Spontaneous Hypoglycaemia with Failure to Increase Adrenaline Output

abdominal constriction as shown by the abdominal circumferences compared with the normal data obtained by Dr Melba McGinty from a series of normal babies in a normal lying-in hospital (Fig 2). The mechanism of death appears to be the prevention of downward excursion of the diaphragm during respiration. When the diaphragm contracts, its effect on the bound abdomen is to compress the liver and abdominal viscera a state that often caused our great-aunts to faint! The need for umbilical binders in the newborn is apparently only tradition. Binders are not advocated by pediatricians in charge of lying-in wards (Parmelee 1952, American Academy of Pediatrics 1957, Corner 1960, McKay & Smith 1964). It is significant that in a series of over 3,000 perinatal autopsies on hospital deaths, I have not seen a possible tight-binder death. The 'binder' now seems to be a feature of home midwifery practice. Until recently, binders, being made of linen or flannel, were probably ineffective for all but obscuring the umbilicus from view but the invention of the elagtic crepe bandage has produced a highly efficient splinting device excellent for sprains and bruises, but perhaps lethal for some newborns.