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Chief of Gynecologic Specialty Surgery, Sloane Hospital for Women Columbia University New York, New York
Jamie N. Bakkum-Gamez, MD Professor Obstetrics and Gynecology Mayo Clinic Rochester, Minnesota
Genevieve Bouchard-Fortier, MD, FRCSC, MSc
Assistant Professor University Health Network Division of Gynecologic Oncology
Obstetrics and Gynecology University of Toronto Toronto, Ontario, Canada
Anne Burke, MD, MPH
Associate Professor Gynecology and Obstetrics Johns Hopkins University Baltimore, Maryland
Leslie H. Clark, MD Assistant Professor
Obstetrics and Gynecology, Division of Gynecologic Oncology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Robert L. Coleman, MD Professor & Deputy Chair Department of Gynecologic Oncology & Reproductive Medicine University of Texas MD Anderson Cancer Center Houston, Texas
Allan Covens, MD, FRCSC Head Sunnybrook Health Science Center; Professor & Chair Division of Gynecologic Oncology
Obstetrics and Gynecology University of Toronto Toronto, Ontario, Canada
Deborah S. Cowley, MD Professor Psychiatry and Behavioral Sciences University of Washington Seattle, Washington
Anne R. Davis, MD, MPH
Wyeth Ayerst Professor
Obstetrics and Gynecology
Columbia University Irving Medical Center New York, New York
Mary Segars Dolan, MD, MPH
Associate Professor
Gynecology and Obstetrics
Emory University Atlanta, Georgia
Sarah K. Dotters-Katz, MD, MMHPE
Assistant Professor
Obstetrics and Gynecology
Duke University Durham, North Carolina
Nataki C. Douglas, MD, PhD
Associate Professor
Department of Obstetrics, Gynecology and Women’s Health
Rutgers–New Jersey Medical School Newark, New Jersey
Sean C. Dowdy, MD Professor
Obstetrics and Gynecology Mayo Clinic Rochester, Minnesota
Linda O. Eckert, MD Professor
Department of Obstetrics and Gynecology; Adjunct Professor Department of Global Health University of Washington Seattle, Washington
Michael Fialkow, MD, MPH Professor
Obstetrics and Gynecology University of Washington School of Medicine Seattle, Washington
Eric J. Forman, MD, HCLD Medical and Laboratory Director Department of Obstetrics and Gynecology Columbia University Irving Medical Center
Division of Reproductive Endocrinology & Infertility
New York, New York
Michael Frumovitz, MD, MPH Professor and Associate Chief Patient Experience Of cer
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center Houston, Texas
Paola Alvarez Gehrig, MD
Professor & Chief
Division of Gynecologic Oncology
University of North Carolina Chapel Hill, North Carolina
David M. Gershenson, MD Professor
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center Houston, Texas
Jennifer Bushman Gilner, MD, PhD
Assistant Professor
Obstetrics and Gynecology
Duke University Durham, North Carolina
Laura J. Havrilesky, MD, MHSc Professor, Division of Gynecologic Oncology
Obstetrics and Gynecology
Duke University
Durham, North Carolina
Cherie C. Hill, MD
Assistant Professor Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia
Hye-Chun Hur, MD, MPH
Associate Professor
Minimally Invasive Gynecologic Surgery Department of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York
Anuja Jhingran, MD Professor Radiation Oncology
University of Texas MD Anderson Cancer Center Houston, Texas
James M. Kelley III, BA, JD Managing Partner Medical Malpractice
Elk & Elk Co Ltd Cleveland, Ohio
Anna C. Kirby, MD, MAS
Assistant Professor
Obstetrics and Gynecology
University of Washington Seattle, Washington
Jeffrey A. Kuller, MD
Professor of Obstetrics and Gynecology Division of Maternal-Fetal Medicine
Duke University Medical Center Durham, North Carolina
Eduardo Lara-Torre, MD, FACOG Vice Chair, Department of OBGYN Section Chief, Academic Specialists in General OBGYN Carilion Clinic
Professor Department of OBGYN and Pediatrics Virginia Tech-Carilion School of Medicine Roanoke, Virginia
Gretchen M. Lentz, MD, FACOG Professor, Obstetrics and Gynecology Adjunct Professor, Urology Division Director, Urogynecology University of Washington Medical Center Seattle, Washington
Roger A. Lobo, MD Professor, Obstetrics and Gynecology Division of Reproductive Endocrinology Columbia University New York, New York
Karen H. Lu, MD Chair and Professor Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center Houston, Texas
Vicki Mendiratta, MD
Associate Professor Obstetrics and Gynecology University of Washington Seattle, Washington
Larissa A. Meyer, MD, MPH
Associate Professor Gynecologic Oncology and Reproductive Medicine University of Texas MD Anderson Cancer Center Houston, Texas
Jane L. Miller, MD
Associate Professor Urology University of Washington Seattle, Washington
Andra Nica, MD, MSc, FRCSC Clinical Fellow
Obstetrics and Gynaecology
Division of Gynecologic Oncology University of Toronto Toronto, Ontario, Canada
Jaclyn D. Nunziato, MD, MS
Assistant Professor of Obstetrics and Gynecology
Department Obstetrics and Gynecology
Virginia Tech Carilion School of Medicine Roanoke, Virginia Roanoke, Virginia
James W. Orr, Jr., MD, FACS, FACOG
Clinical Professor, Florida State College of Medicine
Medical Director, Regional Cancer Center Lee Health
Chief of Surgical Oncology, GenesisCare Tallahassee, Florida
Amanda Padro, MS, CGC
Prenatal Genetic Counselor
MFM OB/GYN
Duke University Raleigh, North Carolina
Natacha Phoolcharoen, MD Lecturer
Obstetrics and Gynecology
Faculty of Medicine, Chulalongkorn University Bangkok Thailand;
Visiting Scientist
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center Houston, Texas
Thomas M. Price, MD
Professor
Obstetrics and Gynecology
Duke University Durham, North Carolina
Beth W. Rackow, MD
Associate Professor
Obstetrics & Gynecology and Pediatrics
Columbia University Medical Center
New York, New York
Pedro T. Ramirez, MD
Professor
Gynecologic Oncology & Reproductive Medicine
University of Texas MD Anderson Cancer Center; Director
Minimally Invasive Surgical Research & Education
University of Texas MD Anderson Cancer Center Houston, Texas; Editor in Chief
International Journal of Gynecological Cancer
Licia Raymond, MD
Clinical Assistant Professor
Obstetrics-Gynecology
University of Washington
Seattle, Washington
Eleanor H. J. Rhee, MD
Assistant Professor
Division of Maternal Fetal Medicine
Obstetrics and Gynecology
Duke University
Katherine Rivlin, MD, MSc
Assistant Professor
Obstetrics and Gynecology
The Ohio State University Wexner School of Medicine
