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
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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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    minor disturbances of pregnancy, as gastric disorders, headache and certain skin lesions, may he referred to a similar source. The following review of the literature on this subject may seem to be somewhat extensive, hut is thought to be necessary. It is reviewed for the purpose of showing (i) the identity of the liver lesions of toxemia of pregnancy with vomiting and eclamptic toxemia.* and for the comparison of these lesions with those of experimental liver necrosis; (2) the frequency with which acute yellow atrophy occurs and (3) the presence of more marked toxic symptoms. The similarity between the liver lesions of toxemia with vomiting and of eclamptic toxemia is suggestive. Stone, in a comprehensive and searching review, draws attention to this resemblance. ITe reports three cases of toxemia with vomiting with one death. Post- mortem examination showed acute yellow atrophy. His con- clusions are as follows: “Eclampsia is now generally recognized as a toxemia whose chief lesion is a degeneration and necrosis with multiple hemor- rhages of the liver. The kidney changes, although forming an im- portant part ol its terminal features, are essentially secondary. All the older theories of eclampsia have been successfully applied to the condition which is described as hyperemesis gravidarum. We have also found under this latter clinical picture lesions which .are identical with those occurring in acute yellow atrophy of the liver. At the same time we know' but little in regard to the patho- genesis of this latter disease, except that in one-quarter of its cases it is associated with pregnancy, thus indicating that it is probably due to a toxemia. An analysis of its symptoms also shows it presents essentially the same clinical picture as eclampsia In other w'ords, under the clinical titles of hvperemesis gravi- darum, eclampsia and acute yellow' atrophy of the liver, we have found enough to warrant a definite statement that they are one and the same disease.” In Stone’s cases the vomiting began early in pregnancy, in two * At present, there is tendency amongst some obstetricians to refer to all of the manifestations of toxemia of pregnancy as eclampsia. This 1 would deprecate. The term, eclampsia, as usually understood and gener- ally used, refers to convulsions, either gestatory, intraspartam or puer- peral. It would therefore seem pref erable that the autotoxic state be designated according to the more prominent symptom, as (al toxemia of pregnancy with vomiting, and (b) eclamptic toxemia (toxemia with con- vulsions. This division will be followed in this paper. For further study of the identity of these conditions, I would refer the reader to Stone’s article in American Gynecology, 1903. and Edgar's Theory and Practice of Obstetrics, 2d edition. New York, 1904.