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Historical Perspectives

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INTRODUCTION

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“Any society, any nation, is judged on the basis of how it treats its weakest members—the last, the least, the littlest.”

 —Cardinal Roger Mahony

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Modern, well-resourced societies in the 21st century expect most newborn infants to survive, especially when they are full term or near term. But in the past, newborn infants frequently died at birth or soon thereafter. As recently as in the 18th century, Queen Anne of England died childless in 1714, despite bearing 17 children. Over the last several hundred years, and especially in the last 50 years, advances in the care of healthy and sick neonates have led to dramatic improvements in their survival and outcomes. These remarkable improvements are the result of changing societal attitudes toward the care of neonates, advances in technology that led to the modern neonatal intensive care unit (NICU), regionalization of neonatal care, and incorporation over time of scientific advances and the principles of evidence-based medicine into neonatal practice. In parallel, improved obstetric care of pregnant women during pregnancy and delivery has also improved neonatal survival and outcomes.

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SOCIETY’S VIEW OF THE NEWBORN AND CHANGES OVER TIME

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From a teleological and evolutionary standpoint, individual adults are primed to react to a baby with tender emotions. However, attitudes of societies to the baby have varied through history. An underlying theme is that as society got more complex and richer, it could afford a more caring approach to the infant. In addition, by the 1800s, society generally viewed that a healthy individual contributed to the economic and social wellbeing of the nation.

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Silverman noted that “infanticide is the oldest method of human family planning.” This was exemplified in the Greek Spartan approach. But this was gradually superseded by strictures against infanticide. By 52 BC, Roman law passed by the Consul Pompeius warned against any murder of any relative, but was still often flouted. In the Justinian Code of AD 529, “foundlings” were not to be made slaves, but at the same time, fathers had rights to destroy “deformed” children and had absolute power over the life of the child. By the 1500s, court records in Nuremberg, Germany, show that women convicted of infanticide were buried alive, yet the practice remained rife. In England, unwanted infants were placed into “baby farms” staffed by “killer nurses” plying “Godfrey’s cordial” (a mixture of opium, treacle, and sassafras). In the 1860s the British press carried “frequent reports of dead infants found under bridges, in parks, in culverts and ditches, and in cesspools.” An outcry led to the first Infant Life Protection Act, in 1872. Yet, at the same time, the Industrial Revolution placed no value on children’s lives, nor on the expectant mothers, as records of medical commissions reported.

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Following the Franco-Prussian War in 1870, French society realized that a strong, healthy conscripted army was needed for ...

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