- Email: [email protected]
The late results of meningeal hemorrhage of the newborn
146
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
Cameron, Hector Charles and Osman, A. A.: The Late Hemorrhage of the Newborn. British Medical Journal, 3244,
GYNECOLOGY
Results March
of MeningeaJ 3,
1923,
No.
p. 363.
There is general agreement that mcningeal hemorrhage is by far the most common cause of death in fresh nonmacerated fetuses and in infants dying shortly after the conclusion of labor. It is impossible not to conclude with Osler, that many, and perhaps the larger number, escape with their lives but suffer perma. nent damage in varying degree. There are, however, difficulties in the way of unqualified acceptance of the view that in the numerous cases of cerebral diplegin which present themselves later in life, we are encountering the aftermath of this da.mage at the moment of birth. Apart from meningeal hemorrhage two other views have been held of the origin of cerebral diplegia dating from birth. Some writers regard the majority of cases as due to infective meningoencephalitis, intranatal or neonatal. To assess the part played by developmental dcfcct in the production of cerebral paraplegia and diplogia is cvcn more difficult. The authors wish to stress the high dcgrcc of mental development which many of these children damaged at birth ultimately achieve, however great the delay in acquiring certain functions may be in infancy and early childhood. After recovery from the initial shock of the hemorrhage it is clear that, as a rule, a period of latency follows which lasts for many months. A consideration of the order in which the different parts of the brain are developed explains the length of the interval which usually intcrvencs between birth, when the damage is sustained, and the time when the child is brought to the doctor and complaint is made of failure to grasp, to sit, to walk, or to speak. of some thirty of these cases, of all ages A long and close sttrdy of a group from earliest’ infancy to adolescence, has convinced the writers that they differ unmistakably from cases of primary mental defect with spasticity due to developmental causes. Among cases of infantile diplegia or paraplegia it is possible to recognize a group in which the defect is confined to the sensorimotor cortical areas. Probably all cases in this group arc due to birth injury, although all cases of birth injury may not belong to the group. Since education at first proceeds almost entirely by sensorimotor paths there is in early childhood a deceptive appearance of gross mental defect. In later childhood progress may be rapid and recovery almost complete. The difficulty is overeome by the remarkable persistence in effort which is characteristic of most of these children. Even when voluntary movements remain stiff and awkward the child may be a quick learner by eye and ear. Incoordination may remain F. L. ADAIR. though character and intelligence may be on a high plane.
Intranatal, and Neonatal, Death: Gauss, PatholBallantyne, J. W.: Antenatal, ogy, and Prevention, with Special Reference to Antenatal Death. British Medical
Journal,
September
30, 192d,
No.
3222,
p. 583.
The author reviews investigations and work done relative to stillbirths. He thinks the following statements may be assumed to be fairly accurate: (1) That there is a great loss of life in the form of stillbirths, the large proportion being due to venereal maladies. (2) There is a great gain in preventing these stillbirths by antenatal supervision and treatment even in the worst group of cases, namely, the venereal infection. (3) That the vast number of stillbirths are preventable. The general conclusion of the whole matter seems to bo that whilst much remains to be done in the study of the causes and pathology and pathogenesis of
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
Cameron, Hector Charles and Osman, A. A.: The Late Hemorrhage of the Newborn. British Medical Journal, 3244,
GYNECOLOGY
Results March
of MeningeaJ 3,
1923,
No.
p. 363.
There is general agreement that mcningeal hemorrhage is by far the most common cause of death in fresh nonmacerated fetuses and in infants dying shortly after the conclusion of labor. It is impossible not to conclude with Osler, that many, and perhaps the larger number, escape with their lives but suffer perma. nent damage in varying degree. There are, however, difficulties in the way of unqualified acceptance of the view that in the numerous cases of cerebral diplegin which present themselves later in life, we are encountering the aftermath of this da.mage at the moment of birth. Apart from meningeal hemorrhage two other views have been held of the origin of cerebral diplegia dating from birth. Some writers regard the majority of cases as due to infective meningoencephalitis, intranatal or neonatal. To assess the part played by developmental dcfcct in the production of cerebral paraplegia and diplogia is cvcn more difficult. The authors wish to stress the high dcgrcc of mental development which many of these children damaged at birth ultimately achieve, however great the delay in acquiring certain functions may be in infancy and early childhood. After recovery from the initial shock of the hemorrhage it is clear that, as a rule, a period of latency follows which lasts for many months. A consideration of the order in which the different parts of the brain are developed explains the length of the interval which usually intcrvencs between birth, when the damage is sustained, and the time when the child is brought to the doctor and complaint is made of failure to grasp, to sit, to walk, or to speak. of some thirty of these cases, of all ages A long and close sttrdy of a group from earliest’ infancy to adolescence, has convinced the writers that they differ unmistakably from cases of primary mental defect with spasticity due to developmental causes. Among cases of infantile diplegia or paraplegia it is possible to recognize a group in which the defect is confined to the sensorimotor cortical areas. Probably all cases in this group arc due to birth injury, although all cases of birth injury may not belong to the group. Since education at first proceeds almost entirely by sensorimotor paths there is in early childhood a deceptive appearance of gross mental defect. In later childhood progress may be rapid and recovery almost complete. The difficulty is overeome by the remarkable persistence in effort which is characteristic of most of these children. Even when voluntary movements remain stiff and awkward the child may be a quick learner by eye and ear. Incoordination may remain F. L. ADAIR. though character and intelligence may be on a high plane.
Intranatal, and Neonatal, Death: Gauss, PatholBallantyne, J. W.: Antenatal, ogy, and Prevention, with Special Reference to Antenatal Death. British Medical
Journal,
September
30, 192d,
No.
3222,
p. 583.
The author reviews investigations and work done relative to stillbirths. He thinks the following statements may be assumed to be fairly accurate: (1) That there is a great loss of life in the form of stillbirths, the large proportion being due to venereal maladies. (2) There is a great gain in preventing these stillbirths by antenatal supervision and treatment even in the worst group of cases, namely, the venereal infection. (3) That the vast number of stillbirths are preventable. The general conclusion of the whole matter seems to bo that whilst much remains to be done in the study of the causes and pathology and pathogenesis of