Harold C. Mack

Epidemiology of cervical cancer: Study of a prison population

The occurrence of cervical cancer among 511 inmates of the Detroit H ouse of Correction was investigated. 30% of the women were prostitutes, 82.6% had trichomonas infestation, 15.5% had syphilis, and 5.3% had gonorrhea. 3.7% of the women were diagnosed as having cancer of the cervix, a rate that was 4 times higher than in a matched control group. Sexual activity of the prisoners, on the average, began 2.8 years earlier than it did for controls. It is concluded that the initiation of coitus at an early age and promiscuity are the primary etiologic factors associated with cervical cancer.

The glycogen index in the menopause

Abstract The iodine vapor method of staining vaginal smears is presented as a rapid and simple means for determining the specific glycogen response to estrogen activity in the human subject. This method of clinical investigation is based upon observations that normal vaginal glycogen content parallels estrogen sufficiency, whereas diminution of glycogen (glycopenia) is indicative of estrogen deficiency. To determine the incidence of glycogen poverty in postmenopausal women, vaginal smears from 130 climacteric women (after staining by the iodine vapor procedure) were graded according to glycogen content. The incidence of the four glycogen grades was calculated according to age, duration of the menopause, and the nature of the climacteric, whether spontaneous or artificially induced. The significance of the findings, in terms of other reports of postmenopausal estrogen elaboration, is discussed. The possible “anti-hormonal” effects of various systemic and local disorders (febrile states and vaginitis) upon estrogenic activity, are suggested by observations in tuberculous women. Experience to date has established the usefulness of the glycogen index in estimating therapeutic response of estrogen therapy in juvenile gonorrheal and senile atrophic vaginitis. Evidence of its further value as a simple and sensitive indicator of estrogen activity in human subjects is presented in potency determinations of several commercial products.The iodine vapor method of staining vaginal smears is presented as a rapid and simple means for determining the specific glycogen response to estrogen activity in the human subject. This method of clinical investigation is based upon observations that normal vaginal glycogen content parallels estrogen sufficiency, whereas diminution of glycogen (glycopenia) is indicative of estrogen deficiency. To determine the incidence of glycogen poverty in postmenopausal women, vaginal smears from 130 climacteric women (after staining by the iodine vapor procedure) were graded according to glycogen content. The incidence of the four glycogen grades was calculated according to age, duration of the menopause, and the nature of the climacteric, whether spontaneous or artificially induced. The significance of the findings, in terms of other reports of postmenopausal estrogen elaboration, is discussed. The possible “anti-hormonal” effects of various systemic and local disorders (febrile states and vaginitis) upon estrogenic activity, are suggested by observations in tuberculous women. Experience to date has established the usefulness of the glycogen index in estimating therapeutic response of estrogen therapy in juvenile gonorrheal and senile atrophic vaginitis. Evidence of its further value as a simple and sensitive indicator of estrogen activity in human subjects is presented in potency determinations of several commercial products.

Physiological adaptation and nutritional status during and after pregnancy.

The physiological adaptation of women to pregnancy and the postpartum and their nutritional status was studied and related literature is discussed. Those aspects studied and discussed included differences in capillary and venous blood samples blood changes in the postpartum methods for analyzing hemoglobin total serum protein serum Vitamin-C serum Vitamin-A and carotenoids and serum alkaline phosphatase the quality of dietary intake the usual physiological changes during pregnancy clinical dietary and seriatim biochemical assessment of nutritional status biochemical assessment of hemoglobin total serum protein serum Vitamin-C serum Vitamin-A and carotenoids and serum alkaline phosphatase and maternal and infant blood components and their relationships. The results are discussed with regard to nutritional status clinical symptoms dietary intakes race socioeconomic factors and other influences.

