New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.
The
results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world.
Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization.
Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world.
Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.
The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.
Few
previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.
GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.
The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.
GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
which are not usually recorded as maternal sepsis, including post-abortion and indirect infections.
The result is a more complete understanding of the frequency and impact of maternal infections in health facilities.
GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk.
Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management.
Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.
Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
haemorrhage.
This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.
Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.
GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively.
For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.
GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.
This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
providers to manage the frequency and outcome of maternal infections.
GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives.
WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
on 5 May which celebrates the central role played by nurses and midwives in clean health care.
In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
2017
WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.
Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.
WHO recommendations for prevention and treatment of maternal peripartum infections
WHO Clinical practice handbook for safe abortion
Global guidelines on the prevention of surgical site infection
WHO statement on maternal sepsis
Infection Prevention and Control
SAVE LIVES: Clean Your Hands 5 May 2020
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https://www.who.int/news-room/detail/27-04-2020-maternal-infections-in-health-facilities
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The term “The Determination of Sex” is employed in two general senses in scientific circles.
The first usage is that of the biologist, and it includes within its scope merely the discovery and understanding of the causes which determine whether the embryo shall develop into a male or into a female. In the discussion of the subject from this standpoint there is but little, if any, attention given to the question of whether the sex of the unborn child may be determined by methods under the control of man. The biologist simply studies the causes which seem to lead to the production of an individual of one or the other sex, without regard to whether these causes, when discovered, may or may not be amendable to human control.
An authority, speaking of this standpoint concerning the question referred to, says: “We may discover the causes of storms or earthquakes, and when our knowledge of them is sufficiently advanced we may be able to predict them as successfully as astronomers predict eclipses, but there is little hope that we shall ever be able to control them. So it may be with sex; a complete understanding of the causes which determine it may not necessarily give us the power of producing one or the other sex at will, or even of predicting the sex in any given case. Whether we shall ever be able to influence the causes of sex-determination cannot as yet be foretold; at present, biologists are engaged in the less practical, but immensely interesting, problem, of discovering what those causes are.”
The second usage of the term, includes and embraces the idea of the voluntary determination or control of the sex of the future child, by means of certain methods or certain systems of treatment, etc. Of recent years, science has been devoting considerable attention to the question of whether or not man may not be able to produce any particular sex at will, by means of certain systems or methods of procedure. Many theories have been evolved, and many plans and methods have been advocated, often with the expenditure of much energy and enthusiasm on the part of the promulgators and their adherents.
In this lesson there will be briefly presented to you the general consensus of modern thought on the subject, with a general outline of the favorite methods and systems advocated by the several schools of thought concerned in the investigation.
Professor Doncaster, the well-known authority on the subject, says: “But little progress has been made in the direction of predicting the sex of any child, and, if possible, even less in artificially influencing the determination of its sex. When the general principles arrived at are borne in mind, it must be confessed that the prospects of our ever attaining this power of control or even of prediction are not very hopeful, but the possibility of it cannot be yet regarded as entirely excluded. The general conclusions arrived at are that sex is determined by a physiological condition of the embryonic cells, that this condition is induced, at least in the absence of disturbing causes, by the presence of a particular sex-chromosome. [A “chromosome” is a portion of the chromatin, or substance characteristic of the nucleus of the cell, this nucleus seemingly controlling the life-processes of the cell.] But there is evidence, which for the present at least cannot be neglected, that certain extraneous conditions acting on the egg or early embryo may perhaps be able to counteract the effect of sex chromosome.
“Quite generally, then, there are two conceivable methods by which the sex might be artificially influenced in any particular case; firstly, if means could be found of ensuring that any particular fertilized ovum received the required chromosomes; and, secondly, by the discovery of methods which always effect the ovum or embryo in such a way as to produce the desired sex. Many suggestions for applying both methods have been made, some of which have attained considerable notoriety, but hitherto none of them has stood the test of practical experience. In the case of the higher animals, especially of the mammals, in which the embryo develops in the maternal uterus until long after the sex is irrevocably decided, it is obviously difficult to apply methods which might influence the sex after fertilization, even if it were certainly known that such methods were ever really effective.
“Apart from the few experiments like those of Hertwig on rearing tadpoles at different temperatures, there have been a very few cases in which there is even a suggestion that the sex of the fertilized egg can be modified by environment, and the belief that this is possible has been entirely abandoned by many of the leading investigators of the subject. It is probable, therefore, that if it will ever be possible to predict or determine artificially the sex of a particular child, the means will have to be sought in some method of influencing the output of germ-cells in such a way that one kind is produced rather than the other. It is in this way that Heape and others interpret the results of their investigations; they find that certain conditions affect the sex-ratio of cells, and they explain the result by assuming that under some circumstances male-determining ova are produced in excess, and under other circumstances, female-determining.”
Professor Rumley Dawson holds to the opinion that the male-determining and female-determining ova are discharged alternately from the ovaries. In woman one ovum is usually discharged each month, and it is maintained that on one month the ovum is male-determining, and in the next, female-determining. It is obvious that exceptions must occur, for boy and girl twins are quite common, but if the cases which support the hypothesis are taken by themselves, and the exceptions explained away, it is possible to make out a strong case in favor of this theory. Some authorities hold that the right ovary produces male-determining ova, and the left ovary female-determining, and that the two ovaries discharge an ovum alternately, but an impartial examination of the evidence for this belief shows that it rests on very slender foundations. Experiments on the lower animals have shown that after the complete removal of one ovary the female may produce young of both sexes. Women, also, have produced children of a particular sex after the corresponding ovary has been removed, and it is hardly possible to believe that the removal in all these cases was incomplete. On the whole it must be concluded that the theory is insufficiently supported by the evidence.
