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STREET MARKETS
746 URINARY TRACT CHANGES IN PREGNANCY AND PUERPERIUM
NUMEROUS recent studies have demonstrated the anatomical changes which normally and abnormally occur in the urinary tract in pregnancy and the puerperium. Most of these examinations were carried out on post-mortem material or on the living subject by means of retrograde pyelography. The more recent introduction of intravenous pyelography has opened up a new method of approach to a difficult subject. William F. Mengert and Harry P. Lee1 have lately used the method on 41 pregnant women, In order to 20 primiparee and 21 multiparse. establish an index of the amount and frequency of urinary tract dilatations, and as a basis for judging postpartum changes, the first radiograms were made during late pregnancy, and further exposures, usually three or four, were obtained during the fortnight following delivery. Stereoradiograms were taken in all cases, lest a single film, if it happened to be taken
canaries, geese, rabbits, guinea-pigs, and tortoises sold side by side with foodstuffs. The traders pay little attention to the disposal of the refuse ; at the end of the day shells, fish scales, feathers, decayed oranges, cabbage leaves, and wilted flowers are
scattered over the roadway, eluding the provision by the borough council of receptacles for their storage. Nutrient agar plates exposed in several street markets grew colon bacilli and coarse streptococci of the salivarius and faecalis types in addition to the moulds and saprophytes of quieter streets. Remedies are hard to apply in the face of the conservatism of Bethnal Green people. The vested interests of the market monopolies unfortunately prevented the use are
of Columbia market for the purpose for which the late Baroness Bilrdett-Coutts, with tremendous generosity, intended it. Councillor Bennett suggests that the stalls selling the more easily contaminated foodstuffs should be placed on a special site. Certainly every stall in the markets should be screened, and any on which foodstuffs are exposed should during a peristaltic contraction, might not represent be completely enclosed, however much this may the true size of the ureter. The antepartum pictures conflict with the conservatism of the public and with the wishes of the traders themselves. were taken from 1 to 65 days before the onset of labour. In all the primiparse dilatation of some degree was present on tne ngnt side in calyces, pelvis, and ureter ; on the left side it was found in about 90 per cent. THE CHILDREN OF MENTAL DEFECTIVES of the cases. Dilatation of marked degree was SPECIFIC information about the mental state of three or four times as frequent on the right side as of mentally defectives is timely. The figures families on the left, and it was encountered more often in in of the special school afterthe annual given primiparae than in multipare. As to postpartum care subcommittee report of Birmingham concerning the involution of the urinary tract, in eight cases a marked reduction in the extent of the dilatation was offspring of ex-pupils of the special schools are observed within 24 hours, while in 9 to 11days after as follows : 1183 children were born into 602 families. In 312 of these families the father was an ex-pupil delivery all dilatation had disappeared in the majority and in 290 the mother, the latter group including of the normal patients examined. The involution of 38 born children to defective mothers ; illegitimate the urinary tract was, on the whole, slower in primi101 of the children are dead and many are under and in was the parse ; presence noticeably slower, too, of infection. It is suggested that this delayed involu- 5 years of age and thus did not come under observation may be a factor in the development of postpartum tion ; of the 494 children over 5 years old who had 16 are definitely mentally one defective parent pyelitis. This assumption is not unreasonable in defective-i.e., 3’24 This figure, however, per <’(nt. view of the important part played by dilatation of under the true proportion of estimates the ureter in predisposing a patient to antepartum certainly since defective children, systematic examinations for pyelitis. It is probably true that antepartum pyelitis the admission of children to special schools do would never occur if the ureters were normal. Why of not 7 or 8. It would be until the ages begin they should become so often dilated during pregnancy is still a controversial question, and even more perhaps valuable to ascertain the number of children above 8 years of age, and also the number who are not why the dilatation should be more frequent on the elementary schools. But even if every attending right side than on the left. allowance is made for cases not ascertained, it seems improbable that the numbers would be swelled to as much as double the figures given, and if this should STREET MARKETS to be a fair deduction the proportion of IN the wide spaces of the country town market prove defective children in this group would not mentally day with its bustle and spirit of holiday is a pleasant exceed 5 per cent. This does not, of course, preclude sight ; in the narrow crowded streets of the metro- the possibility that some of the children may be polis certain disadvantages intrude upon the notice. "carriers" of defect, and that a larger proportion The street markets of the East End have been likened of the grandchildren of the ex-pupils would be to Oriental bazaars where the merchants expose for defective. But as far as they go the figures from sale in the open anything from carpets to dates Birmingham suggest that the prevention of propagaand drinking water. Councillor C. Bennett, at the tion by defectives would not seriously reduce the recent Belfast Congress of the Royal Institute of number of the mentally defective in the next Public Health, described the Bethnal Green Sunday The subcommittee hold that the evidence morning " junk " market as providing a feast of generation. so far collected tends to disprove the popular idea for horrors the conscientious sanitarian. Old that the mentally defective are abnormally prolific. mattresses and furniture are interspersed with secondA very different picture however is given by Dr. A. G. hand (or worse) clothing ; boot stalls are side by side of 84 mental defectives published Morison in a with barrows where apple fritters are being cooked in our issuestudy of Sept. 10th (p. 589). Of these in the open ; slices of tinned pineapple, cakes, sweets, children 23 belong to lower grades and 61 to higher even sliced melon and cut oranges are exposed for of defectiveness. Of the 23 lower-grade sale alongside old hot-water bottles and gum boots. grades children 5 had parents, one of whom was feebleIn one of the markets live-stock such as pigeons, minded ; of the 61 higher-grade children 15 had parents, one or both of whom were feeble-minded. 1 Amer. Jour. Obst. and Gynec., August, 1932
