Frederick H. Falls

A skin test for the diagnosis of pregnancy

T HE use of skin re’actions as an aid in clinical diagnosis of many conditions has long been recognized as a valuable proceldure. The Van Pirquet, Schick, Dick reactions and the use of various proteins intradermally for the purpose of detecting allergic sensitivity have all proved their clinical usefulness, There are so many biologic differences between pregnant and nonpregnant individuals that the possibility of being able to differentiate between these groups by means of a skin reaction to some antigen seemed not too remote. Falls and Bartlett,l in 1914, attempted to extract a protein from the placenta which might be used for this purpose. The results were unsatisfactory, due to the fact that the methods employed were not sufficiently refined to yield a pure protein as was hoped, but a mixture of proteins was obtained which led to nonspecific reactions. By using better methods of extraction and preparation of the placental proteins, Cohen and Freda attempted to produce precipitin reactions and specific skin reactions that might be useful diagnostically. When the precipitin reaction was tried, serum of known pregnant women reacted positively in about 7.5 per cent of the cases. The serum of males a,ud normal females did not react. Certain nonpregnant women with gynecologic pathology gave a rather high percentage of false positive reactions which nullified the usefulness of this method for practical diagnostic purposes. The use of placental tissue extracts in producing skin reactions was to some extent successful, since about 75 per cent of the patients tested by intradermal injections gave positive reactions if pregnancy existed and negative if no pregnancy were present. This result was in accord with the results reported by Esch,” Englehorn and Wintz,4 Gruskin5 and Schwartz6 who made similar tests have reported a higher percentage of correct diagnosis. The high percentage of false reactions (25 per cent) rendered the use of these procedures for diagnostic purposes useless, and so it was decided to try to find an antigen that would give more specific reactions. The possibility of using proteins extracted from breast tissue was suggested, since it was thought that during pregnancy the cells of the breast might secrete a protein of somewhat different compositiou than other body proteins. On further consideration this idea was rejected in favor of using colostrum which must contain the proteins produced by the breast in early pregnancy. By using this material the contamination of

Mesonephroma of the ovary

Abstract A case of ovarian tumor which microscopically corresponds to “Mesonephroma Ovarii” has been presented. The literature has been reviewed and the arguments for the histogenesis have been mentioned. It is felt that the evidence and arguments favor considering the tumor as an entity and that the term “mesonephroma” should be accepted at least until more evidence, pro or con, is forthcoming. The clinical features have been listed.

Use of a sulfanilamide derivative in the treatment of gonorrhea in pregnant and nonpregnant women

Abstract 1. 1. Forty-five cases of gonorrhea in women have been treated with a sulfanilamide derivative (neoprontosil) in doses of 40 gr. daily in five-day courses. Cure was accomplished in all cases except one. 2. 2. No serious toxic effects were observed with this dosage. 3. 3. In the cases in which the infection was limited to the cervix and lower genital tract, no upward extension was observed under treatment. 4. 4. Reinfection occurred 14 times in this series, but never while the patient was under active treatment, and always responded promptly to further medication. No conclusions are justified from such a small group of cases. The results, however, are so uniform and so striking that we are greatly encouraged to continue with this method of treatment until a sufficient number of cases has been studied to confirm or deny its therapeutic value.

Bleeding Late in Pregnancy

Late Pregnancy The causes of bleeding in the second half of pregnancy are different from those in early pregnancy. Common conditions causing minor bleeding include inflammation of, or growths on, the cervix. At times sexual intercourse may irritate the cervix and cause bleeding. Bleeding can also be serious and pose a threat to the health of the women or the fetus. It may require treatment in a hospital. Heavy vaginal bleeding usually involves a problem with the placenta, the tissue that connects the mother and the fetus. The two most common causes are placental abruption and placenta previa. Preterm labor can also cause vaginal bleeding.

