PREMATURITY AND CONGENITAL DEBILITY it is apparent from the very meaning of the words that this idea is false; the word prematurity (partus pruematurus) means only, birth before term, whereas the expression debility (debilitas vitae) is qualitative, in the sense that the respective child is deficient, compared with a healthy newborn infant.
The confusion of terms is, however, apparently justified by the fact that premature children are often debilitated; which occurs when one and the same poison (e.g., parental syphilis) is responsible for both the premature interruption of pregnancy and the damage to the infan tile organism. These constitute the diseased, debilitated, premature infants, on the one side of whom we can place the healthy premature infants, and on the other side, the debilitated full-term infants. Tarnier speaks truly when he says "not all premature children arc weaklings and not all weaklings are premature." It will, in the future, in accordance with the increase of our knowl edge of these topics, be necessary to treat these conditions separately. At present, in view of the existing literature and in accordance with the practical purpose of this manual, this hardly seems feasible and more over would lead to rather needless repetition. Utility, therefore, impels us to adhere, in the following, to a consideration of these themes—pre maturity and congenital debility—in common; their principal points of variance will be succinctly emphasized in the separate subdivisions.
Although the term, prematurity, needs no further explanation, the expression, debility, requires exacter definition. Billard charac terized it as a condition lying between health and disease. Very little is known of the anatomical changes or metabolic anomalies which are at the bottom of this status "debilit6 congenitale." It is characterized by a quantitatively and qualitatively deficient vital energy and a low ered resistance to all infections.
shown by the statistics of lying-in institutions, premature children constitute a formidable percentage of the total number of births. The percentage varies widely with the locality and the country; thus the number of children under 2500 Gm. (53- lbs.) in weight and less than 45 cm. in length were: In Moscow (orphan asylum) 5 per cent. (Hiller).
In Munich (maternity) 13.3 per cent. (von Winckel).
In Halle (maternity) 25 per cent. (Fehling).
In Paris (Clinique Tarnier) 10.7 per cent. (Budin).
In Paris (Maternite and Clinique liandelocque) 15.4 per cent. (Pinard).
It is stated that the percentage of premature births increases in the spring months, sinks during the autumn and is larger in winter than in causes exist for the occurrence of prematurity and they differ widely in their importance.
Thus external influences, such as severe physical exhaustion, moun tain climbing, the lifting of heavy objects, traumata of various sorts, premature rupture of the foetal membranes, etc., can furnish the impetus for premature labor. Twin pregnancy is also a frequent etiological factor. In 33S0 plural births, Miller observed no less than 2040 premature children, that is 60 per cent. with a weight less than 2500 Gm. (53 lbs.) and a body length under 45 cm.; Bachinlont found in super-impreg nated women, who were unable to take adequate rest, that the dura tion of pregnancy was shortened, on the average, by 22 days and the weight of the children brought down to 1900-1935 Gm. It is at present impossible to say to what extent faulty nutrition and physical excesses as well as psychic alterations in the mother, act in producing partus prannaturus. Maternal diseases play an important role in the etiology of both prematurity and congenital debility. Foremost in this connec tion is syphilis—and this ex patre as well—which, by extension to the foetus affects its development and leads to partus immaturus or prfema turns. Other maternal diseases which lead to the premature expulsion of the foetus are overshadowed in importance by the last-mentioned cause; these other diseases are: nephritis, heart disease and tubercu losis. Of the acute infections, scarlet fever is rightly the most dreaded. Prematurity is said to occur in two-thirds of the cases of pneumonia and to increase in probability with advancing pregnancy. Its occurrence with influenza depends upon the severity of the attack. The influence of malaria has been variously estimated, although with it, the spleen of the newborn infant can be enlarged. According to Voigt, prema turity occurs with variola in about one-half the cases befalling mothers vaccinated in girlhood. Measles, typhoid, bubonic plague, and Asiatic cholera can likewise give the impetus for a premature expulsion of the foetus; and gonorrhoea more frequently than was formerly assumed. Endometritis leads to abortion more often than prematurity. Besides acute and chronic alcoholism, which are particularly prone to cause still-birth, there are various other poisons which produce intoxication of both mother and child and can give rise to miscarriage or prematurity; these are especially phosphorus, arsenic, mercury, and lead. Typical signs of lead poisoning have been observed in a premature child.