Cent Of Deaths Research Articles

FETAL ANOXIA AT BIRTH AND CYANOSIS OF THE NEWBORN

ANOXIC INJURY is the primary cause of 60 per cent of deaths among full term and premature infants and of at least as high a proportion of neonatal morbidity. Anoxia may occur in utero at any time; it always occurs to some degree during the birth process, and it may develop after birth. The oxygen lack may be an isolated episode; it may be intermittent or continuous and of greater or less severity and duration. The condition is an overwhelming force that affects every organ and tissue of the body to a variable and unpredictable degree. The chaotic collection of clinical symptoms that oxygen lack can produce becomes better understood when these variables are considered and when the physiologic and pathologic changes produced by anoxia are appreciated. Anoxia may produce an increased hydrogen ion concentration through an accumulation of carbonic and lactic acids. This acidosis in turn may result in

LEUKEMIA IN RADIOLOGISTS

To Editor:— In article on Longevity and Mortality of American Physicians, 1938-1942 (The Journal, August 9) Dublin and Spiegelman state that the greatest excess in mortality of physicians is found from leukemia, their death rate from this cause being 175 per cent of that for white males in general population. In a statistical study on Leukemia in Radiologists (Radiology42:275 [Sept.] 1944) I pointed out that incidence of leukemia deaths in nonradiologic physicians in fifteen year period between 1929 and 1943 inclusive was 0.44 per cent. The incidence of leukemia deaths in adult white men above theage of 25 (and also above age of 30) was 0.33 per cent of deaths with cause given in biennium 1939-1940, according to figures of U. S. Bureau of Census (3,932 leukemic deaths in 1,172,036 above age of 25

ANEURYSM OF THE AORTA RUPTURING INTO THE RIGHT VENTRICLE

Excerpt Aneurysms of the thoracic aorta are quite common; rupture into the right ventricle as herein reported is, however, of infrequent occurrence. Boyd1states that 0.1 to 0.5 per cent of deaths ...

Clinical-pathological study of the infant and fetal mortality for a ten-year period at the chicago lying-in hospital

A summary of the probable causes of all stillbirths and infant deaths at the Chicago Lying-in Hospital for a ten-year period is found in Table III. Interference with the circulation of the fetus while it is still in utero appears to cause more deaths than any other condition. With death occurring before the onset of labor this is most commonly premature placental detachment; with death during labor it is most often cord prolapse or entanglement; and in death after birth it is most often placenta previa. In actual numbers premature placental detachment occurred with one and one-half times the frequency of the other conditions.Second in importance is prematurity, although it is highly probable that this should rank first because the combination of a harmful maternal complication and prematurity is doubtless more likely to result in a fatality after birth than would be the same complication acting on an infant at term. The fetuses who die before the onset of labor and the majority of those dying during labor cannot be considered to have died because of prematurity. The total number of prematures who die without specific lesions and whose deaths are probably due to inadequate development make up 25.6 per cent of deaths after birth, but only about 12 per cent of the total mortality.Birth trauma accounts for 13 per cent of the deaths. Included with the infants showing specific intracranial hemorrhage are 31 infants who either were not subjected to autopsy or who exhibited no gross bleeding, but in whom there was difficulty in effecting delivery or in whom there was clinical evidence of trauma in the infant after birth.Major malformations are almost equal to trauma as a cause of death. In deaths occurring in the neonatal period, malformations are second only to prematurity as a causative factor.Infections are not common during this period, and the few which are found consist almost entirely of pneumonia.Erythroblastosis, syphilis, and a few miscellaneous conditions make up the remainder of the conditions producing death.

PULMONARY EMBOLISM

When patients die of pulmonary embolism following operation or childbirth, a feeling of helplessness and discouragement prevails until the incident is forgotten. Many months pass before the occurrence of the next one. It is remarkable, however, that the survey of large collective statistics reveals a fairly steady incidence in large services, namely from 0.1 to 0.2 per cent of all operations, 2 per cent of all deaths, 6 per cent of postoperative deaths and about 10 per cent of all autopsies. The prevention of postoperative or postpartum thromboses and the investigation of types of patients, types of diseases and types of operations which are especially endangered by pulmonary embolism are possible avenues of approach to the problem. In this discussion, however, we wish to limit ourselves to observations on the value of early diagnosis and the employment of simple procedures which may reduce its incidence and its high mortality. <h3>THE</h3>

Postoperative Pulmonary Embolism

Pulmonary embolism is still the gravest complication that occurs postoperatively. Although measures have been taken toward prophylaxis, it seems to be on the increase. There are two possible explanations for this: It is recognized more frequently and as the lives of cardiac patients have been prolonged, they are subjected to surgery more often than in the past. Some believe that it is the commonest cause of postoperative deaths and that 50 per cent of deaths in gynecological cases are due to pulmonary embolism. Collins, in a review of 316,000 operative cases taken from the literature, found 1676 cases of pulmonary embolism, an incidence of 0.53 per cent. Henderson, in a review of 63,347 operations at the Mayo Clinic in a 10 year period, gave the incidence as 0.34 per cent; Farrar reported 30,000 operations with 65 cases (0.2 per cent) of pulmonary embolism.