Another widely promulgated and vigorously supported theory is that which holds that the sex of the future child may be determined by specific nutrition of the mother before conception, and in some cases after conception. Schenk’s theory, advanced about 1900, attracted much attention at the time. He based his method on the observation that a number of women whose children were all girls all excreted sugar in their urine, such as happens in the case of persons affected with diabetes. From this he suspected that the physiological condition which leads to the excretion of sugar was inimical to the development of male-determining ova, and that males could be produced by its prevention. He therefore recommended that those who desire a male child should undergo treatment similar to that prescribed for diabetes for two or three months before conception, and held that a boy would be produced by these methods. Although this method has had considerable vogue, it cannot be held to have been established on a scientific basis.
Doncaster says “The general conclusion with regard to man must therefore be that if sex is determined solely by the spermatozoon there is no hope either of influencing or predicting it in special cases. On the other hand, there is considerable evidence that the ovum has some share in the effect, and if this is so, before any practical results are reached it will be necessary to discover which of two conceivable causes of sex-determination is the true one. It is possible that there are two kinds of ova, as well as two kinds of spermatozoa, and that there is a selective fertilization of such a kind that one kind of spermatozoon only fertilizes one kind of ovum, the second kind of spermatozoon the second kind of ovum. If this should prove to be the case, it is possible that means might be found of influencing or predicting that kind of ovum which is discharged under any set of conditions. Secondly, it is possible that the ova are potentially all alike, but that their physiological condition may under some circumstances be so altered that the sex is determined independently of the spermatozoon. * * * It is hardly possible to avoid the conclusion that the sex of the offspring may be influenced, at least under certain circumstances, by the mother. The search for means of influencing the sex of the offspring through the mother is not of necessity doomed to failure. No results of a really positive kind have been obtained hitherto, and some of the facts point so clearly to sex-determination by the male germ-cell alone in man and other animals that many investigators have concluded that the quest is hopeless; but until an adequate explanation has been given of certain phenomena discovered in the investigation of the subject, it seems more reasonable to maintain an open mind, and to regard the control of sex in man as an achievement not entirely impossible of realization.”
Another writer on the subject has said: “Every individual among the higher animals, whether male or female, begins as an impregnated ovum in the mother’s body. Any such ovum contains elements of constitution from both of its parents. In the earliest existence of this impregnated ovum, there is a season of sexual indifference, or indecision, in which the embryo is both male and female, having the characteristic rudiments of each sex, only indifferently manifested. In this stage, the embryo is susceptible of being influenced by external conditions to develop more strongly in the one or the other direction and thus become distinctly and permanently male or female. It is evident that this is the season in the development of the individual in which influencing conditions and causes must operate in deciding its sex, although it is possible in some of the lower animals to alter the tendency of sex in the embryo from one sex to the other, even after it has been quite definitely determined. It is well established, in fact, that differences do not come from a difference in the ova themselves; that is, there is not one kind of ova from the female which becomes female, while other ova become male, for it is possible to alter the tendency toward the one sex or the other after the ovum has been fertilized and the embryo has begun its career of development. This possible change in sex tendency in the embryo also proves that sex is not decided by a difference in the spermatozoa; that is some of the sperm cells from the father are not male, while others are female, in their constitution.
“It is incorrect to suppose, as has been held by some theorists, that one testicle give rise to male spermatozoa and the other to female spermatozoa, for both male and female offspring have been produced from the same male parent after one testicle or the other has been removed. The same is true in cases in which either ovary has been removed from the mother; that is, male and female offspring are produced from mothers in whom either ovary has been removed. In like manner, the sex of offspring is shown not to be materially affected by the comparative vigor of the parents; thus, a stronger father than mother does not necessarily produce one sex to the exclusion of the other. These negative decisions are important because they simplify the solution of the problem of sex-determination, by excluding, more or less fully, various causes which have been supposed to operate quite forcibly in deciding the sex of offspring. Some of the more positive agencies that enter into the determination of sex are found (1) in the influence of nutrition upon the embryo during its indifferent stage of sexual development, and (2) in the constitution and general condition of the mother before and during the early stages of pregnancy. These two factors appear to enter more fully than any others in the decision of the sex in offspring, and deserve the greatest consideration. The influence of food in supplying the embryo with nourishment for its development is, perhaps, the most potent of these determining causes.”
Investigators along the line of theory indicated in the above last quotation, i. e., the theory of sex determination by means of nourishment of the mother and embryo, have presented a volume of reports which demand respectful consideration. The general report may be said to be the discovery that abundant nourishment during the period of sexual neutrality tends to produce females; while lack of abundant nutrition during such period tends to produce males.
These experiments, of course, have been chiefly performed upon the lower animals. The frog has been a favorite subject of such experiments—the tadpole stage being the one selected, because in that stage there exists a lack of sex, the stage being one of sex neutrality. Professor Yung’s celebrated experiments will illustrate this class of experiments. Here were chosen 300 tadpoles, which when left to themselves manifested a ratio of 57 prospective females to 43 prospective males. These were divided into three classes of 100 tadpoles each. Each class was then fed upon one of several kinds of nutritious diet in order to ascertain the change in sex-tendency due to such food. The first set, with an original ratio of femaleness of 54 to 46, were fed abundantly on beef, and the ratio of femaleness was changed to 78 to 22. The second class, with a ratio of femaleness of 61 to 39, were fed on fish (specially nourishing to frogs), and the ratio changed to 81 to 19. The third class, with a ratio of 56 to 44, were fed upon a still more nutritious diet (i. e., that of frogs’ flesh), and the ratio was raised to 92 to 8. In short, the experiments showed that the increase of nourishment in diet changed every two out of three male-tendency tadpoles into females. The experiment was held to prove that a rich diet, affording nourishment, during the period of sexual neutrality in the embryo, tended to develop femaleness.
