ECLAMPSIA 535 



icity of tlie blood in eclampsia leave nothiiif^ proved 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. 

 The antitryptic titer of the blood may be much increased. ^^'^ Zang- 

 meister ^^ ascribes importance to edema of the brain, liallerini *" 

 found that the physico-chemical changes in tlie blood are quite tlie 

 same as in corresponding conditions of nephritis. An increase in the 

 sugar content of the blood has been observed by Benthin/^ but no 

 other abnonnality of carboh^'drate 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. 

 Repeated bacteriological and histological studies have failed to dem- 

 onstrate that infection with either vegetable or animal parasites is 

 the cause, and clinical observations do not support such an hypothe- 

 sis. The association of the condition with pregnancy, and particularly 

 the rapid improvement that often follows the removal of the con- 

 tents 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 nor- 

 mal 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 Zweifel 

 that lactic acid is responsible seems untenable, and the degree of 

 acidosis present is not sufficient to account for the intoxication (Losee 

 and Van Sh-ke). 



The Placenta as a Source of Intoxication. — Histologists having fre- 

 quently observed placental cells in the blood and vessels of eclamptic 

 patients, it was once suggested that multiple capillary emholi of pla- 

 cental cells, detached from chorionic villi and forced into the pla- 

 cental circulation, cause the manifestations of the disease ; this theoiy 

 is entirely inadequate, however, to explain all the features of eclamp- 

 sia. Eelated to this hypothesis is the idea that the placental tissues, 



"Cent. f. Gyn., 1909 (3.3), 142. 

 44a Franz, Arch. f. Gvn., 1914 (102), 579. 

 45Deut. med. Woch.,"l911 (37), 1879. 

 40Annali Ostet. e Gin., 1910 (32), 273. 



4TMonats. Geb. u. Gvn., 1913 (37), 305; Rvser, Deut. Arch. klin. Med., 1916 

 (118), 408. 

 47a Jour. Med. Res., 1913 (24), 357. 



