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History and Epidemiology
Mary Ellen Avery and Douglas Richardson
EARLY HISTORY OF CARE OF INFANTS*
In the late nineteenth century and the early part of the twentieth century, deaths from infectious diseases in the first years of life were so common that it is not surprising to find so few students of premature birth and so few articles concerning the special needs of low-birth-weight infants. These small infants were not expected to live. In fact, in the 1940s, some authorities thought of birth weights under 3 pounds as incompatible with life, although rare exceptions have always been noted, as in the case of the Dionne quintuplets, each of whom weighed under 3 pounds. Dafoe, who delivered them on May 28, 1934, wrote, ‘‘There were no scales small enough to measure accurately the separate weights of the babies, but on May 29 [second day] their combined weight was 13 pounds 6 ounces.’’ They were born about 2 months early. Marie, the smallest, weighed 1 1/2 pounds. Yvonne, the largest, weighed nearly 3 pounds. (Accurate scales arrived on the 6th day.)
As many infectious diseases came under control, physicians turned more attention to newborn infants. It is believed that Budin in Paris published one of the first articles on premature infants in 1888. At about the same time, German physicians, one of whom was Finkelstein in Berlin, became interested in the problems of premature infants and initiated special programs for their care. In Helsinki in 1912, Ylppo pioneered the research on prenatal and postnatal growth and the pathology of prematurity. Hess, an American physician who studied in Europe, was the founder of the first center in the United States that specialized in the care of premature infants; it was established at Michael Reese Hospital in Chicago in 1922. The criterion of 2500 g (5 1/2 pounds) birth weight was used to distinguish a premature from a term infant, and not until much later was the concept of gestational age widely accepted as being a more accurate measure of the stage of development of an infant than weight alone. Physicians who were first concerned with premature infants noted early that these children were unable to maintain their own body temperatures. Various devices, including double-walled metal tubs with the space between the walls filled with circulating hot water, were in use in Europe and Russia in the mid- nineteenth century. Other devices, such as hot-water bottles and electrically heated cribs, were the predecessors of more modern incubators. Occasionally the whole room in which many infants were cared for was kept at high temperatures, paving the way for the modern requirements that constant year-round temperature and humidity be maintained in nurseries where premature infants are cared for.
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