Cesarean section in detroit during 1945—A comparison with 1925 and 1930☆

Abstract In Detroit, during 1945, there were 1,000 cesarean sections, or one in 37 births, as contrasted to 154 or one in 217 deliveries in 1925 (Welz), and 203 or one in 167 in 1930 (Seeley). On the other hand, maternal mortality with cesarean section for these series were 13 per cent in 1925, 4.4 per cent in 1930, and only 0.8 per cent in 1945. The fetal death rates for the same years were 11, 12.8, and 7.8 per cent. The incidence of the operation during 1945 in the fourteen larger hospitals with 1,000 or more deliveries varied from one in 78 to one in 13 births, and, in most instances, the 1945 rates represented increases over those for 1925 and 1930, thus reflecting the general trend for the city as a whole. The low cervical operation had become the one most frequently employed by 1945 and, as before, showed distinct maternal advantage over the classical type. Cesarean-hysterectomy and extraperitoneal section were only forty in number but without mortality. The hospitals were divided into three groups according to numbers of deliveries as follows: 2,000 or more—5 hospitals; 1,000 to 1,999—9 hospitals; and less than 1,000—25 hospitals. In the first two groups there were 13,997 and 13,130 deliveries with a maternal mortality rate of 1.1 per 1,000 for both. In these same two groups, cesarean sections had incidences of 3.6 and 2.5 per cent, with death rates of 0.39 and 0.62 per cent, respectively. In the third group, there were 6,946 deliveries in the 25 hospitals, with a general maternal mortality of 3.46 per 1,000, and a cesarean section incidence of 2.4 per cent with 2.38 per cent deaths. Moreover, three of the four cesarean fatalities ascribable in whole or in part to questionable treatment occurred in these hospitals. The number of cesarean sections done for the various indications increased markedly in all important categories. However, the proportional variations remained remarkably constant except for the toxemias of pregnancy. Cesarean sections for these conditions had increased from 26 in 1925 to 73 in 1945, but these figures represented a decrease from 17 per cent of all sections in 1925 down to 7 per cent in 1945. The proportional and absolute increase under the heading “Miscellaneous” is explained in part by some new indications such as “Rh negative.” An outstanding feature, on comparing the three periods, is the marked reduction in cesarean section mortality—from the appalling rate of 13 per cent in 1925, to 4.4 in 1930, and down to only 8 cases or 0.8 per cent in 1945. In spite of this good record for 1945, there was, however, good reason to believe, on the basis of the available data, that poor judgment and disregard of indications and contraindications were largely responsible for two of the eight deaths. In at least two others, the indications for abdominal delivery were highly questionable. Regarding the conditions for which cesarean section was done, the toxemias remain the most serious—three deaths in 73 during 1945. There were also two fatalities among the 164 operations for placenta previa and premature separation of the placenta. No deaths occurred in 166 elective sections performed because of previous cesarean, and none in the 384 done for cephalopelvic disproportion. Only a few details were secured regarding the fetal deaths. Of the 78 infants lost, 28 (35.8 per cent) are known to have been stillborn, and 25 (32 per cent) were neonatal deaths. At least 13, or 16.6 per cent, were premature infants. Three were maldeveloped, and five deaths were attributed to erythroblastosis. This analysis of cesarean sections from Detroit led to some interesting conclusions, comparisons with other communities, and other data as follows: A rise in hospital confinements during the twenty years to more than 94 per cent of the deliveries in 1945 was accompanied by a reduction in the general maternal mortality to 1.6 per 1,000 live births. At the same time, there was an increase in cesarean sections from 154 in 1925 to 1,000 in 1945, a percentage of 2.7, or one in 37 births. This high incidence is in accord with the average (2.84 per cent) obtained from the recent studies in various states and cities. The Detroit cesarean section mortality rate of 0.8 per cent compared very favorably with that of these other communities. In Detroits largest and, generally speaking, better organized obstetric services, there were 75 per cent of the citys deliveries with a substantially lower over-all mortality. In these hospitals there was also a definitely higher incidence of cesarean section, but again a very low death rate (0.48 per cent). In view of the markedly increased incidence of cesarean sections on the one hand and the greatly decreased mortality on the other, it is well to ask if too many are now being done or if too few were done before. There is evidence that, in 1945, many sections were done for scant reason, to say the least. Apparently there is widespread disregard of the fact that, though the death rate is low, surgically speaking, it represents a high immediate obstetric risk, as well as a definite hazard for future pregnancies. On the other side of the question, it is noteworthy that in 1945 at least 20 of the 58 maternal deaths were considered to have been preventable, a number of them by timely cesarean section. Both sides of the question, then, seem to involve a proper regard for established indications and contraindications. Specifically pointing the way to further improvement, as mentioned before, is the fact that, in at least four of the eight cesarean deaths in 1945, the fatal outcome was in considerable part due to faulty judgment or management. The fetal mortality rate of 7.8 per cent in the 1945 cesarean sections, though definitely better than in previous years, is still twice the over-all death rate for infants during the first year of life. The fact that 36 per cent were stillborn again emphasizes the fact that cesarean section does not necessarily offer the best chances for a living child. Hence, there is no justification for undue extension of the use of cesarean section for purely fetal indications.

