442 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



which is extremely labile, being firmly united to the proteid 

 molecule, and as yet not successfully isolated. 



The Fetus as a Source of Intoxication. A reasonable 

 view of the cause of eclampsia is that it is initiated by the 

 excessive products of metabolism thrown into the blood of 

 the mother, both from the fetus and from her own overactive 

 tissues ; these cause injury to the kidneys, leading to a further 

 retention, or injure the liver so that the normal metabolic 

 processes of that organ (particularly oxidation) cannot be 

 carried on ; or, perhaps more often, both liver and kidney as 

 well as other organs are injured. In this way a vicious circle 

 is established which rapidly leads to an overwhelming of the 

 maternal system with toxic products derived from both her own 

 and the fetal tissues. It must be admitted, however, that the 

 rapid improvement that so often follows removal of the products 

 of conception indicates strongly that the poisonous substances 

 arise chiefly, if not exclusively, in the fetus or the placenta. 

 But, as Liepmann points out, the child shows relatively little 

 evidence of intoxication, while, on the other hand, eclampsia 

 may develop after delivery of the fetus, which facts speak in 

 favor of the place of the origin of the poison being the placenta 

 and not the fetus. Especially important in this connection is 

 the observation of a case of eclampsia by Hitschmann l in a 

 patient with a hydatid mole and no fetus. 2 



The Thyroid in Eclampsia. In view of the mystery sur- 

 rounding the cause and effect of the enlargement of the thyroid 

 during pregnancy, it is not strange that the suggestion has been 

 made that the enlargement is for the purpose of neutralizing 

 the excessive amounts of toxic materials in the maternal blood, 

 and that failure of this enlargement is responsible for eclampsia. 

 In support of this idea Lange 3 states that absence of the 

 normal thyroid enlargement is usual in eclampsia, and Fruhins- 

 holz and Jeandelize 4 note the frequency of eclampsia in 

 myxedematous women. 



Summary. Most 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. More probably there are present not only the 



1 Cent. f. Gyn., 1904 (28), 1089. 



2 Dienst (Cent. f. Gyn., 1905 (29), 353) has advanced the proposition that 

 in eclampsia there is a mixture of the heterogeneous fetal blood with that of 

 the mother, based on the finding of direct communication between the 

 maternal and fetal circulation in eclampsia. 



3 Zeit. f. Geb. u. Gyn., 1899 (40), 34. 



*Presse MeU, 1902 (10), 1023. 



