Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition

Abstract

In some ways it is reassuring to learn from Brewer that the day of the pamphleteer is not yet over. For example, we look back with pleasure to the raging arguments over obstetrical anesthesia since we know that the heat of the invective hastened the spread of medical information. But the book is otherwise disturbing. Brewer has concluded that the acute toxemia of pregnancy is a disease of malnutrition which leads to limitations of hepatic conjugation of injurious substances, some of which derive from bacterial decompositions in the bowel and some of which are steroids produced by the placenta. The clinical manifestations are presumably results of the impact of these insults. It follows that all other etiologic hypotheses are wrong and must be destroyed. Therapy, other than lifesaving procedures in the terminal phases of the disease, preeminently delivery, consists of administration of a high protein diet and bowel antiseptics. All