James E. Davis

Pathologic findings in genital bleeding two or more years after spontaneous cessation of menstruation.

Abstract 1. A brief review of the literature is presented. 2. A survey is made of 514 cases of genital bleeding two or more years after cessation of menstruation. 3. Criteria are reviewed with respect to: (a) pathologic findings according to location, (b) race, (c) age at menopause, (d) duration of amenorrhea before bleeding, (e) duration of bleeding, (f) type of bleeding. 4. Explanatory comments are made concerning some of the more interesting cases.

A critical study of 335 hysterectomies: Done from September 1, 1928, to September 1, 1929☆

Abstract The diversified material supplied in this group of cases for the past year from Detroit hospitals, when checked up against stated indications for treatment by hysterectomy, may invite some adverse criticisms. In answers from a questionnaire sent to prominent gynecologists of United States and Canada one learns with some degree of surprise how great is the diversity of opinion and practice among leaders in this type of work. The question asked was “What percentage of your hysterectomies have been performed for the removal of myomata or fibromyomata of the uterus?” The answers gave an average of 71.6 per cent of all hysterectomies having been done for the removal of fibromyomata. This compares closely with the percentage 72.15 for our group of 325. This average of the questionnaire answers resulted from three grades of percentages, one from a group between 10 and 35 per cent, another between 65 and 75 per cent and one between 90 and 100 per cent. One operator treated all fibromyomata by myomectomy. Other operators did hysterectomies only for fibromyomata. The majority, however, did hysterectomies for fibromyomata in about 72 per cent of their cases. The remaining 28 per cent of the operations were for hemorrhages related or unrelated with recent pregnancies, for infections of the uterus and adnexa, for malignancies of fundus and cervix. The tabulated findings of this study show in conclusion: 1. 1. Hysterectomy is the prevailing operation of choice for fibromyomata of the uterus averaging approximately 72 per cent in this study and in the clinics of 45 of our leading operators in this country and Canada. 2. 2. Approximately 30 per cent of uteri are removed for malignancies, inflammations, hyperplasias, and malpositions. 3. 3. The prevailing symptoms of uterine pathology for which relief is sought are pain, tumor, and bleeding. 4. 4. The combined use of hysterectomy and x-ray or radium is a treatment of great promise in all types of uterine pathology, especially for cancer of the cervix.

Fatal hepatic necrosis associated with halothane anesthesia

Abstract Fatal hepatic necrosis following halothane anesthesia occurs in rare instances. It seems that the risk is increased by multiple exposures. There is a typical clinical pattern, a laboratory test to alert the suspicion, and morphologic changes which are characteristic but not pathognomonic. The literature is reviewed, and two case reports are presented. It appears to be pertinent to gynecologists because it is suggested that, although the risk from halothane is small, its use should be avoided in a first and minor operation when anesthesia may be required at a later time.

Anatomical and clinical studies upon 875 placentae

Abstract This study is a preliminary endeavor to ascertain data pertaining to maternal and fetal morbidity and mortality through routine and special methods for the examination of the placenta and umbilical cord; also by clinical controls to further accurate estimation of the significance in the histopathologic changes obtaining beyond the normal for a matured decidual organ. Statistical estimates have assigned for United States a maternal mortality rate second highest of a large number of countries. Students of public welfare point to the fact that there has not been any noticeable decrease in this mortality for twenty-five years. In many cities, according to Levy, the percentages vary from 5.6 to 11.9 per 1000 births (1 in 178 to 1 in 84). The neonatal mortality has ranged from 23 per 1000 (1 in 43) to 49 per 1000 (1 in 20). The combined loss for mother and child in the first month reaches the appalling figure of 61 per thousand (1 in 17). It would seem urgent that all possible means from clinical and laboratory sources should be utilized and combined to further economy here in human lives.

Rupture of prosthetic graft of aorta in pregnancy

AORTIC COARCTATION is an infrequent anomaly. Life expectancy without surgical treatment is limited to the midthirties. Crafoord and Nylin’ and Gross and Hufnagelt working separately but almost simultaneously in 1945, reported the first attempts at surgical correction. The prognosis was so improved that, since then, the operation has been used extensively. Early complications with prosthetic grafts are well known but now, with improved techniques, occur infrequently. Late complications are even less frequent. One such case, in a 19-year-old pregnant woman, seven years after implantation, is described below. A discussion of the implications of pregnancy in this type of case follows.

