James F. Donnelly

Causes of death in five hundred thirty-three fatal cases of toxemia of pregnancy

Abstract Analysis of 1,500 maternal deaths which occurred in North Carolina during the period of six and one-half years revealed that toxemia was directly responsible for 393 fatalities, and contributed to an additional 140. Clinically it appeared that cerebral disturbances, pulmonary edema. or renal suppression was the immediate cause of death in almost all cases. Autopsies performed in 21 cases revealed focal necrosis and hemorrhage in many organs, but principally in the liver, kidneys, lung, heart, and brain. These findings emphasize the complexity of toxemia and indicate the need for consideration of the patient as a whole in the treatment of this condition.

Spontaneous premature rupture of the membranes.

Abstract A sample of cases of spontaneous premature rupture of the membranes associated with the delivery of approximately 7,500 infants weighing 400 grams and above is presented. The over-all incidence of premature rupture of the membranes was 15.8 per cent. The incidence of premature rupture of the membranes among the fetal and neonatal deaths was 26.7 per cent. Premature rupture of the membranes occurred in association with a sizable number of major obstetrical complications. Infection was the principal lethal factor in the infant deaths which were primarily due to premature rupture. It occurred more frequently among the non-white and less educated mothers, and was tolerated less well by the older mothers from lower socioeconomic groups, whether the classification was based upon the mothers education, race, or the fathers occupation. Premature rupture of the membranes is a major obstetrical complication which requires additional study.

The induction of premature labor by means of pitocin in patients with toxemia of pregnancy

Abstract All obstetricians are faced at some time with the necessity for interrupting a pregnancy complicated by toxemia between the twenty-eighth and the thirty-fourth week. When the toxemia fails to respond to treatment, termination of the pregnancy is advisable for the sake of both mother and child. Once the decision has been made, with full knowledge that prematurity is a factor to be considered, the next question is what method to use. The majority of these mothers show no sign of impending labor such as engagement of the head or effacement and dilatation of the cervix. They have what is described so often in the literature as the “long, closed cervix.” It is this type of patient, primigravida or multigravida, who is usually subjected to cesarean section. The purpose of this paper is to describe a method of induction which permits vaginal delivery in such cases. We believe that the technique, because it achieves a normal birth, is preferable to the surgical approach, as it not only increases the infants chances for survival, but also improves the outlook for future childbearing on the part of the mother.

Cerebral venous thrombosis in the puerperium: Report of two cases with necropsy findings

Abstract 1. 1. Two cases of primary cerebral venous thrombosis in the puerperium are reported. 2. 2. The clinical features and treatment of this condition are briefly reviewed.

An evaluation of the radical hysterectomy in the treatment of carcinoma of the cervix

Abstract Surgery was the only available treatment for cancer of the cervix before 1912. The most popular and successful surgical procedure at that time consisted of the removal of all the upper genital structures, the pelvic lymphatic system, and the upper portion of the vagina and was known as the Wertheim operation or radical hysterectomy. With the advent of irradiation treatment, the therapeutic pendulum swung to nonoperative treatment and remained there until recent years. There were three main reasons for this change: (1) 50 per cent of the patients were inoperable; (2) the primary operative mortality varied from 20 to 27 per cent; (3) irradiation therapy offered a much lower primary mortality rate, a universal application, and a satisfactory salvage rate. As late as 1938, one of the leading gynceologists 1 in the United States considered the Wertheim procedure obsolete. During the past ten years, there has been an increasing interest in the surgical treatment of cancer of the cervix, either alone or in combination with irradiation. The results published to date indicate that surgery has a promising role in the treatment of cervical cancer. The purpose of this paper is to discuss our experience with the Wertheim operation in an effort to improve the present rate of salvage from this disease.

Plasma alpha-amino nitrogen in pregnancy

Abstract 1. 1. Administration of estrogenic material, with or without progesterone, to patients in the early puerperium did not influence the normal postpartum rise in amino nitrogen. 2. 2. Although other factors may be involved, these observations are consistent with the concept that the hypo-amino-acidemia of pregnancy is based on active placental transfer of amino acids from the maternal circulation.