Boston Lying-in Hospital Research Articles

Historical Perspectives: Berry Brazelton: Le Magnifique.

I was privileged to have worked with Berry Brazelton (Fig) for over 40 years. In 1978, as a new graduate student from Ireland, I first looked over his shoulder in the company of his pediatric fellows, as he used the scale he had just developed—the Neonatal Behavioral Assessment Scale (NBAS)—to examine a less than 1-day-old female newborn in the old Boston Lying-In Hospital. Even as he examined the baby’s reflexes, I was immediately struck by his—what could only be called gentleness, even tenderness—in the way he both held and spoke to the baby. He called her by her first name. “You are so alert, Sarah. Your mother must be very proud of you.” When he took a red ball out of his kit and moved it slowly from 1 side to the other, the baby began to track the ball and locked on to it, as if she did not want to release it from her gaze. “She can see,” blurted her mother, shaking her head in disbelief. When he began to talk to her in lilting, melodic phrases, Sarah’s face relaxed and her eyes widened and brightened. They were now interacting with each other—in a give-and-take, back-and-forth cyclical rhythm that had all the hallmarks of true conversation. Figure. Berry Brazelton (courtesy of Insieme photo by Fulvia Farassino). That babies could see and hear and had a wide repertoire of behavioral endowments at birth was a revelation to me, but Berry Brazelton had just demonstrated that this less than 1-day-old baby also had her own well-defined personalized behavioral style and was already shaping and leaving her mark on the world. She and Berry Brazelton left their mark on me and on all the pediatric fellows who were present on that August day, many years ago. In this clinical newborn encounter, we …

Gene-environment interactions.

Gene-environment interactions.

My tribute to Mary ellen avery.

My tribute to Mary ellen avery.

Neonatology Specialty Grand Challenge

Neonatology Specialty Grand Challenge

Robert E. Scully, MD (1921-2012)

Robert Edward Scully, MD, a surgical pathologist at the Massachusetts General Hospital (MGH) for 55 years and Emeritus Professor of Pathology at Harvard Medical School, died in Boston, MA, on October 30, 2012, after suffering a stroke. He was born in Pittsfield, MA, on August 31, 1921, graduated magna cum laude from the College of the Holy Cross in 1941, and received his MD from Harvard Medical School in 1944. Dr Scully trained in pathology at Peter Bent Brigham Hospital and Boston Children’s Hospital under Dr S. Burt Wolbach and Dr Sidney Farber. He then spent a year as resident at the Free Hospital for Women in Brookline, MA, and Boston Lying-In Hospital under the direction of Dr Arthur T. Hertig. That was followed by a year at Pondville State Cancer Hospital in Norfolk, MA. Dr Scully was next an instructor in pathology at Harvard Medical School for a year before being recruited by Dr Tracy B. Mallory to the MGH. His early tenure there …

Milestones in Transplantation

The patient was admitted to the Boston Lying-in Hospital to await delivery. To avoid any possible trauma to the transplanted kidney as the vertex engaged, it was decided to deliver the patient by cesarean section. This was performed under spinal anesthesia on March 10, 1958, a time arbitrarily regarded as the 41st week of gestation. A normal male infant weighing approximately 3300 grams was delivered.1

Milestones in transplantation

The patient was admitted to the Boston Lying-in Hospital to await delivery. To avoid any possible trauma to the transplanted kidney as the vertex engaged, it was decided to deliver the patient by cesarean section. This was performed under spinal anesthesia on March 10, 1958, a time arbitrarily regarded as the 41st week of gestation. A normal male infant weighing approximately 3300 grams was delivered.

Minimal Intervention — Nurse-Midwives in the United States

I first observed childbirth in 1973 during a rotation at the Boston Lying-In Hospital, where I witnessed many women in labor screaming in a scopolamine stupor. What I remember most vividly were not the physicians and nurses, competent though they may have been, but the British-trained nurse-midwives who practiced as labor nurses. Their competence, confidence, and compassion had a calming effect on everyone in the room (including this terrified student-nurse). The experience was so gripping, in fact, that I left the hallowed halls of New England Deaconess Hospital for the hollows of Kentucky to enter the Frontier Nursing Service School . . .

