87

H—3l

Stage at which death of infant occurred: Ante-partum, 111 cases —i.e., 37 per cent.; intrapartum, 83, 27-6 per cent. ; post-partum, 106, 35-3 per cent. It is to be noted that the deaths are fairly evenly distributed in the three groups. Condition of foetus : Fresh, 120 cases—i.e., 62 per cent. ; macerated, 67, 34-4 per cent. ; not stated, 7, 3-6 per cent. The proportion of macerated bodies is fairly high (34-4 per cent.). Eardley Holland amongst 1,408 cases found 298 macerated (21 per cent.). Future advances in ante-natal treatment might eliminate some of these cases. Effect of the course of labour on the foetus : Injurious, 110_ cases —i.e., 36-6 per cent. ; noninjurious, 146, 48-6 per cent. ; not stated, 44, 14-6 per cent. Among the principal causes of increased risk were : Prolonged labour, 23 cases ; breech presentation, 15 ; instrumental labour, 12; disproportion, 8; version, placenta prsevia, twins, &c., 7. In this group improved treatment may be expected to reduce the fatalities. Condition of child at birth : Asphyxiated, 73 cases—i.e., 24-3 per cent. ; non-asphyxiated, 119, 39-6 per cent. ; not stated, 108, 36 per cent. The seventy-three cases of asphyxia included fifteen cases of " asphyxia pallida " which is now recognized to be a condition of " shock." Method of resuscitation adopted : This question was framed to elicit any increased risk to the child. The replies were few, and did not give the information soxight. Presence of congenital defects : Present in 37 cases —i.e., 12-3 per cent. ; absent in 246, 82 per cent. ; not stated, 17, 5'6 per cent. The principal defects noted were : Anencephaly, 7 cases ; deformity of limbs, &c., 6 ; congenital deformity or disease of heart, spina bifida, hydrocephalus of each, 5 ; monstrosity (not further defined), 3. The prevalence of anencephaly among the defects is notable—viz., seven cases out of thirty-seven, forming 18-9 per cent, of the defects and responsible for seven of 300 deaths —i.e., 2-6 per cent. Eardley Holland noted thirty-nine cases of anencephaly in 1,673 deaths (or 2-34 per cent.) and thirty-nine cases of anencephaly in 138 cases of deformity (or 28-2 per cent.). Malcolm Eraser has shown that " early infancy " and " malformations " are the cause of 97 per cent, of the deaths occurring on the first day, of 92 per cent, of those occurring in the first week, and of 87 per cent, of those occurring in the first month. As deaths from other causes are eliminated, those due to malformations become of increasing importance and prominence. Among deaths due to malformations, anencephaly, as we see, holds a leading place. Can this mortality, which amounts to about 2J per cent, of all cases of still-birth and neo-natal deaths be reduced ? The origin of this condition is still obscure, but in many cases it has been noted that there is an absence of or great diminution in the size of the suprarenal glands. The following statement from Langdon Brown's " Endocrines in General Medicine " has an important bearing on this point : " The adrenals are of double origin, the cortex developing from the Wolffian body while the medulla arises from the sympathetic nervous system. Swale Vincent has shown that in fishes these two parts form separate structures, the cortex being respresented by a median inter-renal body, the medulla by the chromaffin bodies or paired supra-renals. Higher in the vertebrate scale these two come together, and, if this fails to occur, the central nervous system fails to develop beyond the fish stage resulting in anencephaly." This research of Swale Vincent's pushes the query a stage further back, but does not explain why the failure in fusion should occur. Existence of placental or umbilical abnormalities : Present in 60 cases —i.e., 20 per cent. ; absent in 222, 74 per cent. ; not stated, 18, 6 per cent. The abnormalities described were : In twelve cases, unhealthy; in ten cases, placenta prasvia ; and, in seven cases, infarcts, &c. Ten cases of abnormalities of the cord included four in which it was round the neck. Existence of neo-natal disease which may have caused death : Present in 22 cases, absent in 84. Among neo-natal conditions may be noted : Heemorrhagic disease of the new-born, 6 cases ; pyrexial conditions (influenza, &c.), 5; broncho-pneumonia, 2; inanition, haemophilia, intestinal obstruction of each, 1. Among these the first place is taken by hsemorrhagic disease of the new-born. It is interesting to note in this connection that Collip (quoted by Langdon Brown) isolated from the parathyroid an active hormone which, if given to excess, led to heematemesis and mehena. PART lI.—DYSENTERY IN AUCKLAND AND SOUTH AUCKLAND HEALTH DISTRICTS. Towards the end of January, 1929, cases of dysentery began to be reported in the Auckland Central Health District. The first three cases were reported from Auckland City on the 23rd January, 1929. These three were Maori cases. A definite bacteriological diagnosis as to the " type "of infective organism was not arrived at for some time, as the early cases gave negative results. About the middle of February, however, it was definitely determined that the causative organism was the Shiga bacillus. For a time the outbreak remained localized to the city area of the Auckland Central Health District. By the 23rd February, however, cases began to be notified from the outer area of this health district. Almost exactly a month later (23rd March) the outbreak had spread farther south and invaded the northern part of the South Auckland Health District.