Publications by authors named "Michael Obladen"

99 Publications

Revived for Paradise: A History of Respite Sanctuaries.

Authors:
Michael Obladen

Neonatology 2018 26;113(3):249-255. Epub 2018 Jan 26.

Infant baptism originated when St. Augustine proclaimed the doctrine of original sin in 412 CE. Neonates stillborn or deceased before baptism were declared to go down to Hell and were buried outside of sacred ground. From the 15th century, parents carried these infants to "respite sanctuaries" in remote mountain chapels, where miraculous images were believed to revive the infant in order to allow baptism and a Christian burial. Monasteries made fortunes out of the parents' anguish. In 1528, the abuse of the Oberbüren image ignited iconoclasm and heralded the beginning of the Reformation. From 1740, Pope Benedict XIV opposed the sanctuaries, especially Ursberg in Swabia, declaring as invalid any apparent signs of life, e.g., changes in skin color, a change from rigidity to flexibility, blood flowing from the nose, sweat on the skin, cessation of a cadaveric smell, and the movement of a feather held at the infant's mouth. Only crying and sounds of respiration remained valid signs of revivification. The debate ran for centuries, highlighting the difficulty of distinguishing a stillborn from a liveborn baby before the stethoscope became available. The existence of respite sanctuaries is an illustration of the failure of the doctrine of original sin, which was never accepted by the pious.
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http://dx.doi.org/10.1159/000485666DOI Listing
September 2019

Cot Death: History of an Iatrogenic Disaster.

Authors:
Michael Obladen

Neonatology 2018 15;113(2):162-169. Epub 2017 Dec 15.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Since antiquity, cot death has been explained as accidental suffocation, overlaying, or smothering. Parents were blamed for neglect or drunkenness. A cage called arcuccio was invented around 1570 to protect the sleeping infant. Up to the 19th century, accidents were registered as natural causes of death. From 1830, accidental suffocation became unacceptable for physicians and legislators, and "natural" explanations for the catastrophe were sought, with parents being consoled rather than blamed. Two assumed causes had serious consequences: thymus hyperplasia was irradiated, causing thyroid cancer, and the concept of central apnea was widely accepted, which led to home monitors and distracted from epidemiological evidence. Prone sleeping originated in the 1930s and from 1944, it was associated with cot death. However, from the 1960s, many authors recommended prone sleeping for infants, and many countries adopted the advice. A worldwide epidemic followed, peaking at 2‰ in England and Wales and 5‰ in New Zealand in the 1980s. Although epidemiological evidence was available by 1970, the first intervention was initiated in the Netherlands in 1989. Cot death disappeared almost entirely wherever prone sleeping was avoided. This strongly supports the assumption that prone sleeping has the greatest influence on the disorder, and that the epidemic resulted from wrong advice.
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http://dx.doi.org/10.1159/000481880DOI Listing
September 2019

From "apparent death" to "birth asphyxia": a history of blame.

Authors:
Michael Obladen

Pediatr Res 2018 02 8;83(2):403-411. Epub 2017 Nov 8.

Department of Neonatology, Charité University Medicine, Berlin Germany.

Since the sixteenth century, competition between midwives and surgeons has created a culture of blame around the difficult delivery. In the late seventeenth century, 100 years before oxygen was discovered, researchers associated "apparent death of the newborn" with impaired respiratory function of the placenta. The diagnosis "birth asphyxia" replaced the term "apparent death of the newborn" during the mass phobia of being buried alive in the eighteenth century. This shifted the interpretation from unavoidable fate to a preventable condition. Although the semantic inaccuracy ("pulselessness") was debated, "asphyxia" was not scientifically defined until 1992. From 1792 the diagnosis was based on a lack of oxygen. "Blue" and "white" asphyxia were perceived as different disorders in the eighteenth, and as different grades of the same disorder in the nineteenth century. In 1862, William Little linked birth asphyxia with cerebral palsy, and although never confirmed, his hypothesis was accepted by scientists and the public. Fetal well-being was assessed by auscultating heart beats since 1822, and continuous electronic fetal monitoring was introduced in the 1960s without scientific assessment. It neither diminished the incidence of birth asphyxia nor of cerebral palsy, but rather raised the rate of cesarean sections and litigation against obstetricians and midwives.
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http://dx.doi.org/10.1038/pr.2017.238DOI Listing
February 2018

Social Birth: Rites of Passage for the Newborn.

