To the Editor:—
In connection with the "Contribution to the Study of Eclampsia" by Whitacre, Loeb and Chin in The Journal, February 15, may I draw your attention to the publication "Protein Depletion in Pregnancy Toxemia" in the Western Journal of Surgery, Obstetric and Gynecology (54: 392 [Oct.] 1946). The main sequence in eclampsia is (1) fetal demand for maternal protein, aggravated by inadequate protein intake, (2) hypoalbuminemia, (3) hypoproteinemic cerebral edema, (4) increased intracranial pressure and (5) elevation of blood pressure. There are many side effects complicating the picture. Changes in the kidneys are secondary and may be partly responsible for the high blood pressure. The important cause of the elevation of blood pressure in eclampsia is the increase in intracranial pressure. Hypoalbuminemia is a constant finding in pregnancy toxemia.