Pathology of the reproductive cycle based upon over half a million obstetric deliveries in detroit

R EPRODUCTION pathology may have its origin in any one of five biologic periods. The first or premating phase of the reproduction cycle anticipates the possession of a creating complementing chain of genes which are to be t,he most effective biologic sublimation of life. The selection may be mental or emotional with or without intelligent knowledge of the first principles of genetics. Intelligent selection will have scientific familiarity with the fundamental genie groupings as recognized in the body systems, constitution, qualities of mind, talents and foundations of personality, and will act in harmony with creative ideals, t,he supreme privilege of a creative mind. Mating of defective genes anticipates familial pathology of prematurity, malformations, increased mortality and morbidity. The preconception period may be lived under normal or abnormal obediences, fertility may be promoted or cheated, birth control or int,erruption of pregnancy practiced with due contributions to pathology. The antenatal period challenges obstetric ability in preventive pathology, tests judgment and knowledge of physiology in pregnancy, and demands expert appreciation of deficiencies in diet and endocrines. The natal period is the opportunity where the science and art of obstetrics meet and where one or t,he other too often departs. Interference may be science but too often it is art. The success of an opera.tion may yield three percentages, one for the operation, one for the mother, and one for the child, and unless all three are a success, there is failure. There is no justification for belittling the mortality and morbidity in the child. Elective interference of present-day obstetrics is inferior to normal biologic technic. The postnatal phase of reproduction is the physiologic bookkeeping time of the cycle when debit balances go to pathology to be carried over to the next confinement as a liability, or to later life as a malignancy. The medical profession has established its obligations and leveled them with its ideals and it now finds itself liable to uncomfortable

The differentiation of cancer tissue

Abstract 1.1. Cancer cells or cancer tissue cannot be differentiated either in vivo or in vitro from dead cells or from normal cells. 2.2. Two genetic sources undoubtedly supply the units of cancer formation, namely the injured and the embryonic cells. 3.3. It is plausible to believe that heredity may supply in certain families and individuals protoplasm of low potential quality for ultimate differentiation, and the physical evidence will appear in the abnormal number of cells unable to gain maturity. 4.4. The preponderance of evidence and modern opinion point to irritation, regardless of its type (whether traumatic, thermic, chemical, bacteremic or parasitic), as the exciting cause, which can act with equal facility upon embryoid or atavistic type of cells in producing uncontrolled, incompletely organized, dysfunctioning tissue. 5.5. Under the conditions prevailing in cancer, function no longer determines form, but conversely, form determines function, which is inadequate, abnormal and superfluous. 6.6. With inadequate tissue organization, lacking as it does nerve and lymph supply, and possessing a precarious blood vessel canalization, supported by an uncertain stroma and exercising free parasitic characteristics, there can be little wonder that degenerative changes are constant. 7.7. The chemical activities of cancer tissues tend towards acidification of body fluids with consequent body demineralization and cancer tissue hypermineralization. 8.8. The differentiation of cancer cells can be advantageously studied by estimating both the number of the new growth cells differentiated and their nearness or remoteness to normal standards of form. 9.9. Observation of the cell division figures and the degenerative changes in nuclei affords useful information as to rapidity of growth. 10.10. It should be expected that cancer cells will differentiate after the pattern of their parent tissue, but frequently the influence of a new environment compels a close resemblance to surrounding structures but occasionally no imitation of either is recognizable. 11.11. The kind of food consumed or the mode of life pursued have but little to do with the development of cancer. 12.12. The better nutrition supplied by younger subjects is the greatest factor in producing a maximal growth impulse in malignancy. 13.13. Growth, pressure, nutrition, specialized function and organization, all represent central, general, purposeful provisions for the body, but malignant growth has no purpose in the body economy. 14.14. The cancer tissue may repeat or depart from its pattern form. It may or may not be influenced by its environmental structures. 15.15. Tissue susceptibility to cancer varies widely and metastasis from different anatomic locations is often distinctive. 16.16. The connective tissue is the only functional relation of the normal to the tumor tissues and reaction to the cancer can be judged by the stroma formation as well as by degeneration. 17.17. As epithelial cells depart less from their primordial type, they consequently have a greater potential and actual growth impulse. 18.18. Differentiation, which is a change from the general to the special in type of cell, tissue, organ, and animal, is always incomplete in all four types if it is cancer tissue.