PATHOLOGICAL METABOLISM IN PREGNANCY 849 



sweetbreads, whereupon there is an immediate accumulation of uric acid 

 in the blood. 



An analysis by Gettler of the blood of several eclamptics on the 

 Bellevue service showed a definite increase in the uric acid content with 

 a slight increase in the urea and non-protein nitrogen. 



A most extensive study of this subject has been made by W. E. 

 Caldwell and W. G. Lyle. Working with material from Bellevue and 

 the Nursery and Childs Hospitals they examined die blood in 150 cases 

 of normal pregnancy and of a number of nephritic toxemias and eclamp- 

 tics. This work is now in preparation for publication and through 

 courtesy they have permitted me to review their findings and to present 

 the tables that follow.* 



These 150 cases of normal pregnancy not only form the foundation for 

 comparison but they are of particular interest because they show very 

 low urea fractions. The average for the entire series shows a non-protein 

 nitrogen of 29.6 mg., urea of 11.5 mg., creatinin of 1.0 mg. and uric 

 acid of 1.7 mg. per 100 c,c. The urea nitrogen ratio to non-protein nitro- 

 gen is 39 per cent. The comparison for the different months of pregnancy 

 would indicate that there is a slight increase in all the fractions in the 

 ninth month, the non-protein nitrogen for 12 cases rising to 33 mg. and the 

 urea to 12.6 mg. This occurs at a time when the fetus is growing rapidly 

 and the increase of the total nitrogen may represent the provision of a 

 floating reserve. 



If the results of those cases that had a toxemia of the nephritic type 

 and without convulsions are studied, gradual deviation from the normal 

 may be noted and quite in accordance with the clinical symptoms. There 

 were two cases (Nos. 1 and 2, Table VI) that had a trace of albumin in 

 their urine but with no other symptoms and represent the "kidney of preg- 

 nancy." The creatinin and uric acid components were slightly above 

 normal. 



There is nothing distinctive about the figures of Case 3, Table VI, but 

 the urea is somewhat high. The same may be said of Case 4, in the find- 

 ings 22 days before delivery, but in addition there was a marked increase 

 of the uric acid. A second specimen showing further increase in the 

 urea and the blood picture fitting the clinical symptoms, led to the induc- 

 tion of labor which resulted in a stillbirth. In the blood taken five days 

 after delivery there is a marked decrease in the urea content. Case 5 is 

 definitely abnormal and the specimen taken 14 days after delivery places 

 it in the class of chronic parenchymatous nephritis. Cases 6 and 7 were 

 both received at the hospital in a comatose condition and without history 

 of having had convulsions. They died without regaining consciousness 

 and appeared to be typical cases of uremia. The blood picture of Case 6 



* Since the writing of this article Caldwell and Lyle have published their work. 

 See Bibliography. 



