1059
trends; they rely heavily on perinatal mortality rates. And, after Sir Dugald Baird’s pioneering work in Aberdeen, an increasing number of clinicians have joined them. Britain now has a National Perinatal Epidemiology Unit in Oxford, staffed by epidemiologists to help clinicians. Unfortunately the coarse perinatal mortality rate is but a poor measure of perinatal health. It is greatly influenced by two disparate factors-the background health and nutrition of the mother; and the qual ity of obstetric and paediatric care. We must of course strive to improve the second, but the first commonly has a greater bearing on outcome. We need better perinatal indices to identify the important background influences, which should point the way to effective prevention. As to technical improvements, we now have means to monitor various indices of fetal metabolism, growth, and behaviour during pregnancy and labour. Doubtless all these devices have their place. The danger is that they will be employed unthinkingly on the wrong population, or that the results will be harmfully misinterpreted. Perinatal health, and the exchequer, would benefit if clinicians were more ready to submit new tests to statistical evaluation: at what time are they most valuable and in what population? The British perinatal surveys of 1946, 1958, and 1970 were cross-sectional. At one time it seemed that the 1982 survey might follow a similar plan, but this is now unlikely; expense apart, many people favour other ways of learning about perinatal services. Regional systems are needed; and there must be continuous systematic measurement of perinatal risks. Some countries already have standardised maternity information systems brisk enough to give clinicians an up-to-date picture of their local perinatal affairs. All these themes need drawing together, and this week The Lancet launches a series of linked articles under the heading Better Perinatal Health. Mr Geoffrey Chamberlain (who gave much help with the organisation of the series) and Dr lain Chalmers open with background articles, and in the coming weeks we shall have discussions of the major causes of perinatal ill-health and of the perinatal scene in various countries. As usual we hope that readers will join in, via the correspondence columns. FISH POISONING IN many parts of the world poisonous fish are comand dangerous. The two most frequently reported intoxications are ciguatera, which is essentially tropical, and scombroid poisoning which can happen anywhere. Scombroid fish are dark-meated and migratory; they include mackerel, tuna, bonito, and skipjack, and their flesh has a high content of free histidine which is normally metabolised to ot-ketoglutarate. Many bacteria, particularly Proteus spp., can decarboxylate histidine to histamine and, if fish are contaminated with such organisms, large amounts of amine may accumulate in the flesh.2 Fish are generally toxic when concentrations mon
1 Halstead BW. Poisonous and venomous marine animals of the world:
vol. 1,
Washington, D.C.: U.S. Government Printing Offices, 1967. 2. Taylor SL, Gutherty LS, Leatherwood M, Tillman F, Lieber ER. Histamine production by foodborne bacterial species. J Food Safety 1978; 1: 173-87. Vertebrates.
in the muscle reach about 100 mg per 100 g (normal
trends; they rely heavily on perinatal mortality rates. And, after Sir Dugald Baird’s pioneering work in Aberdeen, an increasing number of clinicians have joined them. Britain now has a National Perinatal Epidemiology Unit in Oxford, staffed by epidemiologists to help clinicians. Unfortunately the coarse perinatal mortality rate is but a poor measure of perinatal health. It is greatly influenced by two disparate factors-the background health and nutrition of the mother; and the qual ity of obstetric and paediatric care. We must of course strive to improve the second, but the first commonly has a greater bearing on outcome. We need better perinatal indices to identify the important background influences, which should point the way to effective prevention. As to technical improvements, we now have means to monitor various indices of fetal metabolism, growth, and behaviour during pregnancy and labour. Doubtless all these devices have their place. The danger is that they will be employed unthinkingly on the wrong population, or that the results will be harmfully misinterpreted. Perinatal health, and the exchequer, would benefit if clinicians were more ready to submit new tests to statistical evaluation: at what time are they most valuable and in what population? The British perinatal surveys of 1946, 1958, and 1970 were cross-sectional. At one time it seemed that the 1982 survey might follow a similar plan, but this is now unlikely; expense apart, many people favour other ways of learning about perinatal services. Regional systems are needed; and there must be continuous systematic measurement of perinatal risks. Some countries already have standardised maternity information systems brisk enough to give clinicians an up-to-date picture of their local perinatal affairs. All these themes need drawing together, and this week The Lancet launches a series of linked articles under the heading Better Perinatal Health. Mr Geoffrey Chamberlain (who gave much help with the organisation of the series) and Dr lain Chalmers open with background articles, and in the coming weeks we shall have discussions of the major causes of perinatal ill-health and of the perinatal scene in various countries. As usual we hope that readers will join in, via the correspondence columns. FISH POISONING IN many parts of the world poisonous fish are comand dangerous. The two most frequently reported intoxications are ciguatera, which is essentially tropical, and scombroid poisoning which can happen anywhere. Scombroid fish are dark-meated and migratory; they include mackerel, tuna, bonito, and skipjack, and their flesh has a high content of free histidine which is normally metabolised to ot-ketoglutarate. Many bacteria, particularly Proteus spp., can decarboxylate histidine to histamine and, if fish are contaminated with such organisms, large amounts of amine may accumulate in the flesh.2 Fish are generally toxic when concentrations mon
1 Halstead BW. Poisonous and venomous marine animals of the world:
vol. 1,
Washington, D.C.: U.S. Government Printing Offices, 1967. 2. Taylor SL, Gutherty LS, Leatherwood M, Tillman F, Lieber ER. Histamine production by foodborne bacterial species. J Food Safety 1978; 1: 173-87. Vertebrates.
in the muscle reach about 100 mg per 100 g (normal
