Congenital malformations are of interest to the pediatrician because they contribute greatly to children's mortality and morbidity.When pediatrics emerged as a new medical specialty around the turn of the century it was dominated by interest in nutritional and infectious diseases, which were in those days the most urgent problems confronting our predecessors. The two generations of pediatricians who worked before ours were incredibly successful; they reduced the mortality and morbidity of infants and children to an extent considered impossible by the founders of the specialty. Although much credit must be given to improved sanitation, to improved social and economic conditions and to other sciences, pediatrics can claim a share in the success, because it recognized the problems, directed the reforms and applied and devised medical treatment. However, children are still subject to illness or death and our hospitals are overcrowded. It is generally recognized that a shift has taken place in the spectrum of the causes of death and disease.1-4 The fetal and neonatal mortality rates have not fallen so rapidly as have those of older age groups.1,5 While some of the causes of early death yield to medical measures, others persist and assume increased relative importance. Congenital malformations are among the persistent offenders. They show a relative increase in neonatal life and throughout early childhood (Figs. 1 and 2).It is of interest to compare the trends of mortality from diseases which were in the center of pediatric attention with those from the neglected congenital malformations. In Figure 3 are plotted the percentage contribution of deaths under 1 year of age from enteritis against deaths from congenital malformations, as reported by the U.S. Vital Statistics between 1910 and 1952.6
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