Columbus, Ohio
David T. Rock, MD
Director of Breast Surgery Fellowship
21st Century Oncology;
Breast Surgeon
Regional Breast Care
Fort Myers, Florida
Timothy Ryntz, MD
Assistant Professor
Obstetrics and Gynecology
Columbia University School of Medicine
New York, New York
Mila Pontremoli Salcedo, MD, PhD
Associate Professor
The Department of Obstetrics & Gynecology
Federal University of Health Sciences/ Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil; Visiting Assistant Professor
The Department of Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Gloria Salvo, MD
Medical Research
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Samith Sandadi, MD, MSc
Gynecologic Oncologist
Breast Surgeon
Clinical Assistant Professor
Florida State School of Medicine
Florida Gynecologic Oncology
21st Century Oncology
Fort Myers, Florida
Kathleen M. Schmeler, MD Professor
Department of Gynecologic Oncology & Reproductive Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Judith A. Smith, BS, PharmD
Associate Professor
Obstetrics, Gynecology and Reproductive Sciences
UTHealth-McGovern Medical School
Houston , Texas;
Oncology Clinical Pharmacy Specialist
Pharmacy
Memorial Hermann Hospital Cancer Center
Houston, Texas
Pamela T. Soliman, MD, MPH Professor
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Anil K. Sood, MD
Professor and Vice Chair Gynecologic Oncology & Reproductive Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Premal H. Thaker, MD, MSc
Professor and Director of Gynecologic Oncology Clinical Research Department of Obstetrics and Gynecology
Washington University School of Medicine St. Louis, Missouri
Mireille Truong, MD
Assistant Professor Program Director, Fellowship in Minimally Invasive Gynecologic Surgery
Cedars-Sinai Medical Center
Jenna Turocy, MD
Reproductive Endocrinology and Infertility Fellow
Obstetrics and Gynecology
Columbia University
New York, New York
Fidel A. Valea, MD Professor and Chair
Department of Obstetrics and Gynecology
Division of Gynecologic Oncology
Virginia Tech Carilion School of Medicine Roanoke, Virginia
Catherine H. Watson, MD Gynecologic Oncology Fellow Obstetrics and Gynecology
Duke University Durham, North Carolina
Shannon N. Westin, MD, MPH
Associate Professor
Gynecologic Oncology and Reproductive Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Zev Williams, MD, PhD
Associate Professor and Division Chief
Department of Obstetrics and Gynecology
Division of Reproductive Endocrinology & Infertility
Columbia University Irving Medical Center
New York, New York
Preface
“Wisdom is not a product of schooling but of the lifelong attempt to acquire it.”
Albert Einstein
Having rst been published in 1987, Comprehensive Gynecology is now in its eighth edition. And once again, it is appropriate to pay tribute to the legacy of the original editors—Drs. William Droegmueller, Arthur L. Herbst, Daniel R. Mishell, Jr., and Morton A. Stenchever—each of whom was a giant within our discipline and who had the wisdom and foresight to create a textbook that has guided generations of gynecologists to make a difference in the lives of women.
At this writing, we are in the midst of the 2020 COVID-19 pandemic. “The Great In uenza” pandemic occurred a little over a century ago, and one of the scientists in that ght was Simon Flexner, rst Director of the Rockefeller Institute and brother of Abraham Flexner, author of the 1910 Flexner Report, which examined the state of American medical education. Thinking about Flexner’s emphasis on medical education reform, Einstein’s advice about the acquisition of wisdom, and the current attention to lifelong learning and self-assessment by the American Board of Obstetrics and Gynecology, it is appropriate to introduce this latest edition of Comprehensive Gynecology, with the hope that it will be of value to practicing gynecologists, trainees in obstetrics and gynecology, and subspecialists alike
The doubling time of medical knowledge was estimated to be 50 years in 1950, 7 years in 1980, and 3.5 years in 2010. In 2020, it is projected to be 0.2 years (73 days). Certainly, the eld of gynecology is no exception. Mastering complex surgical procedures, keeping abreast of the latest medical therapies for gynecologic conditions, grasping the advances and nuances of the electronic medical record, and understanding the rapidly expanding eld of molecular biology and genetics as it relates to our specialty is challenging.
Despite the doubling time of medical information, the contributors and editors have made every effort to deliver the most updated and relevant content. In this edition, we have maintained
the same chapters, although in two instances we have consolidated chapters, combining vulvar and vaginal cancers, as well as combining fallopian tube and peritoneal cancers with ovarian cancer. As in the previous two editions, we have added several new coauthors to continue to enhance the expertise necessary to maintain the book’s high quality. Importantly, each of the chapters has been signi cantly updated.
We have provided the most important references in the body of the chapter, allowing the reader to have immediate access to the source, rather than having to search for the reference. In addition, we have maintained a limited number of Key References at the end of each chapter and Suggested Readings, which are available online.
As in the prior edition, we have provided video content to provide a more visual experience for the reader. New and better illustrations have also been added to assist in visual learning.
Nearly every chapter has key points, which have been bundled together in an online synopsis of the entire book. This will allow rapid assessment of the content of each chapter for more indepth reading of areas of greater interest, as well as provide key learning facts in all areas of gynecology.
We hope readers will enjoy this edition and learn as much as they can from this ever-evolving eld in order to provide better health care for women.
We would like to extend our gratitude to the Elsevier staff— Sarah Barth, Senior Content Strategist; and Melissa Rawe, Content Development Specialist—who have shepherded this entire process with extraordinary professionalism.
We would also like to thank our families, without whose support, patience, and encouragement this project could not have been accomplished.
