John Whitridge Williams' contribution to democracy abroad. (The fetus treated as a patient).

The idealism of American pioneers was a driving force in the development of science, democracy, and sociology in the United States. It also served as a model for the development of new democracies abroad. The first American grafted democracy was established in Czechoslovakia in 1918, under Thomas Garrigue Masaryk as President. As a former professor of philosophy, at Charles University in Prague, he built the foundation of Czechoslovakian democracy on the historical principles of Jan Hus' search for the truth (1415), Jan Amos Komensky's use of Science and Humanism (1630), and on the values of American democracy as he conceived it from multiple visits to the United States and from the practical philosophy of his American wife. His major educational means was the use of science. He became a founder of political science. As president he recognized, that democracy, as a state form, does not educate people, they educate themselves through family, school, church, physician and life experience. In the last quarter of the nineteenth century, on the eve of the opening of John Hopkin's University Hospital, a young American scientist by the name John Whitridge Williams came to Prague, Vienna, and other Europeans cities for the purpose of studying scientific obstetrics. He believed in the power of the truth in the power of the truth equally as Masaryk did and used science uncompromisingly in his speciality. He became the founder of American scientific obstetrics. He was shy of political science and ethnic problems. There was no personal connection between Masaryk and Williams. In 1903, John Whitridge Williams published his review of European and American obstetrics: he abolished the craft of obstetrics and worked the science of physiology and pathology into the practice of obstetrics. For Czechoslovaks the political democracy coming out of America through Masaryk was attractive, but of particular interest was native and personal democracy of Americans as a way of life. John Whitridge Williams' book contributed to European families, even though only through obstetricians, the knowledge about American pioneering, optimism, humanism, and a sense of freedom Williams considered the fetus as a patient and thought of education of the physician and patient of equal and fundamental importance: the mother was to participate in the process and the physician to understand the process. He himself understood feto-placental circulation, maternal metabolism, and the need of maternal participation on fetal development. He commanded physicians' respect of the patient and committed the obstetrician to the life long study of his patients. He considered research inseparable from intelligent care, and his book a guide of how and what to study, not a manual of procedures. Williams' greatest contribution to mankind was abolishing the craft of obstetrics and replacing it by sciences that brought to obstetrics humanism, selflessness, and knowledge. He was the first physician in the history of obstetrics who achieved a balance of science and humanism. The second contribution, of equal importance, was his undertaking a scientific review of European and American obstetrics which served the world as a window of the values of America's pioneer civilization. It made obstetrics a scientific discipline, attracted innumerable new students abroad, and through them promoted American democracy in their relations with patients. Williams' impact on European society was considerable. However, subtle at first, it was not included in the literature. He did not participate personally in the establishment of democracy in Czechoslovakia, but strengthened Masaryk's teaching programs through those Czechoslovakian obstetricians who adapted his scientific teachings and made him a model of American democracy as a view on life. Masaryk himself had in his presidential emblem a sign, veritas vincit, and through it, he accomplished twenty years of the most extraordinary democracy in the world.

Human ovulation and plasma oxytocin.

Plasma oxytocin (OT) concentrations were measured by radioimmunoassay (RIA) method without extracting plasma in 11 normal menstruating women. Mean plasma OT level began to increase steadily from the 7th day of the menstrual cycle and this level rose up to 20 +/- 5 microU/ml (Mean +/- S.E.) on the 10th day of the cycle. OT level declined to 13 +/- 6 microU/ml on the day of LH peak and continuously declined for another 2 days - then rose. The OT level was higher during the follicular phase than during the luteal phase. In 1 individual OT measured in 2 cycles a year apart showed the highest level of OT coincided with LH and FSH peak and abruptly declined. When there was the highest level of progesterone, the OT level was measurable 1 out of 11 cycles. From this study, we conclude that OT may have a role in human ovulation either synergistically or alone with other ovulatory mechanisms and ovarian estradiol and progesterone control the secretion of OT and also suggests that OT may play some role in the regulation of the luteolysis and the menstrual cycle in women.

Plasma oxytocin concentrations in a pregnant woman with total vasopressin deficiency.

