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Part Ⅰ DISTURBANCES OF PRE-NATAL LIFE1

1．ENVIRONMENTAL AND HEREDITARY INFLUENCES3

External environment3

Internal environment4

Heredity9

2．CONGENITAL ABNORMALITIES14

Incidence15

Abnormalities with an established hereditary basis18

Deformities due to physical intra-uterine moulding strains19

The controversy on environment versus heredity19

The contribution of chromosomal abnormality and of gene mutation28

Conclusion29

3．THE FOETAL CIRCULATION，THE PLACENTA AND THE FOETAL MEMBRANES34

The foetal vascular system34

The foetal part of the placenta42

The maternal part of the placenta55

The placenta as a whole—senescent and pathological changes59

Placental efficiency and reserve71

The amnion and the chorion74

Abnormalities of the umbilical cord77

4．FOETAL NUTRITION AND GROWTH83

The sharing of available nutrient between mother and foetus83

Assessment of intra-uterine nutrition87

Validity for man of animal observations90

Some results of maternal nutritional deficiency91

Placental transfer and foetal nutrition95

Conclusion96

5．PREMATURITY AND POSTMATURITY AND LARGE BABIES99

Assessment of the maturity of the infant99

Handicaps imposed by premature birth106

Immaturity and retrolental fibroplasia111

The incidence of prematurity112

Aetiology112

The fate of the premature infant113

Postmaturity119

Large babies122

6．STILLBIRTHS AND FOETAL DEATHS129

Abortion，stillbirth and foetal death129

Methods of classification and comparison of results131

Factors influencing the general incidence of stillbirth139

The pathological study of stillborn infants141

7．MULTIPLE BIRTHS145

Like and unlike twins145

The placenta and foetal membranes in twins147

Asymmetry，double monsters and teratomas150

Incidence of multiple births and influence of environment and heredity158

Triplets，quadruplets and quintuplets159

The hazards of plural births159

8．CONGENITAL TUMOURS163

Hamartomas，heterotopia and simple tumours163

Embryomas and teratomas168

Malignant tumours169

Congenital leukaemia171

Transfer of malignant disease from the mother172

Congenital tumours and carcinogenesis172

Part Ⅱ ADAPTATION TO EXTRA-UTERINE EXISTENCE177

9．ADAPTATION OF THE NORMAL FOETUS TO EXTRA-UTERINE RESPIRATION179

Preparations for the initiation of extra-uterine respiration179

Changes in the circulatory system associated with extra-uterine respiration189

The initiation of extra-uterine respiration190

The maintenance of extra-uterine respiration194

The anatomical basis of imperfect pulmonary respiration195

Pre-natal or extrinsic anoxia and adaptation to extra-uterine respiration198

10．LESIONS WITHIN THE INFANT INFLUENCING ADAPTATION TO EXTRA-UTERINE RESPIRATION211

Lesions involving the air passages and lungs211

Disturbances involving the heart and blood vessels219

Disturbances involving the central nervous system236

11．THE BLOOD CONSTITUENTS AND ADAPTATION TO EXTRA-UTERINE LIFE250

Disturbances involving the red blood cells and their formative tissue250

The metabolism of the bile pigments260

Thrombosis and embolism264

Bleeding disturbances269

12．ADAPTATION TO EXTRA-UTERINE ALIMENTATION278

Disturbances of the movement of the intestinal contents278

Disturbances of digestion303

Absorption from the intestine316

13．THE ESTABLISHMENT OF POST-NATAL METABOLISM324

Metabolism of specific substances325

Energy metabolism and body temperature342

The role of the endocrine glands344

Toxic agents and post-natal metabolism356

14．POST-NATAL EXCRETION AND ITS CONTRIBUTION TO THE INTERNAL ENVIRONMENT364

Biochemical factors influencing excretion364

Excretory disturbances primarily of renal origin366

The urinary passages and disturbances of excretion374

15．CONDITIONS INTERFERING WITH NORMAL POST-NATAL DEVELOPMENT AND GROWTH380

Lesions anatomically limited to the central nervous system380

Lesions of the nervous system associated with defects of adjacent structures389

Lesions of the skeleton and supporting tissues399

Lesions of the integument410

Lesions of the eye413

Abnormalities of sex differentiation414

Disturbances affecting multiple tissues and organs415

Part Ⅲ INFECTIONS IN FOETAL AND NEONATAL LIFE423

16．DEFENCE MECHANISMS IN THE FOETUS AND NEWBORN INFANT425

The integrity and protection of exposed surfaces425

Humoral substances and infections427

Cellular reactions in infection434

17．MICROBES OF THE INTRA-UTERINE AND POST-NATAL ENVIRONMENT440

Microbic environment before the membranes rupture440

Microbic environment after the rupture of the membranes442

Acquisition of the post-natal flora444

18．PATHOLOGY OF ACUTE INFECTIONS ACQUIRED IN UTERO451

Protozoal and bacterial infections with unruptured membranes451

Virus infections with unruptured membranes455

Infections with membranes ruptured：Syndrome of infection of the amnion457

19．THE PATHOLOGY OF ACUTE INFECTIONS ACQUIRED AFTER BIRTH469

Predominant involvement of the respiratory system471

Predominant involvement of the alimentary canal479

Predominant involvement of the nervous system487

Wound and skin infections490

Infection of the urinary system494

Septicaemia and blood disseminated sepsis494

Disseminated virus infections498

20．CHRONIC AND GENERALIZED SPECIFIC INFECTIONS IN FOETUS AND NEONATE505

Syphilis505

Tuberculosis512

Toxoplasmosis513

Torulosis，coccidioidomycosis and histoplasmosis516

INDEX521