David M. Gershenson, MD
Gretchen M. Lentz, MD
Fidel A. Valea, MD
Roger A. Lobo, MD
PART I
Basic Science
1 Fertilization and Embryogenesis, 1
Thomas M. Price, Fidel A. Valea
2 Reproductive Genetics, 21
Jennifer Bushman Gilner, Eleanor H. J. Rhee, Amanda Padro, Jeffrey A. Kuller
3 Reproductive Anatomy, 47
Jaclyn D. Nunziato, Fidel A. Valea
4 Reproductive Endocrinology, 76
Nataki C. Douglas, Roger A. Lobo
5 Evidence-Based Medicine and Clinical Epidemiology, 106
Catherine H. Watson, Fidel A. Valea, Laura J. Havrilesky
6 Medical-Legal Risk Management, 116
James M. Kelley III, Gretchen M. Lentz
PART II
Comprehensive Evaluation of the Women
7 History, Physical Examination, and Preventive Health Care, 127
Vicki Mendiratta, Gretchen M. Lentz
8 Interaction of Medical Diseases and Female Physiology, 140
Sarah K. Dotters-Katz, Fidel A. Valea
9 Additional Considerations in Gynecologic Care, 148
Deborah S. Cowley, Anne Burke, Gretchen M. Lentz
10 Endoscopy in Minimally Invasive Gynecologic Surgery, 188
Licia Raymond, Gretchen M. Lentz
PART III
General Gynecology
11 Congenital Abnormalities of the Female Reproductive Tract, 207
Beth W. Rackow, Roger A. Lobo, Gretchen M. Lentz
12 Pediatric and Adolescent Gynecology, 221
Eduardo Lara-Torre, Fidel A. Valea
13 Contraception and Abortion, 238
Katherine Rivlin, Anne R. Davis
14 Menopause and Care of the Mature Woman, 255
Roger A. Lobo
15 Breast Diseases, 289
Samith Sandadi, David T. Rock, James W. Orr Jr., Fidel A. Valea
16 Early and Recurrent Pregnancy Loss, 323
Jenna Turocy, Zev Williams
17 Ectopic Pregnancy, 342
Hye-Chun Hur, Roger A. Lobo
18 Benign Gynecologic Lesions, 362
19
Mary Segars Dolan, Cherie C. Hill, Fidel A. Valea
Endometriosis, 409
Arnold P. Advincula, Mireille Truong, Roger A. Lobo
20 Pelvic Organ Prolapse, Abdominal Hernias, and Inguinal Hernias, 428
Anna C. Kirby, Gretchen M. Lentz
21 Lower Urinary Tract Function and Disorders, 461
Gretchen M. Lentz, Jane L. Miller
22 Anal Incontinence, 495
23
24
25
26
Gretchen M. Lentz, Michael Fialkow
Genital Tract Infections, 515
Linda O. Eckert, Gretchen M. Lentz
Preoperative Counseling and Management, 543
Jamie N. Bakkum-Gamez, Sean C. Dowdy, Fidel A. Valea
Perioperative Management of Complications, 559
Leslie H. Clark, Paola Alvarez Gehrig, Fidel A. Valea
Abnormal Uterine Bleeding, 594
Timothy Ryntz, Roger A. Lobo
PART IV
Gynecologic Oncology
27 Molecular Oncology in Gynecologic Cancer, 606
Premal H. Thaker, Anil K. Sood
28 Principles of Radiation Therapy and Chemotherapy in Gynecologic Cancer, 618
29
Judith A. Smith, Anuja Jhingran
Intraepithelial Neoplasia of the Lower Genital Tract (Cervix, Vagina, Vulva), 637
Mila Pontremoli Salcedo, Natacha Phoolcharoen, Kathleen M. Schmeler
30 Neoplastic Diseases of the Vulva and Vagina, 648
Michael Frumovitz
31 Malignant Diseases of the Cervix, 674
32
33
Anuja Jhingran, Larissa A. Meyer
Malignant Diseases of the Uterus, 691
Pamela T. Soliman, Karen H. Lu
Malignant Diseases of the Ovary, Fallopian Tube, and Peritoneum, 707
Robert L. Coleman, Shannon N. Westin, Pedro T. Ramirez, Gloria Salvo, David M. Gershenson
Gestational Trophoblastic Disease, 754
Andra Nica, Geneviève Bouchard-Fortier, Allan Covens
V
Endocrinology and Infertility
35 Primary and Secondary Dysmenorrhea, Premenstrual Syndrome, and Premenstrual Dysphoric Disorder, 768
Vicki Mendiratta, Gretchen M. Lentz
36 Primary and Secondary Amenorrhea and Precocious Puberty, 781
Roger A. Lobo
37 Hyperprolactinemia: Evaluation and Management, 801
Roger A. Lobo
38 Androgen Excess in Women, 810
Roger A. Lobo
39 Polycystic Ovary Syndrome, 824
Roger A. Lobo
40 Infertility, 838
Roger A. Lobo
41 In Vitro Fertilization, 861
Eric J. Forman, Roger A. Lobo
Index, 873
Video Contents
1 Fertilization and Embryogenesis
Thomas M. Price, Fidel A. Valea
1.1 Embryo Biopsy and Cell Extrusion
3 Reproductive Anatomy
Jaclyn D. Nunziato, Fidel A. Valea
3.1 Uterine Artery Dissection
3.2 Anatomy of Uterosacral Ligaments
3.3 Identi cation of the Course of the Ureter
10 Endoscopy in Minimally Invasive Gynecologic Surgery
Licia Raymond, Gretchen M. Lentz
10.1 Transection of the Round Ligament and Dissection of the Broad Ligament
Fertilization and Embryogenesis
Thomas M. Price, Fidel A. Valea
KEY POINTS
• Oocyte meiosis is arrested in prophase I from the fetal period until a luteinizing surge (LH) preceding ovulation. With the LH surge, the oocyte completes meiosis I associated with a decrease to 23 chromosomes with diploid (2N) DNA quantity and extrusion of the frst polar body. With fertilization, meiosis II is completed with separation of sister chromatids resulting in 23 chromosomes with haploid (1N) DNA content and extrusion of the second polar body.
• Implantation is a complex process necessitating hormones of estrogen and progesterone, cytokines such as growth factors and interleukins along with prostaglandins. During implantation extravillous trophoblast invade the endometrium to anchor the pregnancy and to remodel the spiral arteries to make the placenta a high-fow, low-resistance organ. Villous trophoblast are in contact with maternal blood in the intervillous space for gas and nutrient transfer.
• Human chorionic gonadotropin (hCG) is secreted by syncytiotrophoblast and functions to maintain steroid production by the corpus luteum through interaction with the LH receptor. Other functions may include promotion of angiogenesis in the uterus, myometrial relaxation, inhibition of immune interaction at the uteroplacental interface, stimulation of fetal testosterone production and mediation of hyperemesis through receptors in the brain.
• Genetic sex is determined at the time of conception. Male differentiation is determined by expression of the SRY
Accompanying video for this chapter is available on ExpertConsult.com.
MEIOSIS, FERTILIZATION, IMPLANTATION, EMBRYONIC DEVELOPMENT, AND SEXUAL DIFFERENTIATION
Several areas of medical investigation have brought increased attention to the processes of fertilization and embryonic development, including teratology, stem cell research, immunogenetics, and assisted reproductive technology (ART). The preimplantation, implantation, and embryonic stages of development in the human can now be studied because of the development of newer techniques and areas of research. This chapter considers the processes of oocyte meiosis, fertilization and early cleavage, implantation, development of the genitourinary system, and sex differentiation.
THE OOCYTE AND MEIOSIS
The oocyte is a unique and extremely specialized cell. The primordial germ cells in both males and females are large eosinophilic cells derived from endoderm in the wall of the yolk sac.