John Rock: Pioneer in the Development of Oral Contraceptives

Gynecologist and obstetrician John Charles Rock is credited, along with endocrinologist-biologist Gregory Goodwin Pincus (1903-1967), with developing the first effective oral contraceptive. The introduction of “the Pill” in 1960 initiated a worldwide sociomedical revolution and led to the use of the pill by millions of women throughout the world. Rock was born on March 24, 1890, in Marlborough in northeastern Massachusetts (about 13 miles northeast of Worcester). His father was a successful businessman in Marlborough. In 1906, Rock left home to attend the High School of Commerce in nearby Boston. After his graduation in 1909, Rock worked for a few years as an accountant, first on a banana plantation in Guatemala and then for an engineering firm in Woonsocket, Rhode Island. Neither job was fulfilling and proved to him that he disliked business work and was not successful at it. Rock enrolled at Harvard University in Cambridge, Mass, in 1912 and received his bachelor's degree in 1915. He attended Harvard Medical School in Boston and graduated with an MD degree in 1918. He specialized in nervous disorders in medical school but subsequently changed his field of major interest to obstetrics and gynecology. In 1919, Rock was an intern at the Massachusetts General Hospital and became a resident in urology. He also underwent residency training at Boston Lying-In Hospital and became a house surgeon in gynecology at the Free Hospital for Women in Brookline (4 miles southwest of Boston) in 1920. Rock entered private practice in 1921. A year later, he began his association with Harvard Medical School when he was appointed an assistant in obstetrics, an association that lasted from 1922 to 1956; from 1947 to 1956, he was clinical professor of gynecology at Harvard. In 1944, with Harvard scientist Miriam F. Menken, Rock achieved the first fertilization of a human ovum in a test tube. In 1953, Rock accepted an invitation from Gregory Pincus of the Worcester Foundation for Experimental Biology to participate in an intensive effort to develop an oral contraceptive. Pincus and Rock had worked together since the 1930s because much of Pincus’ research on ovulation and fertilization in rabbits paralleled Rock's work in humans. Pincus had begun systematic screening for ovulation-suppressing drugs in 1951 and had reached the point in his research at which clinical work with humans was necessary. Rock's interest in a pill that affected human reproduction grew from his use of progesterone as a therapeutic agent in his work with childless patients. The secretion of progesterone, a female hormone, is triggered by ovulation. Rock began experimenting with progesterone in 1950. He then turned his attention to the possibility of synthetic compounds that could be clinically feasible. In December 1954, after Pincus had proved in animal studies that steroids similar in molecular structure to progesterone are effective and harmless, Rock began the first tests with synthetic oral contraceptive steroids in humans. Rock conducted his studies at The Rock Reproduction Clinic, which he founded in 1956 in Brookline. Beginning in 1956, full trials on the effectiveness of the contraceptive pill were conducted under the general supervision of Pincus among women in Brookline, Puerto Rico, Haiti, and elsewhere. In 1957, the US Food and Drug Administration authorized marketing of the corticosteroids for miscarriage and certain menstrual disorders and in 1960 licensed the pill for sale to the public. In 1963, Rock wrote a controversial book on oral contraceptives called The Time Has Come. In 1969, he retired from his practice and moved to a farmhouse in Temple in southern New Hampshire. On December 4, 1984, at the age of 94 years, Rock died of a myocardial infarction at Peterborough (southern New Hampshire). A stamp promoting family planning that was issued by the Marshall Islands in 1999 indirectly honors John Rock and Gregory Pincus.

