Paper - Fields, graphs, and other data on fetal growth (1915)
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Meyer AW. Fields, graphs, and other data on fetal growth. (1915) Contrib. Embryol., Carnegie Inst. Wash. 2: 55-68.
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Fields, Graphs, and Other Data on Fetal Growth
Contributions to Embryology, No. 4.
By Arthur William Meyer
From the Division of Anatomy of the Stanford Medical School.
Introduction
At the suggestion of Professor Mall and through the courtesy of Professor Williams I was enabled to obtain abstracts giving the fetal measurements, the duration of pregnancy, and such other data as might be desired from the case histories of patients from Professor Williams' clinic. As these abstracts were made more than half a decade since, they do not cover the entire material from the Department of Obstetrics of the Johns Hopkins Medical School, but only 4,530 cases. The immediate object of making these abstracts was the utilization of the data so obtained for the correction and, so far as might be, also for the extension of the curve of prenatal growth for length.
Since material from early abortions is comparatively rare among the cases ordinarily coming for obstetrical care, by far the largest part of the statistics covered the later months of pregnancy only. From the 4,530 abstracts, 2,470 were selected for the construction of graphs of growth. For this purpose the cases were usually plotted with duration in days as the abscissa and weight in grams or length in centimeters as the ordinate. However, on one chart weight in grams was used as the abscissa and length in centimeters as the ordinate. Other graphs were also formed to reveal the character and to illustrate the reliability of the data themselves. All plotting was done on a large and corresponding scale and cases falling at the same point of intersection were indicated by an Arabic numeral at that point. Although only 2,476 different cases were involved, approximately 12,000 plottings were done. The time-consuming nature of this work has been largely responsible for the delay in the compilation and analysis of the abstracts, the taking of which was a rather arduous task in spite of the careful way in which the histories are kept.
As is shown by reference to the original charted fields here reproduced, the graphs are medians and not averages. The most outlying cases were ignored, and those falling at different distances from the median were assigned equal value in its determination. Hence, all that these curves signify is that as many cases fall on the one side of the median as on the other, but not that most of the cases lie on it nor that the cases falling on it represent the average length or weight of the fetuses at that age. The empirical mode was not determined, except for birth, length, and for the occurrence of labor, as figures 5 and 6 show.
Although some of the outlying cases show clearly that there is occasional error (unavoid- able no doubt) in sonle of the histories, it was thought best not to make corrections, since purely arbitrary criteria would have to be followed in making them. Besides, in so doing there is danger of eliminating all cases representing wide but entirely normal fluctuations. In the selection of the histories cases were included or excluded for plotting solely on the basis of the character of the histories themselves — sometimes the whole history — but only rarely, on account of the character of individual measurements, unless these had been called in question by those taking them or were brought in question by the subsequent history of the case to which they belonged.
Before proceeding to a discussion of the graphs a summary of the cases utilized will be given. This will convey a better idea of the character of the data used for graphical representation. The publication of the original charts as plotted also enables anyone to draw his own curves and conclusions and reveals any personal equation that may have intruded itself.
The average duration of pregnancy (as reckoned from the beginning of the last men- strual period, in all cases, with a duration of 236 to 329 days) was 279.8 days in the case of 1,186 Caucasians and 276.9 days in the case of 1,181 negroes. These averages agree very well with the story of the charts, although they are, of course, too low for full-term averages. Since the average duration of pregnancy for mature fetuses, as counted from the date of coitus, in a total of 2,578 cases reported by Ahlfeld, 1869 and 1871, Schlichting, Issmer, 1889, and Inouye, 1912, and those of Lowenhardt as well, was 269.19 days, a somewhat lower average duration than the normal could be expected in the series of cases con- cerned here. As will be seen later, the comparatively high average duration never- theless obtained, which so closely approximates the normal, has undoubtedly resulted from the inclusion of histories with an erroneously long duration.
