Multidisciplinary collaboration Supports for low birth weight infantsPremature Infant Healthcare in Pre-war and Wartime Japan: Who is Responsible for Saving the Lives of Premature Infants?
A gap between obstetrics and pediatrics
Today, when a problem such as premature birth arises with a newborn infant, he or she is passed from the obstetrician to a pediatrician and receives care in a special facility such as a NICU (Neonatal Intensive Care Unit). But this kind of system has not always existed.
When modern medicine was introduced in Japan during the Meiji period, topics related to the treatment of premature infants were covered in both obstetrics and pediatrics textbooks. Both went no further than introducing keeping infants warm using incubators and recommending feeding them their mother’s milk, however, and comparatively little was written on these topics. In regard to this state of affairs, it has been pointed out that research had not progressed very far at that time because the care of newborns, including that of premature infants, fell into a gap between obstetrics and pediatrics.
An era of birthing assistants
While there was nothing different about the content itself, there was one difference between what was said about premature infants in obstetrics and pediatrics textbooks: in the latter it was viewed as a “disease”, while in the former it was taken to be part of “nursing care”. Here it becomes necessary to look at the midwife, who is the profession charged with providing nursing care in the field of obstetrics.
Midwife textbooks of the era also addressed the topic of premature infant nursing care, and Shiraki Masahiro, who would later become a professor at Tokyo Imperial University (now the University of Tokyo), wrote in the 15th edition of Shiraki jyosangaku: zenpen [Shiraki Midwifery: part one] (1932, Nanzando shoten) that while premature infants are kept under a doctor’s supervision, “the life or death of premature infants is in the hands of the nurses who take care of them”. And when a premature birth occurred under the observation of an obstetrician, pediatrician and midwife in a certain wealthy household in the 1920s, it was the midwife who took care of the newborn infant rather than the doctors who did not know what to do in such circumstances (Shusankiigaku [Perinatal medicine] 12(5), 1982).
From collaboration of obstetricians and pediatricians to an era of pediatricians
In 1930s the state of life-saving care for premature infants was changing. In 1940 the first textbook on newborn medicine, Shinsanji byoōgaku [Newborn medicine] (Nankōdō) was published in Japan. Here, unlike in earlier obstetrics/pediatrics textbooks, topics related to premature infants were discussed in considerable detail. Its author, Kominami Yoshio, was an obstetrician who worked at a facility called the “Kyoto City Children’s Center”. This was a facility established for low-income people at which obstetricians and pediatricians were stationed. In other words, as he studied newborn medicine including the care of premature infants, Kominami found himself in circumstances in which it was easy to collaborate with pediatricians.
During this period there was a facility in Tokyo that was operating under the same conditions as the Kyoto Children’s Center and was actively making strides in the treatment of premature infants: the Lying-in Hospital at Japan Red Cross Society’s Head Hospital. Here obstetrician Kuji Naotaro, working with colleagues such as pediatrician Sunada Keiichi, from the 1930s onwards produced research results on treatments for premature infants such as inserting a catheter into an infant’s mouth to give it milk.
In this way, doctors came to take on a central role in saving the lives of premature infants. This trend accelerated after the war; in the final volume of Keio University Professor of Obstetrics and Gynecology Ando Kakuichi’s Sankagaku [Obstetrics] (1948, Homeido), the topic of premature infants is addressed not as “nursing care” but as an “abnormality”, and this kind of phenomenon can also be seen in other obstetrics textbooks. In other words, in obstetrics textbooks the life-saving care of premature infants was gradually separated from “nursing care”, and after the war pediatricians gradually took over primary responsibility for conducting research into the treatment of premature infants from obstetricians.