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Congenital malformations are worldwide occurrences striking in every condition of society. These severe physical abnormalities which are present at birth and affecting every part of the body happen more often than usually realized, once in every 33 births. The most common, after heart defects, are those of the neural tube (the brain and spinal cord) which happen in as many as one in every 350 births. They have been noted as curiousities in man and beast throughout recorded history and received great attention in our time by various fields of study, for example, their faulty prenatal development by embryologists, familial patterns by geneticists, causation by environmentalists and variability by population scientists. Attention turned much in recent years to the relation of these malformations to deficiency of a particular dietary ingredient, folic acid, a subject this book analyzes in depth. The greatest conundrum of all, which this latest matter like so much else hinges on, is the amazing fact of the tremendous, almost universal decrease in the frequency of these anomalies since early in the 20th century. The puzzle is ‘What can this downward trend possibly mean?'and at bottom ‘Whether it is part of a long-term cyclical pattern'. This fascinating biological phenomenon is explored in the book together with various other topics.

Congenital malformations are worldwide occurrences, they know no national borders, do not distinguish between races, ethnicities, rich or poor. These severe physical abnormalities, present at birth, happen more often than is usually realized, once in every 33 births. They strike every part of the body, limbs, head, heart, and all others. The most frequent of them all are the many types of malformations of the cardiovascular system, the heart and its blood vessels, which happen in about once in every 250 births. Study of these conditions during the twentieth century took many forms, revolving about examination and analysis of their causes, genetic, nongenetic, and complex. To aid in unraveling the complexities of this causation, various influences on their frequency are considered, among them social conditions, maternal health, birthweight, newborn maturity. And of course the known and possible environmental bases of their occurrence are fully described.The relation of infant death to cardiovascular malformation is noted; and puzzlement that the level of such deaths had not kept pace with the reduction of infant death itself and of that associated with other kinds of malformations during this period. An introductory record of the history of perinatal mortality in the last three centuries gives foundation for the discussion of death in contemporary decades.