Authors:
Michael Obladen

Neonatology 2017 28;112(4):317-323. Epub 2017 Jul 28.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Rites of passage mark important changes during human life and, for the neonate, its transition from intrauterine life into society. Their original intent was to purify the body from blood and meconium. But the cleansing rites had a spiritual dimension from the very start. When the rites of Mesopotamian, Egyptian, Jewish, Greek, Roman, Hindu, Nordic, Muslim, Maya, and Christian cultures are briefly compared, they reveal a remarkable similarity. What most rites had in common was the cleansing of the body, or sprinkling it with water; special clothing; the exorcism of evil spirits; blessings and prayers for good spirits; and a name-giving ceremony and a feast for family, relatives, and friends. Before this rite, the infant's social existence was incomplete and it could easily be abandoned or killed, as was usual in cases of severe malformations. Infant baptism originated in the 4th century CE with the concept of original sin. Emergency baptism originated in the 12th century and had a profound influence on the development of obstetrics and neonatal care. Rites of passage defined, but also set an end to, the liminal status between life and death in a phase of high mortality and partial personhood, and granted the right to live for the infant.
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http://dx.doi.org/10.1159/000477955DOI Listing
July 2018

Pulmo uterinus: a history of ideas on fetal respiration.

Authors:
Michael Obladen

J Perinat Med 2018 Jul;46(5):457-464

Department of Neonatology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

Theories about fetal respiration began in antiquity. Aristotle characterized pneuma as warm air, but also as the enabler of vital functions and instrument of the soul. In Galen's system of physiology, the vital spirit was carried by the umbilical arteries, the nutrients by the umbilical vein from the placenta to the fetus. In 1569 Aranzio postulated that the maternal and fetal vasculatures are distinct. From 1670 to 1690, a century before the discovery of oxygen, researchers understood that during respiration some form of exchange with the air must occur, naming the substance biolychnium, phlogiston, sal-nitro, or nitro-aerial particles. An analogy of placental and pulmonary gas exchange was described in 1674 by Mayow. In 1779, Lavoisier understood the discovery of oxygen, discarded the phlogiston theory, and based respiration physiology on gas exchange. With the invention of the spectroscope, it became possible to measure hemoglobin oxygenation, and in 1876 Zweifel proved fetal oxygen uptake. Major progress in understanding fetal gas exchange was achieved in the 20th century by the physiologists Barcroft in Cambridge and Dawes in Oxford.
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http://dx.doi.org/10.1515/jpm-2016-0403DOI Listing
July 2018

Hepar uterinum: a history of ideas on fetal nutrition.

Authors:
Michael Obladen

J Perinat Med 2017 Oct;45(7):779-786

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The means of fetal nutrition has been debated for over two millennia, with the controversy of oral versus parenteral nutrition already in the Corpus Hippocraticum. In 1587 Aranzio rejected connections between maternal and fetal blood vessels, and coined the term "hepar uterinum" for the placenta. From the 16th to the 18th century, a fervent debate focused on the type and extent of connection between maternal and fetal vessels, which was finally settled by Hunter's injection experiment in 1774. But up to the middle of the 19th century, an important nutritive function was attributed to amniotic fluid. When with the discovery of oxygen the placenta's respiratory function became understood, its nutritional function fell from grace. Most scientists realized reluctantly that the organ had numerous functions. As late as in the 19th century, the advent of microscopy allowed cell theory to develop, and analytical chemistry furthered the understanding of the transport of nutrients across the placenta. The identification of the syncytiotrophoblast made passive diffusion unlikely. Radioisotopes, molecular biology and the fluid mosaic model of the cell membrane revealed active transport mechanisms for nearly all macronutrients.
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http://dx.doi.org/10.1515/jpm-2016-0402DOI Listing
October 2017

Animatio: a history of ideas on the beginning of personhood.