The advocates of this theory also point to the instance of the bees. With the bees, the larva of ordinary worker-bees are fed ordinary food, and do not develop sex; while the larva which is intended to produce the queen-bee is fed specially nutritious “royal food,” and consequently develops larger size and full female sex powers. If the queen is killed, or dies, the hive of bees proceeds to produce a new queen by means of feeding a selected larva with the “royal food” and thus developing full femaleness in it. It is said by some authorities that in cases in which some other of the larva accidently receive, through mistake, crumbs of the “royal food,” they, too, grow to an extraordinary size, and develop fertility. This fact is held by the advocates of the nutrition theory to go toward establishing the fact that abundant nourishment of the embryo, during the neutral stage, tends to produce femaleness in it. They also claim that caterpillars which are very poorly nourished before entering into the chrysalis stage usually develop into male butterflies, while those highly nourished in the said stage tend to become females. Experiments on sheep have shown that when the ewes are particularly well nourished the offspring will show a large proportion of females.
A writer, favoring the theory in question, says: “In general, it is reasonable to infer that the higher sexual organization which constitutes the female is to be attained in the greatest number of cases by embryos which have superior vital conditions during the formative period. Among human beings, some facts of general observation become significant in the light of the foregoing inferences. After epidemics, after wars, after seasons of privation and distress, the tendency is toward a majority of male births. On the other hand, abundant crops, low prices, peace, contentment and prosperity tend to increase the number of females born. Mothers in prosperous families usually have more girls; mothers in families of distress have more boys. Large, well-fed, fully developed, healthy women, who are of contented and passive disposition, generally become mothers of families abounding in girls; while mothers who are small or spare of flesh, who are poorly fed, restless, unhappy, overworked, exhausted by frequent childbearing, or who are reduced by other causes which waste their vital energies, usually give birth to a greater number of boys. As a general proposition, the facts and inferences tend to establish the truth of the doctrine with women, that, the more favorable the vital conditions of the mother during the period in which the sex of her offspring is being determined, the greater the ratio of females she will bear; the less favorable her vital conditions at such times, the greater will be her tendency to bear males. That many apparent exceptions occur does not disprove the general tendency here maintained. Moreover, it is impossible to know in all cases what were the conditions of the mother’s organism at the time in which her child was in its delicate balance between predominant femaleness and maleness; else many cases which seemingly disprove the proposition would be found to be forcible illustrations of its truth. Still further, it is probable that other causes besides those here mentioned act with greater or less effect in determining the sex of offspring.”
Based upon this general theory of the relation of nutrition to sex-determination, many methods and systems have been devised by as many authorities, and have been followed and promulgated by as many schools. Without going into the almost endless detail which would be necessitated by a synopsis of these various methods and systems, it may be said that they all consist of plans having for their object the decrease of nutrition of the woman in cases in which male children are desired, and the increase of nutrition in cases in which female children are sought for. This increase or decrease in nutrition is enforced for a reasonable period before the time selected for the conception of the child, and also for a reasonable period after the time of conception. The decrease in nutrition does not consist of “starvation,” but rather of a “training diet” similar to that followed by athletics, and from which dietary all rich foods, sweets, etc., are absent. In fact, the average dietary advocated by the “Eat and Grow Thin” writers would seem to be almost identical with that of the “male offspring” theorists.
Many persons who have followed the methods and systems based on the nutrition theory above mentioned claim to have been more or less successful in the production of the particular sex desired, but many exceptions to the rule are noted, and some writers on the subject are disposed to regard the reported successes as mere coincidences, and claim that the failures are seldom reported while the successes are widely heralded. The present writer presents the claims of this school to the attention of his readers, but without personally positively endorsing the idea. He is of the opinion that the data obtainable is not as yet sufficient to justify the strong claims made for the theory in some quarters; but, at the same time, he does not hesitate to say that there are many points of interest brought out in the presentation of the theory, and that many thoughtful persons seem to accept the same as reasonably well established and logical.
Another theory which has been heard of frequently of late years is that in which it is held that the ova are expelled in alternating sex, each month. Thus, if a male ovum is expelled in January, the February ovum will be a female one, according to this theory. Under this theory if the date of conception of a child be ascertained, and the sex of the child noted at its birth, it is a simple matter to count forward from the menstrual period following which the child was conceived, and thus determine whether the ovum of any succeeding period is male or female. It should be noted, however, that the periods are regulated by the lunar months, and not the calendar months. The fact that twins of different sexes are sometimes born would seem to disturb this theory—but not more than any other theory of sex-determination voluntarily produced, for that matter. The several schools explain this apparent discrepancy by the familiar saying that “exceptions prove the rule.”
Another theory of sex-determination is that which holds that when conception occurs within a few days after the last day of menstruation, the child will be a girl; and that when conception occurs at a later period, the child will be a boy. Methods and systems based upon this theory are also reported as being reasonably successful in producing satisfactory results. But, inasmuch as there appears to be a great difference in individual women in this respect (even according to the claims of this school of sex-determination), it would seem that it would be difficult to proceed with certainty in the matter in most cases. One of the writers advocating this method, says: “Conception within five days after the end of the menstrual period is almost certain to produce a girl child; within five days to ten days, it may be either a boy or a girl; from ten to fifteen days, it is almost sure to be a boy; from eighteen to twenty-five days is the period of probable sterility, in which conception is extremely unlikely to occur.”
In conclusion, it may be said that Nature undoubtedly has certain rules of sex-determination which govern in these cases; and that it is possible if not indeed probable that these rules may some day be discovered by man, and turned to account; but that it is very doubtful whether the secret has as yet been solved by the investigators. The writer may be pardoned for suggesting that, in his opinion, if the discovery is ever made it will likely be found to be very simple—so simple that we have probably overlooked it because it was in too plain sight to attract our attention. Nature’s methods are usually very simple, when once discovered. She hides her processes from man by making them simple, it would seem.
