Antenatal Protection of Infancy

ANTENATAL PROTECTION OF INFANCY (from Latin ante - before and natare - to give birth), the protection of the child before birth, has the goal of lowering infant mortality and stillbirths. The issue was first raised in 1895 by Pinard in a report titled 'Puericulture intra-uterine' at the French Academy. The necessity of antenatal protection of infancy is proven by data on the mortality of children in the first month of life ('early mortality, neonatal mortality'), according to which the mortality of children in the first year of life is to a significant degree determined by mortality in the first month (Rott). In Germany in 1920, according to data from the state statistical department, mortality in the first four weeks constituted 1/3 - 1/2 of all deaths in the first year of life. Of 199,200 children dying annually in the United States, which constitutes 7.6% of the number of live births, 109,000 children die in the first month (Dublin). In Leningrad, according to Binshtok's data, mortality in the first month constituted 6.3% per 100 live births for 1906-1915. Over the last decades, infant mortality has significantly decreased everywhere (see Infant mortality). In this steady fall of infant mortality in the 1st year of life, the age up to one month takes almost no part (according to the data of a number of authors, mortality in the 1st month not only does not fall, but even grows). Thus, in 1920 in Australia, early mortality constituted 31.8 per 1,000 live births, while in 1910 it equaled 30.2 (Dublin). Analogous figures are obtained on the basis of data on the mortality of children in Leningrad as well: while mortality from the 1st to the 12th month fell over the period from 1909-14 to 1923 by 51%, mortality at the age up to 1 month over the same period fell only by 19.3%. On the basis of a thorough study of the data, Dublin arrives at the following important conclusions: 1) neonatal mortality is a non-constant value; it varies within fairly significant limits; 2) there exists a fairly complete correlation (relationship) between early-age mortality (up to one month) and mortality from the 1st to the 12th month, i.e., lower mortality up to one month is encountered simultaneously with lower mortality after the first month; 3) measures for antenatal protection of infancy influence the lowering of early mortality and stillbirths; 4) the pace of the fall of mortality in the first month, even under favorable conditions, is still somewhat slower than at the age after the first month. If one adds the number of stillbirths to the figure of early mortality (such summation is dictated by the circumstance that the causes of early mortality and stillbirths are almost the same), then the figure will become even more impressive: the number of stillbirths constitutes from 3% to 5% of the number of live births (Heinecke). From 1,000 live births died from congenital weakness, pneumonia, nutritional disorders (according to Zeltner). If one turns to the causes of mortality, then out of the three main groups—gastrointestinal diseases, diseases of the respiratory tract (pneumonia), and congenital weakness—the first experienced a large decrease, the second remained almost in place, and the third underwent a change in the direction of an increase. This is demonstratively shown by the curve of Zeltner. Congenital weakness carries away the majority of victims in the first month; 60 out of 100 of all those who died in the 1st month die from it. After 2 months, congenital weakness, as a cause of death, constitutes only 3%. The vast majority of deaths in the first day of life are caused by congenital weakness: according to Rott - 90 out of 100. In relation to general mortality up to one year, congenital weakness is, according to Rott, the cause of mortality in 1/3 of all cases. According to data from the Leningrad Statistical Department, congenital weakness constituted 34.8% in 1923, and according to Baker - 40% among the causes of death in the first year. Under the diagnosis 'congenital weakness,' various conditions are registered. Thus, according to Rott, in Prussian statistics, congenital weakness and malformations are combined into one group. Into this same category, in fact, fall not only the weakly born, but also the premature (born prematurely), as well as those who died during and shortly after birth due to complications during delivery. Such inaccuracies in registration occur, undoubtedly, everywhere. Of all the groups registered as weakly born, the largest is the group of premature children. Prematurity constitutes 3-5% of the number of live births. Premature children are the most frequent victims of death in the 1st month of life; in 1922-1923 in Berlin, per 100 deaths from so-called congenital weakness, there were 71.4 cases of prematurity; 9.3% fell to injuries during birth and only 19.3% to congenital weakness (functional inability for extrauterine life, according to Pfaundler). Prematurity and weak birth are subdivided into three groups: 1) prematurity as a consequence of traumatic injuries and operative intervention, 2) prematurity as a consequence of excessive labor and weakness of the mother, 3) prematurity and weakness as a consequence of the mother's disease. The prognosis from these causes is very different. The deciding moment is the state of health of the parents, mainly the mother: of those born prematurely from healthy mothers, 21.5% died in the 1st year, from sick mothers - 89.4% (Lorey). Of 100 premature children born from healthy mothers, according to Pfaundler, 75 survive in the first days of life, 63 in the first year. Of 100 children from sick mothers, 62 survive in the first days, 18 in the first year. The mother's diseases that cause weak birth and prematurity are: a) chronic infections; of them, the first place is occupied by syphilis, the second by tuberculosis; b) chronic intoxications (mainly alcoholism, then poisoning by industrial poisons - lead, mercury, phosphorus, arsenic, nicotine, etc.); c) of chronic diseases (non-infectious), the most unfavorable influence is exerted by heart diseases, then metabolic diseases (diabetes, Basedow's disease); d) acute infections of the mother during pregnancy (malaria, etc.); e) of especially great importance are diseases connected with the pregnancy itself, such