Authors:
Michael Obladen

J Perinat Med 2018 May;46(4):355-364

Department of Neonatology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

The onset of individual human life has fascinated thinkers of all cultures and epochs, and the history of their ideas may enlighten an unsettled debate. Aristotle attributed three different souls to the subsequent developmental stages. The last, the rational soul, was associated with the formed fetus, and entailed fetal movements. With some modifications, the concept of delayed ensoulment - at 30, 42, 60, or 90 days after conception - was adopted by several Christian Church Fathers and remained valid throughout the Middle Ages. The concept of immediate ensoulment at fertilization originated in the 15th century and became Catholic dogma in 1869. During the Enlightenment, philosophers began to replace the rational soul with the term personhood, basing the latter on self-consciousness. Biological reality suggests that personhood accrues slowly, not at a specific date during gestation. Requirements for personhood are present in the embryo, but not in the preembryo before implantation: anatomic substrate; no more totipotent cells; decreased rate of spontaneous loss. However, biological facts alone cannot determine the embryo's moral status. Societies must negotiate and decide the degree of protection of unborn humans. In the 21st century, fertilization, implantation, extrauterine viability and birth have become the most widely accepted landmarks of change in ontological status.
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http://dx.doi.org/10.1515/jpm-2016-0404DOI Listing
May 2018

Despising the weak: long shadows of infant murder in Nazi Germany.

Authors:
Michael Obladen

Arch Dis Child Fetal Neonatal Ed 2016 May 26;101(3):F190-4. Epub 2016 Feb 26.

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http://dx.doi.org/10.1136/archdischild-2015-309257DOI Listing
May 2016

From Crime to Disease: Laws on Infanticide in the Modern Era.

Authors:
Michael Obladen

Neonatology 2016 16;109(3):170-6. Epub 2016 Jan 16.

Department of Neonatology, Charité - University Medicine Berlin, Berlin, Germany.

This is the third of three papers investigating the legislative history concerning infanticide. After Antiquity and the Middle Ages, this paper focuses on legislative reforms during the last 400 years. Despite dreadful punishment, the practice remained frequent until safe abortion became available. In the 17th century, the rate of executions of women for this crime was 1 per 100,000 inhabitants. The actual incidence greatly exceeded this figure. The death penalty failed to deter, and punishing fornication promoted rather than prevented infanticide. Well into the 18th century, severely malformed infants were killed. The lung flotation test, albeit unreliable, was used to save the mother from the death penalty. When the motives for infanticide - poverty, shame, despair, and preserving honour - became understood in the late 18th century, the image of the 'child murderess' changed, and infanticide shifted from constituting a capital crime to a privileged delict. Illegitimate pregnancy was no longer punished, and lying-in hospitals for pregnant unmarried women and foundling hospitals for their children were established. Specific infanticide laws were issued in Prussia in 1756, Britain in 1803, and France in 1811. Once psychosis and denial of pregnancy became understood, severe penalties were no longer issued. The justifications for lenient legislation included social circumstances, difficult proof, and curtailed protection of the newborn due to its illegitimacy, helplessness, and diminished awareness. Thoughts on the limited right to live of newborn infants are still hampering ethical decisions when the beginning and end of life are near each other.
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http://dx.doi.org/10.1159/000441275DOI Listing
November 2016

From Sin to Crime: Laws on Infanticide in the Middle Ages.

Authors:
Michael Obladen

Neonatology 2016 20;109(2):85-90. Epub 2015 Nov 20.

Department of Neonatology, Charité - University Medicine Berlin, Berlin, Germany.

This is the second of three papers investigating the legislative history concerning infanticide. It compares the efforts of various states to protect the newborn infant between 534 and 1532 CE. When the Roman Empire collapsed in the 5th century, the jurisdiction of infanticide was relegated to the church, which regarded carnal delicts a sin rather than a crime. The punishment - public penance of the mother for 7-15 years - was milder than that which the murder of an adult would incur. The Council of Florence decreed in 1439 that the souls of children who died without having been baptized descend to hell. This turned infanticide from a penitential sin to the most heinous of all crimes. The states passed laws that abominated infanticide even more than the murder of older humans and punished women with ever more cruel forms of execution. Towards the men, however, who usually abandoned the women they had impregnated, the laws were lenient. Churches and society continued to vilify illegitimate birth, thus enhancing rather than preventing infanticide. The Habsburg-German legislation of 1532 ordained to torture any woman who had concealed pregnancy and birth and claimed the infant was stillborn. Legislation developed similarly in other countries, albeit at a different speed. French (1556) and British (1623) legislation reversed the burden of proof and demanded the death penalty for concealing pregnancy and birth when a dead infant was found.
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http://dx.doi.org/10.1159/000440876DOI Listing
October 2016