Clinico-pathological study of 47 fatal cases of cranio-cerebral injury

1. 1. The findings in a clinico-pathological study of 47 fatal cases of craniocerebral injury are presented. 2. 2. In accordance with well-recognized facts, the majority of fatal cases were found to occur in young males, death occurring in more than 50 per cent of instances within twenty-four hours. 3. 3. Seventeen per cent of deaths were found to result from primary shock, with an average survival time of 5.8 hours; 57.4 per cent of the deaths were attributable to intracranial damage, with an average survival time of 6.9 days; 25.5 per cent of deaths occurred due to some complication, with an average survival time of 12.2 days. 4. 4. Of the complications, 83.3 per cent were cases of meningitis. One case was a fulminating suppurating infection of the submaxillary gland. Another was one of purulent frontal sinusitis. 5. 5. The operative incidence in these 47 cases was 8.5 per cent (4 cases). The indications were in 2 instances failure to respond to conservative therapy, in one the elevation of a depressed fracture and in one débridement. 6. 6. In 19.1 per cent it was definitely recorded that spinal pressure was not elevated at any time, though there was definitely present acute intracranial pathology. 7. 7. In 8.7 per cent of these fatal cases autopsy failed to reveal any skull fracture. 8. 8. In every instance of contrecoup injury demonstrated at autopsy, the history indicated that the injury occurred with the patient in motion. 9. 9. Microscopic evidence of edema was found to be widened pericapillary spaces with rupture of delicate suspensory fibers.

PEPTIC ULCER

In 1926 we published a portion of a study of all the peptic ulcers recorded in 7,700 necropsy records in Bellevue Hospital.¹The part then published dealt with frequency, number, size, shape, location, color, sex and age. This article is a continuation of that study and will record the association of peptic ulcer with tuberculosis. Fifteen years after Cruvelhier's original description of gastric ulcer, von Jaksch,²in 1844, reported that of his patients afflicted with gastric ulcer one-fifth were tuberculous. Dittrich,³the same year, mentioned a similar connection. Nine years later, Engel⁴found 19 per cent. In 1864, Brinton⁵quoted these figures but felt that the association of gastric ulcer with other diseases is "in proportion more akin to their known frequency, than to other of their circumstances." He pointed out that deaths from phthisis are rather more than 18 per cent of deaths from

An Intracranial Calcification, Probably of Choroid Plexus

Brain tumors are responsible for about 1 per cent of deaths (Ewing, 1), deaths which most often occur in early or middle adult life and are preceded by great suffering. It has been possible only within recent years to treat a few of these patients with success, a success which has been attained chiefly because of the earlier localization of the tumor. Roentgenography has contributed much to the earlier and more accurate localization of brain tumor, through the works of Schüller, Sosman, Dandy, and many others. Any further knowledge which may strengthen or clarify the diagnosis seems desirable. This paper is concerned chiefly with the occurrence and localizing value of a radiographic shadow due to calcium deposits in the choroid plexuses of the lateral cerebral ventricles. The normal gross anatomy and histology are fully described in most text-books (Fig. 1). Each of the ventricles contains a plexus — highly vascular, villous tufts, covered by epithelium (ectodermal) derived from the ependyma. They occupy a relatively small space within the ventricles, and are bathed by the ventricular fluid. They are attached to the ventricular wall by delicate laminæ which represent developmental infoldings of the pia-arachnoid (mesodermal) and which form a supporting meshwork for their many capillaries. The choroid plexuses of the lateral ventricles, with which this paper is mainly concerned, are elongated structures, diverging slightly as they pass backward from each foramen of Monro. They lie on the floor of the body of the ventricle, and terminate a little beyond the junction of the inferior and posterior horns. The posterior extremity is expanded to a diameter of about one centimeter, called the glomus. The right and left glomus lie, one on each side of the sagittal plane, separated by a distance of about five centimeters. The glomus is the only part wherein calcification occurs in sufficient amount to produce an X-ray shadow. (The suprapineal portion of the plexus of the third ventricle may be an exception.) The pineal body, which more often casts a shadow, is exactly in the sagittal plane, about two centimeters in a frontal direction, midway between the right and left glomus. The function of the choroid plexuses is to produce the cerebrospinal fluid. This they do, according to prevalent belief, not as secretory glands, but as semipermeable membranes (2). However, certain investigators believe the plexuses absorb the cerebrospinal fluid, while a minority believe they have nothing to do with the fluid (3, 4, 5). Important as their function is generally conceded to be, it is somewhat striking that no disease or symptom-complex aside from tumor has been convincingly attributed to pathologic states limited to the plexuses. Yet regressive metamorphoses are so commonly present as to be considered “physiologic.” These changes start in childhood, gradually increase with advancing years, becoming pronounced and characteristic in old age.

Distribution of Five Years of Ph.D. Research in the Social Sciences

4. The duration of life of the great monarchs is higher than that of the average ones. 5. A lower royal longevity in comparison with that of the non-royal prominent men is the result of the influence of the monarchs' environment and occupation. 6. This is corroborated by the detrimental character of the royal environment and occupation; by a shorter actual in comparison with the expected duration of life of the American public men; by a high per cent of death by violence among monarchs; by the fact that the posterior generations of the same dynasty have a shorter longevity than the preceding ones; by a very close correlation between the age of ascent to the throne and that of death. 7. The group of monarchs and State executives gives the highest per cent of death by violence. Nearly one-third of them died in this way. In this respect the presidents of modem democracies are in a position no better than that of hereditary monarchs. 8. The royal group in general shows an extraordinarily high per cent of men of talent and men of mental deficiency: the higher the per cent of great kings, the higher the per cent of mentally deficient. 9. The position of monarch has not been closed for the upstarts. The per cent of upstarts among the monarchs strongly fluctuates from time to time, from country to country. In some countries it was as high as the per cent of presidents of democracies who came out of the poor and humble families. In general, the per cent of upstarts among presidents of modem democracies is higher than that among the monarchs of autocratic societies. io. Hereditary monarchs ascend to the throne at an age considerably earlier than that of the upstarts. The same is true in regard to other high social positions. ii. Average duration of reign of monarchs strongly fluctuates from country to country. In general, it is longer than the period of service of the elected presidents or the elected Roman Catholic popes.