ANNOTATIONS

failure of various homeostatic mechanisms as a result of immaturity or a complicated labour and delivery.

By quantitating the infant’s condition at birth and relating these measurements to it, it has been possible to subdivide data into broad groups which, though overlapping to some extent, have proved to be significantly different. This has been true in studies of acid-base status, foetal electrocardiograms, cardiac silhouette, cardiac mumurs and venous pressure. Without the rapid method of evaluation provided by the scoring system imme- diately after birth, when the clinical condition is changing rapidly, these relations would have been overlooked.

The method has also proved a valuable guide both in teaching and in clinical practice for deciding which infants to resuscitate. By its use delivery-ward personnel learn to observe several physical signs at once, evaluate them rapidly and act accordingly.

Theoretically, the newborn scoring system of infants should afford a basis of comparison for future and musculoskeletal development. It is hoped that the use of this system by the 15 hospitals in the U S A . who are co-operating in the Collaborative Study of Neuro- logical Deficiency will in time disclose whether the baby’s physical state shortly after birth bears a relationship to its future development.

Early studies involving the scoring system indicated a significant correlation with mortality, and provided the first evidence that it might have some predictive value. A chart comparing mortality and score can readily be constructed for any obstetrical service and can serve as a useful baseline for improvement or for comparison with results from other clinics. Differences in mortality may provide important leads for future investigation.

Though a standard method of evaluation such as the Apgar Scoring System has the advantages of uniformity and simplicity, it has definite limitations. It is no substitute for a careful physical examination or serial observations over the first few hours of life. Nor will it predict neonatal death or survival in individual infants. Indeed, few signs in medicine give such a definitive answer. This objection in no way detracts from the System’s value in estimating the probability of survival or death in groups of infants.

Perhaps its greatest value is that it ensures careful observation and documentation of the infant’s condition immediately after birth.

L. STANL.EY JAMES

Tests of Manipulative Ability THE high level of manipulative ability in man’s upper limbs is one of his most useful natural endowments. It is difficult to describe and define this ability because of the complexity of the numerous skills involved, but a reliable measure of such function would obviously be extremely useful, especially in handicapped people. A quantitative measure of manipulative ability would be used (a) to assess the degree of disability; (b) to indicate the functional possibilities of training; and (c) as a guide to progress and response to treatment.

These needs are realised by Mme. ROSSEL and M. TILON, and in a preliminary com- munication in Readuptation (1960, 73, 31) they describe how they try to solve this difficult problem. They find that the measurement of four items gives a comprehensive assessment of upper limb function. The tests do not require the handling of any material or special apparatus and can, therefore, be done anywhere, and the results are not invalidated by tactile stimulation. The four items are:

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(a) ‘Bilan .fonctionnel’: noting the possession of the fundamental movements,

(6) ‘Auto contrble’: the constancy of the performance of the tests during periods of

(c) ‘Pricision’: the performance of repetitive tests accurately and without hesitation. ( d ) ‘Co-ordination’: the co-ordination of all movements necessary to complete the

Unfortunately, the writers do not describe exactly how these tests are carried out, but they do report careful studies of the correlation between the test results and intellectual function as measured by the Terman Merrill test, Koh’s cubes, and the Progressive Matrices (1938, form A.B.C.D.E.). There is a close relationship between the tests of limb function and the tests of intellectual function. ROSSEL and TIZON feel that the level of the intelligence quotient determines the possiblity of re-education in the patients, and they also find that spatial perception is important in the performance of the tests.

The test results are expressed graphically in a circular diagram, the upper half of which represents static ability, the ‘bilan fonctionnel’, and the lower half dynamic ability, ‘pricision’, ‘l’auto contrBle rapide’, ‘l’auto contrble lent’, and ‘co-ordination’, both segmenta, and global. The bilan fonctionnel is charted in five areas-the thumb, fingers, wrist, elbow and shoulder. The right-hand half of the circle represents the right arm, and the left-hand half the left arm. These various items are scored from 0 to 40 along radii, and the points are then joined to give a figure within the circle which represents the status of the upper limbs, and shows at a glance the nature of the disability. The method is claimed to be very useful in practice.

This is only a preliminary communication, but the authors are to be congratulated on their constructive approach to this difficult problem. Their future publications, describing the tests in detail and illustrating the use of the method in practice, will be eagerly awaited.

including ihe actions of all the muscle groups of the upper limb.

repetition, and increased speed of performance.

preceding tests.

KENNETH HOLT

Recent Work on Mongolism THE promising work done in the last few years on chromosome abnormalities in mongolism has lately been reviewed by ROWLEY,~~ who remarks that the reports reviewed indicate how incomplete our information is even for this, the most widely studied of the autosomal chromosome changes. Lehmann and Forssman,* who are researching into familial mongolism, have published an interesting report, including the family tree, idiogram and a photograph of the 6-year-old boy concerned, on familial mongolism with chromosomal translocation which was also found in a normal boy in the family. In addition to the finding of an extra chromosome in some mongoloids, which will call for changes in the theories of causation, another likely clue which is bzing energetically pursued lies in the ‘chemical anomalies’ found in various serum-protein fractions in mongoloids, and NELSON and GHOLZ~ in California have now discovered two new anomalies.

In the midst of these laboratory excitements, the human being who supplies the pathological material tends to be overlooked. Of all mentally handicapped people, mongols have in the past been the least regarded by research workers, partly because, being easily recognisable at an early age, they were apt to be ’written off’ and put in an institution as a matter of course, partly because their development is very slow, and partly because, owing to their vulnerability to infections, their life-span was usually short. This

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