One area in which medicine has made gigantic strides in the last thirty years is the treatment of very premature babies. Pregnancy lasts on average 40 weeks; a baby born before 37 weeks’ gestation is classed as premature. Most premature babies are born in what is known as the ‘late preterm’ stage, only two or three weeks earlier than expected – and for the large majority, this will not have any long-term health implications.
But those born substantially before their due date can face a daunting range of complications including lung and heart problems, brain haemorrhage, and of course infection. Until quite recently very few babies born before 30 weeks would survive – but advances in neonatal intensive care in the last few decades have been dramatic. Babies born at 25 weeks now often thrive without any sort of developmental problems in later life. There are even a few children (and one adult) alive today who were born at 21 weeks – barely halfway through the usual length of pregnancy.
But 150 years ago a baby born in such circumstances would not have had a chance of survival – or would they? In 1866 the Southern Journal of the Medical Sciences published this truly extraordinary article by William Kennedy, a physician from New Orleans:
In 1845, Mrs. A.B., primipara, suffered, as she thought, during one whole night with colic.
‘Primipara’ means that this was her first pregnancy.
I saw her next morning, when I recognized that she was in labor, which had progressed so far that I made no attempt to arrest it. Within a half hour after my arrival she gave birth to a foetus. It was not more than eight inches long, and was as red as a piece of raw beef.
Eight inches is amazingly tiny: at 24 weeks’ gestation the average foetus is already 12 inches in length. The doctor observed that the child’s skin was so delicate that the tissues underneath were plainly visible through it.
The eyes were still closed; there was no trace of cilia or supercilia; its chest was about two inches broad; the arms and legs were very slender, and the toes and fingers devoid of any traces of nails. The head was about the size of a small orange.
‘No trace of cilia or supercilia’ = no eyelashes or eyebrows.
The respiration was so feeble as scarcely to be perceptible, and not a sound was uttered after birth. I was almost afraid to handle it, as I could not divest myself of the idea that the slightest pressure of the fingers would thrust them into the soft, red, jelly-like mass before me. When I raised it from the couch, and laid it in the length of my left hand, the head lay on the convexity of my flexed fingers, the chest and breech in the palm, and the feet reached almost an inch beyond the wrist.
This newborn could almost fit in the palm of the doctor’s hand – he was truly minute. It is striking, incidentally, that until recent decades it was normal to call an infant ‘it’ rather than using gender-specific pronouns.
I wrapped it carefully in batting, and carefully attended to maintaining a proper surrounding temperature.
Batting was a form of cotton sheet, used for bedding. The doctor’s attention to the child’s body temperature was vital, since premature babies have almost no fat and struggle to thermoregulate.
It was fed drop by drop with sugar and water every four or five minutes, and later, when the mother could supply it with milk, half a teaspoonful was given every half hour or hour. Within three weeks after birth it had a mild attack of trismus.
A locked jaw, probably caused by a spasm.
During treatment I gave it frequent baths in a tumbler.
A touching little aside!
The period of infancy was one of the most stormy I ever saw. Hydrocephalus, cholera-infantum, measles, diarrhoea, are some of the many affections it suffered from during that time, and up to three or four years.
This is hardly surprising. A child born so prematurely, and without the possibility of any of the medical interventions available today, would have been extremely vulnerable to infection. But somehow he survived:
When last I saw him he was a fine healthy boy of twelve years, and gave promise of a vigorous manhood.
Remarkable. The doctor goes on to explain that he had intended to share more details of the case, but the recent Civil War had made it impossible.
The importance of the subject demands it. But my note-book, carefully preserved during many years of arduous practice, and which I hoped, in my declining days, to make useful to my brethren, through the medium of the press, has, like my library and every vestige of household material, passed from my possession under the ruthless hand of destructive war.
The loss of Dr Kennedy’s notes was also unfortunate in that it makes it more difficult to corroborate his story. The journal’s editor, appreciating that some readers might be inclined to doubt his story, offers the New Orleans physician this ringing endorsement:
No man stands higher in his profession in this community than Dr. Kennedy, and his observations may be relied on as strictly accurate. It is certainly a matter for real regret, that Dr. K. should have lost his complete notes of the case, as it would have been most truly interesting to have watched the progress of development, from week to week, of so young a foetus thrown into the external world.
The article concludes by surveying the medical literature for previous cases of premature birth.
Dr. Kennedy’s case takes precedence of all these, as the description of its length and general development go to indicate clearly that it could not have been more than one hundred and forty to one hundred and forty-five days old at birth.
Judging by the size and description of the newborn, 145 days (a little under 21 weeks) would appear to be a plausible estimate of its gestation. But what are the chances that such an extraordinarily premature child could have lived for more than a few hours in 1845, let alone survive into a healthy childhood? It does seem rather unlikely to me – but if you have any opinions on the subject please do leave a comment below.