The average weight of 1,026 females with a duration of 236 to 320 days was 3,242.3 grams and that of 1,033 males was 3,387.4 grams, while that of 1,031 whites and 1,027 negroes was 3,436.5 and 3,185.4 grams respectively. The average length of the Caucasians falling in this period was 49.8 cm., that of the negroes 48.5 cm., and that of the females of both races was 48.7 cm. as compared to 49.6 cm. for the males.
The average weight of 1,146 males of both races of all ages as plotted was 3,258.4, and that of 1,161 females was 3,197.6 grams; although below the preceding averages (as would be expected) it is evident that both these averages are only slightly below the normal aver- ages for the sexes as reported from some European clinics, in spite of the fact that my statistics include fetuses from 180 days on and that approximately half of them are negroes. Zangenmeister (1911) reports the average weight for 11,181 collected European cases as 3,242.49 grams and their average length as 49.93 cm. The average weight of all plotted cases of both sexes and races in this series was 3,228 grams. However, the averages for length for these plotted cases of all ages, which are 48.1 cm. for the males and 47.1 for the females of both races, are manifestly somewhat lower in comparison with the weight averages. It is interesting to observe that the differences between the average weight of the sexes in the charted cases of all ages is only 60.8 grams, although the difference in length is 1 cm., or fully equivalent to the sexual differences at birth. These Weissenberg (1911) gave as 0.8 cm., while Stratz (1909) regarded them as practically non-existent, and later (in 1910) as quite insignificant, in spite of the fact that he reported (1909) a sexual difference in natal weight of 250 grams as obtained from 400 cases. This sexual weight- difference far exceeds that of the usual European statistics.
From a comparison of these figures it is evident that the difference between the average weights of the sexes rises from 60.8+ to 157.1 grams merely by the exclusion of all cases with a duration of less than 236 days, and similarly, that the differences in average length rises from 1.0+ to 1.6+ cm. Moreover, it is also evident that the percentage sexual differ- ences in both length and weight increase with advancing maturity, as might be expected. Although I regret exceedingly that the data at hand did not enable me to determine how early these sexual differences are recognizable and when the greatest percentage sexual differences occur, yet it may be quite safely inferred, I think, that sexual differences in weight probably appear earlier than sexual differences in length. It would also be interest- ing to learn whether the advent of these differences can be correlated in any way — as seems probable — with special developmental changes in the ovaries and testis after the manner of the later adolescent differences and changes. However, the observation of Fesser (1873) that males are 77 grams heavier in the ninth than in the eighth month and that females are heavier in the eighth month, as well as the similar but somewhat contrary conclusions of Hecker, probably rest on too small and hence on a misleading basis.
Out of a total of 2,298 cases as plotted for weight 252, or 10.9 per cent, weighed over 4,000 grams, and of this number 154 were males and 98 females. Only 8 weighed over 5,000 grams, and of this number 7 were males and 1 a female, 6 wore white and 2 black. The total number of cases which were 52 cm. long and over, out of a series of 2,307 of both races and sexes, was 415, or 17.9 per cent, Of these, 262 were males, 153 females, 287 white, and 128 black.
Of 2,092 cases with a given duration of over nine month* [252 days) the heaviest was a white male 49 cm. long, with a duration of 261 days and a weight of 7,545 grams, but the longest, on the contrary, was a white female weighing 4,035 grams, with a duration of 287 days and a length of 59 cm. The shortest was a male negro measuring 21 cm., with a dura- tion of 266 days and a weight of 2,920 grams. The shortest Caucasian was a female 40 cm. long, weighing 2,450 grams and having a duration of 275 days. The lightest of all cases was a white female, with a length of 41 cm., a duration of 256 days, and a weight of 1,295 grams. The heaviest negro was a female 52 cm. long, with 316 days duration and a weight of 5,556 grams. The longest negro was likewise a female, weighing 4, 1 95 grams, with a length of 57.75 cm. and a duration of 306 days.