(sex-determining region Y) gene found on the short arm of the Y chromosome. SRY protein is a transcription factor and expression is unique to the Sertoli cell of the developing testis. SRY induces expression of another transcription factor, SOX9, which is also obligatory for male sex differentiation. A loss of function mutation of either SRY or SOX9 results in XY sex reversal in which genetic men are phenotypic women. Several genes regulate SRY/SOX9 expression including WT1 (Wilms’ tumor suppressor 1) and SF1 (steroidogenic factor 1). Although ovarian formation can only occur in the absence of SRY/SOX9, there are unique genes necessary for development. FOXL2 encodes a transcription factor necessary for granulosa cell expansion. BMP15, located on the X chromosome, and GDF9 on chromosome 5 encode growth factors expressed in oocytes required for granulosa cell proliferation.
• Renal and internal genital development are closely related. Under the infuence of testosterone, the primordial renal mesonephros (wolffan ducts) differentiate into the vas deferens, epididymis, and seminal vesicles, while the paramesonephric ducts (müllerian ducts) are suppressed because of the secretion and action of antimüllerian hormone (AMH), also known as müllerian Inhibitory Substance (MIS), by Sertoli cells. In the absence of MIS, the wolffan ducts regress and the müllerian ducts differentiate into the fallopian tubes, uterus, and cervix.
These 700 to 1300 cells migrate to the germinal ridge by way of the dorsal mesentery of the hindgut by ameboid action by 5 to 6 weeks. Oogenesis begins with the replication of the diploid oogonia through mitosis to produce primary oocytes, reaching a peak number of 600,000 (confdence interval [CI]: 70,000 to 5,000,000) at 18 to 22 weeks of gestation. Through apoptosis, the numbers decline to about 360,000 (CI: 42,000 to 3,000,000) at menarche (Wallace, 2010). As can be seen, there is a large variance among individuals and a direct correlation between the number of fetal oocytes and the age of menopause. The maximum rate of fetal apoptosis occurs between 14 and 28 weeks gestation. Accelerated apoptosis is seen in Turner syndrome resulting in few oocytes at birth.
The meiotic process actually begins at 10 to 12 weeks gestation and is the mechanism by which diploid organisms reduce their gametes to a haploid state so that they can recombine again during fertilization to become diploid organisms. In humans this process reduces 46 chromosomes to 23 chromosome structures in the gamete. The haploid gamete contains only one chromosome for each homologous pair of chromosomes, so that it has either the maternal or paternal chromosome for each pair, but not both. Meiosis is also the mechanism by which genetic exchange is completed through chiasma
Oogonia Oocytes undergoing meiosis
Oocytes at diplotene
1.1 Diagram of the different meiotic cell types and their proportions in the ovaries during fetal life. (Courtesy Edith Cheng, MD.)
formation and crossing over (recombination) between homologous chromosome pairs. Two meiotic cell divisions are required to produce haploid gametes. In the human female, oogonia enter meiosis in “waves” (Fig. 1.1), that is, not all oogonia enter meiosis at the same time.
Meiosis initiation is dependent on mesonephric-produced retinoic acid (Childs, 2011). Oocytes in the frst substage of prophase, leptotene, are found in the human fetal ovaries as early as 10 weeks’ gestation. With increasing gestational age, greater proportions of oocytes in later stages of meiosis may be observed,
and by the end of the second trimester of pregnancy, the majority of oocytes in the fetal ovaries have cytologic characteristics that are consistent with the diplotene/dictyotene substages of prophase I of meiosis I (the stage at which the oocytes are arrested until ovulation) (Fig. 1.2).
Meiosis is preceded by interphase I during which DNA replication occurs, thus transforming the diploid oogonia with a DNA content of 2N to an oocyte with a DNA content of 4N. Meiosis is defned in two stages. The frst, known as the reduction division (division I, or meiosis I), initiates in the fetal ovaries but is then arrested and completed at the time of ovulation.
Meiosis I starts with prophase I (prophase includes leptotene, zygotene, pachytene, and diplotene), which occurs exclusively during fetal life and sets the stage for genetic exchange that ensures genetic variation in our species (Fig. 1.3). More oocytes are found in the leptotene stage of prophase then in the other three stages of zygotene, pachytene, and diplotene in the fetal ovary. Leptotene is proportionately the most abundant of all the prophase I substages in early gestation. Cells in this meiotic phase are characterized by a large nucleus with fne, diffuse, string-like chromatin evenly distributed within the nucleus (Fig. 1.3A). Chromatin of homologous pairs occupies “domains” and does not occur as distinct linear strands of chromosomes. The zygotene substage is defned by the initiation of pairing, which is characterized by the striking appearance of the synaptonemal complex formation in some of the chromosomes (Fig. 1.3B). There is cytologic evidence of chromosome condensation and linearization, and the chromatin is seen as a fne, stringlike structure. The
(resting stage)
1st polar body formation
Fertilization
I
mature each cycle Meiosis continues
bodies
2nd polar body formation
Meiosis complete
Fig. 1.2 Diagram of oocyte meiosis. For simplicity, only one pair of chromosomes is depicted. Prophase stages of the first meiotic division occur in the female during fetal life. The meiotic process is arrested at the diplotene stage (“first meiotic arrest”), and the oocyte enters the dictyotene stages Meiosis I resumes at puberty and is completed at the time of ovulation The second meiotic division takes place over several hours in the oviduct only after sperm penetration. (Courtesy Edith Cheng, MD.)
Fig.
Dictyotene
Puberty
Oocytes
Anaphase
A
C D B
Fig. 1.3 Fetal ovary with fluorescent in situ hybridization. The first three images are meiotic cells from a 21-week fetal ovary. A, Fluorescent in situ hybridization (FISH) with a whole chromosome probe for chromosome X was completed to visualize the pairing characteristics of the X chromosome during leptotene. B, Zygotene. C, Pachytene. D, Image of a meiotic cell from a 34-week fetal ovary that underwent dual FISH with probes for chromosomes 13 (green signal) and 21 (red signal) to illustrate the pairing characteristics of this substage of prophase in meiosis I. (Courtesy Edith Cheng, MD.)
pachytene substage is the most easily recognizable period of the prophase and is characterized by clearly defned chromosomes that appear as continuous ribbons of thick beadlike chromatin (Fig. 1.3C). By defnition, this is the substage in which all homologues have paired. In this substage the paired homologues are structurally composed of four closely opposed chromatids and are known as a tetrad. The frequency of oocytes in pachytene increases with gestational age and peaks in the mid-second trimester of pregnancy (about 20 to 25 weeks’ gestation). The diplotene substage is a stage of desynapsis that occurs as the synaptonemal complex dissolves and the two homologous chromosomes pull away from each other. However, these bivalents, which are composed of a maternally and a paternally derived chromosome, are held together at the centromere and at sites of chiasma formation that represent sites where crossing over has occurred (Fig. 1.3D). In general, chiasma formation occurs only between chromatids of homologous pairs and not between sister chromatids. Usually, one to three chiasma occur for each chromosome arm. Oocytes at this stage of prophase I constitute the majority of third-trimester fetal and newborn ovaries. Diplotene merges with diakinesis, the last substage of meiosis I, and is a stage of transition to metaphase, lasting many years in the humans.