From Right to Sin: Laws on Infanticide in Antiquity.

Authors:
Michael Obladen

Neonatology 2016 28;109(1):56-61. Epub 2015 Oct 28.

Department of Neonatology, Charité - University Medicine Berlin, Berlin, Germany.

This is the first of three papers investigating changes in infanticide legislation as indicators of the attitude of states towards the neonate. In ancient East Asian societies in which the bride's family had to pay an excessive dowry, selective female infanticide was the rule, despite formal interdiction by the law. In Greece and Rome children's lives had little value, and the father's rights included killing his own children. The proportion of men greatly exceeding that of women found in many cultures and epochs suggests that girls suffered infanticide more often than boys. A kind of social birth, the ritual right to survive, rested on the procedure of name giving in the Roman culture and on the start of oral feeding in the Germanic tradition. Legislative efforts to protect the newborn began with Trajan's 'alimentaria' laws in 103 CE and Constantine's laws following his conversion to Christianity in 313 CE. Malformed newborns were not regarded as human infants and were usually killed immediately after birth. Infanticide was formally outlawed in 374 CE by Emperor Valentinian.
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http://dx.doi.org/10.1159/000440875DOI Listing
September 2016

Lethal Lullabies: A History of Opium Use in Infants.

Authors:
Michael Obladen

J Hum Lact 2016 Feb 10;32(1):75-85. Epub 2015 Jul 10.

Department of Neonatology, Charité University Medicine, Berlin, Germany

Poppy extract accompanied the human infant for more than 3 millenia. Motives for its use included excessive crying, suspected pain, and diarrhea. In antiquity, infantile sleeplessness was regarded as a disease. When treatment with opium was recommended by Galen, Rhazes, and Avicenna, baby sedation made its way into early medical treatises and pediatric instructions. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. A freerider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet-nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity. What is remarkable is that the willingness to use it in infants persisted and that physicians continued to prescribe it for babies. Unregulated trade, and even that protected by governments, led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and broke the dangerous habit of sedating infants.
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http://dx.doi.org/10.1177/0890334415594615DOI Listing
February 2016

Innocent blood: a history of hemorrhagic disease of the newborn.

Authors:
Michael Obladen

Neonatology 2015 7;107(3):206-12. Epub 2015 Feb 7.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Hemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but have been considered different diseases depending on their location. Umbilical hemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatin, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal hemorrhagic disease. Kernicterus occurred when high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up.
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http://dx.doi.org/10.1159/000369523DOI Listing
January 2016

Historic records on the commercial production of infant formula.

Authors:
Michael Obladen

Neonatology 2014 4;106(3):173-80. Epub 2014 Jul 4.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Industrialized food production first appeared in 1856, pioneered by Borden in the USA, Liebig in Germany, Nestlé in Switzerland, and Mellin in the UK. Their products differed remarkably and deviated from human and cow's milk, and physicians discussed the importance of minute variations in protein, fat and carbohydrates. Proprietary formulas were free of bacteria, and the companies prospered with mass production, international marketing and aggressive advertising. From 1932 on, medical societies restricted advertising to the laity. In 1939 Williams in Singapore and in 1970 Jelliffe in Jamaica suspected that commercial formula may be increasing infant mortality in the Third World. Breastfeeding continued to decline during the early 20th century, falling in 1970 below 10% in the USA. The Swiss 'Third World Group' and the US 'Infant Formula Action Coalition' linked infant mortality and industry marketing in the Third World. The controversy of 1970-1984 led to the WHO Code, which regulated the advertising and marketing of baby food. This was one of several public health statements contributing to the resurgence of breastfeeding.
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http://dx.doi.org/10.1159/000363494DOI Listing
June 2015

From swill milk to certified milk: progress in cow's milk quality in the 19th century.