Midwifery and Medicine in Boston: Walter Channing, M.D., 1786-1876

Midwifery and Medicine in Boston: Walter Channing, M.D., 1786-1876. By Amalie M. Kass. (Boston: Northeastern University Press, 2002. Pp. xv, 386. Illustrations, chronology. Cloth, $40.00.)Medical men in the early republic faced the challenges of defining themselves within a complex environment. They were expected to combine European training with commitment to their country, a high level of manual skill with the manners and address of a gentleman born. If their specialty was midwifery, they needed another unlikely combination: a talent for pleasing ladies while maintaining a resolutely asexual professional persona. Amalie Kass's biography of Walter Channing (1786-1876) is a sensitive account of the way Channing negotiated these challenges, as well as his sometimes-difficult personal life, becoming a leading member of the Harvard Medical Faculty and the Boston medical establishment.The prologue and first chapter chart Channing's childhood into a well-respected professional family with Revolutionary War credentials. Though clearly among the Boston elite, the Channings were not wealthy, and young Walter was expected to earn his living. He chose medicine and, as Kass explains in chapter two, followed a typical course of study for a young man of his generation and background: apprenticeship to a leading Boston physician, followed by study first in Philadelphia and then in Edinburgh and London. Supportive family members provided the loan that made such an extended course of study possible, and Channing repaid his debt by returning an accomplished, sought-after young physician. Chapter three describes the steps attendant on beginning medical practice, involving talents & industry, aided by powerful friends (44) as one correspondent aptly put it. Channing attended family and his wide circle of family friends, volunteered for medical charities, joined medical and scientific societies, and was appointed to the medical faculty of Harvard. His marriage at the age of twenty-nine was another sign of his success; sadly, his wife died young, leaving him a widow with four small children.The next three chapters deal with Channing's practice and teaching. Kass bases chapter four, Obstetrical Practice, on Channing's papers, augmented with other contemporary obstetrical works. They show Channing to be careful, if not innovative, thoroughly mindful of the authority he wielded as physician. Chapter five discusses Channing's long and fruitful association with both the Massachusetts General Hospital and the Boston Lying-in Hospital. Chapter six discusses Channing's teaching of both midwifery and medical jurisprudence. Channing's forty years' commitment to Harvard ensured his influence over the next generation of medical men.The next four chapters depict the range of Channing's activities as a mature, accomplished physician. Chapter seven discusses the changes in antebellum Boston and in Channing's own life, as he married again and, sadly, lost his second wife in childbirth, surely an especially heavy blow to an obstetrician. This was a period of rapid change in obstetrical practice, and in chapters eight and nine, Kass analyzes Channing's favorable response to Oliver Wendell Holmes's essay on puerperal fever and James Young Simpson's use of anaesthetic. …

Policy Partners—Nursing and Psychiatry in the Capital: An Interview With Dr. Mary Jane England

In this era of change in psychiatric service delivery, we have been bombarded with the realities of man aged care. At the same time we are forging new rela tionships with payers, providers, and with each other. To most nurses, the term collaboration means work ing cooperatively with one's interdisciplinary team. Yet in this changing world where we are forced to ex pand our horizons at an increasingly faster rate, it is important to create dialogs with others who are influ ential in arenas other than those we live in day to day. Our guest is a well-known and highly respected child psychiatrist who rose to national prominence from her roots in Boston. She also has a very special orientation to nurses because her mother was a nurse graduate of the Eastern Maine Medical Center in Bangor, Maine, and practiced for many years at the Boston Lying-in Hospital, the Florence Crittenden- Hastings Home, and at the Phillips House of the Mas sachusetts General Hospital. At a time in psychiatry's evolution when so many are squabbling over turf is sues, Dr. Mary Jane England offers a fresh and non- discipline-specific view of the future of the delivery sys tem for psychiatric services and one where in the con tinuum of care nurses can best serve clients and their families. Dr. England is a child psychiatrist trained in adult psychiatry at Boston University Hospital and at Mount Zion in San Francisco. She also received training in child psychiatry at Boston City Hospital. After that she worked in the neighborhoods of Boston. In the mid- 1970s, she was appointed Associate Commissioner of the Department of Mental Health in Massachusetts. After 5 years, she was appointed Commissioner of So cial Services, a new state agency in Massachusetts for children and families. After 10 years in state govern ment, Dr. England joined the faculty at the Kennedy School of Government, Harvard University, where she was Associate Dean and Director of the Mid-Career Master in Public Administration Program. From academia she went to the Prudential Insurance Com pany of America as National Vice-President of Men tal Health and Substance Abuse, responsible for policy and program development for 25 million Americans. In 1990 she was recruited to serve as president of the Washington Business Group. The Washington Busi ness Group on Health is a national nonprofit health policy group whose membership includes the nation's largest employers, mostly from the private sector, such as International Business Machines, Chrysler, Ford Mo tor Company, Honeywell, and Pepsico. Some of the large public employers, such as the U.S. Postal Service and the California Public Employees Retirement Sys tem, are also members. Dr. England is the president of the American Psychiatric Association (APA), the third woman to hold the position.

