TOXKMIAS or rHEdXAXCY 533 



TOXEMIAS OF PREGNANCY ^o 



Under this h('a(lin<«- are iiieliuled eclampsia, as characterized by 

 convulsions and certain anatomical ohano-es, together with those in- 

 stances of intoxication with similar anatomical changes and no con- 

 vulsions, and the related pernicious vomiting of pregnancy. Acute 

 yellow atrophy of the liver belongs in the same category, 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 iTrea, 

 and also violent convulsions and profound coma teniiinating in death. 

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

 anatomical 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.— f/rinany 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 

 usually 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 greatly increased in the 

 blood, this has been interpreted as indicating that during eclampsia 



3« Excellent review and lnblioj:rapliy by Kwinjr, Amer. .Jour. ^\ed. Sei.. 1010 

 (130), 820. 



37 Literature is jriven liv Sikes in The Practitioner. 100.5 (74), pp. 47S and 

 642; L. Zuntz, Handb. d. Biochem., 1000, HI (I), 360; Seitz, Arch. f. Gyn., 1000 

 (87), 79. 



38 Concerning the liver changes see Konstantinowitsch, Ziegler's Beitr.. 1007 

 (40). 483. 



