The Erythrocyte-Sedimentation Test in Gynecology

146

THE AMERlCAN

JOURNAL

OF OBSTETRICS AND GYNECOLOGY

babies prematurely born. For a long time we have known toxic mothers will act in the same way as babies born after pressure. The symptoms in both cases are almost the same the same. If we do not know whether or not the mother call the cerebral hemorrhage a birth injury. In the majority cause.

that babies born of a long labor with great and the hemorrhage is is t,oxic, we should not of cases toxemia is the

DR. SCHUMANN said he confcssud to a feeling of pessimism iu the matter. The rather discouraging statistics presented some time ago before this Society by Dr. Wm. Sharpe of New York showed an incidence of 10 per ecnt of cerebral hemorrhage in 1000 eonsecut.ire labors of all kinds, breech, cesarean, forceps, etc. In every case the existence of cerebral hemorrhage was proved by lumbar puncture. On the one hand we learn that a long labor predisposes to cerebral hemorrhage. We learn that pressure from forceps predisposes. We hear that premature birth is an important etiologic factor. Prematurity is one of the obstetric problems which is beyond our ability to control. The toxic mother who delivers herself prematurely is beyond our skill to succor from such an accident. Dr. Schumann believed that cerebral hemorrhage will continue to be the most frequent cause of unless perhaps the universal us,: infant death in spite of any obstetric measures, of cesarean section. Difficult labor may be a predisposing factor, and yet we have all sern cases of rapid la.bor in the multiparx, followed by devastating l~emorrh:~gc of the brain in the child. ‘s remarks about Ir~mo~ DR. CAPPER (closing), said in rrfcrcncc to Dr. Stuckert rhagic diathesis and its ctiologic rblc in rorcbral hemorrhages, that Ehrenfest 1~~s emphasized the fact tha.t we must put hemorrhagic diathesis as the last etiologic factor in cerebral birth trauma. Clinically, it means a predisposition to bleeding and it is recognized by certain clinical or laboratory methods, such as tho occurrence of petechial hemorrhages in the skin, prolongation of bleeding or coagulation time, and t,he finding of a diminution in the blood platelets. Dr. Schumann referred to the work of Sharpc of Now York who did lumbar punctures on 500 consecutive ~;~ses, and t,lley had also done eo:tgulat.ion and bleeding time determinations iu these cases and found no correspondence between the two diagnostic methods, i.p., cases where blood was found iu the spinal fluid showed normal coagulation time On the other hand, some of the eases in which the and normal bleeding timr. fluid was normal with no evidence of hemorrhage, the cases showed long bleeding time, rte. We must not forget that a coagulation time of ten t.o twelve minutes, while abnormal io adults, is norm:rl in tht: infant and even fifteen minutes may be normal in the immature infant. Jaundice occurs more frequently in the premature infant and that, eontrihutpx to the lengthening of the bleeding and coagulating t.ime. Dr. Capper did not, fFr.1 WC. shnuld use the term hrmorrhagic diathesis in discussing cerebra.1 birth t.rnumn \K’~%~PX~ it. dors not 11l:r.v the Jl:iTt whirLh \TP k1vP previously supposed that it did.

DRS. CHARLES IS. REYNOLDS AND IJBONAKD EVERETT

of Smaritan

Hospital

presented a Report

Clinics.

DR. C. M. STIMSON

AND DR. HAROLD A. JONES (by invitation) read a paper on The Erythroc~Sedimentaticm Test in Gynecology. (See page 81 for original paper.) DISCUSSION

DR. VIRGIL which

require

H. MOON emphasis

if

(by invitation) we wish to take

said that there are the broa,der view of

one the

or two reaction.

points

One

PHILADELPHIA

OBSTETRICAL

147

SOCIETY

is the variety of conditions in which the sedimentation test is applicable, in each of which the patient is absorbing tonic material from some source, eliminating it and being intoxicated by products of protein disintegration. Applying the test to eac_h, we find: in pneumonia, a rapid sedimentation velocity; in typhoid fever, the same; also, in the more chronic conditions such as tuberculosis, syphilis, etc., conditions in which the patient is suffering from infections of low grade and absorbing more or less of protein material. Even in the non-infectious conditions such as extensive crushing injuries of the limbs, or in uninfected burns the body is absorbing material of injured protein and the sedimentation will be found to be The results reported by Dr. Stimson verify those found in a number of rapid. cases reported in Continental Europe. The test has only now begun to be applied in this country to the same extent t,o which it has been in European countries. The opinion of those who have tried it in many cases is that sedimentation velocity, temperature and white cell count run parallel, but where not parallel, the sedimentation velocity is more accurate than either of the other two, in giving information as to the condition of the patient.

DR. PHILIP

Toxemias DR.

F. WILLIAMS of Pregnancy.

GEORGE M. B~YD read

After

presented See a paper

a report

entitled

Classification

on

38 for

page

original

Puerpera-l

of the

article.)

Fever Before and

Lister.

STATED DR. BERNARD

MANN

by Severe Anemia

MEETING,

NOVEMBER

described a Large Cervical and Bil&eral Pyelitis.

1, 1928

Fibroma,

Complkted

M. H. Case No. 47603, colored, aged thirty-five years. Admitted to the Mt. Sinai Hospital April 7, 1928, because of a marked anemia, vaginal bleeding and pain in the lower abdomen. Temperature 101” F. pulse 145, respiration 30. Five days before admission to the hospital she had a sudden profuse hemorrhage from the vagina. About ten months ago she had a similar hemorrhage which lasted about two weeks, when a curettage was done. She had 3 children, last born four years ago, all spontaneous deliveries. She had one miscarriage nine years ago. Has been married ten years. Menstruation normal until two years ago, since then the flow has been profuse. Pat,ient was markedly emacial-ed, mucous membranes very pale, eyes rather prominent, with puffiness of the egelids. Heart small, with rough and accentuated second aortic sound associated with a systolic murmur. There was no arrhythmia. The lungs were negative. A suprapubic mass the size of a three months’ pregnancy was prominently outlined through the thin abdominal wall. The vagina was filled with a soft mass the size of a fetal head, the cervix could not be palpated. The’ vaginal bleeding at the time was moderate but the odor very offensive. Above this vaginal tumor an enlarged uterus could be felt about the size df a four months’ pregnancy. The adnexa could not be outlined. R.B.C. 1,880,OOO. W.B.C. 28,600. Pmn. 81. On admission : Hb. 13 per cent. KM. 15. Tr. 1. L.M. 3. Sedimentation time: index 35 m. m. thirty minutes. Urine acid, 1025, trace of albumin, no sugar, many W.B.C., and R.B.C. Few

granular casts. Blood Wassermann, Kolmer, and Kahn tests plus 4. Blood culture negative. She was given 485 C.C. of blood by transfusion on April 9, 1928, 400 C.C. the next, day and 575 C.C. on the third day. The blood count following the last trann-