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Still-birth and neo-natal death in India
244:
PUBLIC HEALTH.
consequentlyresults were only partly successful. Dental caries is shown to be the most Coinmon ailment o.fthe school-child, and next in importance comes hook-worm disease. School clinics were maintained for the Colombo schools in the eye hospital, the dental institute and the anti-tuberculosis institute. The report is well illustrated with charts and plans, and deals with a great variety of matters, but from the view of public health as appreciated in this country, sanitary efforts do not, relatively to curative work, a p p e a r to hold the position which the public have the right to demand. Congratulations are, however, offered to Dr. Bridger on the excellent record he shows as the result of his administratio.n, and, fully appreciating the difficulties in dealing with sanitary matters in tropical colonies, no surprise will be expressed that tt?e progress shown is not more marked.
Still-Birth and Neo-Natal Death in India. N D E R this title, the Countess of U Dufferin's F u n d Council has published a report* of an interesting piece of research carried out, under the auspices of the L a d y Irwin R e s e a r c h Fund, as part of the wider investigation into. maternal and infantile mortality in 'India, which is no.w in progress. Dr. Christine Thomson, a member of the Durham County Council medical staff, who was released from her duties for the purpose of this research, began her enquiries "in 1929 at the. Gaffikin Institute, Bombay, whence they were extended to Madras, Calcutta and Delhi, taking fourteen months to complete. The report falls mainly into two parts. The first and larger part deals with a series of 200 cases o.f neo-natal death or still-birth in which tl~e body was subjected to a full pathological examination, and an inquiry made into all the circumstances--social, econc~mic and medical--relating to. the case. The various factors invol'eed--contracted pelvis, syphilis, a n m m i a , placental disease, etc.--are consideyed in separate chapters, their effects summarised, and the findings compared with. those of ott~er workers. ~The second part of the report deals with the-_information, obtained from replies to a questionnaire isued to all thewomen'shospitals administered through the Fund, a n d to a "g I_.~ndor£: H. K. Lewis & Co., Ltd., 1981. pp. 16g. Pried ls. 6dl. net.
MAY,
number of government and missionary hospitals throughout the whole of India. Specific information was asked for in regard to all still-births and neo-natal deaths occurring in the hospitals d u r i n g 1929, and 3,517 cases were reported upon. The figures so obtained are compared with the results of the 200 postmortem examinations and with those published elsewhere. A full appendix gives details of individual districts a n d cases. The difficulties in the way of obtaining exact and comparable data for an enquiry o.f this kind 'in India can be easily imagined, and Dr. Thomson herself points out that the ~ findings of her report are to be taken as suggestions for further work along particular lines rather than as scientific deductions. This, however, will not lessen the interest of this enquiry to readers who know the dire effect of stilI-birth and rico-natal death on the_infantile mortality rates of all countries, the ignorance that exists as to its causes, and the failure that has so far met all attempts to cope with it. Complications of labour accounted for 19"5 per cent. of the deaths in the post-mortem series o.f cases. This is lower than the average for Great Britain, but the evidence of the questionnaire yielded percentages of 80 in Madras, and of 50 to. 60 in the Northern cities where osteomalacia comes into play. Antepartum haemorrhage occurred in connection with 13"5 per cent. of the post-mortem cases, and for the whole of India appeared to be rather less prevalent than in this country. W h e n present, it tended, as here, to prematurity, still-birth or neo-natal death, tn connection with the toxmmias of pregnancy, which caused death in 18"5 per cent. ~f the post-mortem cases, and for all India seemed of the same prevalence as in Great Britain, certain .differences were found according to season., geographical distribution, and community. It appeared that eclampsig:~g{s-ten times commoner in Calcutta than in Bombay, and that Mohammedan mothers suffered from it more than Hindu-mothers, the latter difference once more raising the question of meat and vegetarian diet in relation _ta-its causation. SCphilis has been supposed to. be very common in India, but this enquiry suggests some exaggeration in these fears, t h e percentage of definitely syphilitic fcetuses being 14"5, w i t h ' a n o t h e r possible four per cent. Anmmia of pregnancy has also been said to. cause much fmtal death :in India,
1931.