NUMEROUS recent studies have demonstrated the anatomical changes which normally and abnormally occur in the urinary tract in pregnancy and the puerperium. Most of these examinations were carried out on post-mortem material or on the living subject by means of retrograde pyelography. The more recent introduction of intravenous pyelography has opened up a new method of approach to a difficult subject. William F. Mengert and Harry P. Lee1 have lately used the method on 41 pregnant women, In order to 20 primiparee and 21 multiparse. establish an index of the amount and frequency of urinary tract dilatations, and as a basis for judging postpartum changes, the first radiograms were made during late pregnancy, and further exposures, usually three or four, were obtained during the fortnight following delivery. Stereoradiograms were taken in all cases, lest a single film, if it happened to be taken
canaries, geese, rabbits, guinea-pigs, and tortoises sold side by side with foodstuffs. The traders pay little attention to the disposal of the refuse ; at the end of the day shells, fish scales, feathers, decayed oranges, cabbage leaves, and wilted flowers are
scattered over the roadway, eluding the provision by the borough council of receptacles for their storage. Nutrient agar plates exposed in several street markets grew colon bacilli and coarse streptococci of the salivarius and faecalis types in addition to the moulds and saprophytes of quieter streets. Remedies are hard to apply in the face of the conservatism of Bethnal Green people. The vested interests of the market monopolies unfortunately prevented the use are
of Columbia market for the purpose for which the late Baroness Bilrdett-Coutts, with tremendous generosity, intended it. Councillor Bennett suggests that the stalls selling the more easily contaminated foodstuffs should be placed on a special site. Certainly every stall in the markets should be screened, and any on which foodstuffs are exposed should during a peristaltic contraction, might not represent be completely enclosed, however much this may the true size of the ureter. The antepartum pictures conflict with the conservatism of the public and with the wishes of the traders themselves. were taken from 1 to 65 days before the onset of labour. In all the primiparse dilatation of some degree was present on tne ngnt side in calyces, pelvis, and ureter ; on the left side it was found in about 90 per cent. THE CHILDREN OF MENTAL DEFECTIVES of the cases. Dilatation of marked degree was SPECIFIC information about the mental state of three or four times as frequent on the right side as of mentally defectives is timely. The figures families on the left, and it was encountered more often in in of the special school afterthe annual given primiparae than in multipare. As to postpartum care subcommittee report of Birmingham concerning the involution of the urinary tract, in eight cases a marked reduction in the extent of the dilatation was offspring of ex-pupils of the special schools are observed within 24 hours, while in 9 to 11days after as follows : 1183 children were born into 602 families. In 312 of these families the father was an ex-pupil delivery all dilatation had disappeared in the majority and in 290 the mother, the latter group including of the normal patients examined. The involution of 38 born children to defective mothers ; illegitimate the urinary tract was, on the whole, slower in primi101 of the children are dead and many are under and in was the parse ; presence noticeably slower, too, of infection. It is suggested that this delayed involu- 5 years of age and thus did not come under observation may be a factor in the development of postpartum tion ; of the 494 children over 5 years old who had 16 are definitely mentally one defective parent pyelitis. This assumption is not unreasonable in defective-i.e., 3’24 This figure, however, per <’(nt. view of the important part played by dilatation of under the true proportion of estimates the ureter in predisposing a patient to antepartum certainly since defective children, systematic examinations for pyelitis. It is probably true that antepartum pyelitis the admission of children to special schools do would never occur if the ureters were normal. Why of not 7 or 8. It would be until the ages begin they should become so often dilated during pregnancy is still a controversial question, and even more perhaps valuable to ascertain the number of children above 8 years of age, and also the number who are not why the dilatation should be more frequent on the elementary schools. But even if every attending right side than on the left. allowance is made for cases not ascertained, it seems improbable that the numbers would be swelled to as much as double the figures given, and if this should STREET MARKETS to be a fair deduction the proportion of IN the wide spaces of the country town market prove defective children in this group would not mentally day with its bustle and spirit of holiday is a pleasant exceed 5 per cent. This does not, of course, preclude sight ; in the narrow crowded streets of the metro- the possibility that some of the children may be polis certain disadvantages intrude upon the notice. "carriers" of defect, and that a larger proportion The street markets of the East End have been likened of the grandchildren of the ex-pupils would be to Oriental bazaars where the merchants expose for defective. But as far as they go the figures from sale in the open anything from carpets to dates Birmingham suggest that the prevention of propagaand drinking water. Councillor C. Bennett, at the tion by defectives would not seriously reduce the recent Belfast Congress of the Royal Institute of number of the mentally defective in the next Public Health, described the Bethnal Green Sunday The subcommittee hold that the evidence morning " junk " market as providing a feast of generation. so far collected tends to disprove the popular idea for horrors the conscientious sanitarian. Old that the mentally defective are abnormally prolific. mattresses and furniture are interspersed with secondA very different picture however is given by Dr. A. G. hand (or worse) clothing ; boot stalls are side by side of 84 mental defectives published Morison in a with barrows where apple fritters are being cooked in our issuestudy of Sept. 10th (p. 589). Of these in the open ; slices of tinned pineapple, cakes, sweets, children 23 belong to lower grades and 61 to higher even sliced melon and cut oranges are exposed for of defectiveness. Of the 23 lower-grade sale alongside old hot-water bottles and gum boots. grades children 5 had parents, one of whom was feebleIn one of the markets live-stock such as pigeons, minded ; of the 61 higher-grade children 15 had parents, one or both of whom were feeble-minded. 1 Amer. Jour. Obst. and Gynec., August, 1932