Demarcation Point Research Articles

The Marital Termination Period of the Divorce Adjustment Process

This paper deals with the marital dynamics characteristic of the period immediately prior to a decision to divorce. The period is termed the Period of Termination and occurs while a couple is still living together. It is one of the two peak stress periods of the divorce adjustment process. The concept of a marital Point of No-Return (N/R) is introduced. Guidelines for working with the concept are presented. Two marital termination strategies and the implications of these concepts for clinical practice are examined. A demarcation point for marital therapy vs. divorce therapy is also suggested. Finally, observations regarding the nature of the emotional scarring that may result from this period are discussed.

Perforation of Peptic Ulcer

Perforation is the most serious complication of peptic ulcer and may also be the first definite evidence of ulceration. Portis and Jaffe, reviewing 9,171 consecutive autopsies, found 457 peptic ulcers, of which 120 had perforated. In an extensive review of the literature Speck (quoted by Feldman) estimated that 10 per cent of all peptic ulcers perforate. Feldman collected 3,897 examples of perforation, of which 3,656 were in males. Uncommonly, perforation may result from an ulcerating cancer of the stomach. The majority of ulcerative lesions are on the anterosuperior wall of the duodenum and stomach near the pylorus. Anatomically the anterior wall is more exposed to the general peritoneal cavity than is the posterior wall. Lesions on the posterior wall and those along the curvatures are well or partially protected. Perforation is more frequently seen in younger than in older patients. Generally speaking, it is more common in duodenal than in gastric ulcers, although statistical studies are not entirely in accord on this point. According to Dillon (quoted by Cecil), perforation occurs in about 5 per cent of duodenal ulcers and in less than 2 per cent of gastric ulcers. Shawan collected 277 examples of perforation, of which 39 were in the pylorus, 55 in other parts of the stomach—mostly the pars media, along the lesser curvature—and 132 in the duodenum. Of this series 87 per cent occurred between the ages of twenty and fifty. Of Johnson's series of 1,149 perforations, 56 per cent were in the stomach and the remainder in the duodenal bulb. Of 211 cases of gastroduodenal perforation in the Charity Hospital series, De Bakey found 44 per cent near the lesser curvature, in the region of the junction of the pars media and pylorica, and 40 per cent in the bulb. Ninety-five per cent of all the cases were on the anterior wall. At operation it may be difficult to distinguish between duodenal and prepyloric ulcers; in such cases Mayo used the pyloric vein as a demarcation point. Classification There are three types of perforation: acute, subacute, and chronic. Acute perforation produces a severe prostration. Of all the sudden catastrophes to which an ulcer-bearing patient is liable, it is the most ominous. Moynihan, Sherren, and Walton have observed that an ulcerating lesion which undergoes acute perforation is usually chronic, and that it is the perforation that constitutes the acute process. The perforation is usually, though not always, small, often only the size of a pinpoint. Acute perforation occurs most frequently from ulcers on the anterior wall. Subacute perforation is characterized by an attack of sudden epigastric pain, which is severe, but less so than in acute perforation, and from which recovery occurs.

Flaxman Island, a Glacial Remnant

Flaxman Island is located close to the north shore of Alaska, approximately in Lat. 700°, Long. 1460, and a hundred miles west of the international boundary. It is one of the innumerable small islands that fringe the coast between Point Barrow and Demarcation Point. Failing to reach their goal in Banks Land, this island was chosen as the winter quarters of the Anglo-American Polar Expedition, commanded by Capt. Ejnar Mikklesen, and the writer. A couple of miles to the south lies the mainland, a low tundra plain extending some twenty miles back to the mountains. Both the mountains and the coastal plain are characteristic features of the northern part of Alaska. From Cape Lisburn on the west coast a chain of mountains runs eastward into Canada, separated from the ocean by a plain of greater or less width. At Point Barrow the plain is over a hundred miles wide, but it narrows to the eastward until at Demarcation Point the mountains come within a few miles of the