.852 HAROLD BAILEY 



number of eclamptics and besides ascertaining the nitrogenous constituents 

 he found also the percentage of sugar, chlorid concentration and 

 the carbon dioxid combining power. He separates the cases into two 

 groups, the Hepatic and the Nephritic Toxemias. In the former there is 

 little evidence of nitrogen retention and the urea fraction is low so that 

 compared with the non-protein nitrogen the coefficient is from 0.15 to 0.38. 

 In the latter just the reverse is true and the coefficient is 0.50 or above. 



In the table entitled Hepatic Toxemia the first two blood examina- 

 tions were from typical cases of pernicious vomiting. The results are 

 interesting for they furnish absolutely new evidence concerning this dis- 

 ease and support the deamination theory. With a normal or slightly 

 lowered urea there is an increase in the non-protein nitrogen producing 

 a very low ratio 0.33 in the first case and 0.15 in the second. In the 

 former there is a marked acidosis represented by 28 c.c. carbon dioxid, 

 combining power and in the latter by 42 c.c. In the absence of amino-acid 

 determinations one may only conclude that there is either a failure of 

 deamination of amino bodies or failure of oxidation of more complex 

 portions of the protein molecule. Withdrawal of ammonia for combina- 

 tion with these amino bodies would lead to a reduction of the blood acidity. 

 A sort of "spurious acidosis" as Ewing terms it. These figures support 

 the urinary findings in Ewing and Wolf's, and Losee and Van Slyke's 

 vomiting cases, especially as regards the high ammonia and the high 

 undetermined nitrogen. 



Of the 17 eclamptic cases three died (Cases 4, 7, and 12, Table VIII) 

 and in these three cases there was only a slight rise in the non-protein 

 nitrogen with a low urea so that the coefficients were 0.32, 0.36, and 0.29 

 respectively. There was marked acidosis in most of the cases and in Case 

 12 there was a carbon dioxid combining power of only 12 c.c. 



Of the other 14 eclamptic cases there were 12 that had a non-protein 

 nitrogen figure below 50 mg. and the ratio with the urea of 0.35 or under, 

 although in three cases the ratio was as low as 0.16. The uric acid was 

 increased and in a few instances so was the creatiniu. In all the cases 

 there was a slight increase of the blood sugar but this was also noticed 

 in normal pregnancy. Those cases that showed considerable edema were 

 found to have an increased concentration of the chlorids of the \vhole blood 

 and in all cases where the chlorids were above 0.50 per cent the urine was 

 very heavy in albumin. 



A study of these results leads to the conclusion that there was failure 

 of the liver to respond with increased urea formation and the relationship 

 of the known fractions together with the results of other analyses would 

 indicate that undetermined nitrogen of the blood is not amino-acid but 

 some as yet unknown metabolite of the nature of a higher protein. In 

 these eclamptic cases there is but slight evidence of insufficiency 

 of the kidneys as regards the nitrogen excretion. In Cases 18 and 





