by Julius H. Hess, M.D.
In the absence of any definite collection of material on the care of prematurely born human infants, I have attempted to compile information taken from many sources. The foundation of this work with premature infants was laid in the researches of the French obstetricians and was adopted and further popularized by English and German physicians.
The growing importance of the subject is indicated by the increase in premature births during recent years revealed by vital statistics. Of 2806 deaths of infants occurring in Chicago during one year, 739 deaths in the first month of life were due to prematurity. Of 860 who died during the first twenty-four hours, 399 deaths were due to premature birth, while of 1700 who died during the first week of life, 588 deaths were due to premature birth.
A study of the etiological factors predisposing to premature birth emphasizes the necessity for proper prenatal care of the mother, thus eliminating a large group of premature births precipitated by her overwork and her anxiety, or by trauma, as well as by improper hygiene and insufficient and improperly balanced diet. The general experience of workers who have interested themselves in prenatal care of the mother in its larger aspect proves that careful following of scientific instructions inevitably decreases the number of premature births coming under observation.
Many diseases, such as syphilis and nephritis, which are direct causes of premature birth, are amenable to treatment which will prolong the intra-uterine life to the natural period, or at least to the point where prenatal development is compatible with post-natal existence. Proper preparation for the care of these infants will justify the induction of labor prior to full-term when pathologic conditions exist; moreover this procedure may be undertaken at a much earlier time than when proper facilities are not available.
In the United States the care of premature infants has not received the general attention of the medical profession which it merits. Facilities for the care of such infants are lacking, first, because special obstetrical hospitals in most instances decline outside cases, and, second, because comparatively few general hospitals are properly organized to undertake the special care required. Proper handling of these infants demands a thorough knowledge of their immediate needs. The first intimation of coming labor must be met by preparation for the infant's reception in order to avoid the dangerous period of exposure immediately after birth which is a primary cause of the high mortality. If a sudden lowering of temperature produces fatality in some cases in full-term infants, how much more likely it is to produce fatality in an immature infant, whose organs are not completely developed, who is lacking in the protective covering of body fat possessed by the mature infant, whose vitality is low and whose resistance is at a minimum. Coming from an equalized temperature of unvarying degree it is precipitated into alien surroundings, deprived of its usual nutrition and subjected to handling which, however tender, is still a shock to its delicate external and internal structures.
As part of the great movement toward conserving and developing the individual to his highest point of health efficiency, as an important factor in national health, and as an effort directed toward the source of a considerable morbidity, the care of premature infants and the conservation of their flickering lives has a prominent place.
I desire to acknowledge my indebtedness to Dr. Martin Couney for his many helpful suggestions in the preparation of the material for this book.
J. H. H.
Chicago, 1922