as nephropathy, eclampsia, and local diseases of the genital sphere: endometritis, incorrect positions, etc. The most frequent cause of prematurity in healthy mothers is excessive physical strain as a consequence of professional labor. In further development, authors find in surviving weakly and prematurely born children hypoplastic and asthenic phenomena, hydrocephalus, neuropathia, etc. Ylppo found idiocy and imbecility in 7.4%, Little's symptom complex in 3.1%, etc. All authors agree that in the fight against mortality and morbidity in the first days of life, the first place belongs to the protection of the future mother. The results of antenatal protection of infancy manifest themselves both in the figures of neonatal mortality and stillbirths. According to Dublin's data, stillbirths constituted 46.5 per 1,000 births in New York in 1920; among women who used antenatal protection of infancy (consultation), the number of stillbirths constituted 25 per 1,000. Neonatal mortality constituted 35 per 1,000; among those who used protection - 25.9 per 1,000. Thanks to measures of antenatal protection of infancy, mortality in the first month in Amsterdam fell from 23.2 per 1,000 live births in 1905 to 13 in 1922. Of 100 syphilitic mothers who were not treated, 74% aborted or gave birth to dead children (data of Tixier - Paris 1924, congress of pediatricians). Of 100 pregnant women treated with salvarsan + mercury or salvarsan + bismuth, 6% had an abortion or stillbirth, the rest gave birth to healthy children (data of Iersild and Kristjansen, Copenhagen, 1925, report at the conference on congenital syphilis in Paris). Thanks to measures of antenatal protection of infancy in France, eclampsia and dystocia - as causes of early mortality and stillbirths - are disappearing. The weight of newborns, as one of the indicators of the child's development, increases by 250-300 g given the mother's rest in the last period of pregnancy (Pinard, Peller, Michnik). Of especially great importance from the point of view of social hygiene and eugenics is antenatal protection of infancy for the prevention of congenital syphilis. Treatment of the woman during the period of pregnancy is one of the most rational measures for the prophylaxis of congenital syphilis. Congenital syphilis is encountered, according to German and Russian data, in 2-4 cases per 100 births; according to French data - in 30 cases; 52% of pregnancies in syphilitic women end in miscarriage or death of the newborn at birth or shortly after it (Davidsohn); children with congenital syphilis perish, according to Davidsohn, in 69% of cases; premature syphilitic children, according to Planchu, in 75% of cases. Antenatal protection of infancy has great social significance in the direction of the prevention of child abandonment, child dumping, and infanticide.

In the future, Antenatal Protection of Infancy must play an extremely important role in the eugenic direction, i.e., in preventing the birth of knowingly inferior, hereditarily diseased offspring from alcoholics, the mentally ill, the nervously ill, etc. (Grotjahn, Lentz). Measures for Antenatal Protection of Infancy can be divided into the following groups: I. Legislative measures: labor protection for women in general, and for pregnant women in particular, especially in industries harmful to maternity; maternity insurance; leave during pregnancy. In this regard, Soviet legislation occupies the first place among the legislations of the world. It is also advisable to introduce mandatory medical examination of those marrying to prevent the birth of knowingly diseased offspring. The goals of Antenatal Protection of Infancy are also served by laws on the compulsory treatment of syphilitics, on criminal liability for infecting others with syphilis, laws on the registration of patients with venereal diseases, etc. -II. Social-hygienic measures: 1) Medico-social institutions for the protection of pregnant women. The central place is occupied by the "Women's Consultation" (see Consultation). 2) So-called consultations on the "regulation" of childbirth and "marriage hygiene" must acquire important significance (Antonov, Lyublinsky, Michnik, Feldmann, Delfino). Their tasks are: a) to contribute to the improvement of offspring through negative and positive eugenics; b) to regulate childbirth for the purpose of protecting the health of the mother and family; c) to combat artificial and natural abortions by teaching the practice of contraceptive methods. These institutions exist in America and Western Europe; in the USSR, they are beginning to penetrate into life as a measure to combat abortions, in the form of departments at women's consultations. 3) Social-legal protection (for the prevention of homelessness, abandonment, etc.) is carried out through the mediation of social assistance councils and legal consultations. 4) One of the branches of social assistance consists of closed institutions for healthy pregnant women: mother and child homes, shelters, asylums for single and destitute pregnant women, and wards for pathological pregnancies. 5) An extremely important branch of ante- and intranatal care is the organization of obstetric aid. Hospitalization has an advantage over non-hospital care. This issue is of particular importance for the village, where the midwife plays a significant role in the matter of Antenatal Protection of Infancy. The duty of the midwife, from the point of view of Antenatal Protection of Infancy, is sanitary-educational work on the hygiene of pregnancy, childbirth, and the newborn, and preparation for childbirth. Scientific institutions have particular importance in the matter of Antenatal Protection of Infancy: institutes for the protection of motherhood and infancy, for the fight against occupational diseases, etc. The task of the institutes is the scientific development of issues related to motherhood, in particular data on early mortality, the study of measures for Antenatal Protection of Infancy, the methodological development of issues of Antenatal Protection of Women, and the training and retraining of personnel. The systematic implementation of measures for Antenatal Protection of Infancy contributes not only to the reduction of infant mortality and stillbirths, but also to the reduction in the number of miscarriages.