Authors:
Michael Obladen

Ann Nutr Metab 2014 5;64(1):80-7. Epub 2014 Jun 5.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Background: Industrialization and urbanization jeopardized infant nutrition during the 19th century. Cow's milk was produced in the cities or transported long distances under suspect conditions. Milk was contaminated with bacteria or adulterated with water, flour, chalk and other substances. When distilleries proliferated in the metropoles, their waste slop was fed to cows which then produced thin and contaminated swill milk.

Summary: Following a press campaign in the USA, the sale of swill milk was prohibited by law in 1861. Bacterial counts became available in 1881 and helped to improve the quality of milk. Debates on pasteurization remained controversial; legislation varied from country to country. Disposal of the wastewater of millions of inhabitants and the manure of thousands of cows was environmentally hazardous. It was not until 1860 and after several pandemics of Asiatic cholera that effective sewage systems were built in the metropoles. Milk depots were established in the USA by Koplik for sterilized and by Coit for certified milk. In France, Budin and Dufour created consultation services named goutte de lait, which distributed sterilized milk and educated mothers in infant care.

Message: Multiple efforts to improve milk quality culminated in the International gouttes de lait Congresses for the Study and Prevention of Infantile Mortality.
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http://dx.doi.org/10.1159/000363069DOI Listing
February 2015

Technical inventions that enabled artificial infant feeding.

Authors:
Michael Obladen

Neonatology 2014 8;106(1):62-8. Epub 2014 May 8.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Artificial feeding of infants, called hand-feeding, was unsafe well into the 19th century. This paper aims to identify technical innovations which made artificial feeding less dangerous. In rapid succession from 1844 to 1886, the vulcanization of rubber, production of rubber teats, cooling machines for large-scale ice production, techniques for milk pasteurization, evaporation and condensation, and packing in closed tins were invented or initiated. Remarkably, most of these inventions preceded the discovery of pathogenic bacteria. The producers of proprietary infant formula made immediate use of these innovations, whereas in the private household artificial feeding remained highly dangerous - mostly because of ignorance about bacteria and hygiene, and partly because the equipment for safe storage, transport, preparation and application of baby food was lacking.
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http://dx.doi.org/10.1159/000357936DOI Listing
March 2015

Feeding the feeble: steps towards nourishing preterm infants.

Authors:
Michael Obladen

J Perinat Med 2015 Sep;43(5):627-35

This paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant's elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.
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http://dx.doi.org/10.1515/jpm-2014-0054DOI Listing
September 2015

Pap, gruel, and panada: early approaches to artificial infant feeding.

Authors:
Michael Obladen

Neonatology 2014 26;105(4):267-74. Epub 2014 Feb 26.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

This paper collects information on artificial infant feeding published before 1860, the year when commercial formula became available. We have extensive artifactual evidence of thousands of feeding vessels since the Bronze Age. Special museum collections can be found in London, Paris, Cologne, Fécamp, Toronto, New Mexico, and elsewhere. The literature on the use of animal milk for infant feeding begins with Soranus in the 2nd century CE. Literature evidence from the very first printed books in the 15th century proves that physicians, surgeons, midwives, and the laity were aware of the opportunities and risks of artificial infant feeding. Most 17th to 19th century books on infant care contained detailed recipes for one or several of the following infant foods: pap, a semisolid food made of flour or bread crumbs cooked in water with or without milk; gruel, a thin porridge resulting from boiling cereal in water or milk, and panada, a preparation of various cereals or bread cooked in broth. During the 18th century, the published opinion on artificial feeding evolved from health concerns to a moral ideology. This view ignored the social and economic pressures which forced many mothers to forego or shorten breast-feeding. Bottle-feeding has been common practice throughout history.
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http://dx.doi.org/10.1159/000357935DOI Listing
January 2015

Milk demystified by chemistry.

