Bei der Betreuung von Frauen unter der Geburt steht häufig die medizintechnische Seite im Vordergrund. Mit dieser Arbeit zeigen wir, daû in diesen Stunden viele Freiheiten gegeben werden können, ohne dadurch an Sicherheit für Mutter und Kind einbüûen zu müssen. Insbesondere wird die Beziehungsebene zwischen betreuendem Personal, Hebammen und 3⁄4rzten und den Familien die zur Geburt kommen, beleuchtet. Geburt als etwas Ganzheitliches betrachten ± das beginnt und endet nicht mit dem Vorgang des Geborenwerdens im Kreiûsaal. Vielmehr wird gezeigt, daû die präund postpartale fürsorgliche und sanfte Betreuung einen wichtigen Faktor in der Begleitung von Geburten darstellt. Es werden auch andere Möglichkeiten wie die Wassergeburt oder die neue Form der Sectio caesarea nach Misgav Ladach beschrieben.

Globulins of antipertussis and of normal rabbit serum were fractionated by diethylaminoethyl cellulose (DEAE-cellulose) chromatography. Concentration of antipertussis globulins resulted in two elution areas-first, by 0.05M of tromethamine (tris buffer [tris (hydroxymethyl) aminomethane]) at a pH determination of 8.2, followed by sodium chloride gradient. That is, following immunization, rabbits produced active antipertussis IgG (7Sγ) globulins of two different charges. Comparing antipertussis and normal globulins, their protein concentrations following NaCI gradient elution were similar. However, with tromethamine, the high protein-concentration observed for antipertussis globulins was lacking for normal globulins. All active antipertussis globulins had both serologic and mouse-protective activities. Separation of the two activities was not demonstrated. It is suggested that studies of antipertussis globulins prepared in response to purified antigens could add importantly to existing knowledge of pertussis antigens. At the same time, this approach might contribute to studies on the mechanism of antibody formation.

To determine the Bordetella pertussis serotypes currently causing whooping cough in the United States, recently isolated cultures from different geographic areas were studied. Specific adsorbed antisera were prepared in our laboratory and used in both tube and slide agglutination tests. Among the 177 cultures isolated during 1966 and 1967 in seven states and one Canadian province, the predominant serotype was 1.3 (or 1.3.6), represented by 85% of the cultures. Fifteen cultures were serotype 1.2.3.4.6. The 376 cultures isolated in the Grand Rapids area during the last 30 years showed a changing pattern from serotype 1.2.3 during the early years to the currently prevailing 1.3 (or 1.3.6). During the 2-year study period, seven cultures of B. parapertussis were isolated in Michigan, and seven were received from other states. One culture of B. bronchiseptica, recovered from a child in Boston, was sent to us.

In a passive protection procedure in which the ed(50) values of Bordetella pertussis antisera were determined, groups of mice were given graded intraperitoneal doses of serum, followed the next day by intracerebral challenge with 100,000 organisms. Antiserum produced with B. pertussis culture 5373, serotype 1.3, protected mice against challenge with culture 18-323, serotype 1.2.3, as effectively as did an antiserum produced with a serotype 1.2.3 culture. When two groups of mice similarly treated with pertussis immune serum were challenged with culture 353Z (serotype 1) and 18-323, respectively, much lower ed(50) values were obtained with the animals challenged with 353Z. Passive protection tests with adsorbed antiserum gave equivocal results, suggesting that some of the adsorbing antigen remained in the serum and interfered with the tests. There was no evidence that serotype is related to protection.

Eldering, Grace (Michigan Department of Public Health, Grand Rapids), Jack Holwerda, and Julia Baker . Bordetella pertussis culture having only species factor 1. J. Bacteriol. 91: 1759–1762. 1966.—Preston's description of Bordetella pertussis 353-Z as a culture possessing only factor 1 was confirmed by agglutination and agglutinin-adsorption tests. The ld 50 values of this culture for mice inoculated by the intracerebral route were approximately the same as that of B. pertussis 18-323, the challenge culture in mouse potency tests of pertussis vaccine. In mouse protection tests, vaccine prepared with the factor 1 culture protected as well against challenge with B. pertussis 18-323, which has a broad antigenic pattern, as did vaccines made with cultures possessing factors 2, 3, 4, and 5 in addition to factor 1. When two groups of similarly immunized mice were challenged with 353-Z and 18-323, respectively, much lower ed 50 values were obtained with the animals challenged with 353-Z. This was true whether a factor 1 vaccine or a vaccine with factors 1, 2, 3, 4, and 5 was tested.