Sink or Swim: Training to Be an Obstetrician

June 14,1928, my first obstetric delivery! In my just-completed second year at Harvard Medical School, the training had included only 12 lectures in obstetrics from Chubby Newell and an intense study of a mimeographed syllabus that might have been titled How to Deliver a Baby. I had reported to the Boston Lying-In Hospital's headquarters along with two classmates whose ignorance equaled mine, each of us armed with his self-prepared bag of instruments, gloves, cotton, and pans for sterilization by boiling water on the kitchen stove. For medication we each had an ounce of fluid extract of ergot that was replaced daily from the hospital with a freshly prepared supply. The patients had all been screened by the lordly interns who conducted the hospital's prenatal clinics, and the women, mostly multiparas, lived all over the eastern suburbs. When a telephone call came into the district headquarters, one of us would

Variability of blood lead concentrations during infancy.

As part of a study of early childhood development, more than 200 children had their blood lead concentrations (PbB) determined semiannually during the first 2 yr of life. These children were selected from 11,837 consecutive births surveyed for umbilical cord PbB at Boston Lying-In Hospital. Candidate subjects were drawn from the highest, lowest, and middle deciles of PbB. The mean PbB was 7.2 +/- 5.3 (standard deviation) micrograms/dl at birth and did not change appreciably with age. However, the average change in an individual's PbB every 6 months was 4 micrograms/dl, which was several fold in excess of the analytical reproducibility. Only 25% of the children in the highest category at birth were in the highest category at 2 yr of age. Approximately 40% of the children remained in their immediately previous PbB tertile category. A stochastic description of these patterns of change fits the data. Our results should caution investigators who might wish to rely on a single determination to categorize children with PbB.

APPEARANCE OF RETROLENTAL FIBROPLASIA

The first description of RLF as a disorder of extreme prematurity was published as a preliminary report by Terry in 1942. He stated that the condition was either "persistence of the entire vascular structure of the fetal vitreous" or a "fibroblastic overgrowth of the persistent tunica vasculosa lentis." His studies led him to conclude that an "overgrowth of embryonic connective tissue in the interstices of the persistent tunica vasculosa lentis behind the lens" accounted for the pathology observed. He stated: "It is really a retrolental fibroplasia." The terminology was used in his subsequent reports and became generally accepted, although later studies by Owens and Owens (1949) showed that RLF was not related to an embryonic abnormality but was caused by an abnormal blood vessel change in the retina. On the basis of clinical observation, Terry (1942) concluded that the disease in its classical form was not present at birth but developed between two and six months after birth. He considered many possible factors: "Of all the probable causes listed, precocious exposure to light is considered the most tenable, and preventive measures should be taken." The light theory was discarded after several investigators found that occluding the eyes after birth had no effect on development of the disease (Hepner et al., 1949; Crosse, 1950; Locke and Reese, 1954). After discovering a disease that had appeared as an isolated rarity in 1942, Terry collected 117 cases of RLF during the next three years. The condition appeared to be on the increase. In 1945 Terry found that the incidence at the Boston Lying-In Hospital was approximately 12% in infants weighing 1,400 gm or less (based on fewer than 50 cases).