During puberty, folliculogenesis includes progression of the follicle, consisting of the oocyte and granulosa cells from primordial to antral, which is characterized by granulosa cell proliferation, development of gonadotropin receptors, and expression of enzymes for sex steroid production (Baerwald, 2012). It takes approximate 85 days for a follicle to mature to the point of ovulation. There is no change in the chromosome stage during folliculogenesis.
Meiosis I resumes with the surge of luteinizing hormone before ovulation completing metaphase, anaphase, and telophase. The result is two daughter cells, which are diploid (2N) in DNA
content but contain 23 chromosome structures, each containing two closely held sister chromatids. One daughter cell, the oocyte, receives the majority of the cytoplasm, and the other becomes the frst polar body. The polar body is located in the perivitelline space between the surface of the oocyte (oolemma) and the zona pellucida (ZP).
Meiosis II is rapid, with the oocyte advancing immediately to metaphase II, where the sister chromatids for each chromosome are aligned at the equatorial plate, held together by spindle fbers at the centromere. With sperm penetration, meiosis II is completed with extrusion of the second polar body yielding a haploid oocyte (1N) that is entered by a haploid (1N) sperm (Fig. 1.4).
Crossover and Female Aneuploidy
Aneuploidy in embryos is the most common cause of miscarriage and certain chromosomal abnormalitie s in live births, including Down syndrome (trisomy 21). The majority of the time these originate from an abnormal oocyte, increasing with age, and are more likely to affect chromosomes with short p arms (acrocentric). These chromosome segregation errors occur predominantly during meiosis I and are more common in the oocyte compared with the sperm. This is associated with defcient formation of chiasma between homologous chromosomes associated with DNA crossover (recombinati on) sites. Defective sites lead to less tension between homologous chromosomes, making segregation errors more likely as the spindles (microtubules) attached to the kinetochore protein complex adjacent to the centromere pull chromosomes toward the centrioles ( Wang, 2017 ).
Oocyte Cryopreservation
The clinical importance of meiotic spindle integrity was evident during the development of oocyte cryopreservation. Oocyte freezing is becoming more common for fertility preservation in women with medical conditions, such as cancer, for which chemotherapy and/or radiation therapy may result in ovarian failure, and in women of increasing reproductive age. The original technique for oocyte freezing was referred to as slow freezing, which was subsequently replaced by vitrification. Freezing involves removal of intracellular water so that ice crystals will not form during freezing, which may disrupt organelles. With slow freezing, cryoprotectants such as dimethyl sulfoxide (DMSO) and ethylene glycol are allowed to permeate the cell, replacing the water, as the oocyte is slowly cooled at 1°C to 2°C/min to –196°C and stored in liquid nitrogen. In contrast, vitrification involves the use of higher concentrations of cryoprotectant and very rapid cooling at 15,000°C to 30,000°C/min. With slow freezing there is a slow change from liquid to solid, whereas vitrification consists of immediate solidification of the cryoprotectant into a glasslike consistency. With human oocytes, vitrification causes much less spindle damage, resulting in higher oocyte survival rates.
FERTILIZATION AND EARLY CLEAVAGE
In most mammals, including humans, the egg is released from an ovary in the metaphase II stage (Fig. 1.5). When the egg enters the fallopian tube, it is surrounded by a cumulus of granulosa cells (cumulus oophorus) and intimately surrounded by a clear ZP. Within the ZP are both the egg and the frst polar body. Meanwhile, spermatozoa are transported through the cervical mucus and the uterus and into the fallopian tubes.
Although 20 to 200 million sperm may enter the vagina during intercourse, only 1 in 25,000 will make it to the fallopian tubes (Williams, 1993). This journey involves processes of capacitation, chemotaxis, hyperactivated motility, and acrosome reaction
Fig. 1.4 Diagram of oocyte meiosis. For simplicity, only three pairs of chromosomes are depicted (1 to 4). Prophase stages of the first meiotic division, which occur in most mammals during fetal life. The meiotic process is arrested at the diplotene stage (“first meiotic arrest”), and the oocyte enters the dictyate stages (5 to 6). When meiosis is resumed, the first maturation division is completed (7 to 11). Ovulation occurs usually at the metaphase II stage (11), and the second meiotic division (12 to 14) takes place in the oviduct only after sperm penetration. (From Tsafriri A. Oocyte maturation in mammals. In Jones RE, ed. The Vertebrate Ovary. New York: Plenum; 1978. With permission of Springer Science and Business Media.)
(Fig. 1.6). Capacitation precedes all other changes and involves initial removal of cholesterol from the plasma membrane altering the permeability and fuidity. This allows infux of calcium and bicarbonate, with many downstream effects, such as increased cyclic adenosine monophosphate (cAMP), protein tyrosine phosphorylation, and activation of protein kinases. A function of capacitation is to allow localization of protein complexes in the head of the sperm that will subsequently bind the ZP. Chemotaxis is shown by a greater number of sperm in the ampullary portion of the fallopian tube containing a cumulus-oocyte complex (COC) compared with the side lacking a COC. In vitro, follicular fuid acts as a chemoattractant, possibly because of progesterone, but the exact responsible constituents of the fuid continue to be debated (Eisenbach, 1999). Hyperactivated motility involves increased vigorous movement of the sperm to penetrate the cumulus (granulosa) cells surrounding the oocyte and is most likely caused by progesterone. A major action of progesterone is to increase calcium infux into the sperm, with multiple downstream effects. Likely the progesterone concentration increases as the sperm approaches the egg, resulting in more aggressive motility. When the egg is reached, receptor complexes on the outer
most plasma membrane bind to speci c ZP glycoprotein receptors (primarily ZP 3). These interactions are very species specifc. Human sperm can only bind to the ZP of human, baboon, and gibbon oocytes. Binding results in fenestrations forming between the plasma membrane and the underlying acrosome membrane, releasing enzymes, including acrosin (a serine protease), to locally degrade the ZP.
Because many sperm may initially bind the ZP, a mechanism must be in place to prevent fertilization by more than one sperm (polyspermia). With initial binding of the sperm membrane to the oolemma, a calcium-dependent release of cortical granules occurs. Cortical granules are vesicles containing protein made during oogenesis and located in the periphery of the cell. Contents are released into the perivitelline space and modify ZP proteins and enlarge the perivitelline space to prevent sperm entry. With sperm entry, the oocyte completes its second meiotic division, casting off the second polar body into the perivitelline space.