From these figures it will be seen that the fluctuations in weight amounted to 113.5 per cent of the weight of the lightest and 31.8 per cent of that of the heaviest. The shortest fetus, which was only 51.3 per cent as long as the lightest, nevertheless weighed 208.5 per cent of the latter. Similarly, the fluctuation between the shortest and longest fetuses was equal to 17.4 per cent of the former and 63.1 per cent of the latter.
It is interesting to compare the fluctuations in weight in these cases with those existing between twins of the same and of different pregnancies, even if the results in the one case can not be considered confirmatory of those in the other. Because peculiar circulatory conditions may exist in case of multiple pregnancy, one might expect to find greater varia- tions in these cases, but such is not the fact in this series, at least. The greatest difference in the lengths of practically full-term twins (250 and 266 days) from the same pregnancy was 5 cm., or 11.6 per cent of the length of the shorter in two instances. The difference in weights between the individuals of these respective pairs was equal to 330 grams, or 14.9 per cent of the weight of the fighter in case of the younger pair of female twins and 690.4 grams or 30.4 per cent of the weight of the lighter of the older pair of male twins. How- ever, these differences are not the maximum differences noticed between individuals of the same pair, for the length and weight of the male of much younger twins were 42 cm. and 1 ,6S0 grams respectively, and the corresponding measurements of the female were 36 cm. and 1,285 grams. Hence, in this pair the difference in length was 16.6 per cent of the length of the shorter and the difference in weight was 30.7+ per cent of that of the lighter.
The weight of the heaviest twin was 3,882.4 grams and that of its mate (which was also a female) was 3,402 grams. If we contrast with this the weight of the lightest twin over 252 days or 9 months old (which was 2,052 grams) and that of its female companion (which was 2,685 grams), we see that the difference in weight between full-term twins is 89.2 per cent of that of the lightest, while the greatest difference in length was 27.5 per cent of the length of the shortest, which was 40 cm. long. It is also interesting to note that the two longest twins, which measure 51 cm. each, are exceeded in weight by several which are only 44.5 cm. long. From these things it is evident that the fluctuation in the size of twins, at large, both in length and weight, is considerably less than in the case of single births. In the latter the maximum weight differences amounted to 113.5 per cent of the lightest as compared with 89.2 per cent in the case of twins. Similarly, the maximum differences in length amounted to 171.4 per cent of the length of the shortest in case of single births, but only to 27.5 per cent in case of twins of different pregnancies and, of course, much less in case of twins from the same pregnancy. The existence of such exceed- ingly large and apparently normal fluctuations naturally necessitates the greatest caution in the use of any curve of growth for the determination of the age of a fetus even in the later months of pregnancy. It also enforces the necessity for a large basis if more than the roughest kind of approximation is to be attained in the construction and use of curves of growth. Moreover, it also justifies, it seems to me, the disregarding of far-outlying cases in the construction of graphs representing the median.
The above lack of correlation between weight and length recalls the observations of Bonnet (1884 and 1889) on ruminants, especially the sheep, and also those of Lomer (1889), who stated that it is surprising that two fetuses which may have the same length and weight, equally long fingers, and equally sized eyes and ears, may nevertheless not infre- quently have hearts of wholly different size. Or, on the contrary, the fact that three fetuses whose body-weight varies by 1,000 grams may be found to have hearts of the same size and weight. As might be expected from this, Lomer found similar variations in all organs of the healthy fetal body. Moreover, it may be recalled that Oppel (1891) found the same thing true in a number of vertebrates and that Keibel (1894 and 1895) called attention to the occurrence of the same phenomenon in pigs.
In reflecting upon the possible explanation for these things one is naturally led to think of the internal secretions. As far as body-length and total weight are concerned the recent work of dishing (1911) and others would seem to suggest a possible explanation for fetal gigantism or obesity. However, such an explanation could scarcely hold for individual organs, although there would, a priori, seem to be no reason why these could not be affected individually as well as individual portions of the osseous system or the whole of it. Although I do not wish to assume a causal relationship, I am also reminded in this connection that some years since I noticed that many of the sheep fetuses of the third month, even, with marked goiters, were very plump. However, since the basis of observation was very small, I could only conclude that this was probably nothing more than a mere coincidence.