Olson, B. H. (Division of Laboratories, Michigan Department of Health, Lansing), Grace Eldering, and Bernice Graham. Stabilization of pertussis vaccine in the presence of benzethonium chloride. J. Bacteriol. 87:543-546. 1964.-Data are presented showing that pertussis vaccine preserved with benzethonium chloride (BC; Phemerol) was inactivated during storage. BC-preserved vaccine stored at 37 C showed no measurable mouse-protective potency at 16 weeks. That stored at 0 to 4 C lost approximately 80% of its potency within 1 year. Treatment of pertussis vaccines with aluminum, calcium, magnesium, choline, or dl-lysine before the addition of the BC prevented its uptake by the cells. Pertussis vaccines pretreated with 0.004 m Ca(++) or 0.0004 m Al(+++) retained 70% of the initial potency after 42 weeks of storage at 37 C. Similar vaccines showed no loss of protective antigens when stored for 1 year at 0 to 4 C.

Holwerda, Jack (Michigan Department of Health, Grand Rapids) and Grace Eldering. Culture and fluorescent-antibody methods in diagnosis of whooping cough. J. Bacteriol. 86:449-451. 1963.-Nasopharyngeal swabs from 517 suspected whooping-cough patients were examined by culture and by fluorescent-antibody (FA) staining procedures applied to direct slide preparations. A total of 138 were positive by both methods, 25 by culture only, and 25 by FA only. The FA technique was also used in the identification of young cultures. It was shown that a positive culture report could be speeded up by about 1 day by this method. Without FA, onehalf the positive culture reports were made in 3 days; with FA, 75% were reported in a similar period.

Eldering, Grace (Michigan Department of Health, Grand Rapids), Warren C. Eveland, and Pearl L. Kendrick . Fluorescent antibody staining and agglutination reactions in Bordetella pertussis cultures. J. Bacteriol. 83: 745–749. 1962— Bordetella pertussis antisera produced with smooth cultures gave positive results in agglutination and fluorescent antibody (FA) tests with smooth B. pertussis cultures. Similar results were obtained with antisera produced with the related species B. parapertussis and B. bronchiseptica when each was tested with the respective homologous antigen. Cross reactions occurred with some of the antisera and heterologous antigens but a positive agglutination test was not always correlated with a positive FA reaction, and the reverse was also observed. Adsorbed B. pertussis antisera specific for factors 2, 3, 4, and 5 agglutinated appropriate B. pertussis cultures, but gave negative FA reactions. Factor 1 antiserum prepared by adsorption with heated (100 C) antigen gave positive results in both FA and agglutination tests. Rough B. pertussis cultures were inagglutinable, but were FA positive when tested with unadsorbed antiserum produced with either smooth or rough cultures. Rough cultures were FA negative with factor 1 serum. The results suggest that for B. pertussis different serum components may be responsible for agglutination and FA staining. The implications with respect to the protection-inducing antigen are discussed.

The diagnosis of early, mild, or atypical whooping cough is dependent upon identification of the etiologic agent. Although procedures for the isolation of Bordetella pertussis1have been available for many years and are of proven diagnostic aid, they have not gained the wide usage they seem to deserve. A recognized limitation is the time needed: 3, more often 4, and occasionally more, days are required for a positive report. The possibility of using fluorescent antibody methods for rapid identification of B. pertussis in nasopharyngeal specimens is suggested by the promising results reported in recent studies of a number of bacterial infections. For example, Group A streptococci,2,3enteropathogenic Escherichia coli,4Haemophilus influenzae, Type B,5Neisseria gonorrhoeae,6Vibrio comma,7Leptospira,8and certain other bacterial agents have been demonstrated by means of this technique in specimens taken directly from the patient. The work of de Repentigny

Multiple Antigen Committee, Epidemiology Section, (Response to Multiple Antigens) William E. Bunney, H. D. Anderson, Gordon C. Brown, Grace Eldering, Russell Gottshall, Pearl L. Kendrick, Alexander D. Langmuir, Roderick Murray, R. E. Serfling, Franklin H. Top, V. K. Volk, and Robert Wilson CopyRight https://doi.org/10.2105/AJPH.51.4.604 Published Online: August 29, 2011

