Historical Perspectives

Abstract

One hundred years ago, preterm birth was considered an unfortunate event that occurred for unknown reasons and led to loss of the child. The cause of death generally was ascribed to “weakness” (Lebensschwache). Many obstetric textbooks considered babies born before 28 weeks' gestation as unviable; others put this limit at birthweight less than 2,000 g. Midwives were taught that preterm birth occurs between 29 and 39 weeks' gestation, and under favorable circumstances, the baby may survive, effectively leaving those below this range without care. In the late 1800s in France, Pierre Budin developed an incubator for keeping infants warm (see Toubas PL. NeoReviews . 2009;10:e60–e64), but these were available in few obstetric or pediatric hospitals. Impressive results in treating preterm infants were obtained by Martin Couney, a disciple of Budin's, who collected from delivery wards tiny infants otherwise doomed to die untreated. He put them in incubators, fed them with human milk, and put them on display at Coney Island in New York, as well as in fairs and exhibitions in the United States and in Europe between 1902 and 1940. The treatment of preterm infants could not progress until a change of attitudes was achieved and therapeutic nihilism abandoned. Enter Arvo Ylppo! Ylppo was born in 1887 in a farmhouse in southwestern Finland. Birthweight was not recorded because no balance was available, but the mother's estimate was 2,000 g. Catch-up growth took him up to an adult height of only 154 cm (5 ft), but small physical size was compensated by a keen intelligence and boundless energy. Ylppo decided early in life to become a physician and started his medical studies at the University of Helsinki in 1906. When he entered the Children's Hospital for the first time, toward the end of the clinical curriculum, he immediately felt at home …