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The rapidly growing interest in Eugenics, and the scientific consideration of the world-wide decline in the birth-rate have drawn attention to the study of the eugenic factors which determine the production of high ability in offspring. Many distinguished investigators have conducted long and exhaustive investigations for the purpose of ascertaining and summarizing all possible biological data concerning the parentage and birth of the most notable persons born in European countries, and to a lesser extent in America.
The investigations are now acquiring a fresh importance, because, while it is becoming recognized that we are gaining a control over the conditions of birth, the production of children has itself gained an importance. The world is no longer to be bombarded by an exuberant stream of babies, good, bad, and indifferent in quality, with mankind to look on calmly at the struggle for existence among them. Whether we like it or not, the quantity is steadily diminishing, and the question of quality is beginning to assume a supreme significance. The question then is being anxiously asked: “What are the conditions which assure the finest quality in our children?”
A German scientist, Dr. Vaerting, of Berlin, published just before the War a treatise on the subject of the most favorable age in parents for the production of offspring of ability. He treated the question in an entirely new spirit, not merely as a matter of academic discussion, but rather as a practical matter of vital importance to the welfare of modern society. He starts by asserting that “our century has been called the century of the child,” and that for the child all manner of rights are now being claimed. But, he wisely adds, there is seldom considered the prime right of all the child’s rights, i. e., the right of the child to the best ability and capacity for efficiency that his parents are able to transmit to him. The good doctor adds that this right is the root of all children’s rights; and that when the mysteries of procreation have been so far revealed as to enable this right to be won, we shall, at the same time renew the spiritual aspect of the nations.
The writer referred to decided that the most easily ascertainable and measurable factor in the production of ability, and efficiency in offspring, and a factor of the greatest significance, is the age of the parents at the child’s birth. He investigated a number of cases of men of ability and efficiency, along these lines, and made a careful summary of his results. Some of his results are somewhat startling, and may possibly require the corroboration of other investigators before they can be accepted as authoritative; but they are worthy of being carefully considered at the present time, pending such further investigation.
Vaerting found that the fathers who were themselves not notably intellectual have a decidedly more prolonged power of procreating distinguished children than is possessed by distinguished fathers. The former may become the fathers of eminent children from the period of sexual maturity up to the age of forty-three or beyond. When, however, the father is himself of high intellectual distinction, the records show that he was nearly always under thirty, and usually under twenty-five years of age at the time of the birth of his distinguished son, although the proportion of youthful fathers in the general population is relatively small. The eleven youngest fathers on Vaerting’s list, from twenty-one to twenty-five years of age, were with one exception themselves more or less distinguished; while the fifteen oldest, from thirty-nine to sixty years of age, were all without exception undistinguished.
Among the sons on the latter list are to be found much greater names (such as Goethe, Bach, Kant, Bismarck, Wagner, etc.) than are to be found among the sons of young and more distinguished fathers, for here is only one name (Frederick the Great) of the same caliber. The elderly fathers belonged to the large cities, and were mostly married to wives very much younger than themselves. Vaerting notes that the most eminent men have frequently been the sons of fathers who were not engaged in intellectual avocations at all, but earned their living as humble craftsmen. He draws the conclusion from these data that strenuous intellectual energy is much more unfavorable than hard physical labor to the production of marked ability in the offspring. Intellectual workers, therefore, he argues, must have their children when young, and we must so modify our social ideals and economic conditions as to render this possible.
Vaerting, however, holds that the mother need not be equally young; he finds some superiority, indeed, provided the father is young, in somewhat elderly mothers, and there were no mothers under twenty-three on the list. The rarity of genius among the offspring of distinguished parents he attributes to the unfortunate tendency to marry too late; and he finds that the distinguished men who marry late rarely have any children at all. Speaking generally, and apart from the production of genius, he holds that women have children too early, before their psychic development is completed, while men have children too late, when they have already “in the years of their highest psychic generative fitness planted their most precious seed in the mud of the street.”
The eldest child was found to have by far the best chance of turning out distinguished, and in this fact Vaerting finds further proof of his argument. The third son has the next best chance, and then the second, the comparatively bad position of the second being attributed to the too brief interval which often follows the birth of the first child. He also notes that of all the professions the clergy come beyond comparison first as the parents of distinguished sons (who are, however, rarely of the highest degree of eminence), lawyers following, while officers in the army and physicians scarcely figure at all. Vaerting is inclined to see in this order, especially in the predominance of the clergy, the favorable influence of an unexhausted reserve of energy and a habit of chastity on intellectual procreativeness.
It should be remembered, however, that Vaerting’s cases on his list were all those of Germans, and, therefore, the influence of the characteristic social customs and conditions of the German people must be taken into account in the consideration.
Havelock Ellis in his well known work “Study of British Genius” dealt on a still larger scale, and with a somewhat more precise method, with many of the same questions as illustrated by British cases. After the publication of Vaerting’s work, Ellis re-examined his cases, and rearranged his data. His results, like those of the German authority, showed a special tendency for genius to appear in the eldest child, though there was no indication of notably early marriage in the parents. He also found a similar predominance of the clergy among the fathers, and a similar deficiency of army officers and physicians.
Ellis found that the most frequent age of the father was thirty-two years, but that the average age of the father at the distinguished child’s birth was 36.6 years; and that when the fathers were themselves distinguished their age was not, as Vaerting found in Germany, notably low at the birth of their distinguished sons, but higher than the general average, being 37.5 years. He found fifteen distinguished sons of distinguished British fathers, but instead of being nearly always under thirty and usually under twenty-five, as Vaerting found it in Germany, the British distinguished father has only five times been under thirty, and among these only twice under twenty-five. Moreover, precisely the most distinguished of the sons (Francis Bacon and William Pitt) had the oldest fathers, and the least distinguished sons the youngest fathers.
