POSTNATAL PATHOLOGY 



1059 



IL Double parasitic : — Heterotypus, Heteialius, Poly- 

 gnathus, Polymelus, and Endocyma. 

 III. Triple monsters. 



Foetal monstrosities and abnormalities appear to be much commoner 

 in the tropics than in the other parts of the world, or else we have 

 been singularly fortunate in meeting with them. This is hardly 

 the place to give a detailed account of these abnormalities, but we 

 should advise the tropical practitioner to have some elementary 

 ideas, at all events, on the subject, and therefore we indicate in the 

 above classification the varieties known and in the reference? the 

 works dealing with this subject. We have met with the following : — 

 Foetus papyraceus, cyclops, agnathia: several double monsters of 

 both general types, including a specimen of symmetrical janus; 

 acephalic monsters; and rachischisis, meningocele, non-development 

 of the eye, coloboma iridis, hare-lip, cleft palate, branchial fistula, 

 non-development of the thigh. Macrodactylism has been reported 

 from the Philippines, and pes gigas from China. 



Further, McCarrison and others have shown that endemic cretin- 

 ism is brought about by goitre in the mother, combined with psychic 

 impressions or illnesses during the pregnancy, as well as with nutri- 

 tional difficulties and difficult labour ; and it should be the duty of the 

 Government of districts in which goitre is endemic to take steps to 

 combat these factors. 



Postnatal Pathology. 



The infantile mortality of the tropics is much higher than 

 that in the Temperate Zone, and must be combated by ' Baby 

 Welfare Work, ' as in Eur ope,^with a ' Baby Chnic ' in all the hospit a Is. 

 In Calcutta daily visits are paid by the midwives during the puer- 

 peral period, and then the work is carried on by the lady health 

 visitor by weekly visits until the child is three months old. Among 

 other matters, the feeding of the mother is attended to by organized 

 private charity. A pure milk supply is an essential in every com- 

 munity, and should be under Government control and at a cheap 

 rate. 



Meningitis is rare among the newborn, and seems, according to 

 Barron, to be mostly associated with spina bifida and to be caused 

 by Bacillus coli, staphylococci, streptococci, and more rarely by the 

 pneumococcus, the meningococcus, B. lactis aerogenes, or B. pyo- 

 cyaneus ; but of dll,B. coli is the most important according to him. 



Breast-feeding is most important, and it may be that it helps 

 to raise the resistance of the infant against disease. 



Weaning is a difficult and dangerous period in the tropics, and 

 it is considered that if possible a child should not be weaned in the 

 very hot weather. 



In calculating out the dilutions necessary for cow's milk it will 

 be remembered that the milk of the Bos indicus, the humpbacked 

 cow, is very rich in fat, attaining generally about 5 per cent, thereof. 