PUBLIC HEALTH.
but it accounted for the death of the baby in only two per cent. of tile post-mortem cases, and, although an important cause of maternal death in the general cases, did not appear to influence the foetus to the extent expected from other observations. It is pointed out, however, that this form of anmmia is more common a m o n g the better classes, and that these scarcely came under review in the enquiry. Tropical diseases generally, in the mother, caused death in 10'5 per cent. of the foetuses examined. Disease of the placenta caused death in 5'5 per cent. Of the cases, and in all led " to prematurity. Prematurity itself seemed to rank higher in India as a cause of neo-natal death than in this country. As a result of her work Dr. Thomson makes certain recommendations, among them the following : - 1.--Better teaching in the schools and colleges of India as to the causes of still-birth and rico-natal death, and better medical staffing and equipment for the maternity hospitals in order that neo-n.atal conditions can be dealt with more efficiently. 2.--Research into, among other things, the relation between poverty and malnutrition and the condition of the Indian child at birth; the relation of tropical diseases to neo-natal deatll ; the geographical distribution of eclampsia with a view to obtaining more knowledge of its causation; and syphilis in regard to iG true incidence. It is to be hoped that these recommendations may be followed up and lead to further information on the various points raised in this valuable report.
245
logy, chemistry, entomology, pathology, malaria research, etc. It is obvious that the bulk of the work carried on is in relation to tropical disease, and among the subjects to which special attention was given during the year were tropical typhus, malaria, including mosquito investigations, and leprosy. It would be impossible here to deal at length with the scientific findings, but suffice it to say they are welt laid out and elucidate many important facts. In addition to the work of research, the Institute is the headquarters of departments dealing with food adulteration, water and sewage analysis, biochemical work and medicolegal investigations, while tables of temperature and humidity also find a place in the report. Vaccine lymph is prepared, and it is interesting to note that the methods employed in the Dutch Indies have been adopted and seed lymph was kindly supplied by Dr. Otter. Buffalo lymph is employed for human vaccination, buffaloes being inoculated with calf lymph, which, when necessary, is rejuvenated by passage through rabbits. It is recorded too, that 20,513 fluid ounces of liquid extract of rice potishings were prepared during the year, this being a sufficient supply to meet the demands of the Federated Malay States. The report also contains a wealth of information on other public health matters, and Dr. K i n g s b u r y and his staff are entitled fully to receive the congratulations of their colleagues at home, and the thanks of the very mixed population for whom they labour.
Medical Research in the Far East. P to two or three decades ago, very few 'pe0151e in this country had heard of K u a l a Lumpur, yet at t h e present time it is a fine city of 100,000 "inhabitants with magnificent government buildings, clubs and sportsgrounds, and the headquarters of the Government .of:the Federated Malay States. To readers of PuBLm HEALTH it is perhaps even more interesting to know that it possesses an Institute for Medical Research, well-planned and equipped with a distinguished and en'ergetic staff. The annual report for 1929 is just to hand, and is a most interestin G docurhent. The Institute is under the direction csf Dr. Neave K i n g s b u r y , well known for his work in connection with rabies, and the Institute comprises divisions devoted to bacterio-
U
Public Health in Tanganyika. E S S than fifty years ago so little was of the interior of Africa that it was spoken of as the Dark Continent. Speke, Grant, Livingstone, and other explorers had given us glimpses of its vastness, its rivers, lakes, forests and swamps, its numerous tribes generally at war with one another when not decimated or weakened by disease or by the ravages of slave raiders. In old atlases we find that--" Geographers on Afric's maps Placed elephants to fill up g a p s . "
L known
In comparison with these, the map of Tanganyika Territory which accompanies the
PUBLIC HEALTH.
