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During recent years, we have accumulated considerable data on the general question of nitrogen retention in the blood during the late toxemias of pregnancy; and, in view of the divergent opinions that prevail concerning the value of such determinations in the differential diagnosis and prognosis of these conditions, it seems that they should be recorded. Our investigations have led us to believe that blood chemical studies are at present of little or no practical assistance in the clinical management of these cases, and that the older methods of examination—urinalysis, blood pressure readings and ophthalmoscopy—yield the most valuable information concerning the patient's condition.Previous workers (Folin,1 Caldwell and Lyle,2 Killian and Sherwin,3 de Wesselow 4 and others) have demonstrated that the substances studied (total non protein nitrogen, urea and uric acid) occur in normal concentrations in the blood during normal gestation. They have, moreover, pointed out that there

It is generally agreed by those who have used both nitrous oxide-oxygen and ethylene-oxygen in obstetric work that the latter has the following advantages:Ethylene has a shorter induction period.It produces better analgesia and anesthesia in less concentrations, since it is the more powerful anesthetic agent.It promotes better relaxation, with the result that the addition of ether is less frequently necessary.It induces less cyanosis and less fetal asphyxia.It does not cause sweating or an increase of saliva and mucus in the mouth.It has a greater margin of safety, especially in patients with heart and kidney complications.It is less expensive.Its possible disadvantages, as gathered from the available literature, may be enumerated thus:Vomiting is probably more frequent, although it is usually mild in character and quite transient.Labor may be slightly prolonged, especially if the gas is given for any considerable period.There may

The current interest in the use of preserved human blood for transfusions has been especially motivated by economic pressure in the United States and by military necessity in Europe. Hence the empirical clinical use of transfusions of preserved blood has tended to precede rather than to follow fundamental objective biologic and chemical studies in the laboratory.A review of the literature reveals few data from which the clinician can establish satisfactory criteria for the use or rejection of preserved blood. Two factors appear to have contributed to this paucity of laboratory observations: first, the practice of blood transfusion has been so extensive and the indications have been so diverse that it is often difficult for the clinician to define precisely which elements of the transfused blood he most desires his patient to receive; second, the exact mechanism of the production of the various reactions from blood transfusions is not well

Retroposition of the uterus as an obstetric complication is not a new subject for discussion by this section or by obstetricians generally, but apparently no attempt has been made to learn what will happen if no corrective treatment is instituted during pregnancy or after delivery. Various degrees of conservatism have been advocated from time to time until the retroverted uterus has lost a great deal of its former importance, but there is still a feeling that it is a real complication. Among obstetricians it is frequently blamed for sterility and for early abortion, and the advice is usually given that a retroposed uterus discovered in early pregnancy should be replaced at once, lest untoward symptoms develop. Moreover, there is a strong feeling that child-bearing plays an important rôle in producing posterior displacements and that it is essential for the physician to insist on correctional exercises and to institute pessary treatment

There have recently appeared several reports on gestational polyneuritis (neuronitis), emphasizing the clinical and pathologic aspects of this little known disease (Berkwitz and Lufkin,1 Wilson and Garvey,2 McGoogan,3 Hoffman4 and Strauss and McDonald5). Having seen twelve certain or probable cases within the past seven years, we are persuaded that the condition is not so rare as is generally thought and that a wider knowledge of the essential clinical picture will increase the frequency with which the diagnosis is made and will proportionately diminish the number of patients reported as succumbing to "late toxic vomiting of pregnancy." It is our purpose to discuss particularly the clinical observations in the light of the recorded cases and of our own experience.ETIOLOGYIt has been commonly assumed that the disturbance is the direct result of the action of a toxin which is elaborated by the product of conception

A previous communication1 recorded our experience with the prophylactic administration of penicillin to women during labor and shortly after delivery between Feb. 3, 1947 and Jan. 31, 1948. In that study a control group of 430 patients was compared with two treated series given 600,000 (202 women) and 900,000 units (263 women) of penicillin. Patients were grouped alternately according to their admission to the labor rooms. Women delivered abdominally and those receiving penicillin therapeutically for any reason were excluded, but no other selection was employed. Penicillin suspended in beeswax and oil was used for the first ten months, but subsequent to that date penicillin G in oil and wax was utilized. The two groups showed a distribution according to parity, financial status, incidence of operative intervention and gestational and parturitional complications similar enough to make comparisons reasonably valid.The penicillin-treated group showed no significant reduction in intrapartum fevers or

The concentration of potassium in the human erythrocyte is normally from seventeen to twenty times that in the serum.1 Any change in this ratio occurring during the storage of blood is of clinical interest in view of the well known toxicity of potassium salts injected intravenously. Dulière2 noted a progressive increase in the plasma potassium of human blood stored for ten days. Jeanneney and his co-workers3 confirmed this observation and also demonstrated a coincidental diminution of plasma sodium.The studies here recorded were undertaken with the hope that the increase in plasma potassium might serve as an index of corpuscular deterioration. Some of the data were published in a preliminary report4 and later presented in an exhibit.5 Scudder, Drew, Corcoran and Bull6 have since published detailed experiments dealing with the same subject. METHODS Blood was drawn aseptically from the median basilic veins of healthy men into pyrex Erlenmeyer flasks of

During the past decade especially, public attention has been drawn to the high maternal mortality in this country, and many alleged contributory factors have been advanced. In certain quarters there has been a tendency to place a great part of the blame for the admittedly undesirable situation on those who are undertaking the undergraduate teaching of obstetrics. Much of this criticism has come from persons who are not now and never have been engaged in this type of instruction and who therefore do not appreciate the difficulty, in fact the practical impossibility, of providing truly adequate obstetric instruction in any medical school. It is my purpose to discuss several factors related to this problem and to offer a considered defense of the men now actually engaged in obstetric teaching.Both the profession and the public have been reluctant to admit obstetrics to a position of parity with the other clinical

The application of forceps is the most important numerically of the various procedures aiming at delivery, since every physician who does obstetric work includes the instrument in his armamentarium and holds himself in readiness to assist delivery with its help, even though it may be the only surgical operation he is inclined to undertake. The procedure is also unique in that it is frequently performed under conditions which would be deemed a bar to satisfactory surgical measures of any other form. That the results are not more disastrous is a tribute to the patience and skill of the host of general practitioners throughout the country.The incidence of instrumental delivery varies considerably, depending on the individuality of the physician and the conditions under which he operates. A reasonable cross-section of medical practice in this regard has been provided by a study of the records of 40,143 births in Iowa during

To the Editor:—The communication by Drs. Weisman and Coates in The Journal, March 27, page 1109, starts with the unwarranted assumption that rabbits utilized for pregnancy (Friedman) tests are unsuitable for food and that therefore a less satisfactory test should be substituted.If rabbits are apparently in good condition when killed in order to read the test, they are as edible as litter mates which are killed primarily for food. Various members of my staff have been eating test rabbits for years with no harmful effects: they are more sought after now than previously, because of meat rationing. The line forms on the right.Why should such animals not be eaten? The urine which was injected into their veins came from human beings who passed all the urinary materials through the blood without any toxic effects; and the hormones which produced the ovarian changes are among the profession's modern