in the body as a reaction of the maternal 

 organism to the foreign fetal elements. These theories will be dis- 

 cussed after considering the known facts concerning the chemical 

 changes of the disease that have been reported by various observers. 



Chemical Changes in Eclampsia. — Urinary changes are practi- 

 cally invariably present, and usually they are profound, although 

 there are no known characteristic qualitative or quantitative differ- 

 ences from the urinary changes of puerperal albuminuria without 

 eclampsia. Proteins are abundant, including a large proportion of 

 globulin, decreasing rapidly after delivery as a rule. The urea is 

 usuall}'- very low, but generally increases with great rapidity after 

 delivery, until two or three times the normal amount is passed per 

 day; as urea and ammonia do not seem to be greatl}^ increased in the 

 blood, this has been interpreted as indicating that during eclampsia 

 there is an accumulation of the precursors of urea in the system 

 (Sikes). However, the involution of the uterus itself results in an 

 increased nitrogen excretion which probably accounts for much if 

 not all of these findings (Siemens). ^^ There is an excessive elimina- 

 tion of nitrogen in the form of ammonia, which is said to be due to 

 the formation of abnormal quantities of sarcolactic and other organic 

 acids in the body, which are combined with ammonia in the blood and 



^' Literature is given by Pikes in The Practitioner, 1905 (74), pp. 478 and 

 642; L. Zuntz, Handb. d. Biochem., 1909, III (I), 366; Seitz, Arch. f. Gvn., 1909 

 (87), 79. 



^^ Concerning the liver changes see Konstantinowitsch, Ziegler's Beitr., 1907 

 (40), 483. 



" Bull. Johns Hopkins Hosp., 1914 (25), 195. 



