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Part Ⅰ DISTURBANCES OF PRE-NATAL LIFE 1

1．ENVIRONMENTAL AND HEREDITARY INFLUENCES 3

External environment 3

Internal environment 4

Heredity 9

2．CONGENITAL ABNORMALITIES 14

Incidence 15

Abnormalities with an established hereditary basis 18

Deformities due to physical intra-uterine moulding strains 19

The controversy on environment versus heredity 19

The contribution of chromosomal abnormality and of gene mutation 28

Conclusion 29

3．THE FOETAL CIRCULATION，THE PLACENTA AND THE FOETAL MEMBRANES 34

The foetal vascular system 34

The foetal part of the placenta 42

The maternal part of the placenta 55

The placenta as a whole—senescent and pathological changes 59

Placental efficiency and reserve 71

The amnion and the chorion 74

Abnormalities of the umbilical cord 77

4．FOETAL NUTRITION AND GROWTH 83

The sharing of available nutrient between mother and foetus 83

Assessment of intra-uterine nutrition 87

Validity for man of animal observations 90

Some results of maternal nutritional deficiency 91

Placental transfer and foetal nutrition 95

Conclusion 96

5．PREMATURITY AND POSTMATURITY AND LARGE BABIES 99

Assessment of the maturity of the infant 99

Handicaps imposed by premature birth 106

Immaturity and retrolental fibroplasia 111

The incidence of prematurity 112

Aetiology 112

The fate of the premature infant 113

Postmaturity 119

Large babies 122

6．STILLBIRTHS AND FOETAL DEATHS 129

Abortion，stillbirth and foetal death 129

Methods of classification and comparison of results 131

Factors influencing the general incidence of stillbirth 139

The pathological study of stillborn infants 141

7．MULTIPLE BIRTHS 145

Like and unlike twins 145

The placenta and foetal membranes in twins 147

Asymmetry，double monsters and teratomas 150

Incidence of multiple births and influence of environment and heredity 158

Triplets，quadruplets and quintuplets 159

The hazards of plural births 159

8．CONGENITAL TUMOURS 163

Hamartomas，heterotopia and simple tumours 163

Embryomas and teratomas 168

Malignant tumours 169

Congenital leukaemia 171

Transfer of malignant disease from the mother 172

Congenital tumours and carcinogenesis 172

Part Ⅱ ADAPTATION TO EXTRA-UTERINE EXISTENCE 177

9．ADAPTATION OF THE NORMAL FOETUS TO EXTRA-UTERINE RESPIRATION 179

Preparations for the initiation of extra-uterine respiration 179

Changes in the circulatory system associated with extra-uterine respiration 189

The initiation of extra-uterine respiration 190

The maintenance of extra-uterine respiration 194

The anatomical basis of imperfect pulmonary respiration 195

Pre-natal or extrinsic anoxia and adaptation to extra-uterine respiration 198

10．LESIONS WITHIN THE INFANT INFLUENCING ADAPTATION TO EXTRA-UTERINE RESPIRATION 211

Lesions involving the air passages and lungs 211

Disturbances involving the heart and blood vessels 219

Disturbances involving the central nervous system 236

11．THE BLOOD CONSTITUENTS AND ADAPTATION TO EXTRA-UTERINE LIFE 250

Disturbances involving the red blood cells and their formative tissue 250

The metabolism of the bile pigments 260

Thrombosis and embolism 264

Bleeding disturbances 269

12．ADAPTATION TO EXTRA-UTERINE ALIMENTATION 278

Disturbances of the movement of the intestinal contents 278

Disturbances of digestion 303

Absorption from the intestine 316

13．THE ESTABLISHMENT OF POST-NATAL METABOLISM 324

Metabolism of specific substances 325

Energy metabolism and body temperature 342

The role of the endocrine glands 344

Toxic agents and post-natal metabolism 356

14．POST-NATAL EXCRETION AND ITS CONTRIBUTION TO THE INTERNAL ENVIRONMENT 364

Biochemical factors influencing excretion 364

Excretory disturbances primarily of renal origin 366

The urinary passages and disturbances of excretion 374

15．CONDITIONS INTERFERING WITH NORMAL POST-NATAL DEVELOPMENT AND GROWTH 380

Lesions anatomically limited to the central nervous system 380

Lesions of the nervous system associated with defects of adjacent structures 389

Lesions of the skeleton and supporting tissues 399

Lesions of the integument 410

Lesions of the eye 413

Abnormalities of sex differentiation 414

Disturbances affecting multiple tissues and organs 415

Part Ⅲ INFECTIONS IN FOETAL AND NEONATAL LIFE 423

16．DEFENCE MECHANISMS IN THE FOETUS AND NEWBORN INFANT 425

The integrity and protection of exposed surfaces 425

Humoral substances and infections 427

Cellular reactions in infection 434

17．MICROBES OF THE INTRA-UTERINE AND POST-NATAL ENVIRONMENT 440

Microbic environment before the membranes rupture 440

Microbic environment after the rupture of the membranes 442

Acquisition of the post-natal flora 444

18．PATHOLOGY OF ACUTE INFECTIONS ACQUIRED IN UTERO 451

Protozoal and bacterial infections with unruptured membranes 451

Virus infections with unruptured membranes 455

Infections with membranes ruptured：Syndrome of infection of the amnion 457

19．THE PATHOLOGY OF ACUTE INFECTIONS ACQUIRED AFTER BIRTH 469

Predominant involvement of the respiratory system 471

Predominant involvement of the alimentary canal 479

Predominant involvement of the nervous system 487

Wound and skin infections 490

Infection of the urinary system 494

Septicaemia and blood disseminated sepsis 494

Disseminated virus infections 498

20．CHRONIC AND GENERALIZED SPECIFIC INFECTIONS IN FOETUS AND NEONATE 505

Syphilis 505

Tuberculosis 512

Toxoplasmosis 513

Torulosis，coccidioidomycosis and histoplasmosis 516

INDEX 521