Clifford B. Lull

Pubertas praecox due to ovarian tumors

Abstract Two cases of ovarian tumors associated with precocious puberty are reported in this communication. The one tumor is what we consider to be a typical granulosa cell tumor, the other is a simple follicular cyst of the ovary. The fact that the second case responded to operative procedure and returned to normal infantile type would lead one to believe that surgery is indicated in these ovarian tumors, even though they are not of granulosa cell type. From a review of the literature and a study of these two cases, I have no doubt that important advancements will be made, particularly with regard to the hormonal studies of this group of neoplasms. Functioning tumors of the ovary which were formerly unrecognized, today represent a subject of such broad possibilities as to be of interest to the medical profession in general. From an endocrinologic viewpoint, these tumors furnish definite evidence of hormonal production and its clinical effects. To the embryologist, the various phases of cellular differentiation are of especial interest. The identification of these “unusual tumors” stirs the interest of the internist. The pathologists, as well as the surgeons, interest is concentrated upon the difficult problem of confirming the clinical diagnosis and choosing a proper course of treatment. The general interest in the study of these tumors has been stimulated to such a degree that a positive diagnosis is more likely in the majority of cases. Consequently, through proper diagnosis, pathologic confirmation and proper treatment, the prognosis today is more favorable than in the past.

A Survey of Cesarean Sections in Philadelphia

Summary A ten year period comparative statistical survey of cesarean sections performed in 45 hospitals throughout the city of Philadelphia is herewith presented. During this period numerous authorities have made a plea for reduction in the incidence of cesarean section, but their efforts have been of no avail as far as the city of Philadelphia is concerned. The decrease in maternal mortality in spite of the increased number of cesarean sections performed, proves that better judgment has been used in the selection of cases for hospitalization, the time element, the type of operation performed, and the anesthesia used. Errors in judgment where these factors were concerned were probably the most frequent causes of fatalities. The decrease in maternal and fetal mortality would indicate that cesarean section is now performed when it is truly the procedure of choice and is not used as frequently as a last resort when trial labors and attempted vaginal deliveries have failed. It has been the consensus of opinion that a statistical survey is of little value, but a comparative statistical survey would seem to be of greater aid in determining whether progress has been made during a definite period of time. In conclusion, it is recommended that a committee be appointed to make suggestions as to standardization of the various indications for the operation of cesarean section so that in future surveys these indications would be more accurate and less confusing. Appreciation is expressed to Dr. Ruth Hartley Weaver, Assistant Director of Health of the City of Philadelphia, and Miss Dorothy Malkiel, Secretary of the Maternal Welfare Committee of the County Medical Society, for their assistance in the compilation of these statistics.

A résumé of 223 cases of surgical sterilization

Abstract 1. 1. A series of 223 patients operated upon by the Pomeroy method of sterilization is hereby reported. 2. 2. This number of 223 patients constituted 1.30 per cent of all patients admitted to the Philadelphia Lying-In Hospital on both obstetric and gynecologic services from Oct. 1, 1924, to Dec. 31, 1933, a period of nine years and three months. 3. 3. A definite follow-up was obtained in 71.7 per cent. 4. 4. All patients in this series were sterilized by the same method. 5. 5. Because of its simplicity and safety, and because there have been no known failures up to the present time, we feel that it is also a secure operation to do. 6. 6. This operation can be done vaginally as well as abdominally. 7. 7. Five deaths occurred in this series; all were either bad operative risks or death was caused by some of the accidents of postoperative convalescence. Finally, this series is reported to stimulate similar evaluations of results in other clinics. In the light of our experience with this procedure, together with a review of the results of other methods, we believe that the simplicity and safety of the Pomeroy operation warrants its continued use.

A preliminary report on the use of barbiturates with ether by rectum

Abstract 1. 1. We do not feel that our conclusions can be final at the present time, but the results have been satisfactory enough to warrant the continued use of these drugs for a further time. 2. 2. This method of sedation can be given earlier in the course of labor than most methods in vogue up to the present time. 3. 3. Primiparous patients seem to respond more definitely than do multiparous. 4. 4. If one uses this procedure, he should be prepared to deliver the patient with outlet forceps at the termination of the second stage of labor. 5. 5. There is no contraindication to giving inhalation anesthesia to complete the delivery. 6. 6. There has been no harmful effect upon the mother or the child. 7. 7. These patients should be watched carefully at all times following the injection. 8. 8. The injection should be given by a person who is particularly trained in the administration of rectal medication. 9. 9. There was no evidence of the child suffering from either the injection of the drugs or the small amount of inhalation anesthesia given to the mother at the end of the second stage. 10. 10. Relaxation of the pelvic muscles seem to be better than under ordinary circumstances. 11. 11. There is a tendency, we believe, for slightly more bleeding than normal, but this has not been definitely proved. 12. 12. Protection of the buttocks and the perineum, particularly as small amounts of material is expelled, should be carefully done. 13. 13. Patients given this instillation can not be depended upon to cooperate during the second stage of labor because if not entirely unconscious, are mentally confused to the point of being irrational. 14. 14. The contraindications as listed above should be particularly stressed, and especially toxemia where the amount of liver damage is not definitely known, as the therapeutists tell us that the barbituric acid preparations are eliminated principally through this organ. 15. 15. In our limited experience this method of analgesia has proved satisfactory enough and not fraught with any danger, so that we will continue its use until a larger series has been collected.