Plasma concentrations of oxytocin and vasopressin were determined by radioimmunoassay in a woman with clinical diabetes insipidus. Plasma oxytocin levels were normal and ranged from less than 0.25 microU/ml to 76 microU/ml during the last month of pregnancy and during spontaneous labor. Vasopressin requirements did not change during pregnancy. Unexplained vasopressin resistance and massive diuresis occurred early in the postpartum period. Plasma vasopressin concentrations were undetectable in the nonpregnant state. The documentation of normal oxytocin production and total vasopressin deficiency suggests that an anatomic defect is unlikely to cause this disorder unless it is limited to axons and cell bodies containing vasopressin and not oxytocin.

Plasma oxytocin in initiation of labor.

Serial radioimmunoassay measurements of plasma oxytocin (OT) in maternal venous blood have been carried out in 15 patients, during pregnancy, labor, and delivery. Fetal plasma OT was also measured in the blood from the umbilical vein and umbilical artery. The results indicate that: (1) during pregnancy, plasma OT is present in maternal blood; (2) the quantity of plasma OT increases with advancing pregnancy; (3) no OT surge occurs around the onset of labor; (4) the plasma OT surge occurs with cervical dilatation and vaginal distention. The data indicate that OT does not play a primary role in the initiation of labor and support the concept that OT most likely contributes to formation of prostaglandins through the uterine contractions OT produces. OT surges, frequently called spikes, have been observed to occur during pregnancy as well as during labor. During the course of labor, OT surges have been encountered in association with rupture of the membranes, vaginal examination, and descent of the vertex, and have occurred almost consistently with maximal cervical and vaginal distention. Such OT surge was suppressed by effective spinal and pelvic regional anesthesia. Therefore, this surge is consistent with the Ferguson reflex described in experimental animals, and it represents the first evidence that the Ferguson reflex, in fact, exists in human beings. Evidence is presented here that an excess of OT in fetal blood over that found in maternal plasma was associated with hypertonic, irregular, tumultuous or prolonged labor and with mild to moderate fetal hypoxia and fetal distress peculiar to abnormal uterine contractions.

Immunologic and biologic activity of oxytocin in midtrimester pregnancy.

Immunologic and biologic activity of oxytocin (OT) were studied by simultaneous monitoring of plasma OT measured by radioimmunoassay (RIA) and uterine contractility measured by recording of intrauterine pressures during the step-up rate of infusion of synthetic OT. The results in 11 patients with midtrimester pregnancy and step-up increase of OT infusion by 20 mU. showed a positive correlation of the increase of plasma OT and uterine contractility only at the plasma OT levels of 20 to 60 muU. per milliliter and only with hypertonic contractility but no correlation at plasma levels below and above this range. The lack of correlation of "dose and response" either prior to OT infusion or during low or very high rate of infusion suggests that other factors than merely the quantity of plasma OT are involved in determining the degree of uterine response.

PIP: Immunologic and biologic activity of exytocin (OT) were studied simultaneously in midtrimester pregnancy in 11 patients. Plasma OT was measured by recording intrauterine pressures during the step-up rate of infusion of 20 mU synthetic OT. The results showed a positive correlation of the increase of plasma OT and uterine contractility but no correlation at plasma levels below and above this range. This lack of correlation of "dose and response" either prior to OT infusion or during low or very high rate of infusion suggests that other factors than quantity of plasma OT are involved in determining the degree of uterine response.

Oxytocin in maternal and fetal blood.

Radioimmunoassayable plasma oxytocin (OT) has been measured in maternal and fetal blood. Simultaneous samples were obtained in maternal forearm venous blood and in umbilical venous and arterial blood in 29 patients at term delivery. In addition, maternal forearm venous blood samples were also obtained 10 minutes prior to delivery. Mean OT level in maternal plasma at delivery was 82 +/- 12 muU/ml, and at 10 minutes prior to delivery the mean OT level was 90 +/- 11 muU/ml. The umbilical arterial plasma OT showed 95 +/- 12 muU/ml and the umbilical vein plasma OT was 60 +/- 10 muU/ml. Oxytocin levels higher in maternal blood than in fetal blood were found with the following incidence: In 51% of samples there was more OT in maternal venous blood than in umbilical arterial blood, and in 84% of samples there was more OT in maternal blood than umbilical vein blood. During the postpartum period, the mean maternal plasma OT was 66 +/- 8 muU/ml for the first day, and 50 +/- 9 muU/ml and 54 +/- 9 muU/ml for the second and third days, respectively. This study indicates that both the fetus and the mother are active producers of oxytocin.