Ellis says of his general conclusions resulting from this investigation: “I made some attempts to ascertain whether different kinds of genius tend to be produced by fathers who were at different periods of life. I refrained from publishing the results as I doubted whether the numbers dealt with were sufficiently large to carry any weight. It may, however, be worth while to record them, as possibly they are significant. I made four classes of men of genius: (1) Men of Religion, (2) Poets, (3) Practical Men, (4) Scientific Men and Sceptics. (It must not, of course, be supposed that in this last group all the scientific men were sceptics, or all the sceptics scientific.) The average age of the fathers at the distinguished son’s birth was, in the first group, 35 years; in the second and third group, 37 years; and in the last group, 40 years. (It may be noted, however, that the youngest father of all the history of British genius, aged sixteen, produced Napier, who introduced logarithms.)
“It is difficult not to believe that as regards, at all events, the two most discrepant groups, the first and last, we come upon a significant indication. It is not unreasonable to suppose that in the production of men of religion in whose activity emotion is so potent a factor, the youthful age of the father should prove favorable; while for the production of genius of a more coldly intellectual and analytic type more elderly fathers are demanded. If that should prove to be so, it would become a source of happiness to religious parents to have their children early, while irreligious parents should be advised to delay parentage.
“It is scarcely necessary to remark that the age of the mothers is probably quite as influential as that of the fathers. Concerning the mothers, however, we always have less precise information. My records, so far as they go, agree with Vaerting’s for German genius, in indicating that an elderly mother is more likely to produce a child of genius than a very youthful mother. There were only fifteen mothers recorded under twenty-five years of age, while thirteen were over thirty-nine years; the most important age for mothers was twenty-seven.
“On all these points we certainly need controlling evidence from other countries. Thus, before we insist with Vaerting that an elderly mother is a factor in the production of genius, we may recall that even in Germany the mothers of Goethe and Nietzsche were both eighteen at their distinguished son’s birth. A rule which permits of such tremendous exceptions scarcely seems to bear the strain of emphasis.”
The student, however, must always remember that while the study of genius and exceptionable talent is highly interesting, and even, as is quite probable, not without significance for the general laws of heredity, still we must beware of too hastily drawing conclusions from it to bear on the practical questions of eugenics. Genius is rare—and, in a certain sense, abnormal. Laws meant for application to the general population must be based on a study of the general population. Vaerting, himself, realized how inadequate it was to confine our study to cases of genius.
Another investigator, Marro, an Italian scientist, in his well-known book on puberty which was published several years ago, brought forth some interesting data showing the result of the age of the parents on the moral and intellectual characters of school-children in Northern Italy. He found that children with fathers below twenty-six at their birth showed the maximum of bad conduct and the minimum of good; they also yielded the greatest proportion of children of irregular, troublesome, or lazy character, but not of really perverse children—the latter being equally distributed among fathers of all ages. The largest number of cheerful children belonged to the young fathers, while the children tended to become more melancholy with ascending age of the fathers. Young fathers produced the largest number of intelligent, as well as of troublesome children; but when the very exceptional intelligent children were considered separately, they were found to be more usually the offspring of elderly fathers.
As regarded the mothers, Marro found that the children of young mothers (under twenty-one) are superior, both as regards conduct and intelligence, though the more exceptionally intelligent children tended to belong to more mature mothers. When the parents were both in the same age-groups, the immature and the elderly groups tended to produce more children who were unsatisfactory, both as regards conduct and intelligence—the intermediate group yielding the most satisfactory results of this kind.
Havelock Ellis makes the following plea for further investigations along these lines, in the interest of the well-being of the race: “But we have need of inquiries made on a more wholesale and systematic scale. They are no longer of a merely speculative character. We no longer regard children as the ‘gifts of God’ flung into our helpless hands; we are beginning to realize that the responsibility is ours to see that they come into the world under the best conditions, and at the moments when their parents are best fitted to produce them. Vaerting proposes that it should be the business of all school authorities to register the ages of the pupils’ parents. This is scarcely a provision to which even the most susceptible parent could reasonably object, though there is no cause to make the declaration compulsory where a ‘conscientious’ objection existed, and in any case the declaration would not be public.
“It would be an advantage—although this might be more difficult to obtain—to have the date of the children’s marriage, and of the birth of previous children, as well as some record of the father’s standing in his occupation. But even the ages of the parents alone would teach us much when correlated with the school position of the pupil in intelligence and conduct. It is quite true that there are unavoidable fallacies. We are not, as in the case of genius, dealing with people whose life-work is complete and open to the whole world’s examination.
“The good and clever child is not necessarily the forerunner of the first-class man or woman; and many capable and successful men have been careless in attendance at lectures, and rebellious to discipline. Moreover, the prejudice and limitations of the teachers have to be recognized. Yet when we are dealing with millions most of these fallacies would be smoothed out. We should be, once for all, in a position to determine authoritatively the exact bearing of one of the simplest and most vital factors of the betterment of the race. We should be in possession of a new clue to guide us in the creation of the man in the coming world. Why not begin today?”
Considerable attention on the part of the American thinking public has been directed toward the investigations and researches of Casper L. Redfield. Mr. Redfield combats the orthodox scientific position that the acquired qualities are not transmitted to offspring; and he most positively states that such characteristics are transmitted to offspring, and are really the causes which have tended toward the evolution and progress of the race. But he insists upon this vital point, namely, that the parent must already have acquired improved quality before he can transmit improvement to the offspring—and that before he can have acquired this improved quality, he must have lived sufficiently long to have experienced the causes which have developed improvement in himself. Consequently, he holds that delayed parentage produces great men.
