PUERPERAL ECLAMPSIA 543 



teins, fibrin ferment has been found increased by Dienst/^ while 

 Schmidt found a rehitive increase in the globuHn. Sikes concludes 

 that the statements to be found in the hlciature concerning the tox- 

 icity of the blood in eclampsia leave notliing pnjvcd concerning this 

 point, but more recent studies by Graf and Landsteiner*'' affirm an 

 increase of toxicity of the blood, not due to any special poison but to 

 an increase in the amount of the toxic substances ordinarily present; 

 however, any studies of toxicity of the blood are of doubtful value 

 because of the reactions produced by injections of even normal blood. 

 More attention may be given to the observation of Hiissey^^ that 

 while the serum of pregnant women has a shght vasodilator effect, in 

 eclampsia and other pregnancy toxicoses there is a marked vasocon- 

 strictor effect. The antitryptic titer of the blood may be much in- 

 creased.^^ Zangmeister^" ascribes impoTtance to edema of the brain. 

 Ballerini^^ found that the physico-chemical changes in the blood are 

 quite the same as in corresponding conditions of nephritis. An in- 

 crease in the sugar content of the blood has been observed"^ but no 

 other abnormality of carbohydrate metabolism is usually present. 

 Blood lipase is much increased because of the hepatic injury (Whip- 

 ple)." 



Theories as to Etiology. — The anatomical changes of eclampsia 

 are such as to leave little or no room for doubt that there is a severe 

 intoxication with poisons that have a markedly toxic effect upon all 

 the organs of the body, thus differing from the toxic materials at work 

 in uremia, which seem to affect chiefly the central nervous system and 

 to produce no marked tissue changes. Repeated bacteriological and 

 histological studies have failed to demonstrate that infection with either 

 vegetable or animal parasites is the cause, and clinical observations do 

 not support such an hypothesis. The association of the condition with 

 pregnancy, and particularly the rapid improvement that often follows 

 the removal of the contents of the uterus, almost compels us to admit 

 that the causative agent is produced by the fetus or the placenta. 

 Some investigators (Politi, Liepmann) believe that they have found a 

 greater degree of toxicity in extracts from the placentas from eclamptic 

 than from normal women. We have no exact ideas as to the nature 

 of the supposed toxic substances, except that recent developments in 

 the study of immunity reactions point to their origin from proteolysis 

 of tissue proteins, presumably from the placenta. The hypothesis of 



6" Arch. f. Gyn., 1912 (96), 43; Zeit. Geb. u. Gvn., 1919 (82), 102. 



" Cent. f. Gvn., 1900 (33), 142. 



«8Corrbl. ScW. Aerzte, 1918 (48), 691. 



«9 Franz, Arch. f. Gyn., 1914 (102), 579; Ecolle, Arch. Mens. Obst. Gvn., 1917 

 (6), 97. 



^0 Deut. med. Woch., 1911 (37), 1879. 



'1 Annali Ostet. e. Gin., 1910 (32), 273. 



" Benthin, Monats. Geb. u. Gvn., 1913 (37), 305; Ryser, Deut. Arch. khn. Med., 

 1916 (118), 408; Siemens, loc. cit.^'- 



" Jour. Med. Res., 1913 (24), 357. 



