We prospectively investigated urinary iodine concentration (UIC) in pregnant women and in female, non-pregnant controls in the canton of Berne, Switzerland, in 1992. Mean UIC of pregnant women [205 +/- 151 microg iodine/g creatinine (microg l/g Cr); no. = 153] steadily decreased from the first (236 +/- 180 microg l/g Cr; no. = 31) to the third trimester (183 +/- 111 microg l/g Cr, p < 0.0001; no. = 66) and differed significantly from that of the control group (91 +/- 37 microg l/g Cr, p < 0.0001; no. = 119). UIC increased 2.6-fold from levels indicating mild iodine deficiency in controls to the first trimester, demonstrating that high UIC during early gestation does not necessarily reflect a sufficient iodine supply to the overall population. Pregnancy is accompanied by important alterations in the regulation of thyroid function and iodine metabolism. Increased renal iodine clearance during pregnancy may explain increased UIC during early gestation, whereas increased thyroidal iodine clearance as well as the iodine shift from the maternal circulation to the growing fetal-placental unit, which both tend to lower the circulating serum levels of inorganic iodide, probably are the causes of the continuous decrease of UIC over the course of pregnancy. Mean UIC in our control group, as well as in one parallel and several consecutive investigations in the same region in the 1990s, was found to be below the actually recommended threshold, indicating a new tendency towards mild to moderate iodine deficiency. As salt is the main source of dietary iodine in Switzerland, its iodine concentration was therefore increased nationwide in 1998 for the fourth time, following increases in 1922, 1965 and 1980.

Data from 4081 vaginal deliveries (no caesarean sections) were analyzed retrospectively (IBM 730/158) with regard to duration of second and "final stage" of labour and fetal outcome (acid-base balance and apgar scores). The average duration of the two periods amounted to 22.8+/-29.6 and 9.9+/-7.8 min. Mean pH (UA) was 7.268+/-0.084 and the acidotic risk (pH less than 7.20, pH less than 7.10) 13.4 and 1.6% respectively. The distribution of the Apgar-scores after 1 min was assessed: 0-3: 1.7%, 4-6: 5.4%, 7-10: 92.9%. The dependance of the time variables from parity was studied. Two samples (N1=1755, N2=1098) of uncomplicated term pregnancies were chosen according to 7 clinical selection criteria differing only in the presence of cord entanglements at birth. The association between the two time variables and parameters of the fetal acid-base balance in cord blood was evaluated using rank correlation- and polynomial regression analysis. Highly significant correlations (tau) were found between the variable time and actual pH in blood of the umbilical artery and vein as well as pCO2, BEECF and HbO2 in the umbilical vein. The association however is not very close and thus clinically not of great importance. The deltapH (UA & UV) pro 60 min of second (and "final") stage of labour was computed and amounted to -0.024 (-0.087) in blood of the umbilical artery and -0.036 (-0.115) in blood of the umbilical vein and -0.017 (-0.062) (UA) and -0.032 (-0.120) units (UV) in the sample with and without apparent cord entanglements at birth respectively. The response of fetal acid-base balance to cord compression during second stage of labour was assesses: The acidotic risk (pH less 7.2) was doubled: 14.5% (7.7%) and AV-differences of all variables were "opened" if cordcoilings were observed. Apgar scores were not significantly different. Moreover, the association between AV-differences of each parameter and the variable time was studied: it became evident that with passage of time AV-difference is "closed" (-0.052 AV DpH/60 min "final stage" of labour, N=1098) indicating time related impairment of placental function. From these observations and data of the literature the conclusion is drawn that second stage of labour should not exceed 45 min in any patient. Furthermore it is concluded that in cases without signs of impending fetal distress it seems to be possible to wait more than 20 (Multipara) or 30 min (Primipara) duration of "final stage" without increased risk of fetal peril measured in terms of acidemia and clinical depression. This is valid only in term pregnancies with the possibility of continuous monitoring of FHR, in cases with normal uterine activity, uneventful course of first stage of labour and cooperative, vigorous patients. The indications for termination of delivery by vaginal operations in cases without impending fetal distress are discussed.

