546 ABNORMALITIES IN METABOLISM 



lated to calcium metabolism, that they are concerned;'^ but such theories fail to 

 explain the many changes other than the convulsions, and have not been accorded 

 much importance. Kastle and Healy'" consider that parturient paresis of cattle, 

 which bears some resemblance to human eclampsia, is caused by absorption of 

 toxic substances produced in the formation of the colostrum; it is cured by dilating 

 the lacteal ducts by oxygen or other means. This observation lends support to 

 the theory advanced by Sellheim^i that human eclampsia is of mammary gland 

 origin. 



Pernicious Vomiting of Pregnancy. — This condition is insepara- 

 bly associated with eclampsia and non-convulsive toxemias of preg- 

 nancy, there being transitional and border-line cases of all sorts. In 

 fatal cases of pernicious vomiting anatomical changes resembling 

 those of eclampsia have been found, and albuminuria and icterus are 

 often observed. ^^ The chief chemical interest in these cases lies in 

 the urinary findings, there being commonly observed a relatively 

 high proportion of ammonia and undetermined nitrogen with de- 

 creased urea, which findings have been considered indicative of defec- 

 tive oxidation or deaminization (Ewing and Wolf) and of prognostic 

 and diagnostic significance (Williams). There is also excretion of 

 acetone bodies and other evidence of more or less acidosis.^* Under- 

 bill and Rand^^ hold that the urinary changes are entirely compatible 

 with those which can be produced by starvation which is present, of 

 course, in pernicious vomiting; but Ewing^^ contends that there are 

 other underlying factors beyond those of starvation. 



Summary. — Most of the facts at hand speak against the idea that 

 one definite chemical substance is responsible for the anatomical 

 changes and symptomatic manifestations of eclampsia. More proba- 

 bly there are present not only the poisonous substances that initiate 

 the tissue changes, and which probably originate in the placenta 

 itself or from digestion of placenta proteins in the maternal blood or 

 organs, but also toxic substances that accumulate because of the dis- 

 organization of the liver and kidney cells, and which are possibly 

 similar to the toxic substances most prominent in uremia and in acute 

 yellow atrophy, for eclampsia seems to stand intermediate between 

 these two diseases, encroaching upon the characteristics of each. 

 Acid intoxication, which undoubtedly exists to a greater or less de- 

 gree in some cases of eclampsia, is not an important cause of the clinical 

 manifestations of the disease. The finding of minute quantities 

 of lactic acid in the blood, urine, and in the cerebrospinal fluid (Fiith 

 and Lockemann) is not of great significance, for, as Wolf^*^ rightly 



89 Massaglia and Sparapani, Arch. ital. Biol., 1907 (48), 109. . 



90 Jour. Infec. Dis., 1912 (10), 22G. 

 »i Zent. f. Gyn., 1909 (U), 1G09. 



92 See Ewing and Wolf, Amer. Jour. Obstr., 1907 (55), 289. 



93 See (lilliatt and Konnaway, (Juart. Jour. Med., 1919 (12), 61; Losoo and Van 

 Slyke, Aincr. Jour. Med Sci., 1917 (153), 94; Duncan and Harding, Canad. Mod. 

 Assoc. Jour., 191 S (S), 1057. 



•^ Arch. Int. iMed., 1910 (5), Gl. 



»» Amer. Jour. Med. Sci., 1910 (139), 828. 



9« New York Med. Jour., 1906 (83), 813. 