Human placental lactogen: Further evidence of placental mimicry of pituitary function

THE PRESENCE OF one or more proteins in human placental extracts which would stimulate crop sac growth in the pigeon was first demonstrated by Higashi in collaboration with Ito.“-* Somatotropic activity of extracts of the human placenta was also demonstrated earlier by Fukushima.” This note recounts the efforts to identify and purify human placental lactogen (HPL, human chorionic somatomammotropin~ in our laboratory at the Boston Lying-In Hospital and in the Department of Obstetrics and Gynecology, Harvard Medical School. These endeavors are presented as they summarize the importance of research leadership of the chairman of a clinical department, the importance of early financial support for junior investigator, the provision of time for them to carry out such research, the availability of newer techniques at a criticai time in the development of research project, devotion of one’s research technicians, the close proximity of numerous colleagues in allied fields to help in the development of research techniques, and previous preand post-doctoral training in research meth~ology, I had received preand post-doctoral training supported by the Josiah Macy, Jr., Foundation at the Harvard Medical School, Department of Physiology, laboratory of Ernst Knob& where the species specificity of human pituitary growth hormone was discovered, Because of this background, Duncan E. Reid suggested that I embark on a search for the growth hormone-like factor

Diethylstilbestrol in pregnancy. Frequency of exposure and usage patterns.

In view of the reported association between exposure in utero to diethylstilbestrol (DES) and clear-cell adenocarcinoma of the vagina, data on the prenatal use of DES in some 51,000 pregnancies in 12 hospitals between the years, 1959 and 1965, were examined. Among these women, in whom prenatal drug exposure was carefully documented, there was considerable variation in DES usage, the frequency being highest in the Boston Lying-In Hospital (exposure in 1.5% of pregnancies) and the Children's Hospital, Buffalo (exposure in 0.8% of pregnancies). Data from two marketing research sources were used to estimate DES usage in the United States. It is calculated that a maximum of 50,000 liveborn females per year, born between 1960 and 1970, were exposed to DES in utero, while the most likely estimate is in the range 10,000 to 16,000.

An Investigation of Mood States in Women Taking Oral Contraceptives

Longitudinal studies with psychological interviews and tests were performed to investigate emotional changes in 72 women (under age 35) taking oral contraceptives. The analysis was based on patients at the Boston Lying-In Hospital (BLI, 28) and at the Peter Bent Brigham Hospital (PBBH, 44). Most women at BLI had 5 or more children; most at PBBH had 1 or more children. 79% of the BLI sample were 26 or older; 61% of the PBBH sample were 25 or under. The former hospital administered Enovid (5 mg) or Enovid-E (2.5 mg); the latter hospital administered Enovid-E (2.5 mg or 5 mg). After preliminary examination of results, it was considered justifiable to analyze the data for both groups together. During therapy the patients as a group perceived themselves as in nondepressive states. Psychiatrists detected depression in some patients, but too infrequently to change the mean depression scores. Most instances of depression were linked to the disillusionment of women expecting unreasonable benefits, such as cure of frigidity or end of marital conflict, with pill use. Religion, amount of education, and number of children had no observable effect on the depression scores. No evidence for depression arising from religion-related guilt in Catholic women was found. Sedative-like effects, which occurred in a few patients, need further investigation. 5 case histories are detailed.

RELATIVE POTENCY OF AMETHOCAINE AND LIGNOCAINE

Anesthesia Department, University of Alabama Medical Center, Birmingham, Alabama, and Boston Lying-in Hospital, Boston, Massachusetts

PERSPECTIVES IN HUMAN TERATOLOGY 1965

Boston Lying-In Hospital, Boston, Massachusetts. Read at the 39th Congress of the International Anesthesia Research Society, March 28-April 1, 1965, Washington, D.C.

INFANTS OF DIABETIC MOTHERS; NEONATAL PROBLEMS AND THEIR MANAGEMENT.

A study of neonatal problems of 329 liveborn infants of diabetic mothers indicates that prematurity is the single most significant factor influencing outcome. The direct relationship of prematurity to increased incidence of respiratory distress syndrome, hyperbilirubinemia, and neonatal mortality is demonstrated. Severity of maternal diabetes, while extremely important in relation to stillbirth, does not seem to be as significant a factor in liveborn infants. The present plan of care designed to deal with these problems in liveborn infants at the Boston Lying-in Hospital has been presented.