Toxemia of pregnancy with vomiting : its toxic manifestations, its relation to eclamptic toxemia, acute yellow atrophy and experimental necrosis of the liver / by Ellice McDonald.

  • McDonald, Ellice, 1876-1955.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Toxemia of pregnancy with vomiting : its toxic manifestations, its relation to eclamptic toxemia, acute yellow atrophy and experimental necrosis of the liver / by Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the escape of the fetus. In this connection Hitschmann reports a case in which eclampsia occurred in a four and one-half months’ pregnancy as the result of a mole. Gueniot's figures show conclusively that termination of preg- nancy has a direct effect upon the mortality. In cases without abortion, the mortality was 90.2 per cent.; with spontaneous abor- tion, 35 per cent., and with induced abortion, 52.3 per cent. Hirst in 239 cases, gives a mortality of 30.7 per cent, in all. In cases treated by abortion the mortality was 25 per cent.; without abor- tion, 49.1 per cent. Thus, it will be seen that toxemia or preg- nancy with vomiting is a disease which has a mortality even higher than that of eclamptic toxemia, of which we may take Meyer- Wirz’ figures (27.3 per cent.) as a very fair estimate. The question of anesthesia is an important one both in toxemia with vomiting and eclamptic toxemia, should it be necessary for operative interference or the control of convulsions, in view of the fact that Ballin has collected nine postoperative cases of acute yellow atrophy of the liver following chloroform narcosis. Von- derbrugge also reports a case of death in a child, 10 years old, with icterus and vomiting. Autopsy showed fatty degeneration of heart, liver and kidney. So, it would seem that in these conditions, it would be better to abstain from adding fuel to the fire and sub- stitute ether for chloroform as much as possible. In the review of these cases one is struck with the very large percentage of primiparae, and the fact that the disease is at its height from three to four and one-half months. Coffee ground vomit, due to disorganized blood, is shown to be a serious symptom in these cases. Esophageal pain is frequent. The combination of the two as an increasing amount of albumin in the urine should be indication for the serious consideration of operative intervention. DO EXPERIMENTAL LIVER NECROSES AID IN EXPLAINING THE LIVER LESIONS OF TOXEMIA OF PREGNANCY? Of the three theories of eclamptic toxemia based upon a bio- chemical foundation, the first is that of Viet, which assumes that the excessive influx of placental elements into the maternal circu- lation leads to the production of a cytolysin which is responsible for the morbid symptoms. Ascoli supposes that the pathogenic changes and symptoms are due to this lytic substance—“syncytiolysin”—which is produced