Harold Speert

Serum phosphatase relations in mother and fetus.

Abstract Profound alterations in the bodys economy of calcium and phosphate occur during pregnancy and lactation, to provide for the fetal needs for these substances and for their excretion by the mammary glands. Studies in placental permeability employing tracer doses of radioactive phosphorus have shown, for example, that the guinea pig fetus near term retains in each hour as much phosphorus as the total quantity of this element in the circulating plasma of its mother. 27 Changes in inorganic phosphate as well as calcium in the serum of the pregnant woman are so slight, however, that they are practically completely lacking in significance for the interpretation of metabolic phenomena. Maternal stores are obviously essential to the growth of the fetus. These stores of phosphorus exist in the form of organic esters, the phosphate ions being liberated as needed through the mediation of enzymes, notably alkaline phosphatase. This enzyme, widely distributed in the body, occurs in particularly high concentration in bone and cartilage, where it presumably plays an essential part in the process of ossification by producing an excess concentration of phosphate ions which leads in turn to the precipitation of calcium phosphate. The enzyme is present also in the blood serum, where it can be measured by a variety of techniques. Its activity is expressed in arbitrary units, dependent upon the type of substrate employed in the determination. When glycerophosphate is used (Bodansky method) the range of normal for adults is 1.5 to 4.0 units per 100 c.c. of serum. In children the phosphatase activity is increased, ranging between 5 to 12 units per 100 c.c. The enzyme concentration is also elevated in some diseases of the liver, especially those with obstructive jaundice, and in many types of bone disease including rickets, osteomalacia, osteitis fibrosa cystica, and osteitis deformans. 24 The behavior of alkaline phosphatase in relation to the various phases of reproduction is interesting because of the need for mobilization of phosphorus which the reproductive cycle imposes. This study is divided into four parts: pregnancy, puerperium, lactation, and fetal-maternal relations.

Nutrition and premature labor.

Abstract 1. 1. The literature dealing with the relation of maternal nutrition to premature labor has been reviewed. Despite the prevailing view that nutritional inadequacy is a common cause of premature labor, the evidence for this is not convincing. 2. 2. Dietary histories of a group of patients who had premature labors revealed no significant differences from those of a control group with full-term pregnancies in calculated intake of the various food essentials. 3. 3. Hematological and blood biochemical determinations in the early puerperium also failed to reveal any significant differences between the premature parturients and their full-term controls. Determinations included serum proteins, serum amino acid nitrogen, red cell volume, hemoglobin, serum alkaline phosphatase, serum vitamin A, serum carotene, serum ascorbic acid, and whole blood ascorbic acid. 4. 4. This study offers no support to the theory that nutritional deficiency is a common cause of premature labor.

The uterine decidua in ectopic pregnancy: Its natural history and some biologic interpretations

Abstract The endometrial changes in ectopic pregnancy, from 4½ weeks to full term, have been recorded from the study of 12 uteri removed without prior curettage; and the integrity of the decidua has been correlated with the histologic appearance of the trophoblast. The decidua of ectopic gestation reflects the purely hormonal influence of pregnancy, dissociated from the chemical action of the trophoblast and the pressure effect of the fetal sac. Great variations were observed in the thickness of the decidua but without relation to the stage of pregnancy or to the viability of the trophoblast. In 2 of the 4 cases in which the trophoblast was dead, the decidua had already been replaced by cyclic, nongestational endometrium. Pronounced dilatation of the superficial veins of the compacta characterized the decidua of early pregnancy. By the twelfth week most of the gestational glands had undergone secretory exhaustion, the decidua consisting chiefly of a broad sheet of transformed stroma. The integrity of the decidual stroma was maintained until full term or until death of the trophoblast, when dissolution of the reticulum, increased leukocytic infiltration, interstitial hemorrhage, vascular thrombosis, autolysis, and slough occurred. It is suggested that these decidual changes may initiate labor in normal intrauterine pregnancy. Vaginal bleeding in ectopic pregnancy, which was noted in 10 of the 12 cases and does not necessarily signify death of the fetus or trophoblast, may be regarded as the counterpart of the physiologic bleeding of intrauterine pregnancy, both probably resulting from the same vascular phenomena that produce the bleeding of menstruation.

Memorable medical mentors: I. Lewis Hill Weed (1886-1952).