The majority of a single sperm enters the oocyte, and this is indeed the case during intracytoplasmic sperm injection (ICSI) for infertility. Only the centrioles and the nucleus survive, whereas
Posterior wall of uterus
Oocyte penetrated by sperm
Early primary follicle
Blood vessels
Epithelium
Corpus albicans
Mature corpus luteum
Atretic (degenerating) follicle
Endometrium
Released oocyte
Ruptured follicle
Connective tissue Coagulated blood
Developing corpus luteum
Fig. 1.5 Summary of the ovarian cycle, fertilization, and human development during the first week Stage 1 of development begins with fertilization in the uterine tube and ends when the zygote forms. Stage 2 (days 2 to 3) comprises the early stages of cleavage (from 2 to approximately 32 cells, the morula). Stage 3 (days 4 to 5) consists of the free (unattached) blastocyst. Stage 4 (days 5 to 6) is represented by the blastocyst attaching to the posterior wall of the uterus, the usual site of implantation. The blastocysts have been sectioned to show their internal structure. (From Moore KL, Persaud TVN. The Developing Human: Clinically Oriented Embryology. 7th ed. Philadelphia: WB Saunders; 2003.)
mitochondria in the midpiece and tail are destroyed. The sperm centrioles interact with -tubulin from the oocyte to form a microtubule network for migration of pronuclei and subsequent separation of chromosomes during the frst mitosis (Schatten, 2009). Thus mitochondria are of maternal origin and centrioles are paternal. Early cell division (cleavage) is not synchronous and varies in time (Fig. 1.7). Time intervals from two pronuclei to two cells, two cells to three cells, three cells to four cells, and four cells to fve cells are 26 hours, 12 hours, 0.8 hours, and 14 hours, respectively, as determined with time-lapse photography during in vitro fertilization (IVF) (Meseguer, 2011). A signifcant number of fertilized oocytes do not complete cleavage for a number of reasons, including failure of appropriate chromosome arrangement on the spindle, specifc gene defects that prevent the formation of the spindle, and environmental
factors. Importantly, teratogens acting at this point are usually either completely destructive or cause little or no effect. Twinning may occur by the separation of the two cells produced by cleavage, each of which has the potential to develop into a separate embryo. Twinning may occur at any stage until the formation of the blastocyst (blast) because each cell is totipotent. Both genetic and environmental factors are probably involved in the causation of twinning.
Morula and Blastula Stage: Early Differentiation
After fertilization the zygote (term for a fertilized egg) has a diameter of 83 to 105 m and undergoes rapid mitotic division to reach the next stage of approximately 16 cells called a morula. The cells of the zygote and early cleavage embryo are considered totipotent
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Title: The lucky little stiff
Author: H. P. S. Greene
Release date: April 28, 2024 [eBook #73484]
Language: English
Original publication: United States: The Butterick Publishing Company, 1927
Credits: Roger Frank and Sue Clark *** START OF THE PROJECT GUTENBERG EBOOK THE LUCKY LITTLE STIFF ***
Anairpilotandthefieldofbrokenwings
THE LUCKY LITTLE STIFF
By H. P. S. Greene
France. Mud. A khaki-clad column of fours slogging along to the rhythm of their own muttered but heart-felt blasphemy a common enough sight in the winter of 1917-1918.
But in one particular this procession of sufferers was unique. On the shoulders of each performer shone bright silver bars, and their more or less manly chests were spanned by Sam Browne belts. A casual observer would have taken them for officers. But no, on each breast was a pair of silver wings, and their uniforms were of wellfitting but variously designed whipcord. The pot-bellied little person in the indecently short yellow serge blouse who led them was an officer; his followers were flying lieutenants.
They were a part of the personnel-in-training of the great American aviation field of Issy-la-Boue, the advance guard of the ten thousand American bombing planes which publicity agents said were going to blast the Huns out of Berlin.
The column passed between two long barracks, one of which, filled to capacity with double-decker bunks, yawned thru an unfinished open end.
“Squads right!” shrilled the pot-bellied one with the captain’s bars in a startling tremolo. “Heh!”
The men behind squads-righted in a dispirited fashion and came to a halt in straggling lines. The squawky voice continued:
“I want to say that you are the most undisciplined body of men I ever saw. That—er—mélée you staged when you were unwittingly marched into—er—contact with a body of enlisted men was the most disgraceful exhibition on the part of officers so-called I ever saw in my life. I—er want to say you are a disgrace to the service. That’s all I want to say. Oh, I—er—believe Lieutenant Crosby has something to say to you.”
Flying-Lieutenant Crosby stepped forward and cleared his throat. He was a born Babbitt, a destined getter-together.
“Men,” he began, and then hesitated. Perhaps he should have said “officers,” but that wouldn’t have sounded right either. He rushed on, “I want to remind you that Happy’s and Sam’s funeral is this afternoon. All flying is called off as usual. There wasn’t much of a crowd out for poor old Bill yesterday. I know it’s a long walk and all that but we want to get a good crowd out this afternoon. The cadets are going to try to get a good crowd out for their fellow who got bumped, and we want to get a good crowd out too. That’s all I wanted to say.”
He retired to the ranks. The fat officer shouted “Dismissed!” Then he changed his mind.
“As you were. The commanding officer wanted me to announce that quarantine to the post is on again until the perpetrator of the outrage of stopping the Paris Express has been discovered and punished. Dismissed!”
The half-broken ranks scattered in the direction of their barracks. Toward the one with the unfinished end went three oddly dissimilar figures. They were always together, and of course some one had already thought of calling them “The Three Musketeers.”
One was short, dark and slim, with pathetic eyes and a dispirited mustache. Another was tall and lathy, with a long lugubrious countenance. The third was blond and almost corpulent.
“I knew it, Tommy, I knew it,” said the tall man. “How come you and ‘Fat’ to pull such a stunt, anyway? Ain’t such a joke now, is it?
What’re you going to do about it?”
The three entered their barrack and sat down on a bunk near the open end, well away from the crowd huddled around the stove in the middle. The little man gazed sadly before him.
His mustache drooped dolefully. Some observant person had remarked that he could read Tommy by his mustache. When it was freshly waxed and pert, he was just going on a party. When it was sorry and unkempt, he had just been on one.
“You know we didn’t mean any harm,” he said. “All that stuff the frogs put out about our trying to wreck the train was a dish of prunes. As if it wasn’t bad enough to miss the truck and walk out here twelve miles from town without having all this on top of it. When the quarantine for the itch was taken off, and Fat and I got those “thirty-six hours on condition you don’t go to Paris” passes, we got by the M. P.’s at the garein Paris all right.
“We went out through the baggage-room. I wasn’t in the Ambulance for nothing. We came back into the station the same way, and once we got on the train we went right to sleep. They sure do put up a good champagne cocktail at Henry’s, and then all those beers at the Follies!