All vaginal deliveries of the Department of Obstetrics and Gynecology of the University Basel (N = 4081) during the year 74/73 and of the University Tübingen (N = 3249) 75/74 were analysed using an IBM-system 370/135 Only alive singletons beyond the 28th week of gestation were analysed. Clinical management was quite different in the two departments; the incidence of vaginal operations (Basal 11.2%, Tübingen 12.6%), however, as well as the distribution of pH-values and Apgar-scores after 1 min were quite similar. Basel: Acidotic risk (i.e. pHUA less than 7.200) 13.5%, severe acidotic risk (i.e. pHUA less than 7.100) 1.55%, low Apgar-scores (1--3) 0.7%. Tübingen: :12.3%, 2.11%, 1.6%. 3.5% of all parturients (Basel) had duration of second stage of labour with active maternal pressure support lasting more than 30 min. In two highly selected samples differing only with regard to the occurrence of cord-entanglements at birth (N1 = 1755, N2 = 1098) the association (rank correlation method according to Kendall) between the parameters of the fetal acid-base balance and the duration of second stage of labour as well as duration of the period with "active bearing down" was studied. Without cord encirclements pH in the umbilical artery fall --0.087 and in the umbilical vein --0.115 units and with cord complications the values amounted to --0.062 (UA) and --0.120 (UV) respectively pro 60 min duration of second stage with "bearing down efforts". Analogous computations for pCO2, pO2 and HbO2 are presented. Apgar-scores in these samples showed a very loose connection with the time variables. From these data the conclusion is drawn that the indication to perform vaginal operations for termination of delivery should not primarily be governed by the factor time but rather by the whole obstetrical situation i.e. the possible fetal risk of the intervention. This holds only if maternal welfare is established and fetal well being is monitored continuously.

Bei 14 Patienten mit akuter Ösophagusvarizenblutung, bei denen eine portocavale Shunt-Operation nicht in Betracht kam, wurde in den Jahren 1971-1972 eine palliative Ösophaguswandsklerosierung durchgeführt. Sieben Patienten überlebten die zweijährige Beobachtungszeit. Von den übrigen sieben Patienten starben zwei an Ösophagusvarizenblutungen, zwei im Coma hepaticum, zwei an Pneumonie, und einer verblutete aus Hämorrhoiden. Die durchschnittliche Uberlebenszeit betrug 33 Wochen. In der Vergleichsperiode 1969-1970, ohne Skierosierung, überlebten nur zwei Patienten, neun verbluteten, und die dúrchschnittliche tJberlebenszeit dieser 14 Patienten betrug 8 Wocheñ. Das Ziel der Behandlung ist die Verhütung neuer Ösophagusvarizenblutungen bei Patienten, bei denen eine Shunt-Operation nicht möglich ist. Der gute Allgemeinzustand der sieben überlebenden Patienten nach Sklerosierungsbehandlung ermutigt uns, diese einfache Therapie weiterzuführen.

WE are gathered here this evening to celebrate a special occasion. On i6 October it was exactly 250 years ago that Albrecht Hailer was born in Berne, the most powerful state in the old Swiss Confederation. On this anniversary, the name of Haller, the greatest of his countrymen in the eighteenth century, was recalled in deep respect throughout Switzerland-a sign that his memory is still revered among the public at large. But can the same be said as regards his place in the history of science? The late Henry E. Sigerist, another of my fellow-countrymen of whom no doubt you will also have heard, comments in the following words upon a fact that is, alas, only too well known:' For men of science posterity has indeed only a short memory. No matter how epoch-making their work may have been, the time inevitably comes when it is obsolete and is swallowed up all too soon in oblivion.I think Sir William Osler accurately summed up the situation with regard to Haller as a scientist when he said that his work had long been judged as an impersonal achievement. Haller was such a versatile scholar that the foundations which he laid have simply been taken for granted by later generations. It never occurred to anyone that there must have been a personality behind these accomplishments of his. For us as medical historians, and particularly for a Swiss representative of this field of study, it is shameful to have to confess that, despite all the commemorations held earlier in his honour, it is only in recent times that we have at last begun to penetrate into the details of Haller's lifework. It is rather as a young man that Haller appeals to us most intimately as a person of extraordinary charm. Not only have most parts of his travel journal and diaries been handed down to us, but also his magnificent poems-which still have power to move the reader today, today perhaps more than everafford an insight into his innermost personality.May I suggest that we begin by first considering Haller's connections with England; in the second part of my talk I propose to select physiology as one of the aspects of his general medical work. Its connections with his teachings on disorders of the circulation will serve to show how far his biological studies encroached on the realm of pathology. In view of the short time at our disposal, however, it will scarcely be possible to do more than hint at certain aspects.