Milk Fever: its possible association with derangements in the internal secretions.

While the etiology of milk fever has received much consideration in the past, we are still without knowledge of the essential nature of the disease. Twenty-eight years ago Schmidt gave us a simple specific remedial measure, in intra-mammary injection. It has often been felt that our possession of so simple a remedy should have afforded us a valuable clue to the pathology of the disease, yet, although many hypotheses of a highly speculative nature have been advanced, none of those capable of test by experimental methods has shown itself worthy of general acceptance. We are still confronted with an enigmatantalus could we comprehend the nature of the disease, the meaning of the dramatic recovery following insufflation should become evident. Could we understand the action of the remedy, the nature, not only of milk fever, but of the whole group of eclampsias to which it appears to belong should become capable of conception. That the problem of the specific action of mammary distension has so long remained unsolved occasions us no surprise, since we believe it can be made clear only in the light afforded by recent physiological research. In view of the need for a free expression of considered opinion upon the subject, we welcome the papers by Mr. L.P. Pugh. Pugh (1) brought forward a suggestion that there is a strong resemblance between the symptoms ofthis disease and a toxaemia of the botulismus type. The same writer further elaborates (2) the etiology of the disease by postulating the existence of a ketosis as the predisposing factor to the development of the botulismus intoxication. A survey of this latter paper conveys the idea that the author has been tempted to support his hypothesis by data that are not above criticism. It is well, in seeking to elucidate the etiology ofany disease, that the problem should be approached without bias if a satisfactory conclusion is to be arrived at. We do not think that Pugh has exhibited sufficient caution in this respect, and one of our objects in criticising his paper is to correct, thus early, certain errors in his premises, so that subsequent investigators may not be misdirected. To take the points as they appear in his paper, he makes the statement that, after the digested fat is re-synthetised in the villi of the intestinal mucosa, it passes from there to the liver. Now, this is not so; it was shown as long ago as 1885 by Schafer (3) that the fat is absorbed into the lymphatics of the gut and is then transported, via the receptaculum chyli and the thoracic duct, into the blood stream to be distributed throughout the body. This has been confirmed by many subsequent workers, including Zawarykin (4) and Clark and Clark (5). While it is conceivable that a small amount of the fat may be.absorbed via the portal circulation, it has never yet been demonstrated. Again, Pugh says that "if a fat containing iodine is fed to an animal, that same type of fat will be found in the depots. " Surely he has confused this with a reference to the "iodine value" of fats quite a different thing. It is true that the incomplete desaturation of the fats in the liver and the consequent formation of hydroxy-acids and acetone bodies may become evident by the appearance of such products in the urine, but the converse does not necessarily hold. Pugh does not seem to be aware that an acetonuria does not necessarily imply an acidosis; it may be present in alkalosis (6), and this point will be referred to later. Pugh states that very little is known regarding the conversion of depot fat into butter fat, but, nevertheless, he bases his whole hypothesis on the assumption that the liver is the all-important organ which creates this change. He quotes Coope and Mottram (7) to support the view that there is a relatively sudden increase in the liver fat at parturition, but it should also be mentioned that these workers in the same paper recorded that in cats, fatty infiltration was found in the liver in some non-pregnant cases, and that therefore "no certain conclusion can be drawn from the infiltration found in pregnant animals. " That the liver is not required to desaturate fats and that this can take place in, e.g., incubating eggs, was tentatively shown, also by Mottram (8). Dealing more specifically with the function ofthe liver in