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ANNOTATIONS

MATERNAL MORTALITY AND MORBIDITY

IN June, 1928, Mr. JNeviiie Chamberlain, then

Minister of Health, appointed a DepartmentalCommittee to advise upon the application to maternalmortality and morbidity of the medical and surgicalknowledge at present available, and to inquire intothe needs and direction of further research work.An interim report of this Committee appeared in

August, 1930, and was reviewed in our columns,and a final report has now appeared, 2 Sir GeorgeNewman has acted throughout as chairman of theCommittee, the other members of which are Prof. F. J.Browne, Dame Janet Campbell, Dr. Ethel Cassie,Dr. Leonard Colebrook, Prof. Archibald Donald,Dr. C. E. S. Flemming, Sir Walter Fletcher, Dr.Harold Kerr, Dr. W. H. F. Oxley, Prof. Miles H.Phillips, Dr. C. E. Tangye, and Prof. 0. L. V. S. deWesselow, with Dr. Jane H. Turnbull as secretary.After a brief summary of the scope and generalconclusions of the interim report, and the actionsarising out of recommendations made therein, thefinal report deals successively with a further investiga-tion of maternal deaths, further considerations as to amaternity service, statistical points, the maternityservices of the Netherlands, Denmark, and Sweden,the high- maternal mortality in certain districts of

England and Wales, puerperal sepsis, maternalmorbidity, the final chapter summarising the factspresented and the recommendations based thereon,which are briefly these:In every case a registered midwife should be

available, to act either as a midwife or as a maternitynurse, and to be responsible for normal midwiferyand for routine antenatal supervision on the lines laiddown by the Central Midwives Board.A doctor should be available in every case to carry

out antenatal and postnatal examinations, and toattend as may prove necessary during pregnancy,labour, and the puerperium all cases showing anyabnormality. It should be the part of the doctor tosend cases other than the simplest abnormalities tohospital early.

Maternity hospitals should be staffed in such a wayas to secure prompt specialist service for seriouscases. -

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THE RACIAL EFFECTS OF ALCOHOL

THE effect of alcohol on the individual and on therace is a subject that has often provoked strong statements, but it is also one that has interestedmany serious students. The first biological investiga-tion was that of Karl Pearson and his school in 1910.It suggested clearly a greater death-rate amongchildren of alcoholic parents, but a superiority amongthe surviving children. As is usual, the investigationswere soon transferred from man to laboratory animals,and perhaps the most important and most widelyquoted of all experiments are those of C. R. Stockard,of Cornell University, New York, whose early workwith fish and guinea-pigs indicated a deleteriouseffect on the embryo after exposure of the parent to alcohol. In his first paper he reported a largenumber of abnormal and unhealthy young. In hislater work, however, he emphasised more the beneficialeffects of alcohol on the stock, pointing out thatthe weak embryos were killed off, often at the germ-

1 THE LANCET, 1930, ii., 321, 367.2 H.M. Stationery Office. 1932. Pp. 156. 2s. 6d.

cell stage, so that the young who eventually survivedwere decidedly superior when compared with the-controls. Raymond Pearl’s work on the fowl andE. C. MacDowell’s on the rat agreed that the effectof alcohol was reduction in the litter size and in the-number of pregnancies, followed by a superiorityin the survivors. So convincing were these experi-ments that in a recent summary of the subjectProf. F. A. E. Crew says :-

" It is quite unthinkable that any biologist would urgethat the garden of humanity should be weeded by the ruthless,hand of parental alcoholism. It would be utterly ridiculous,not to say criminal, to suggest that anyone should be a sotfor the sake of the race ... Nevertheless, biology mustteach that, if there be excessive drinkers, they may wellbe indulging, unwittingly, in a eugenic practice." 1

Soon after Stockard’s early papers appeared, theMedical Research Council decided that the matterneeded further investigation, and nine years agoinstituted research by Miss F. M. Durham and MissH. M. Woods. This arduous piece of work has nowbeen completed and the report published.2 The reasonsfor undertaking the work are given in the preface.Stockard’s results appeared to the Council to suggestthat alcohol in the circulation can injure the germplasm and produce a permanent deterioration ofthe race ; these findings, if confirmed, they considerwould have implications of the gravest importancefor humanity, because not only alcohol but anycirculating poison, such as those generated in acuteinfections, might be expected to cause an injurywhich would reveal itself only in subsequent genera-tions. Here stress seems to be laid on one side ofProf. Stockard’s findings ; he concluded also thatan individual selection took place through theelimination from the race of the defective and sterilespecimens and the evolution of a group of unusuallystrong specimens, whose offspring show a recordsuperior in vitality.3

Concentrating on the suggestion of racial deteriora-tion, the authors of the new report oppose it in aseries of conclusions, some of which seem hardly to bejustified by the text. Their first conclusion is thatthere is no evidence that exposure to alcohol causes theproduction of abnormal young. This is a contradictionof Stockard’s first findings, though as early as 1916 headmitted that his later experiments, in which greatercare was taken of the animals, did not produce somany abnormalities. Miss Durham’s animals werekept according to* the very latest methods of care ofexperimental rodents, and she suggests that Stockard’ssmall litters were due to inadequate supply of greenfood in the diet, while the abnormalities were thenatural result of inheritance. She adds that alcoholmay perhaps cause a diminution in breeding-powerif the supply of green food is restricted, but has madeno experiments on this point. This is an interestinghypothesis, but one without experimental basisqualifying it to cancel the results of many years ofexperimental work. Stockard claimed a reductionof fertility as a result of alcoholisation; the prefaceto this report declares that " the litters have beenas numerous and as heavy as those from the controlmatings." Miss Durham believes that " fertilitywould appear to be unaffected by alcohol," but the

1 A Review of the Effects of Alcohol on Man. London : VictorGollancz, Ltd. 1931.

2 Alcohol and Inheritance : An Experimental Study. ByF. M. Durham and H. M. Woods. Medical Research Council,Special Report Series No. 168. H.M. Stationery Office. 1932.Pp. 63. 1s. 3d.

3 Brit. Med. Jour., 1922, ii., 255.