Like a Virgin by Prasad, Aarathi (recommended reading txt) 📕

In 1897, a German paediatrician named Dr Martin Arthur Couney moved his showcase of medical specimens from Coney Island in New York City to the Victorian Era Exhibition, at Earls Court, London. Rather than the usual monkeys, midgets, minstrels, and Moors, visitors to Couney’s were met with a true spectacle: a room neatly arranged full of large, glass-lidded wooden boxes, each containing a tiny baby, his ‘child-hatchery’.

The boxes were based on the original designs of the French obstetrician Etienne Stéphane Tarnier, who had realized that keeping premature babies warm was not enough; they had to be provided with isolation, excellent hygiene, appropriate feeding, and a warm, humid atmosphere in order to survive. Tarnier had studied a warming chamber used for rearing poultry at the Paris zoo. In 1880, he built his first enclosed wooden box for infants, outfitted with a compartment to hold a hot-water bottle that could warm the space without letting in germs. This crude incubator reduced the mortality of premature babies by nearly one third. Thirteen years later, Tarnier’s assistant, Pierre-Constant Budin, improved the basic contraption, adding a thermostat and natural-gas heating and more windows through which the babies could be observed – an innovation that his student, Martin Couney, must have applauded. Observed the babies certainly were – in Earls Court alone, the display drew crowds nearly four thousand strong.

The babies with whom Couney filled his incubators had been supplied by a Berlin hospital. As they were born prematurely, they were fully expected to die prematurely, too, which released the ‘incubator-doctor’ from liability for their deaths. Yet it was claimed that every one of the babies from his exhibitions had survived. With the money he made from his various circuses, Couney purchased more glass boxes for his hospital. His attempts to manufacture an artificial, independent environment for growing babies had proved a success.

A more technologically sophisticated means of sustaining the premature was developed in the late 1950s. This comprised a mass of machinery – plates and gaskets clamped together, with connectors for blood and gas; stainless steel plates and bolts; fixed volume gas exchangers; pressure transducers; and water baths. This incubator was used in experiments conducted on lamb,

goat, and rabbit foetuses that were extracted very early from the mothers’ wombs. The incubator was meant to replicate the idealized environment within a mother’s body, and the age of foetuses for which this became possible was pushed further and further towards the beginning of life. The ultimate aim, of course, was to translate this technology into saving human babies’ lives.

A baby who is born full term, after spending thirty-seven to forty weeks in a woman’s body, should have lungs that are sufficiently developed to support breathing air by him- or herself. The lungs of babies born at around six months, however, are prone to collapsing between breaths. This problem can be overcome by providing the baby with a ventilator, which mechanically keeps the lungs slightly inflated between breaths, and by treating the lungs with a chemical called a pulmonary surfactant (which reduces the surface tension in the lungs) that would have been produced naturally, had the lungs been able to develop fully in the womb.

Underdeveloped lungs are a major battle front in sustaining the very premature; indeed, newborns’ deaths because of respiratory failure have been recognized since ancient times. In the third millennium BCE, the legendary Chinese emperor and philosopher Huangdi reportedly noticed that this fatal syndrome occurred more often among infants born prematurely. Techniques for artificially reviving breathing in newborns date back to Soranus of Ephesus, who lived in the first century CE. Soranus even criticized ‘the majority of barbarians’ for the evidently common practice of immersing an infant in cold water to encourage them to breathe. And in the fourth century BCE, the father of medicine, Hippocrates, appears to have been the first to describe an intervention that is still in use to this day – inserting a tube into the trachea to support ventilation.

Even into the early eighteenth century, divine intervention was mostly given the credit for successful resuscitation. From the mid-1600s, midwives were trained to use mouth-to-mouth resuscitation as an attempt to awaken stillborn infants – with little luck. The technique seemed so clearly destined for failure that the Royal Society, dedicated to the discussion and promotion of scientific topics, branded it nonsense, stating in no uncertain terms that ‘life ends when breathing ceases’.

Others were more scientific in their approaches, though some of their solutions were often bizarre, and certainly amusing. In 1752, for example, the Scottish obstetrician William Smellie outlined the standard repertoire for treating apparently lifeless newborns: ‘the head, temples and breast rubbed with spirits; garlic, onion or mustard applied to the mouth and nose’. (Smellie also advocated a form of artificial respiration, and also the application of a straight endotracheal tube for resuscitation, much as is still used today.) Doctors have pried bellows up the nostrils; wafted brandy mist under the nose; shaken the body or swung it upside down; rhythmically pulled the tongue in and out; tickled the chest; tickled the mouth; tickled the throat; yelled. They have also tried dilating the rectum using a raven’s beak or a corncob, and blown tobacco smoke up the rectum with a clay pipe.

Fortunately, corncobs have fallen out of fashion, and artificial respiration using a ventilator – a mechanical device that fills the lungs with air – is now the accepted course. Unfortunately, the ventilator has not overcome one of the problems in resuscitating very premature babies: odds are that the life-saving device will irrevocably damage the delicate lungs, with serious side effects. If the lungs are damaged, that means less oxygen gets to the brain, increasing the likelihood of mental impairment.

So doctors and scientists started looking for a method that more closely simulates how