ECLAMPSIA 439 



internal secretion which depresses proteid katabolism, and thus 

 leads to an excessive formation of nitrogenous substances in the 

 tissues and their accumulation in the blood. 



ECLAMPSIA 1 



In many respects eclampsia resembles uremia ; so much so, 

 indeed, that Frerichs and others have referred to eclampsia as 

 " puerperal uremia." Considering it as a simple uremia occur- 

 ring in pregnancy, uremia and eclampsia have in common the 

 constant occurrence of renal disturbance with albuminuria and 

 decreased elimination of urea, and also violent convulsions and 

 profound coma terminating in death. On the other hand, 

 eclampsia differs greatly from uremia in the anatomical changes 

 observed in the organs of the body other than the kidneys ; 

 these are of such a nature that in some cases it becomes 

 difficult to distinguish eclampsia from acute yellow atrophy of 

 the liver, while in other cases the picture resembles that of a 

 profound bacterial intoxication, so that numerous authors have 

 urged that eclampsia is the result of a bacterial infection. At 

 the present time the cause of puerperal eclampsia is quite 

 unknown, but there is a decided tendency to assume that 

 poisonous substances are developed in the placenta or fetus, or 

 are formed in the body as a reaction of the maternal organism 

 to the foreign fetal elements. These theories will be discussed 

 after considering the known facts concerning the chemical 

 changes of the disease that have been reported by various 

 observers. 



Chemical Changes in Eclampsia. Urinary changes 

 are practically invariably present, and usually they are profound, 

 although there are no known characteristic qualitative or quan- 

 titative differences from the urinary changes of puerperal 

 albuminuria without eclampsia. Proteids are abundant, includ- 

 ing a large proportion of globulin, decreasing rapidly after 

 delivery as a rule. The urea is usually very low, but generally 

 increases with great rapidity after delivery, until two or three 

 times the normal amount is passed per day ; as urea and 

 ammonia do not seem to be increased in the blood, this indicates 

 that during eclampsia there is an accumulation of the precursors 

 of urea in the system (Sikes). There is an excessive elimina- 

 tion of nitrogen in the form of ammonia, which seems to be 

 due to the formation of abnormal quantities of sarcolactic and 



1 A thorough review of the literature is given by Sikes in The Practitioner, 

 1905 (74), pp. 478 and 642, with complete bibliography. Only more recent 

 references will generally be cited in the text. 