Authors:
Michael Obladen

J Perinat Med 2014 Sep;42(5):641-7

This article traces the decline of milk from a heavenly elixir to a tradeable food. Early cultures regarded milk not as a simple nutrient, but a living fluid. Heroes and gods were believed to have been nurtured by animals after being abandoned. Character traits were assumed to be transmitted by milk; infantile diseases were attributed to "bad milk", whereas "good milk" was used as a remedy. With chemical methods developed at the end of the 18th century, it became known that human milk was higher in sugar and lower in protein than cow's milk. During the 19th century, "scientific" feeding emerged that meant modifying cow's milk to imitate the proportion of nutrients in human milk. In Boston from 1893, Rotch initiated the "percentage" method, requiring a physician's prescription. In Paris from 1894, Budin sterilized bottled infant milk. In Berlin in 1898, Rubner measured oxygen and energy uptake by calorimetry, prompting feeding by calories, and Czerny introduced regulated feeding by the clock. These activities ignored the emotional dimension of infant nutrition and the anti-infective properties of human milk. They may have also enhanced the decline in breastfeeding, which reached an all-time low in 1971. Milk's demystification made artificial nutrition safer, but paved the way for commercially produced infant formula.
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http://dx.doi.org/10.1515/jpm-2013-0288DOI Listing
September 2014

Possessed by evil spirits: a history of seizures in infancy.

Authors:
Michael Obladen

J Child Neurol 2014 Jul 13;29(7):990-1001. Epub 2013 May 13.

Department of Neonatology, Charité University Medicine, Berlin, Germany

For 4 millennia, seizures in infancy were believed to be of supranatural origin and were dealt with by incantations, exorcising rituals, and protective amulets. Instead of pursuing scientific research into their causes, gods, devils, mothers, wet nurses, midwives, or obstetricians were blamed. Help from protective gods and patron saints was sought, and amulets against the "evil eye" were recommended by physicians, mostly in the form of necklaces. Infants were despised and hidden away from the community. Among the medical conditions associated with seizures, those most prominent were dentition, gastrointestinal irritation, and "bad" mother's milk. Medical treatment consisted of cutting or rubbing the gums with a hare's brain during dentition, and applying peony or theriac. Even during the 20th century, when laboratory methods, electroencephalography, brain imaging, and powerful pharmaceutical techniques were available, effective treatment evolved empirically rather than systematically.
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http://dx.doi.org/10.1177/0883073813488660DOI Listing
July 2014

Curse on two generations: a history of congenital syphilis.

Authors:
Michael Obladen

Neonatology 2013 13;103(4):274-80. Epub 2013 Mar 13.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Before the microbiologic era, venereal diseases were poorly distinguished. Congenital syphilis was believed to be transmitted during conception by the father's sperm, during delivery in the birth canal, or from infected milk or breasts. The most frequent maternofetal transmission was not considered because the mother's primary infection remained undiagnosed. The concept of treating infants with mercury transmitted by nurses' milk prompted the founding of a specialized infant hospital in Vaugirard in 1780: lactating syphilitic women received mercury orally and by rubbing it into the skin. Their own infant and a second infected infant from the foundling hospital were believed to be cured by their milk. Underwood described snuffles in 1789 and Bertin periosteal bone disease in 1810. Tardive congenital lues with keratitis, deafness, and notched upper incisors were described by Hutchinson in 1863. Feeding remained difficult, as wet nursing transmitted syphilis to the nurse and other infants. Specialized institutions tried goat or donkey milk. A debate between contagionists assuming exclusively maternal infection and hereditists assuming germinal transmission by the father's sperm continued throughout the 19th century. Schaudinn and Hoffmann identified Spirochaeta pallida in 1905. When Ehrlich discovered the efficacy of salvarsan in 1910, Noeggerath treated infants with the new drug, pioneering the injection into scalp veins. In 1943, Lentz and Ingraham established penicillin treatment for congenital syphilis. Whereas this drug effectively prevented maternofetal transmission, treating infants remained difficult due to the Jarisch-Herxheimer reaction.
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http://dx.doi.org/10.1159/000347107DOI Listing
January 2014

Guttus, tiralatte and téterelle: a history of breast pumps.