Among the total 2,476 cases plotted — not all on any one chart — 318, or 12.8 per cent, had a duration of 300 days and over. Hiibner (1913) found only 498 cases, or 3.2 per cent, among a total of 2,000 births in Berlin with a duration of 302 to 324 days, while von Winkel found only 3.3 per cent with a duration of 302 to 347 days among 1,702 cases in Dresden. Of the above 318 cases 133 had a length of over 50 cm. or a weight over 4,000 grams. Among these 133 there were 68 males with an average weight of 3,797.5 grams and an average length of 52.6 cm., and 55 females with an average weight of 3,862.3 grams and a length of 52.2 cm. However, since only 55 of the 318 cases, or 17.2 per cent of those with a duration of 300 days and over, had a length over 52 cm. and only 42 or 13.5 per cent weighed over 4,000 grams, it would seem that the duration of pregnancy must have been inaccurate — i. e., alleged too long — in quite a large percentage of cases. This assumption is also con- firmed by the character of the right extremity of the curve in figure 1, but seemingly con- tradicted by the fact that Kaul (1912) found only 2.8 per cent of the new-born to weigh 4,000 grams and over in a total of 12,886 mature births at Breslau. Kaul also gives the following percentages of heavy births for the following clinics: Dresden 2.76, Munich 3.45, Bonn 4.76, Marburg 3.38, Leipzig 4.68, Kiel 8.31. The average percentage of heavy fetuses in full-term pregnancies for a total of 78,352 cases in these cities, as calculated from the figures given by Kaul, is 4.3.
Since as many as 252 cases, or 10.9 per cent, out of a total of 2,298 cases of all ages plotted in this series in figure 3, had a weight of over 4,000 grams, while only 14.2 per cent of those with a duration of over 300 days reached or exceeded this weight, it is evident that fetuses with this or a greater weight in our series among those with a duration of 300 days and over were only slightly more numerous than among all cases plotted. Kaul, on the other hand, found heavy fetuses 4.2 times as common among those with a duration of over 300 days than among births at large. Similar results were also obtained by others, for according to Htibner (1913), von Winkel found heavy fetuses 4 times as common and Hiib- ner 3 times, among those with a duration of over 302 days, as among full-term births at large. It must also be emphasized in this connection that the percentage of heavy cases among this whole series of mature and premature cases is extremely large, especially, as we have seen, when compared with the European statistics. As stated above, the average for the latter is 4.3 per cent, which is only 42.6 per cent as many as in the Johns Hopkins series. That is, heavy fetuses are less than half as common among a series of 78,000 full- term European births as among 2,298 cases of both races with a duration of ISO days and over from the Department of Obstetrics of the Johns Hopkins Hospital. This dis- proportion in the frequency of heavy cases is all the more striking when it is recalled that half of the Johns Hopkins cases were negroes and that the presence of premature births of necessity considerably lowers the percentage of heavy ones. Moreover, the presence of such a large percentage of heavy infants might also be interpreted as confirming the accuracy of the histories, were it not for the fact that heavy infants among those with a duration of 300 days and over were but slightly more numerous than among all cases at large. It is true that Kaul found that only 37, or 11.7 per cent, of the heavy infants in a series of 12,886 cases had a duration of over 300 days, while in our series this is true of 14.2 per cent. Although Hubner does not give the number of cases, except for himself and von Winkel, he gives the following percentages of heavy fetuses with a prolonged duration as found by the following investigators:
Authority. Per cent.
Duration of time (days).