consequentlyresults were only partly successful. Dental caries is shown to be the most Coinmon ailment o.fthe school-child, and next in importance comes hook-worm disease. School clinics were maintained for the Colombo schools in the eye hospital, the dental institute and the anti-tuberculosis institute. The report is well illustrated with charts and plans, and deals with a great variety of matters, but from the view of public health as appreciated in this country, sanitary efforts do not, relatively to curative work, a p p e a r to hold the position which the public have the right to demand. Congratulations are, however, offered to Dr. Bridger on the excellent record he shows as the result of his administratio.n, and, fully appreciating the difficulties in dealing with sanitary matters in tropical colonies, no surprise will be expressed that tt?e progress shown is not more marked.
Still-Birth and Neo-Natal Death in India. N D E R this title, the Countess of U Dufferin's F u n d Council has published a report* of an interesting piece of research carried out, under the auspices of the L a d y Irwin R e s e a r c h Fund, as part of the wider investigation into. maternal and infantile mortality in 'India, which is no.w in progress. Dr. Christine Thomson, a member of the Durham County Council medical staff, who was released from her duties for the purpose of this research, began her enquiries "in 1929 at the. Gaffikin Institute, Bombay, whence they were extended to Madras, Calcutta and Delhi, taking fourteen months to complete. The report falls mainly into two parts. The first and larger part deals with a series of 200 cases o.f neo-natal death or still-birth in which tl~e body was subjected to a full pathological examination, and an inquiry made into all the circumstances--social, econc~mic and medical--relating to. the case. The various factors invol'eed--contracted pelvis, syphilis, a n m m i a , placental disease, etc.--are consideyed in separate chapters, their effects summarised, and the findings compared with. those of ott~er workers. ~The second part of the report deals with the-_information, obtained from replies to a questionnaire isued to all thewomen'shospitals administered through the Fund, a n d to a "g I_.~ndor£: H. K. Lewis & Co., Ltd., 1981. pp. 16g. Pried ls. 6dl. net.
MAY,
number of government and missionary hospitals throughout the whole of India. Specific information was asked for in regard to all still-births and neo-natal deaths occurring in the hospitals d u r i n g 1929, and 3,517 cases were reported upon. The figures so obtained are compared with the results of the 200 postmortem examinations and with those published elsewhere. A full appendix gives details of individual districts a n d cases. The difficulties in the way of obtaining exact and comparable data for an enquiry o.f this kind 'in India can be easily imagined, and Dr. Thomson herself points out that the ~ findings of her report are to be taken as suggestions for further work along particular lines rather than as scientific deductions. This, however, will not lessen the interest of this enquiry to readers who know the dire effect of stilI-birth and rico-natal death on the_infantile mortality rates of all countries, the ignorance that exists as to its causes, and the failure that has so far met all attempts to cope with it. Complications of labour accounted for 19"5 per cent. of the deaths in the post-mortem series o.f cases. This is lower than the average for Great Britain, but the evidence of the questionnaire yielded percentages of 80 in Madras, and of 50 to. 60 in the Northern cities where osteomalacia comes into play. Antepartum haemorrhage occurred in connection with 13"5 per cent. of the post-mortem cases, and for the whole of India appeared to be rather less prevalent than in this country. W h e n present, it tended, as here, to prematurity, still-birth or neo-natal death, tn connection with the toxmmias of pregnancy, which caused death in 18"5 per cent. ~f the post-mortem cases, and for all India seemed of the same prevalence as in Great Britain, certain .differences were found according to season., geographical distribution, and community. It appeared that eclampsig:~g{s-ten times commoner in Calcutta than in Bombay, and that Mohammedan mothers suffered from it more than Hindu-mothers, the latter difference once more raising the question of meat and vegetarian diet in relation _ta-its causation. SCphilis has been supposed to. be very common in India, but this enquiry suggests some exaggeration in these fears, t h e percentage of definitely syphilitic fcetuses being 14"5, w i t h ' a n o t h e r possible four per cent. Anmmia of pregnancy has also been said to. cause much fmtal death :in India,
1931.