Authors:
Michael Obladen

J Perinat Med 2012 Nov;40(6):669-75

Breast pumps have been used since antiquity, and their form has changed with the available material. The ancient Greeks used the ceramic guttus type, both to empty the breast and feed the infant. The Romans invented glass milk-extractors, sucked by the mother herself to elevate retracted nipples. Devices in the form of a smoking pipe were in widespread use when corsets had caused an epidemic of flat nipples in the 17th century. In the 19th century, vessels to be sucked both by mother and infant were developed to facilitate breastfeeding for preterm infants. When from 1870 the role of pathogenic bacteria became known, easy and thorough cleaning became an important feature of breast pumps. The 20th century sexualized the female breast to such a degree that its nourishing function was threatened. Electric pumps, developed at the beginning of the 20th century for hospital use, found a large private market when breast feeding in public was no longer tolerated. Today, breast pumps are mainly used to enable breastfeeding mothers to return to work.
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http://dx.doi.org/10.1515/jpm-2012-0120DOI Listing
November 2012

Bad milk, part 1: antique doctrines that impeded breastfeeding.

Authors:
Michael Obladen

Acta Paediatr 2012 Nov 31;101(11):1102-4. Epub 2012 Aug 31.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

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http://dx.doi.org/10.1111/j.1651-2227.2012.02814.xDOI Listing
November 2012

Bad milk, part 2: new-age doctrines that impeded breastfeeding.

Authors:
Michael Obladen

Acta Paediatr 2012 Dec 31;101(12):1189-91. Epub 2012 Aug 31.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

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http://dx.doi.org/10.1111/j.1651-2227.2012.02811.xDOI Listing
December 2012

Regulated wet nursing: managed care or organized crime?

Authors:
Michael Obladen

Neonatology 2012 20;102(3):222-8. Epub 2012 Jul 20.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Wet nursing was widely practiced from antiquity. For the wealthy, it was a way to overcome the burdens of breastfeeding and increase the number of offspring. For the poor, it was an organized industry ensuring regular payment, and in some parishes the major source of income. The abuse of wet nursing, especially the taking in of several nurslings, prompted legislation which became the basis of public health laws in the second half of the 19th century. The qualifications demanded from a mercenary nurse codified by Soran in the 2nd century CE remained unchanged for 1,700 years. When artificial feeding lost its threat thanks to sewage disposal, improved plumbing, the introduction of rubber teats, cooling facilities and commercial formula, wet nursing declined towards the end of the 19th century.
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http://dx.doi.org/10.1159/000339732DOI Listing
February 2013

Vascular Endothelial Growth Factor (VEGF) and soluble VEGF receptor 1 (sFlt-1) levels in early and mature human milk from mothers of preterm versus term infants.

J Hum Lact 2012 Nov 24;28(4):522-8. Epub 2012 Jun 24.

Charité Virchow Hospital, University Medicine Berlin, Berlin, Germany.

Background: Vascular endothelial growth factor (VEGF) and its receptors regulate angiogenesis (formation of blood vessels). The soluble VEGF receptor 1 (sFlt-1) binds VEGF as a potent antagonist.

Objective: The objective of this study was to compare VEGF and sFlt-1 levels in milk from mothers of preterm (n = 50) versus term (n = 49) infants in a longitudinal study.

Methods: Milk samples were collected on days 3 and 28 of lactation. Vascular endothelial growth factor and sFlt-1 were quantified by sandwich-type enzyme-linked immunosorbent assay.

Results: Vascular endothelial growth factor and sFlt-1 were found in high concentrations in early milk (lactation day 3) from mothers of preterm and term infants and were lower in mature milk (lactation day 28). On day 3, median VEGF concentration was lower in preterm than in term milk (37.1 vs 53.9 ng/mL, P < .01). Otherwise, VEGF (day 28) and sFlt-1 (days 3 and 28) did not differ in preterm versus term milk.

Conclusions: It was shown for the first time that sFlt-1 is present in human milk. Early human milk contains high concentrations of VEGF and sFlt-1, which decrease over the course of lactation.
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http://dx.doi.org/10.1177/0890334412447686DOI Listing
November 2012

Early neonatal special care units and their scientific achievements.

