538 ABXORMALITIE^ IX METABOLISM 



support to the tlieory advaueed by Sellheim ^'^ that human eclampsia 

 is of mammary o-land origin. 



Pernicious Vomiting of Pregnancy. — This condition is inseparably 

 associated with eclampsia and non-convulsive toxemias of pregnancy, 

 lliere 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 

 urinaiy findings, there being commonly observed a relatively high 

 proportion of ammonia and undetermined nitrogen with decreased 

 urea, which findings have been considered indicative of defective 

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

 diagnostic significance (Williams). Underhill and Rand*'^ hold that 

 the urinary changes are entirely compatible wdth those which can be 

 produced by starvation which is present, of course, in pernicious 

 vomiting ; but Ewing *** contends that there are other underljdng 

 factors beyond those of starvation. 



Summary. — ]\Iost 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. j\Iore prob- 

 ably 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 

 disorganization of the liver and kidnej^ 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 clin- 

 ical manifestations of the disease. The finding of minute quantities 

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

 and Lockemann) is not of great signiticanee, for, as Wolf"" rightly 

 insists, similar amounts may be found in other conditions associated 

 W'ith convulsions and partial asphyxia, or in partial starvation, such 

 as results from the vomiting of pregnancy. The excretion of these 

 organic acids, as well as the large proportion of unoxidized sulphur 

 in the urine, indicates that incomplete oxidation is an important 

 feature of eclampsia, and under such conditions a large number of 

 imperfectly known toxic substances may accumulate in the blood 

 and tissues. The defective oxidation and deaminization indicated by 

 the urinary findings are probably the result of the injury to the 



osZent. f. Gyn., 1909 (:U), 1G09. 



o'iSee Kwinof' and Wolf, Anier. Jour. Ohslr., 1907 (55). 2S9. 



87 Arch. Int. Med., 1910 (5), Gl. 



osAmr-r. Jour. Med. Sci., 1910 (130), 828. 



CO New York Med. Jour., 190(i (83). 813. 



