consequences of the combination of anoxia and a high level of circulating epinephrine on cardiac function can be produced both in the operating room and the labo¬ ratory. The fearful patient subjected to a hurried induc¬ tion of anesthesia or to too much anesthetic agent in the absence of oxygen may be expected to behave in the same manner as the laboratory animal who is partially suf¬ focated deliberately and at the same time given epineph¬ rine experimentally to produce ventricular fibrillation or cardiac standstill.It is safe to predict that the extensive teaching pro¬ gram on the prophylaxis and treatment of cardiac arrest will reduce its incidence. It is of prime importance that the relative infrequency of this complication and the edu¬ cational program of prevention and treatment be known to the public so that necessary operations will not be re¬ fused by patients terrified by newspaper accounts. ADDENDUM Since the preparation of this paper, two additional instances of cardiac arrest have occurred at this hospital, making a total of four cardiac arrests in 54,579 opera¬ tions. In each case the treatment was instituted promptly. Two patients died; the other two recovered completely.Bleeding from the genital tract is an invariable concomitant of reproduction in many species of vertebrates. Most familiar is the macroscopic blood loss that occurs after parturition in mammals with deciduate placentas. Less well known is the microscopic bleeding of maternal origin that accompanies the early stages of placentation and embryonic development. It is the purpose of this paper to summarize the evidence for this phenomenon based on observations in other species and to present evidence for its occurrence in man.
BLEEDING IN LOWER VERTEBRATESThroughout the vertebrate subphylum, whenever the embryo is dependent on maternal sustenance beyond the ovum stage, red blood cells may be found in admixture with the pabulum of the brood chamber. In a delightful little essay on the phylogeny of menstruation, Carl Hartman 1 called attention almost a quarter of a century ago to the purposeful nature of this maternal bleeding, even as it occurs in the viviparous fishes and Amphibia. In certain salamanders, for example, the one or two embryos that survive from among the large number of ova shed at ovulation undergo development within the oviduct, afloat in a semifluid nutrient mass laden with red blood cells. The embryo of the sting ray feeds on the blood and the secretion provided for it by the slender vascularized glandular structures that grow out from the endometrium and into the uterine cavity. By way of the gill slits, these secretory villi are swallowed into the embryonic gut. Maternal red blood cells are liberated directly into the body of the embryo as well as into its uterine environ¬ ment. The embryos of the remarkable bony fish Zoarces develop within the ovarian follicles from which the eggs were derived. Here they remain until birth, feeding on From the departments of obstetrics and gynecology of the Mount Sinai and Presb...
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