Mr. Redfield several years ago offered a prize of two hundred dollars to anyone who could show that a single one of the great men of history was the product of a succession of young parents, or was produced by a line of ancestry represented by more than three generations to a century. But no one ever claimed the prize money. According to Mr. Redfield’s doctrine, race improvement is and will be accomplished as the result of effort, physical and mental, upon the part of prospective parents, particularly if the period of effort is sustained over a considerable number of years previous to reproduction.
The following quotations from Mr. Redfield’s writing will give a general idea of his lines of thought and his theories. He says:
“At some time in the past there was a common ancestor for man and the ape. At that time the mental ability of the man was the same as that of the ape, because at that time man and the ape were the same person. From that common ancestor there have been derived two main lines of descent, one leading to man and the other to the ape of today. In the line leading to man, mental ability has increased little by little so that today the mental ability of the man is far above that of the ape. While it may not be literally true for each and every generation between that common ancestor and man of the present time, still we will commit no error if we divide the total increase in mental ability by the number of intervening generations and say that each generation in turn was a little superior to that which produced it. Now it happens that mental ability is something which is inherited—is transmitted from parent to offspring. Take that fact with the fact that there has been a regular (or irregular) increase in mental ability in the generations leading to man, and it will be seen that each generation in succession transmitted to its offspring more than it inherited from its parents. But a parent cannot transmit something which he did not have. Where and how did those generations get that ability which they transmitted but did not inherit?”
Mr. Redfield in his writings shows that what is true of the human race is true of high-bred domesticated animals, namely, the cow of high milk producing breeds; the fast running and trotting horses; and the highly developed hunting dogs. To each case he applies his question: “Where and how did those generations of animals get that power which they transmitted but did not inherit?” In his investigations he claims to have discovered the secret, namely, that the ancestors, throughout several generations, had each acquired the power which it transmitted, which added to the inherited power raised the general power of the stock. This arose from careful breeding, and directly from the fact that the average age of the parent was much higher in the highly-bred stock than in the “scrub” or ordinary run of stock. In other words, delayed parentage produced better offspring.
Mr. Redfield proceeds to argue from these facts as follows: “At one time man and ape reproduced at the same average age, whereas now they reproduce at widely different ages. Going back to the time when man and ape separated, our ancestors survived by physical and mental activity in securing food and escaping from enemies. As time went on man reproduced at later and later average age until now he reproduces at about thirty years from birth of parent to birth of offspring. When time between generations stretched out in the man line more than it did in the ape line, the man acquired more mental development before he reproduced than did the ape, and he did this because he was mentally active more years before reproducing. The successive generations leading to modern man transmitted to offspring more than they inherited from their parents, and the generations which did this are the same generations which acquired, before reproducing, the identical thing which they transmitted in excess of inheriting.
“Coming now to those rare men of whom we have only a few in a century, how were they produced? It should be noted that each one had two parents, four grandparents, and eight great-grandparents. Also that they are certainly improvements over their great-grandparents. If they were not such improvements, then there would be many ‘rare’ cases in a century. In looking into the pedigrees of these great men it is found that they were sons of parents of nearly all ages, but were predominantly sons of elderly parents. While we sometimes find comparatively young parents in the pedigree of a great man, we never find a succession of young parents. Neither do we find an intellectually great man produced by a pedigree extending over three generations. The great man is produced only when the average for three generations is on the elderly side of what is normal. The average age of one thousand fathers, grandfathers, and great-grandfathers in the pedigrees of eminent men was found to be over forty years. Great men rise from ordinary stock only when several generations in succession acquire mental efforts in excess amounts before reproducing.”
It is the opinion of the present writer that the theories of Mr. Redfield are in the main true, and that in the future much valuable information will be obtained along the same lines, which will tend to corroborate his general conclusions. One’s attention needs but to be plainly directed to the matter, and then he will see that it is absurd to think of a creature transmitting to his offspring qualities which neither he or his mate had inherited or acquired. If there were no transmission of acquired qualities there would be no improvement—and in fact, we know that the bulk of inherited qualities were at some time in the history of the race “acquired.” And, reasoning along the same line, we may see that the young parents who have not had as yet an opportunity to acquire mental power cannot expect to transmit it to their offspring—all that they can do is to transmit the inherited stock qualities plus the small acquired power which they have gained in their limited experience. And, finally, it is seen that offspring produced at a riper age of parenthood, continued over several generations, tend toward unusual ability and powers. Consequently, the people or nation with a higher average age of parenthood may logically expect to attain greater mental powers than the peoples lacking that quality. And what is true of a people or nation is of course true of a particular family.
The subject touched upon in this part of our book is one of the greatest interest to careful students of Eugenics; and is one which calls for careful and unprejudiced consideration from all persons having the interest of the race at heart.
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KUALA TERENGGANU: Terengganu Menteri Besar Dr Ahmad Samsuri Mokhtar today extended assistance to part-time journalists in the state whose income are affected by the Covid-19 pandemic.
The RM10,000 contribution under the state Covid-19 Emergency Aid Fund was presented to the Terengganu Journalists Club (Kawat) for distribution to the affected members.
The contribution was handed over by Ahmad Samsuri’s press secretary Adram Musa to Kawat president Khairul Azlam Mohamad at Wisma Darul Iman, here.
Khairul Azlam said the contribution would definitely help ease the burden of part-time journalists who did not have a fixed income.
Normally, they would be paid based on the number of news they produced he said adding that the current situation of the Movement Control Order had made it difficult for them to generate income. – Bernama
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https://www.thesundaily.my/local/state-govt-contributes-rm10000-to-part-time-journalists-in-terengganu-FF2241106
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This Medical Product Alert relates to a number of confirmed falsified chloroquine products circulating in the WHO region of Africa. Please note that this Medical Product Alert n°4/2020 will be updated as new reports of falsified chloroquine are received and validated by WHO.