Fiith-Enee 15.7
Fuchs 114
Gossrau 17.3
Hubner (397 rases) 9.8
Do 11.9
Jacoby | 9.4
Starcke | 14.7
von Winkel (28,736 cases) . . . 14 .6
From 302 to 351 From 302 to 341 From 303 to 349 Over 302 Over 300 From 302 to 349 Over 302 Over 302
Disregarding the slight discrepancy between the periods, the average percentage of cases with a duration of over 302 days (of these investigators) is 13.3. The slight difference between these percentages and ours could be disregarded were it not for the fact that the total list of premature and mature fetuses in the Baltimore series contains so many more heavy fetuses per 1,000 than the European. However, there seems to be a great difference in the frequency of heavy fetuses, for Inouye found only 0.93 per cent of heavy cases out of a total of 7,285 births, and it is interesting that all these percentages corroborate the well- known fact that many (Kaul puts it at 50.4 per cent) of the heavy fetuses with a prolonged duration were heavy before the end of the normal duration of pregnancy.
The large percentage of heavy fetuses in the service of Professor Williams also suggests the need for caution in the comparison of European with American anthropometrical statistics. One is tempted, to be sure, to suggest explanations for this decided difference in the ratio of heavy fetuses between Baltimore and the above-mentioned European cities, and no doubt someone will be reminded of Shroeder's humorous suggestion that his assist- ants must have exerted considerable tension on the legs of the new-born babies in order to get such a high ratio of long fetuses in his clinic. Nevertheless, I am certain that these differences can not be attributed to errors in the weighing. Besides, there are other much more plausible explanations.
A similar disproportion between the European and American statistics is present in the occurrence of cases weighing over 5,000 grams. During a period of 18 years at Breslau, in a series of 12,886 fetuses, Kaul reports, for example, the occurrence of but a single fetus weighing over 5,000 grams, while in this comparatively small series of 2,298 cases from Baltimore there were 8 with this weight or relatively 5.6 times as many, or 560 per cent. Moreover, Kaul's figures for Marburg, Leipzig, and Munchen, covering 42,941 cases over a long series of years, give only 1 case over 5,000 grams in 3,303 births, or only 9.9 per cent as many as in our series. Kaul also says that during 1 1 years in the Dresden clinic not a single child was found to weigh over 5 kg. and adds that von Winkel found not a single case weighing over 6 kg. in an extensive series of 30,000 cases. Yet there is one case weigh- ing 7,545 grams in this comparatively small series of 2,476 cases.
Among the 252 fetuses weighing over 4,000 grams there were 185 Caucasians and 64 negroes; 1 was a mulatto and 2 were unrecorded. Among the 42 births with a duration of 300 days and over and a weight above 4,000 grams, 30 were whites and 12 blacks, 25 males and 17 females. Only 34 of these 42 cases had a weight of 4,000 grams and over and also a length of 50.5 cm. and over. This would seem to imply that length must be set at practically the normal natal average if it is to be used in conjunction with weight in forensic medicine. Moreover, as will be seen, and as has often been stated, length alone is probably a far better guide than weight alone in the determination of the correctness of unusually long gestations.
Twelve of the above 34 cases were females and 22 males, and 25 belonged to the white race and 9 to the black. There were 123 cases or 27.1 per cent with a length of 51 cm. and over among those with a period of 300 days and over. Of these, 68 were males, 55 females ; 83 whites, 39 blacks, and in 1 case the race was not given. Among the total 2,476 cases plotted, 453 were 52 cm. long and over, but only 299 or 66 per cent of these were more than 52 cm. in length. Of the latter, only 55 or 18.4 per cent had a duration of more than 300 days, and 74 or 24.7 per cent had a duration less than 280 days. Of those with the former duration, 123 or 27.1 per cent were 51 cm. long and over. Moreover, the 18.4 per cent of the cases which had a duration of more than 300 days constituted but 12.1 per cent of those 52 cm. long and over which were contained in the entire series of cases. Similarly, although only 14.2 per cent of the cases weighing over 4,000 grams had a duration of 300 days and over, 59 or 23.4 per cent of them had a duration of less than 280 days, leaving 62.4 per cent of the heavy fetuses as falling between 280 and 300 days. These percentages confirm the now generally accepted opinion, also emphasized by von Winkel and Zangen- meister, that heavy fetuses usually have a prolonged period of gestation. This is true of 76.6 per cent of the heavy cases in this series.
