677 CONGENITALLY MALFORMED INFANTS AND ASSOCIATED GESTATIONAL CHARACTERISTICS

Abstract

CONGENITAL malformations are defects which are present at birth. Lay persons have long ascribed them to a multitude of natural and supernatural prenatal influences and the medical profession, hampered by the difficulties of observing human fetal development within the uterus, has long ascribed them to defective inheritance and adopted a fatalistic attitude toward them. Studies in human teratology until recently have been confined largely to descriptions of frequencies and morphologies. Congenital malformations, as an unhappy result, have remained unchanged in incidence while fetal and infant morbidity and mortality due to many other causes have declined. In 1940, Warkany announced the production of skeletal deformities in rats whose mothers had been reared on a deficient diet. Gregg's report was published the next year and teratology, as an etiologic science, was conceived with this proof that human congenital malformations can result from environmental insult. It is not necessary to summarize here the voluminous literature which has been published since these two papers, and the reader is referred for bibliography to two excellent recent reviews by Gruenwald and Warkany. Wesselhoeft has named rubella the modern Flibbertigibbet, after Shakespeare's fiend who "squints the eye and makes the hare-lip." He writes, in an article which summarizes the literature on this disease, "The Flibbertigibbet of today responsible for at least some congenital defects seems to be the virus of rubella, which stalks unseen by day as well as by night in the house, the school room and crowded places and which until recently was quite unsuspected and unfeared." Numerous other diseases have been indicted, but only rubella seems to have been convicted.