Learning to breathe : the history of newborn resuscitation, 1929 to 1970.

The history of newborn resuscitation in the twentieth century presented thus far in the writings of practitioner-historians describes a ‘hands-off’ attitude to newborn care prior to the 1950s. These practioner-historians tend to recount a positivist narrative with the rapid expansion of newborn care after WWII and the eventual logical uptake of endotracheal intubation and positive pressure resuscitation as the most effective method for treating asphyxia neonatorum. This thesis challenges this positivist narrative my examining the resuscitation of the newborn in Britain and America during the interwar period through to the late 1960s. It uncovers a much more complex and non-linear narrative for the development of newborn resuscitation during the twentieth century, uncovering some interesting themes which the practitioner-histories have not addressed. These themes include the interactions between neonatal and fetal physiologists and their research with clinicians and clinical practice, and the role of new groups of clinicians, the paediatricians and anaesthetists, in newborn resuscitation during this period. Many of the practitioner-histories ridicule what they deem to be ‘failed’ resuscitation techniques, seeing them as ‘deveiations’ from the eventual widespread adoption of positive pressure methods. My analysis of both the clinical and scientific debates surrounding both the use of positive pressure methods and some of these ‘failed’ techniques provides a more complex and detailed story. Two techniques in particular, intragastric oxygen and hyperbaric oxygen, provide useful case-studies to reflect on the factors which influenced the development of newborn resuscitation during the twentieth-century. One important factor which is analysed in detail is the formation of a network of scientists and clinicians with a shared interest in the neonate, which emerged during the 1950s. This ‘neonatal network’ has been identified and mapped, and its actions are discussed in detail. The thesis argues that the neonatal network played a fundamental role in directing neonatal research and care during the 1950s and 1960s. The case of newborn resuscitation is used to highlight the interactions of the network members. The history of newborn resuscitation is used to reflect on some wider themes of late-twentieth century medicine. It highlights the divided role of the post-war academic clinician, who was responsible for both clinical care and research. It also illustrates common trends such as the move towards super-specialization in medicine, the increasingly technological nature of medical care and the growing authority of science in the clinic. The research has analysed a variety of sources including the archives of the Ministry of Health, Medical Research Council, Scottish Home and Health Department, the Neonatal Society and National Birthday Trust Fund. Oral histories have been used to map the relationships forged between key actors. A variety of published resources, including journal articles, textbooks and conference proceedings, have also been studied to track both the changes in neonatal care and changes in the physiological understanding of the newborn.