PUBLIC HEALTH.
but it accounted for the death of the baby in only two per cent. of tile post-mortem cases, and, although an important cause of maternal death in the general cases, did not appear to influence the foetus to the extent expected from other observations. It is pointed out, however, that this form of anmmia is more common a m o n g the better classes, and that these scarcely came under review in the enquiry. Tropical diseases generally, in the mother, caused death in 10'5 per cent. of the foetuses examined. Disease of the placenta caused death in 5'5 per cent. Of the cases, and in all led " to prematurity. Prematurity itself seemed to rank higher in India as a cause of neo-natal death than in this country. As a result of her work Dr. Thomson makes certain recommendations, among them the following : - 1.--Better teaching in the schools and colleges of India as to the causes of still-birth and rico-natal death, and better medical staffing and equipment for the maternity hospitals in order that neo-n.atal conditions can be dealt with more efficiently. 2.--Research into, among other things, the relation between poverty and malnutrition and the condition of the Indian child at birth; the relation of tropical diseases to neo-natal deatll ; the geographical distribution of eclampsia with a view to obtaining more knowledge of its causation; and syphilis in regard to iG true incidence. It is to be hoped that these recommendations may be followed up and lead to further information on the various points raised in this valuable report.
245
logy, chemistry, entomology, pathology, malaria research, etc. It is obvious that the bulk of the work carried on is in relation to tropical disease, and among the subjects to which special attention was given during the year were tropical typhus, malaria, including mosquito investigations, and leprosy. It would be impossible here to deal at length with the scientific findings, but suffice it to say they are welt laid out and elucidate many important facts. In addition to the work of research, the Institute is the headquarters of departments dealing with food adulteration, water and sewage analysis, biochemical work and medicolegal investigations, while tables of temperature and humidity also find a place in the report. Vaccine lymph is prepared, and it is interesting to note that the methods employed in the Dutch Indies have been adopted and seed lymph was kindly supplied by Dr. Otter. Buffalo lymph is employed for human vaccination, buffaloes being inoculated with calf lymph, which, when necessary, is rejuvenated by passage through rabbits. It is recorded too, that 20,513 fluid ounces of liquid extract of rice potishings were prepared during the year, this being a sufficient supply to meet the demands of the Federated Malay States. The report also contains a wealth of information on other public health matters, and Dr. K i n g s b u r y and his staff are entitled fully to receive the congratulations of their colleagues at home, and the thanks of the very mixed population for whom they labour.
Medical Research in the Far East. P to two or three decades ago, very few 'pe0151e in this country had heard of K u a l a Lumpur, yet at t h e present time it is a fine city of 100,000 "inhabitants with magnificent government buildings, clubs and sportsgrounds, and the headquarters of the Government .of:the Federated Malay States. To readers of PuBLm HEALTH it is perhaps even more interesting to know that it possesses an Institute for Medical Research, well-planned and equipped with a distinguished and en'ergetic staff. The annual report for 1929 is just to hand, and is a most interestin G docurhent. The Institute is under the direction csf Dr. Neave K i n g s b u r y , well known for his work in connection with rabies, and the Institute comprises divisions devoted to bacterio-
U
Public Health in Tanganyika. E S S than fifty years ago so little was of the interior of Africa that it was spoken of as the Dark Continent. Speke, Grant, Livingstone, and other explorers had given us glimpses of its vastness, its rivers, lakes, forests and swamps, its numerous tribes generally at war with one another when not decimated or weakened by disease or by the ravages of slave raiders. In old atlases we find that--" Geographers on Afric's maps Placed elephants to fill up g a p s . "
L known
In comparison with these, the map of Tanganyika Territory which accompanies the