“Well, when I woke up we were at a station. I looked out and the sign on it said Chateauroux. I knew where we were all right because I’ve flown over the place. We’d passed Issy. So I woke Fat up and pulled him off the train. There was another train standing in the station, and I asked a frog where it went to and he said it was the Paris Express. So I knew it would take us back to Issy again, and we hopped on.
“We got into a third class compartment with a lot of poilus, and they had beaucoup red wine, and we drank to la belle France, and les-Êtats-Unis, and when I woke up again the train was just leaving a station, and the sign said Issy-la-Boue. By the time I realized what it all meant we were going too fast to jump off, so I pulled that handle on the wall, and the train stopped.
“When we saw how wrought up the frogs were, we beat it. No wonder we had to come over and help them win the war, if they’re
all as bum shots as those birds were! Guess they thought we were bandits or spies or something. Well, we had to walk home to keep from being A. W. O. Loose from roll-call this morning, and never got home till four o’clock. Suppose after flying, I’ll have to go over and ’fess up to Herman, or you birds will never get any more passes. But I know I’ll never get one if I stay here for the duration of the war.”
“No pass ain’t nothin’ to what you’ll get, boy!” said “Long John.”
“Shot at sunrise, is my bet. But I admire your self-sacrificin’ spirit.”
“Never mind, we’ll take our medicine, won’t we, Fat? And if I don’t mention you, maybe he won’t say anything about it.”
Fat grunted dolefully. Outside a bugle blew. The three rose to go.
“It’s me and Tommy to fly the eighteen meters,” said Long John. “Where do you go, Fat?”
“Machine-gun,” was the answer.
“Hum, too bad. I heard the guy they shot there last week croaked. The bullet went right thru his leg, and the quack dressed the place where it went in all right, but forgot to see if it came out. Gangrene set in and his leg rotted off, and they had to shoot him. Now a feller your build— say, it wouldn’t go through at all. Just stay there and fester—”
But his victim was gone.
Tommy flew badly that morning. He was all in, his head ached and, besides, he was worrying about that interview with Major Herman Krause. And then he had to practise landings—nervous work at best in an unfamiliar ship. Finally he blew a tire and was bawled out unmercifully by the instructor.
Luckily it was on his tenth and last trip, and he breathed a sigh of relief when the lecture was over and he could go. He went to the barracks and policed up. Shave, shine, but no shampoo. There was hardly enough water for drinking and shaving, and that was brought many miles in tank wagons. Bathing was something one went without at Issy and felt not much the worse unless the scabbies set in.
Once militarily clean, Tommy dragged himself to headquarters, entirely ruining the new shine so painfully acquired. He entered the presence of the adjutant feeling like a whipped schoolboy. He saluted and stood at attention.
“Sir, Lieutenant Lang to speak to the commanding officer.”
The adjutant kept on writing for about five minutes at a desk stacked with piles of reports. Then he looked up savagely and spoke with a slight accent:
“What? Oh, yes. What for?”
“About the Paris Express.”
“Go right in. He’s waiting.”
Tommy went in and stood with trembling knees before the C. O. He was a large florid man with beetling brows and his manner was not encouraging.
“You? Well? What about it?”
Tommy explained as well as he could, stressing his innocence. He thought his plea must have softened an executioner, but Major Krause was uncompromising in attitude and words.
“Young man,” he said, “you are a disgrace, sir! A disgrace to the United States Army!” Tommy thought he had heard those words before. “We have been having considerable trouble with the guard. Those cadets are the worst disciplined body of men I ever saw.”
Again a familiar note.
“As for you—you seem to have trouble keeping awake. A permanent assignment as commander of the guard ought to give you beneficial practise at it. Of course, after keeping awake all night, you will need to sleep in the day-time. You are therefore relieved from flying duty. Report at guard mount this evening and every evening until further orders. That will do.”
Tommy saluted and went out, his heart sinking. There were only three known ways of getting out of Issy-la-Boue. The first was to break your neck. The second was to fly so well that you were graduated. The third was to fly so poorly that you were sent to Blooey for reclassification, probably as an armament officer. Which
was generally considered the lowest form of life so far discovered in the air service.
All these methods were dependent on flying. Once a man was taken off flying duty, it took an act of Congress to get him away from the place.
The little man wended his way back to the barracks. His comrades were sitting on their bunks, and he poured his tale of woe into their receptive ears. Being beyond words, they accorded him silent sympathy. Finally Fat spoke:
“Well, I’m lucky to be out of it. Say, did you hear the news? Brock was washed out on the fifteens this morning.”
“That makes seven in a week,” said Tommy after a pause. “How’d it happen?”
“Same old thing. Wings came off.”
A bugle called. Most of the flying lieutenants went outside and, joining others from near-by barracks, formed in line. A few commands, and they were in one of the rivers of mud which served as roads at the field. Presently they were halted behind three long two-wheeled pushcarts; each cart bore a long box covered with an American flag. The mourners stood in the mud for half an hour waiting, and then a dispirited looking band appeared. Its bass drum echoed boom-boom-boom-boom-boom, and the procession started.
Through the gate of the camp it went, and out on to the main road, while the drum kept up its sad, hollow sound. Yard after yard, rod after rod, until the cortège had walked two miles. Then it turned into a young but flourishing cemetery, with red, raw mounds in orderly lines.
The men were formed around three fresh graves. A pale-faced Y. M. C. A. man stumbled through the burial service. A red-faced Knight of Columbus did likewise. A Frenchman flew over and dropped some dessicated roses. Then they all marched away again; only the boxes and a small burial party remained behind.
The band struggled with its one tune, a lively quickstep, according to regulations. Two old peasants drew their cart to one side of the road to let them pass.
“Commeilssonttrists,les’titsAmericains!” said the woman.
“Quellemusique!” answered her spouse.
The three chums went back to their bunks.
“Do you birds know anything about being the commander of the guard?” asked Tommy with some concern.
“No,” replied Fat.
“Sure,” answered Long John. “I was chucked out of the first training camp. First, you have to have a gun.”
“A rifle?” asked Tommy.
“No, you little sap. Officers don’t carry rifles, or flying lieutenants either. A pistol.”
“But I ain’t got a pistol.”
“Borrow one then. Do you know the general orders?”
“I don’t know any generals, orders or debility either.”
“Never mind trying to be funny. You may find out it ain’t no joke about generals. The Old Boy himself and the Silly Civilian are going to inspect the post tomorrow. I saw the orders over at the operations office for every machine to be up that can get off the ground. I suppose that means a lot more long walks. But it’s most time for guard mount; you’d better run along and find a gun.”
Tommy disappeared and finally returned with a regulation web belt and holster in one hand, and a .25 caliber automatic in the other.