The Ferment Activity of the Blood Serum in Infectious Diseases

the power of splitting proteins into less complex compounds. E. Abderhalden1 has proved this to be true of the serum of pregnant women, and of that of patients suffering from carcinoma. He is supported and his work has been confirmed by a great many observers, both in Europe and in this country. Fauser,2 Flatow,3 and many others have demonstrated ferment activity in the blood in cases of dementia praecox, epilepsy, and other nervous affections. In this country Williams and Pearce, Jellinghaus and Losee, Schwartz, McCord, and others, report similar results. Jobling, Eggstein, and Petersen4 have shown that normal guinea-pig serum contains active tryptic ferments which can be demonstrated, after removing the antitryptic substances, by treating the serum with various agents, such as kaolin, starch, and iodin, and then allowing the serum to act on preparations of casein. In a recent article I5 have shown that by the dialysis method ferments can be detected in the serum in a large number of pathological conditions, as well as during pregnancy, and at the height of digestion; also that apparently normal individuals occasionally give positive reactions. I pointed out that the length of time in the dialyzer has much to do with the occurrence of a positive or negative reaction. S. Kjaergaard6 has supported this in a recent article; he also confirms my findings of positive reactions in other conditions, as carcinoma, but he has not reported experiments with sera from infectious diseases. Frankel7 supports my view entirely; he found that sera from various pathological conditions usually gave positive reactions.

Conquest of eclampsia.

• The convulsive stage of eclamptogenic toxemia has been gradually eliminated in three hospitals over a period of 20 years, despite the fact that eclampsia remains one of the three most common causes of maternal mortality in the country as a whole. The improvement is related to the increasing frequency with which toxemia is recognized and the systematic attention given to it. The mild nonconvulsive forms of toxemia, found and treated early, are without much danger. It is the convulsive stage of the disease that does irreversible or fatal damage. A simple program of management that has been developed must be brought to bear as soon as toxic symptoms appear and must be continued until the symptoms are brought under control or the patient is delivered. The program includes strict prenatal care, hospitalization if ambulatory care proves insufficient, induction of labor if the toxemia progresses, and cesarean section if certain indications exist. Although more knowledge of this disease is needed, the means for preventing most of the deaths that now occur are already available.

Conservative treatment of pelvic inflammation with the newman thermo-flo

Abstract 1. 1. The Newman thermo-flo apparatus, in our hands, has proved an effective method for the application of prolonged intravaginal heat. The method utilizes heated air and presents advantages over other devices, because of simplicity of operation, comfort, freedom from potential burns, and because it gives uniformly effective application of pelvic heat. 2. 2. Two hundred patients with pelvic inflammatory disease were treated with the thermo-flo, of whom 141 (70.5 per cent) showed complete cure or marked improvement; 44 (22 per cent) moderate improvement, while 15 (7.5 per cent) obtained slight or no improvement. (a) Gonococcal infections in 132 cases showed in 94 (71.2 per cent) complete cure or marked improvement; in 28 (21.2 per cent) moderate improvement; and in 10 (7.6 per cent) slight or no improvement. (b) Nonspecific pelvic infection observed in 35 cases produced in 23 (65.7 per cent) complete cure or marked improvement; 8 (22.9 per cent) moderate improvement, and 4 (11.4 per cent) slight or no improvement. (c) Postoperative residual pelvic inflammatory disease seen in 33 cases yielded 24 (72.7 per cent) completely cured or markedly improved; 8 (24.2 per cent) moderately improved; and 1 case (3.1 per cent) slightly or not improved. 3. 3. Seven patients of the entire series presented additional complaints of sterile periods of two to four years and subsequently conceived after thermo-flo treatments. 4. 4. Bladder and rectal inflammation associated with pelvic infection is favorably influenced by the use of intravaginal heat. 5. 5. In cases of gonococcal, nonspecific, and postoperative residual infections of the pelvis, our clinical impression was that a more rapid and complete resolution of pathology and improvement of clinical symptoms takes place, in a shorter period of time, than with previous methods of treatment. 6. 6. We recommend the use of intravaginal heat therapy (thermo-flo) as a pre- and postoperative measure, in suitable cases. 7. 7. We wish to emphasize that the treatment of pelvic inflammatory disease by intravaginal heat (thermo-flo) does not replace operative therapy in all instances, particularly when associated pelvic pathology exists. In a large group of society, surgery is more frequently indicated because of economic dependency.