The main course of the first year of medical school was anatomy, presided over by Professor Lewis Weed, head of the Department. My encounter with him, on the very first day, proved unforgettable. Dr. Weed had achieved renown for his contributions to our knowledge of the origin and circulation of the cerebrospinal fluid, and in more recent years, as a political force in American medicine. Born in Cleveland, Ohio, in 1886, he received from Yale University his AB degree in 1908, his MA the following year, and from the Johns Hopkins School of Medicine his MD in 1912 (1). After 2 years of postgraduate study in Boston with neurosurgeon Harvey Cushing and a brief stint in the Army Medical Corps during World War I, he was appointed Professor of Anatomy at Johns Hopkins, where he spent the rest of his professional life. In 1923, at age 37, he was named Dean of the School of Medicine, and in 1929, its Director. In his later years, he was much sought for advice on organization and appointments in other schools and laboratories. In 1939, the year of my graduation from medical school, he was made Chairman of the Division of Medical Sciences of the National Research Council; and when the scientific work related to the war effort increased, during World War II, he was named Vice-Chairman of the Office of Scientific Research and Development’s Committee on Medical Research, which played a major role in the search for antimalarial drugs, the production of antibiotics, improvements in transfusion of blood and blood substitutes, and studies in aviation medicine. When Weed was awarded the LL.D. honoris causa from Johns Hopkins University, in February 22, 1951, George W. Corner, a contemporary anatomist and former colleague, said of him: “. . .be-

OBSTETRICAL‐GYNAECOLOGICAL EPONYMS: JAMES YOUNG SIMPSON AND HIS OBSTETRIC FORCEPS

THE obstetric forceps has been modified and redesigned in new form probably more times than any of the other countless number of instruments and devices that man’s mind has conjured up for the diagnosis and treatment of his ills. The Chamberlen family is often credited with invention of the first safe and effective forceps, in the late sixteenth or early seventeenth century ; but archaeological evidence (Fig. 1) shows the forceps to have been in use for the delivery of living infants much earlier, probably the second o r third century, in the days of the Roman Empire (Baglioni, 1937). During the latter part of the nineteenth century almost every obstetrician of renown seems to have felt the need to add his own modification to the forceps; and even now scarcely a year passes without the addition of at least one new instrument to our forceps arsenal. For fully a century now, however, year in and year out, the vast majority of forceps deliveries has been carried out by means of an instrument popularized by Sir James Young Simpson and usually known as the Simpson forceps, although models embodying minor changes continue to bear the names of their new inventors. Simpson demonstrated his forceps for the first time on 10th May, 1848 at a meeting of the Edinburgh Obstetrical Society (Simpson, 1848). “They differ from the short forceps in some points of construction,” he explained, “but more particularly in regard to their mode of application and working. They differ for example in their length; in the shanks being parallel for some distance beyond the lock, an indispensable point in order to prevent them injuring the outlet; in their blades being curved; and in the part intended to embrace the head being sufficiently long and large . . . The blades are the same as Dr. F. Ramsbotham’s, but scarcely so much curved. The lock is Smellie’s, but with knees or projections above it of such size as to prevent the blades readily unlocking in the intervals between the pains, these giving it the fixed character of the locks of Levret and Bunninghausen’s instruments, without their complexity. The joints are made so loose as to allow of their lateral motion and overlapping to a very considerable degree, thus facilitating their introduction and application. And, lastly, the handle is that used by Naegele and other German accoucheurs, viz., with transverse knees or rests below the lock for one or two of the first fingers of the right hand to drag by, the long forceps being only properly used as an instrument of traction, not of compression. In addition, the handles are grooved and marked 011 the anterior side, to distinguish that from the other side when the blades are within the pelvis . . .” The forceps were used in the management of uterine inertia, haemorrhage during labour, and other complications, “but the common reason for employment of the long forceps,” in Simpson’s words, “is morbid contraction of the brim of the pelvis in its most general form, and from its most general cause, viz., in the conjugate or antero-posterior diameter, from projecting forward of the promontory of the sacrum. How are the long forceps applied when used in this, the case in which they are most generally had recourse to in practice? It is first requisite to state, that under this complication the child’s head is found situated in the brim, with its long or fronto-occipital diameter lying in the transverse diameter of the brim, or with the forehead looking to one ilium, and the occiput looking to the other. In other words, the long diameter of the head is not placed, as usual, in the right