Between 31 March and 2 April 2020, the WHO global surveillance and monitoring system on substandard and falsified (SF) medical products received nine reports of confirmed falsified chloroquine products from three countries. All reported products were identified at patient level and all have been confirmed as falsified.
This WHO medical product alert N°4/2020 refers to nine different falsified chloroquine products, with different presentations (see Table 1). It is important to note that widespread vigilance is required from all countries, regardless of where the product was originally identified.
Table 1: List of identified falsified chloroquine products, subject of WHO Alert N°4/2020
All the products listed in Table 1 are confirmed as falsified, on the basis that they deliberately/fraudulently misrepresent their identity, composition or source. Indeed, it can be noted that:
Chloroquine phosphate or sulfate is referenced on the WHO Model List of Essential Medicines for the treatment of Plasmodium vivax infection (malaria). Large clinical trials are under way to generate the robust data needed to establish the efficacy and safety of chloroquine and hydroxychloroquine in the treatment of COVID-19. These medicines are currently authorized for malaria and certain autoimmune diseases and it is important that patients do not face shortages caused by stockpiling or use outside the authorized indications.
Both chloroquine and hydroxychloroquine can have serious side effects, especially at high doses or when combined with other medicines.
The SOLIDARITY trial, led by WHO, is reviewing potential treatments for COVID-19. Please refer to WHO medical product alert n°3/2020 for general information on falsified medical products in relation to the management
of COVID-19.
For photographs of products listed in Table 1, please refer to the WHO Medical Product Alert website, and
to the annex of this medical product alert n°4/2020 (see pages 3-7).
WHO requests increased vigilance within the supply chains of countries likely to be affected by these falsified products. Increased vigilance should include hospitals, clinics, health centres, wholesalers, distributors, pharmacies and any other suppliers of medical products.
If you are in possession of the above products, please do not use. If you have used these falsified products, or if you suffer an adverse reaction/event having used these products, you are advised to seek immediate medical advice from a qualified healthcare professional, and to report the incident to the National Regulatory Authorities/National Pharmacovigilance Centre.
All medical products must be obtained from licensed, authentic and reliable sources. Their authenticity and condition should be carefully checked. Seek advice from a healthcare professional in case of doubt.
National regulatory/health authorities are advised to immediately notify WHO if these falsified products are discovered in their country. If you have any information concerning the manufacture, distribution, or supply of these products, please contact: rapidalert@who.int.
WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products
For more information, please visit: www.who.int/medicines/regulation/ssffc/en/
CAMEROON
Photographs of confirmed falsified Chloroquine Phosphate (100mg)
Photographs of confirmed falsified Chloroquine Phosphate (250mg)
Photographs of confirmed falsified Chloroquine Phosphate 250mg
DEMOCRATIC REPUBLIC OF CONGO
Photographs of confirmed falsified CLOROQUINE 250MG
Photographs of confirmed falsified Chloroquine Phosphate 250mg
NIGER
Photographs of confirmed falsified Samquine 100 (100mg)
Photographs of confirmed falsified Chloroquine phosphate tablets B.P 100mg
Photographs of confirmed falsified Niruquine (100mg)
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https://www.who.int/news-room/detail/09-04-2020-medical-product-alert-n4-2020
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AGAMIC. Unmarried; unmarriageable, sometimes non-sexed.
AGENIC. Lacking in reproductive power; sterile.
AMPHIMIXIS. That form of reproduction which involves the mingling of substance from two individuals so as to effect a mixture of hereditary characteristics. It includes the phenomena of conjugation and fertilization among both unicellular and multicellular organisms.
ANABOLISM. See METABOLISM.
ANAMNESIC. Pertaining to or aiding recollection.
ANEMIC. Deficient in blood; bloodless.
ANTHROPOMORPHISM. The attributing of human characteristics to natural, supernatural, or divine beings.
ANTHROPOMETRY. Science of measurement of the human body.
ARTIFACT. Any artificial product.
APHASIA. Impairment or lose of the ability to understand or use speech.
ASSOCIATIONISM. The psychological theory which regards the laws of association as the fundamental laws of mental action and development.
ATAVISTIC. Pertaining to reversion through the influence of heredity to remote ancestral characteristics.
ATAXIC. Pertaining to inability to coördinate voluntary movements; irregular.
CALAMO-PAPYRUS. Reed papyrus or pen-paper.
CATABOLISM. See METABOLISM.
CATHARSIS. Purgation or cleansing. Aristotle’s esthetic theory that little renders immune for much.
CEREBRATION. Brain action, conscious or unconscious.
CHOREA. St. Vitus’s dance; a nervous disease marked by irregular and involuntary movements of the limbs and face.
CHRESTOMATHY. A collection of extracts and choice pieces.
CHRISTENTHUM. The Christian belief; the spirit of Christianity.
COMMANDO EXERCISES. Gymnastic exercises whose order is dependent upon the spoken command of the director.
CORTEX. The gray matter of the brain, mostly on its surface.
CORTICAL. Pertaining to the cortex.
CRANIOMETRY. The measurement of skulls.
CRYPTOGAMOUS. Having an obscure mode of fertilization; or, of plants that do not blossom.
CULTUS. A system of religious belief and worship.
DEUTSCHENTHUM. The spirit of the German people.
DIATHESIS. A constitutional predisposition.
EPHEBIC. Pertaining to the Greek system of instruction given to young men to fit them for citizenship; adolescent.
EPIGONI. Successors; followers who only follow.
