838 HAEOLD BAILEY 



theory by suggesting that impaired liver function with imperfect oxidation 

 led to the circulation in the blood of intermediate products of protein 

 synthesis. Riviere attempted to prove that the injection of the urine of 

 eclamptics was less fatal to animals than normal urine. He did not 

 take into account the factor of bacterial decomposition and some 13 years 

 later Forchheimer and Stewart showed the fallacy of drawing conclusions 

 from such a procedure. However, although now controverted, these ex- 

 periments made a definite impression on the development of the study of 

 the disease. 



The first practical test of aid in determining the onset of eclampsia 

 was made by E. P. Davis who in 1894 reported 564 urea determinations 

 in 84 cases of pregnancy. He found the average excretion of urea (plus- 

 ammonia) before labor was 1.4 per cent and afterward 1.9 per cent, but 

 at the onset of convulsions it was as low as 0.5 per cent. Helouin called 

 attention to the relationship of the urea to the total nitrogen and advised 

 that use be made of this fact as an aid to diagnosis. 



The first attempt to determine the increase in the ammonia as well as 

 the lowering of the urea as an additional aid to the study of the metabolic 

 disturbances was made by Whitney and Clapp in 1903. The nitrogenous 

 substances were divided into two groups according to whether or not they 

 were precipitated by phosphotungstic acid. Depending upon the libera- 

 tion of ammonia on heating with sulphuric acid, these precipitated sub- 

 stances were again separated into loosely or firmly combined classes. The 

 urines of three normal non-pregnant women were examined and then four 

 cases of pregnancy, before and after delivery. Finally there was one case 

 of toxemia of pregnancy and several cases of eclampsia. In the latter, 

 there was a diminution of the urea and an increased amount of nitrogen 

 precipitated by phosphotungstic acid and readily decomposed into am- 

 monia. They suggested that these loosely combined nitrogens in the 

 precipitate were partly composed of ammonia and partly of some as yet 

 undetermined antecedent of urea. 



This work was soon followed by Folin's(6) development of methods 

 that permitted of an accurate separation of the nitrogen fractions. 



In 1891, -St. Blaise(a) expressed the opinion that the eclamptic attack 

 was due to a hepatotoxemia and seven years later stated his belief that 

 the three chief forms of pregnancy toxemias were of the same nature and 

 due to the insufficiency of the 'liver, not only as regards its inability to 

 synthetize the nitrogenous bodies to urea, but also as to its glycogenic and 

 bile functions. Stone, in 1903, made note of the findings of leucin and 

 tyrosin crystals in the urine of a patient who died of acute yellow atrophy 

 .and called attention to the probability of finding a high ammonia excre- 

 tion in the urine of such cases. Ewing also became committed to the view 

 that pernicious vomiting, acute yellow atrophy and eclampsia are one 

 and the same disease; and that they have a single fundamental basis in 