Out of the 453 cases 52 cm. long and over in a series of 2,476 cases, the sex was given in 415. Of these, 262 were males, 153 females; 287 were white and 128 black. Of the 55 over 52 cm. long, 26 were males and 29 females; 39 were Caucasians and 16 negroes.
Among the total number of 4,530 abstracted cases, there were 73 instances of multiple pregnancy which were composed of 71 cases or 1.6 per cent of twins and two cases or 0.04 per cent of triplets.
The graphs in figure 1 show the cases of a certain length in centimeter intervals from a length of 39 to 59 cm. inclusive in a series of 2,554 cases, from the Department of Obstetrics of the Johns Hopkins Hospital and from Hasse's 935 cases. The extremely close corre- spondence between the forms of these curves is striking and the only essential difference, aside from the great fluctuation in the number of fetuses in the 45 to 48 cm. lengths of Hasse's curve, which is undoubtedly due to the comparatively small number of cases, is that by
Meyer 2554 Hasse 935 a
1
.ases J
ises t
290 300 310 320 330 3
Length in centimeters
Fig. 1.
Graphs illustrating the number of<:ases for each centimeter's length from 39 to 59 cm. inclusive. Fractions of a cen- timeter, which were few, were counted with the nearest integer, the half centimeters going with the lower figure. Meyer 2,554 cases, Hasse 935 cases.
Graphs showing the number of deliveries in each 10-day interval from 150 to 340 days. Meyer 2,440 cases, Has- ler 651 cases.
far the largest percentage of Hasse's cases were 50 cm. long instead of 49 cm. as in my series. The different location of the mode in my series is very evidently due to the fact that half of the cases from Professor Williams' clinic were negroes, and also to the presence of more immature cases. That is, 355 or 37.9 per cent of Hasse's cases are 50 cm. long, but only the same number of the present series of 2,311 cases, or 15.1 per cent, are 49 cm. long. 1
On comparing these curves with those in figure 3, which are based on practically the identical material, the very sharp ascent to and descent from the maximum in the frequency curves for length and the gradual ascent to, and the still more gradual descent from, the maximum in the weight curves are very striking. Moreover, only 129, or 13.8 per cent, of Hasse's cases fall in the most common weight interval of 3,250 to 3,500 grams, while 403, or 17.8 per cent, of the Johns Hopkins series fall into the most common but somewhat lower interval of 3,000 to 3,250 grams. Although the percentages in the most common weight interval in these two series are practically alike, Hasse found 37.9 per cent of his cases in a common length interval, as compared to 15.1 per cent in the Baltimore series. For this difference I can offer no explanation, except that the fluctuations tend to increase with the number of cases, although hardly to the degree here indicated, and that methods of measure- ment may to some extent be responsible. Moreover, in contrast to Hasse, the percentages in the common intervals of length and weight of our series differ but slightly — by only 2.7 per cent. As might be expected, this difference is to the advantage of the weight interval, which is a comparatively larger interval and hence should include a relatively larger per- centage of cases. The length interval of 1 cm. is manifestly only about 2 per cent of the average birth-length, while the weight interval of 250 grams, on the other hand, is approxi- mately 8 per cent of the average birth-weight.
'Curves based on percentages would have been preferable; nevertheless it hardly seemed of sufficient consequence.
Hennig i«
Mryrr 223
A graph similar to that in figure 4, giving the number of rases in each 250-gram interval from 2,500 to 5,250 grams inclusive. Meyer 2,076 cases, Hasse 931 cases.
Graphs for weight of Hennig and Meyer. Hennig 100 cases, Meyer 229 cases.