EPISTEMOLOGY. The theory of knowledge; that branch of logic which undertakes to explain how knowledge is possible and to define its limitations, meaning, and worth.
EUPEPTIC. Having good digestion.
EUPHORIA. The sense of well-being; of fullness of life.
EVIRATION. Emasculation; loss of manly characteristics.
FERAL. Wild by nature; untamed; undomesticated.
FORMICARY. An artificial ants’ nest.
GEMÜTH. Disposition; the entire affective soul and its habitual state.
HEBETUDE. Dullness; stupidity.
HEDONISTIC. Relating to hedonism, that form of Greek philosophy which taught that pleasure is the chief end of existence.
HETAERA. A Greek courtesan. This class was often highly trained in music and social art, and represented the highest grade of culture among Greek women.
HETEROGENY. (1) The spontaneous generation of animals and vegetables, low in the scale of organization, from inorganic elements. (2) That kind of generation in which the parent, whether plant or animal, produces offspring differing in structure or habit from itself, but in which after one or more generations the original form reappears.
HETERONOMOUS. Having a different name.
HOROLOGY. The science of measuring time and of constructing instruments for that purpose.
HYGEIA. The Greek goddess of health; health.
HYPERMETHODIC. Methodic to excess; overmethodic.
HYPERTROPHY. Excessive growth.
INDISCERPTIBLE. Incapable of being destroyed by separation of parts.
INHIBITION. Interference with the normal result of a nervous excitement by an opposing force.
IRRADIATION. The diffusion of nervous stimuli out of the path of normal discharge which, as a result of the excitation of a peripheral end organ may excite other central organs than those directly connected with it.
KINESOLOGICAL. Pertaining to the science of tests and measurements of bodily strength.
KINESOMETER. An instrument for measuring muscular strength.
MEDULLATION. The investment of nerve fibers with a protective covering or medullary sheath, consisting of white, fat-like matter.
MERISTIC. Pertaining to the levels or spinal and cerebral segments of the body.
METABOLISM. The act or process by which, on the one hand, dead food is built up into living matter—anabolism, and by which, on the other, the living matter is broken down into simpler products within a cell or organism—catabolism.
METAMORPHOSIS. Change of form or structure; transformation.
METEMPSYCHOSIS. The doctrine of the transmigration of the soul from one body to another.
MONOPHRASTIC. Pertaining to or consisting of a single phrase.
MONOTECHNIC. Pertaining to a single art or craft.
MORPHOLOGY. The science of form and structure of plants and animals without regard to function.
MYOLOGY. The scientific knowledge of the muscular system.
MYTHOPOEIC. Producing or having a tendency to produce myths.
NOETIC. Of, pertaining to, or conceived by, mind.
NUANCE. Slight shade; difference; distinction; degree.
ORTHOGENIC. Pertaining to right beginning and development.
ORTHOPEDIC. Relating to the art of curing deformities.
OSSUARY. A depository of dry bones.
PALEOPSYCHIC. Pertaining to the antiquity of the soul.
PANTHEISTIC. Relating to that doctrine which holds that the entire phenomenal universe, including man and nature, is the ever-changing manifestation of God, who rises to self-consciousness and personality only in man.
PATRISTICS. That department of study occupied with the doctrines and writings of the fathers of the Christian Church.
PHOBIA. Excessive or morbid fear of anything.
PHYLETICALLY. In accordance with the phylum or race; racially.
PHYLETIC. Pertaining to a race or clan.
PHYLOGENY. The history of the evolution of a species or group; tribal history; ancestral development as opposed to ontogeny or the development of the individual.
PHYLUM. A term introduced by Haeckel to designate the great branches of the animal and vegetable kingdoms. Each phylum may include several classes.
PICKELHAUBE. The spiked helmet of the German army.
PLANKTON. Sea animals and plants collectively; distinguished from coast or bottom forms and floating in a great mass.
POLYGAMIC (LOVE). Pertaining to the habit of having more than one mate of the opposite sex.
POLYPHRASTIC. Having many phrases; pertaining to rambling, incoherent speech.
POST-SIMIAN. Pertaining to an age later than that in which simian or monkey-like forms prevailed.
PRENUBILE. Pertaining to the age before sexual maturity or marriageability is reached.
PRIE DIEU. A praying desk.
PROPEDEUTIC. Preliminary; introductory.
PROPHYLACTIC. Any medicine or measure efficacious in preventing disease.
PSEUDOPHOBIAC. Pertaining to a morbid condition in which the subject is continually in fear of having said something not strictly true.
PSYCHOGENESIS. The origin and development of soul.
PSYCHONOMIC. Pertaining to the laws of mind.
PSYCHOSIS. Mental constitution or condition; any change in consciousness, especially if abnormal.
PUBERTY. The age of sexual maturity.
PUBESCENT. Relating to the dawning of puberty.
PYGMOID. Of pygmy size and form.
RABULIST. A chronic wrangler; one who argues about everything.
SCHEMA. A synopsis; a summary. In the Kantian sense, a general type.
SCHEMATISM. An outline of any systematic arrangement; an outline.
SUPERFOETATION. A second conception some time after a prior one, by which two foetuses of different age exist together in the same female. Often used figuratively.
TEMIBILITY. (From Italian temibile, to be feared.) The principle of adjustment of penalty to crime in just that degree necessary to prevent a repetition of the criminal act.
TIC. A nervous affection of the muscles; a twitching.
TRANSCENDENTAL. In the Kantian system having an a priori character, transcending experience, presupposed in and necessary to experience.
TRAUMATA. Wounds.
TRAUMATISM. A wound; any morbid condition produced by wounds or other external violence.
VERBIGERATION. The continual utterance of certain words or phrases at short intervals, without reference to their meaning, as seen in insane Gedankenflucht or rapid flight of thought.
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