Weight changes and toxemia of late pregnancy

Abstract A series of 100 private patients with definite toxemia of late pregnancy had an average gain in weight of 17 pounds during the last four lunar months of pregnancy, as compared to 15.7 pounds for normals. Sixty-one of these 100 toxemia patients gained at least twice the normal averages at one or more observation periods during this time, while 39 at no time showed such excessive gains. The presence or absence of excessive weight increases bore little or no relationship to the severity or to the type of the toxemia. In 37 patients, excessive weight gain preceded definite signs of toxemia, but in the remaining 63 it appeared along with or after these signs, or not at all. Moreover, it was also present in about 45 per cent of the normals. Sudden or abrupt weight increase was somewhat more frequent with toxemia than among normal patients but was far from the rule. The occurrence of excessive weight gains in pregnancy would appear to be of doubtful significance in predicting impending toxemia and of secondary value, at most, in the diagnosis of the actual disease.

Complications of pregnancy and nutritional status: I. Toxemias of pregnancy

Abstract Although experimental evidence derived from laboratory animals clearly demonstrates a relationship between maternal nutrition and reproductive performance, objective proof of a similar relationship during the gestation of human mothers is lacking. Indeed, reports attempting to relate maternal and fetal complications of human pregnancy to specific aspects of poor nutrition have been contradictory and largely inconclusive. Within recent years several independently sponsored, intensive studies have been initiated in efforts to determine the role of nutrition in normal and complicated pregnancies through the application of more exact techniques. 1–12 Our investigation, 13, 14 begun in 1947, yielded data based upon clinical observations, medical histories, food intakes, and seriatim microchemical determinations of hemoglobin, total serum protein, vitamin C, vitamin A, carotenoids, and alkaline phosphatase. This communication presents data concerning pregnancies complicated by pre-eclampsia and eclampsia in comparison with published data for subjects whose gestations were judged to have followed essentially normal courses. 14

Plasma Proteins in Venous and Cord Blood at Delivery Following Uncomplicated and Complicated Pregnancies

Summary 1. Total protein, albumin, and 5 globulin fractions were determined by electrophoresis in the plasma of samples of cord blood and of venous blood from 11 women whose pregnancies were uncomplicated. Similar samples were obtained for electrophoretic analysis from 21 women whose pregnancies were complicated by toxemia of pregnancy and other diseases. 2. For the samples representing uncomplicated pregnancy total protein values for venous blood were higher than for cord blood. Greater average amounts of albumin and gamma globulin were found in cord blood than in the corresponding venous blood, coincident with lesser amounts of alpha, beta, and phi globulins. 3. In complicated pregnancies the ranges for total plasma protein in venous and cord blood were lower than for the normal group. Ranges of values for serum protein (calculated as plasma minus fibrinogen) fractions in cord blood following complicated pregnancies were, in general, higher for albumin and gamma globulin and lower for alpha, beta, and phi globulins than the ranges for venous blood.

A comparison of the Aschheim-Zondek and the Friedman tests in normal and abnormal pregnancy

Abstract An analysis of the literature on hormone tests for pregnancy and our own experience with 546 Aschheim-Zondek and 566 Friedman tests demonstrates a high degree of accuracy for both methods, the latter being slightly more accurate as well as easier and quicker. In proved cases of normal pregnancy we obtained an accuracy of 97.3 per cent with the Aschheim-Zondek test and an accuracy of 97.8 per cent with the Friedman method. In patients definitely determined not to have been pregnant we obtained an accuracy of 98.5 per cent with both methods. In abnormal or interrupted pregnancy the result of the test should be interpreted with the clinical findings, a negative test signifies either a nonpregnant state or an interrupted pregnancy, a positive test strongly indicates living fetal elements, but due to a temporary persistence in elimination of the hormone, recent interruption or fetal death cannot be excluded. In cases of hydatidiform mole and malignant chorionepithelioma, the amount of hormone excreted is many times greater than that excreted during normal pregnancy. The persistence of positive tests after treatment of these neoplasms strongly suggests continued chorionic proliferation.