The marked difference in the length and weight curves is due to the fact that in the case of weight several adjoining intervals contain almost as large a percentage of cases, but this is not true in case of the length intervals. This difference is also very noticeable indeed if the figures giving the number of cases in each centimeter length and each 250-gram interval are arranged in column form.
The curves in figure 2 give the number of deliveries in each 10-day interval from 150 to 340 days. Here the difference in position of the peak of the graph is due to the fact that Hasler's graph was based on duration as estimated from conception, while my graph is based on duration as estimated from the beginning of the last menstruation. Bearing this in mind the correspondence is excellent.
In figure 5 the number of deliveries per day are plotted, beginning with 260 days. The numbers above indicate the total number of cases for each day. Here, too, the large number of cases with a long duration is evident.
Figure 4 gives the curves of growth of weight of Hennig and myself. The former is based on 100 cases, the latter on 229. Neither is carried beyond 2,500 grams, because that is where Hennig's curve stops. The peculiar disagreement between these curves between a weight of 1,250 and 1,750 grams is puzzling. However, I am inclined to regard Hennig's curve as probably the more defective, for it is based on a comparatively much smaller number of cases and also because we know that a rapid increase in weight occurs between a weight of 1,300 and 2,300 grams. Nevertheless, the sharp increase and decline in my curve are probably also incorrect and due to a too narrow statistical basis.
Figure 6 represents various curves of length. Those of Toldt and Mall are drawn after Mall (1910), page 200. Here the close correspondence between the character and location of the curve of Hennig, that of Shroeder-Ahlfeld as given by Stratz (1909), which coincides with that of Stratz (1910), and my curve is evident. The fact that my graph lies to the left of all the others, including that of Hecker and Michaelis,is difficult to explain, except upon the assumption that the other curves were based on averages, while my curve is a median. Not that I assume a definite mathematical relationship between the average and median values; for as far as I can see it is impossible to decide in advance what their relation in a given case is. An inspection of the fields might help to suggest where both lie, but their exact location could be determined only by calculation. As far as Toldt's curve is concerned, his confusion of two measurements, as Mall (1907) pointed out, affects Toldt's curve in its lower segments only — below an age of \\ months — and can hence be ignored here in the comparison of my curve and Toldt's. However, since I suggested above that my series of cases included too many with a long duration, it may be urged that my graph should consequently be displaced to the right instead of to the left, where it is actually found. Nevertheless, I consider that this effect would be but a slight one and would not compensate for the possible differences between the average and the median. The fact that my curve, which is based on 2,394 cases, does not reach 50 cm. until 282 days, may be due to the fact that it is lowered, especially in its highest portion near term, by the presence of cases with too long an alleged duration. Through a reduction in scale it has also become very regular. The rather marked inclination from the vertical at its upper extremity also characterizes it and is in harmony with the decreased rate of growth in length observed at this time by Shroeder-Ahlfeld, and Hecker, and also by others.
22 20 24 35 50
Duration in days
Number of deliveries daily between 260 and 340 days. The figures above represent the exact number of deliveries indicated on that point on the graph. 1,949 cases.
500
475
450
425
400
375
350
325
300
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3yer 2354 caf Idt (after M
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g 275
c 250
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(V
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175
150
125
100
75
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1234 5678 9 10 Months
Curves of growth based on length Fiq. 6. Graphs of Shroeder-Ahlfeld (Stratz) Hennig, Mall, Toldt, Zangenmeister, Hasse, and Meyer (partial) for length.
An inspection of these curves shows that there is unanimity only regarding the starting- point of the curves, for they diverge somewhat even at term and for a large extent of their course they are separated by an interval of approximately one month. This is practically the amount of fluctuation assumed by Zangenmeister and Heuser in connection with their curves, and if we assume a similar range for curves in figure 6, then it is evident that the most outlying cases on this set of curves will be separated by a time interval of 2 months.
