Summary The characteristics of normal labour in 1306 white, Asian and black parturients have been established following a prospective study of 3217 consecutive labours. Asian patients were found to be of significantly shorter stature than white or black women (p<0.001) and their infants significantly lighter than those of white (p<0.001) and of black (p<0.05) women, and a low positive correlation was found between maternal height and infant birth weight. The mean duration of the first stage of labour, taken from the time of admission to the labour ward, was 5‐6 hours in primiparae and 3.7 hours in multiparae. The mean durations of the second stage of labour were 41.5 and 17.4 minutes respectively. The correlations between the duration of the first and second stages of labour were too low to be of value in patient management. Similar low correlations were found between the duration of the second stage of labour and both infant birth weight and the Apgar score at one minute. Cervical dilatation‐time curves, constructed with reference to the cervical dilatation found on admission to the labour ward, revealed no significant differences in the progress of normal labour in the different racial groups.

A study of 1955 spontaneous labours is presented relating progress and outcome to the presence of a lumbar epidural block in 282 of these patients and to the need for oxytocin augmentation in 427. Graphs for cervical dilatation starting at admission to hospital were constructed for normal and dysfunctional labours of spontaneous onset. Patients requiring augmentation of labour had a lesser cervical dilatation on admission to hospital, a longer first stage, more instrumental deliveries, more Caesarean sections and a greater number of babies with a low Apgar score. An epidural block had no effect on either the duration of first stage or the rate of cervical dilatation but was associated with a 20-fold increase in rotational forceps delivery and no increase in Caesarean section rate. With an epidural block there was no increase in the number of babies with cerebral irritation or low Apgar scores and there was a statistically significant improvement in the Apgar scores of babies of mothers in augmented dysfunctional labour who had an epidural block. The incidence of rotational forceps delivery in patients with an epidural block could be reduced with safety by allowing such patients to have a longer second stage before considering interference purely for delay.

Psychological factors are rather less important than in women, and social factors are different and of less importance. Basically this is because the needs of reproduction can be satisfied by the man by the simple act of ejaculation into the vagina. There is no absolute needs to make provision for offspring, though the social desirability of children having two parents and of fathers being responsible for mother and children do in most cultures apply constraints.The pleasure of the male, like that of the female, can be experienced at different levels. There is satisfaction at being found sexually acceptable and in a loving relationship a pleasure at being able to elicit a sexual response. There is pleasure during the excitement stage and the intense visceral sensation of orgasm at the time of ejaculation. As in the woman this is accompanied by a loss of sensory awareness, a merging of personality with that of the partner, followed by a relaxation as deep as the climax was intense.The foregoing description of human sexual response is given in the most general terms. IntroductionOxytocic stimulation of inert labour has become accepted obstetric practice; it results in shorter labour, a decreased incidence in caesarean section and second-stage instrumentation, and improved maternal and neonatal conditions at the end of labour. 13 Some workers4 have used partograms to achieve these aims. Philpott's partogram5 aids the recognition of abnormal labour by clarifying recordings, and can indicate the correct timing of oxytocic stimulation by the use of "alert lines" and "action lines" based on cervical dilatation. These lines were constructed from data obtained from the slowest 10% of African primigravidae. Friedman's sigmoid curve of labour6 is a valuable pictorial representation of normal labour progression, but it is inadequate for the management of individual patients because it starts at the undefinable time of the onset of labour at zero centimetres and the latent period is of varying length. These factors obscure the position of an early assessment of cervical dilatation along the slope.The confusion surrounding the time of onset of labour can be resolved by using the time of admission in labour as the starting point.3 In a large study of normal spontaneous labour no patients entered hospital at a dilatation of zero centimetres, and 63%h of normal primigravidae and 86% of normal multigravidae entered hospital at a cervical dilatation of 3 cm or more when the latent phase had been completed.8Using the patient's admission as the reference point, we have constructed curves showing cervical dilatation times of normal labour for varying dilatations on admission. These data have

Two schools in rural Tanzania were surveyed regarding the pupils' nutrition (weight and height), serum immunoglobulins (IgA, IgG, IgM, and IgE), autoantibodies, malaria antibodies, hepatitis B antigenemia, and fecal and urinary parasites. The survey attempted to quantify the relative importance of undernutrition and parasitic infestation in determining the serological abnormalities found. Of all the children surveyed 69% were undernourished (less than 80% of expected weight for age); 63% had fecal parasites and 38% had urinary schistosomiasis. Serum IgG and IgM concentrations were raised and the serum IgE concentration was strikingly raised (mean 4990IU/ml). Elevated serum IgE was associated with ascariasis. Autoantibodies were common but no autoimmune disease was detected. Notably there was a 35% prevalence of reticulin antibody. This reticulin antibody positivity correlated with increased malaria antibody concentrations. Reduced malaria antibody concentration was significantly associated with hepatitis B antigenemia. The study illustrates that parasites, notably malaria, are important determinants of the serum antibodies of children in the tropics and suggests that mild undernutrition has little effect.

No abstract