Authors:
Michael Obladen

Neonatology 2012 25;102(2):89-97. Epub 2012 May 25.

Department of Neonatology, Charité University Medicine, Berlin, Germany. michael.obladen @ charite.de

Treatment of sick neonates originated in maternity and foundling hospitals in the 19th century. Nosocomial infections and difficult logistics of wet-nursing prevented admission of neonates in most children's hospitals well into the 20th century. In this article, 31 hospitals are described, all located in large cities, in which preterm and sick neonates were treated before the Great Depression. Even though mostly initiated by private charity, these institutions performed research right from the start. Topics included warming and feeding preterm infants, collecting and distributing human milk, developing and storing breast milk substitutes, prevention of rickets and nosocomial infections, maternal and public education regarding infection control, pathoanatomic characterisation of diseases and malformations and epidemiologic studies of infant mortality. These pioneering hospitals, their founding dates, researchers and classic publications are presented in a table.
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http://dx.doi.org/10.1159/000336285DOI Listing
December 2012

In God's image? The tradition of infant head shaping.

Authors:
Michael Obladen

J Child Neurol 2012 May 28;27(5):672-80. Epub 2012 Feb 28.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Intentional modification of the infant's head has been commonly practiced at all times and in virtually every region of the inhabited world. Motives included aesthetic perception of the human head, greater attractiveness, symbolization of ethnic identity, demonstration of noble origin or sociocultural status, and supposed health benefits. The desired shape was achieved by repeated hand massage, or by using devices like cradleboards, which were applied throughout infancy. In some regions, infant head shaping was the rule rather than the exception. Whereas chronic modification of the skull during the first year of life had no adverse effects, one-time postnatal head shaping by the midwife was a dangerous procedure. Recommended by Soran in the second century CE, it remained in practice for 17 centuries. With the advent of positional plagiocephaly following the back-to-sleep campaign, head shaping has regained acceptance and is now being widely used again.
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http://dx.doi.org/10.1177/0883073811432749DOI Listing
May 2012

Thrush - nightmare of the foundling hospitals.

Authors:
Michael Obladen

Neonatology 2012 22;101(3):159-65. Epub 2011 Oct 22.

Department of Neonatology, Charité University Medicine, Berlin, Germany. michael.obladen @ charite.de

Before safe artificial nutrition, refrigeration, and microorganisms became known, thrush was a severe and frequently lethal disease in foundling hospitals. Overcrowded and understaffed, these institutions were the ideal breeding ground for this disease. Malnutrition, especially when breastfeeding was denied, contributed to the fatal course. Nosocomial infections and high mortality led to a prejudice against infant hospitals in the late 19th century. Candida albicans was discovered in 1840 when a cooperation at the Paris Foundling Hospital between the Hungarian emigrant David Gruby and the Swede Frederik Berg led to this organism being the first pathogen to be identified. After World War II, Candida infections increased with the use of antibiotics. The disease became less threatening after the development of nystatin, the result of an interdisciplinary cooperation in New York between the microbiologist Elizabeth Hazen and the biochemist Rachel Brown.
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http://dx.doi.org/10.1159/000329879DOI Listing
October 2012

Cats, frogs, and snakes: early concepts of neural tube defects.

Authors:
Michael Obladen

J Child Neurol 2011 Nov 5;26(11):1452-61. Epub 2011 Jul 5.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Disturbed neurulation fascinated scientists of all times. In Egypt, anencephalic infants were venerated as animal-headed gods. Roman law required them to be killed. The medieval world held the mother responsible, either because of assumed imagination or "miswatching," or because of suspected intercourse with animals or devils. Modern embryology and teratology began with the use of the microscope by Malpighi in 1672. Details of neural tube closure were described by Koelliker in 1861 and by His in 1874. From 1822, genetic disease and familial recurrence due to insufficient nutrition were discerned and lower social class identified as a risk factor. It took a century to define the malnutrition as insufficient folate intake. The mandatory supplementation of folate in staple foods successfully reduced the incidence of neural tube defects in the United States, Australia, Canada, and Chile, but it was not adopted by most European countries.
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http://dx.doi.org/10.1177/0883073811411191DOI Listing
November 2011