Figures 10 to 13 explain themselves, and for comment on them and on certain deficien- cies in all curves of growth the reader is referred to the companion article on curves of pre- natal growth and autocatalysis published elsewhere. 1 In this article, which is based on the same material, other aspects of the subject are discussed and figures with grouped curves and also others with curves abbreviated from the original charts are included.
References
Ahlfeld, Friedeich. 1869. Ueber die Dauer der Schwangerschaft. Monatsschrift fiir Geburtskunde, vol. XXXIV.
Bonnet, R. 1884-1889. Beitriige zur Embryologie der Wiederkauer. Archiv f. Anat. u. Entwgsch., Bd. — .
Gushing, Harvey. 1911. The pituitary body and its disorders. Philadelphia and London.
Fesser, Vincent. 1873. Die Gewichts- und Langeverhiiltnisse der menschlichen Friichte in verschiedenen Schwangerschaftsmonaten. I. D., Breslau.
Hasler, Max. 1876. Ueber die Dauer der Schwangerschaft. I. D., Zurich.
Hecker, C. 1866. Ueber das Gewicht des Fotus und seine Anhange in den verschiedenen Monaten der Schwangerschaft. Monatschr. f. Geburtskunde, Bd. 27.
Hennio, . 1879. Die Wachstunisverhiiltnisse der Frucht und ihrer wichtigsten Organe in den verschiedenen Monaten der Tragzeit. Archiv f. Gvn., Bd. 14.
Hasse, . 1875. Entbindungsanstallt; Jahresberichte pro 1875. Charite Annalen, Bd. u.
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Description of Figures
Fig. 1. Graphs illustrating the number of cases for each centimeter's length from 39 to 59 cm. inclusive. Fractions of a centimeter, which were few, were counted with the nearest integer, the half centimeters going with the lower figure. 2,554 cases Meyer, 935 cases Hasse.
Fig. 2. Graphs showing the number of deliveries in each 10-day interval from 150 to 340 days. 2,402 cases Meyer, 651 cases Hasler.
Fig. 3. A graph similar to that in figure 1 , giving the number of cases in each 250-gram interval from 2,500 to 5,250 grams inclusive. 2,076 cases Meyer, 931 cases Hasse.
Fig. 4. Graphs for weight of Hennig and Meyer. 100 cases Hennig, 229 cases Meyer.
Fig. 5. Graph giving number of deliveries daily between 260 and 340 days. The figures above represent the exact number of deliveries indicated on that point on the graph. 1,949 cases.
Fig 6. Graphs of Shroeder-Ahlf eld (Stratz) Hennig, Mall.Toldt, Zangenmeister, Hasse, and Meyer (partial) for length.
Fig. 7. Graph based on length in centimeters and age in days. Both races and sexes, 2,436 cases from 10 to 59 cm. The cases represented by rings were added subsequently and were not used in locating the median. A portion of Mall's curve is shown in the lower left-hand corner as a solid line. The dotted portion of the curve is projected.
Fig. 8. Chart and grapli based on weight in grams and duration in days. Both races and sexes. 2,298 cases, 100 to 5,000 grams in weight.
Fig. 9. Chart and graph based on weight in grams and length in centimeters. 2,274 cases. Both sexes and races.
Fig. 10. Graph for females based on length. 1,161 cases.
Fig. 11. Same for males. 1,146 cases.
Fig. 12. Same for negroes. 1,155 cases.
Fig. 13. Same for whites. 1,147 cases.
138 65
7 = total 556
250 260 270
Age in days
290 300 310 320
330 340
Grand total 1161
FIG. 11
250 260 270
Age in days
330 340
Grand total 1146
MEYER 222
FIG. 12
Negroes
7 = Total 580
190 200
330 840
Grand total 1155
FIG. 13 250 260 270
Age in days
340 350
Grand total 1147
Cite this page: Hill, M.A. (2024, April 16) Embryology Paper - Fields, graphs, and other data on fetal growth (1915). Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_Fields,_graphs,_and_other_data_on_fetal_growth_(1915)
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