It has become increasingly evident during recent years that cultures of Bordetella pertussis (Moreno-Lop6z, 1952) (Haemophilus pertussis), even when first isolated, differ serologically. The basis for the differences has been studied by various workers including Andersen (1953), Lacey (1953) and the group in our own laboratory, but no generally accepted antigenic analysis has been worked out. Neither is it known whether the differences among cultures are related in any way to differences in protective properties among vaccines prepared from particular cultures. Andersen's studies based on the methods of Kaiffmann led her to suggest a schema for the three species we now consider under the genus Bordetella. According to her, the relationships among the species are the result of a common heat stable "O" antigen and differences within species to heat labile K antigens, some of which are common to more than one species. Lacey's approach was to induce as many antigenic changes or "modulations" as possible by varying the incubation temperature and the salts in the medium. In the present study, the B. pertussis cultures of Andersen were included as a basis for comparison and reference, and the differentiation of heat labile and heat stable antigens was attempted. Antigens were prepared from cultures of B. pertussis, Bordetella parapertussis and Bordetella bronchiseptica grown on BordetGengou medium and killed either with Merthiolate, or with heat at 120 C for 1 hr. Antisera against the various antigens were produced in rabbits, and the pooled serum from two rabbits was used for agglutination and agglutinin adsorption tests.

A Study of the Stability of Pertussis Vaccine Under Different Conditions of Storage Pearl Kendrick, Grace Eldering, Chester Hornbeck, and Julia Baker CopyRight https://doi.org/10.2105/AJPH.45.9.1131 Published Online: August 29, 2011

Antigenic relationships among the three organisms, Haemophilu-s pertussi8, the parapertussis bacillus, and Brucella bronchiseptica, have been demonstrated by various workers, using different methods. Ferry and Noble (1918), by means of agglutination tests, and Ferry and Klix (1918), using complement fixation procedures, showed cross reactions between H. pertussis and B. bronchiseptica. In connection with the description of the parapertussis bacillus Eldering and Kendrick (1938) outlined the differential characteristics and demonstrated relationships with H. pertusis and B. bronchiseptica using agglutination and agglutinin absorption techniques. Evans (1940) studied the toxins of the three organisms and showed that they were aRl neutralized by pertussis antitoxic serum. Further evidence of these relationships was presented in the work of Eldering (1942) with protection test in mice challenged by the intraperitoneal route. The results indicated cross protection among the three species. In fect, B. bronchiseptica antigens, either the whole culture or a carbohydrate fraction, protected against H. pertus8is infection fully as well as did H. pertuwsi8 antigen itself. It is of interest that both the parapertussis bacillus and B. bronchiseptica occasionally are found associated with clinical whooping cough in children. A recent paper by Eldering and Kendick (1952) reports that approximately 2 per cent of the cultures isolated in the Grand Rapids area during a 16 year period from children with whooping cough symptoms were parapertussis.

In 1950, a study to determine the extent of immunization procedures and of prenatal and postnatal services was made in Grand Rapids, Mich., a city of less than 200,000 population, where unusual emphasis has been placed upon immunization procedures for many years.Questionnaires were mailed to mothers of all babies aged 12 and 13 months, with follow-up by telephone or nurse's vLsit when replies were not received by mail.This method of sam- pling, which was similar to that used in a study in Philadelphia in 1949, and described by Kandle and Goetz (1, 2), appeared to be re- liable and useful, especially with regard to pat- terns of practice, and had the added advantage of being simple and inexpensive.We hope that, in addition to the actual information obtained, further experience witlh the metlhod, this time in a smaller community, will aid in evalu- ating its general usefulness as a public health tooLThe area for study was extended to include not only the city of Grand Rapids but also the surrounding territory comprising Kent County,

Incidence of Parapertussis in the Grand Rapids Area as Indicated by 16 Years' Experience with Diagnostic Cultures Grace Eldering, and Pearl L. Kendrick CopyRight https://doi.org/10.2105/AJPH.42.1.27 Published Online: October 03, 2011

Comparison of Pertussis Cultures by Mouse Protection and Virulence Tests P. L. Kendrick, Elaine L. Updyke, and Grace Eldering CopyRight*Presented before the Laboratory Section of the American Public Health Association at the Seventy-sixth Annual Meeting in Boston, Mass., November 10, 1948. https://doi.org/10.2105/AJPH.39.2.179 Published Online: October 03, 2011

Mouse Protection Tests in the Study of Pertussis Vaccine A Comparative Series Using the Intracerebral Route for Challenge * Affiliation P. L. Kendrick, Grace Eldering, M. K. Dixon, and J. Misner CopyRight*Presented before the Laboratory Section of the American Public Health Association at the Seventy-fourth Annual Meeting in Cleveland, Ohio, November 13, 1946. https://doi.org/10.2105/AJPH.37.7.803-b Published Online: August 29, 2011