“What are you going to do with that popgun, you idiot?” asked Long John disgustedly. “Are you going hunting canary birds, or what?”
“I couldn’t find a regular gun, and a cadet loaned me this. He said officers had taken it before and put a dirty sock or something in the holster so the butt would just show, and got by all right.”
“Very well, then, take one of Fat’s socks. The smell may keep you awake. Is the blamed thing loaded? Look out you don’t shoot yourself. There’s the call, now. Put on your belt. You fool! How many belts are you going to wear? What do you think you are, a past
grand master of the Holy Jumpers? Take off your Sam Browne. There—get going, now.
“Well, away he goes, and he doesn’t know whether Julius Cesar was stabbed or shot off horseback. Did you ever see the like, Fat? But I bet he comes out all right some way, the lucky little stiff. I never knew it to fail. Well, let’s go up by the stove.”
But Tommy wasn’t such a complete fool as he appeared. He knew the old Army advice for shavetails, “Find a good sergeant and stick to him.” The sergeant of the guard was a grizzled old sufferer who had been through it all many, many times. He engineered the guard mount and posted the guard. Then Tommy drew him to one side.
“What do I do now, Sergeant?” he asked.
“Well, the lieutenant has to inspect the guard three times, once between midnight and six o’clock in the morning. First ask them for their special orders, and then for their general orders. If they make a mistake, I’ll nudge you and you say, ‘Correct him, Sergeant,’ and I’ll fix him up. It’s getting dark now. Would the Lieutenant like to make his first inspection before supper?”
Inspection was a hectic affair. The guard was composed of cadets who had joined the Army to fly and remained in it to mount guard, and it was their intention to make it as interesting as possible for all concerned, especially their superiors. But the old sergeant was equal to the occasion. He steered Tommy by the traps planted for him, and then showed him the guardhouse.
There the commander of the guard ate his slum and then returned to his barrack. Long John grabbed him by the arm as he entered.
“That frog was around again today, and he brought a lot of stuff,” he whispered. “You’re in on it. Doc is goin’ to make punch. Be around at nine o’clock.”
Tommy was there at the appointed time. At the far end a crowd was gathered. Men were perched as closely as possible on the doubledeck bunks. In their midst Bacchanalian rites were in progress.
“Doc,” a stout man with a red, satyr-like countenance, was beating a huge bowl of eggs. Before him within easy reach and frequently applied, was an assorted row of bottles. Tommy read some of the labels—Cherry Brandy, Martell, D. O. M., Absinthe.
“My God,” he muttered to himself, “everything but nitroglycerine.”
The party was undoubtedly a success. There were songs and dances and stories. Finally it got to the speechmaking stage. An interruption in the form of a volley of shots was welcome to every one except the current performer. A trampling of feet, and then more shots followed. A voice at the other end of the barrack shouted “Attention!” as Major Krause stumbled in. He had evidently been running, but he tried to stalk around in a dignified manner. Somebody whispered—
“Those damn cadets have been shooting off their guns and raising hell again, and he’s been trying to catch them.”
The major approached the end of the barrack where the party had been in progress. He sniffed suspiciously, but the punch-bowl had been shoved under a bunk and the bottles into boots, and there was no evidence in sight. Finally he asked—
“Are there any guns in this barrack?”
“No,” Tommy spoke up. “I know, because I was trying to borrow one this afternoon to mount guard with.”
A partially suppressed titter rose and fell again. The C. O. wheeled around furiously.
“So it’s you again, is it?” he thundered. “Carousing in here while your superiors attend to your duties. Get out to your guard and put a stop to that indiscriminate shooting. I swear if I see you again tonight I’ll prefer charges and have you broke!”
Tommy stumbled out into the darkness and headed in what he thought was the direction of the guardhouse. His head was buzzing painfully. A volley of shots sounded somewhere in front of him. He felt vaguely that he ought to do something about it, and ran in that direction, only to fall over the guy-rope of a hangar and fall heavily. More shots behind him. He got up and staggered on. Suddenly there was a flash and a report right before him. Then a voice yelled—
“Halt.”
“Commander of the guard,” bawled Tommy.
A dark figure loomed up vaguely in the murk. He struck a match and saw a grinning cadet working the bolt of his rifle and waving the muzzle around dangerously. Suddenly it exploded and Tommy felt mud splatter over him.
“I thought I saw something moving and halted it, and it wouldn’t halt, so I fired, but I don’t understand this gun very well, sir,” said the cadet, still working at the bolt.
The commander of the guard turned and fled. He was getting dizzier every minute. Finally he tripped over another guy-rope and fell, to rise no more.
When he woke, it was with the consciousness of having been annoyed for a long time by a rasping noise which was still going on. He tried to pull himself together and think. He could vaguely discern the bulk of a hangar. There was a queer, unexplained rasping. Filed wires—Wings coming off—Funerals—
The noise stopped, and presently a dark figure crept out through the hangar door and started to steal away. Tommy drew the little automatic from its holster and fired. The next thing he realized was that there were flashlights and men everywhere. The sergeant of the guard. Major Krause. Calls for explanation. Tommy tried to explain. A voice said—
“You fool, you’ve shot the adjutant!” Strong hands seized him and hustled him away.
Next morning, when a detail came to the guardhouse, Tommy was still in a daze. The leader told him to police up, as he was to go before the C. O. He was still confused when he was led into the office at headquarters.
The commanding officer was there, and Captain La Croix, the French officer who advised as to instruction. Also a large, fierce man with stars on his shoulders, and a little civilian with glasses and a
trench coat several sizes too large for him. Tommy’s legs seemed to be made of butter.
Major Krause was speaking, and strange to say, his voice was not unkind.
“Lieutenant Lang,” he said, “I revoke everything I said yesterday. You have done a great service for your country. I regret to say that a small file was found on the body of the adjutant, and that some of the ships were found to have been tampered with—so skillfully that detection was very unlikely. Inspection of the adjutant’s papers brought out evidence that he was an Austrian citizen. Tell the general and the secretary how you came to discover what was going on.”
“Well,” blurted Tommy, “it was this way. I was dizzy and fell down two or three times and finally I decided to go to sleep. Then some guy kept making a filing noise and waking me up, so I shot him.”
That evening three flying lieutenants were finishing an illicit meal of chicken and champagne at a little French inn about three miles from the field, and the smallest of the trio was finishing a story.
“There was a long argument,” he said, “and the general and the major were all for preferring charges, but Captain La Croix stood up for me and said I was a good pilot, and finally they agreed to let him get me transferred to a French observation squadron at the front.”
The tall man and the fat one looked at each other and at their little companion. Then they ejaculated as one—
“You lucky little stiff!”
THE END
Transcriber’s Note: This story appeared in the October 1, 1927 issue of Adventure magazine.
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