The challenge of antibiotic-resistant Staphylococcus: lessons from hospital nurseries in the mid-20th century.

In the late 1940s, epidemics of antibiotic-resistant strains of Staphylococcus aureus began to plague postpartum nurseries in hospitals across the United States. Exacerbated by overcrowding and nursing shortages, resistant S. aureus outbreaks posed a novel challenge to physicians and nurses heavily reliant on antibiotics as both prophylaxis and treatment. This paper explores the investigation of the reservoir, mode of transmission, and virulence of S. aureus during major hospital outbreaks and the subsequent implementation of novel infection control measures from the late 1940s through the early 1960s. The exploration of these measures reveals a shift in infection control policy as hospitals, faced with the failure of antibiotics to slow S. aureus outbreaks, implemented laboratory culture routines, modified nursery structure and layout, and altered nursing staff procedures to counter various forms of S. aureus transmission. Showcasing the need for widespread epidemiologic surveillance, ultimately manifesting itself in specialized "hospital epidemiology" training promoted in the 1970s, the challenges faced by hospital nurses in the 1950s prove highly relevant to the continued struggle with methicillin-resistant Staphylococcus aureus (MRSA) and other resistant nosocomial infections.

Maternal expectations: new mothers, nurses, and breastfeeding.

By the middle of the 20th century, breastfeeding rates had fallen to less than 20% in some areas of the United States. Despite these grim statistics, many mothers continued to seek information, advice, and the experience of breastfeeding their infants. This article explores the role that nurses played in these women's struggles to breastfeed in the years between the end of World War II and the 1970s. The role of the nurse in shaping the meaning and experience of breastfeeding in America has been an important, albeit often overlooked, part of the history of infant feeding. In addition to exploring the ways in which hospital policies and structures shaped nurses' relationships with breastfeeding mothers, this article looks at how different maternal ideologies influenced the nature of these (mostly) same-sex interactions. This article argues that the ideas about, and experiences with, motherhood had important implications for how nurses and mothers approached the practice of breastfeeding in the hospital.

Babies and bacteria: phage typing, bacteriologists, and the birth of infection control.

During the 1950s, Staphylococcus aureus became a major source of hospital infections and death, particularly in neonates. This situation was further complicated by the fact that Staphylococcus quickly gained resistance to most antibiotics. Controlling these infections was a pressing concern for hospital workers, especially bacteriologists who tackled it through the use of a new epidemiologic tool: phage typing. This article argues that during the mid- to late 1950s a series of staphylococcal hospital and nursery epidemics united phage typers, brought international recognition to the usefulness of their technique, and, in the process, contributed to the establishment of the new field of infection control. Through the use of this new tool, phage typers established themselves as experts in infection control and, in some places, became essential members of newly formed infection-control committees. The nursery epidemics represent a particularly important test for phage typing and infection control, for this staphylococcal strain (80/81) was especially virulent and spread rapidly beyond the hospital to the wider community. The epidemiologic information provided by phage typers was vital for devising practical advice on how to control this deadly strain of Staphylococcus and also for transforming the role of the hospital bacteriologist from mere technician into infection-control expert.

Reflections on errors in neonatology: II. The "Heroic" years, 1950 to 1970.

This series errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years from 1920 to 1950, the "Heroic" years from 1950 to 1970, and the "Experienced" years from 1970 on. In this article, the "Heroic" years, we discuss the Blossom air lock, sulfisoxazole, chloramphenicol, novobiocin, hexachlorophene, Epsom salts enemas, feeding gastrostomy, diaper laundering, and equipment cleaning.

Maternal separation at birth and schizophrenia--a long-term follow-up of the Finnish Christmas Seal Home Children.

OBJECTIVE: Problems in the early mother-infant relation pose a hypothetical risk factor of schizophrenia. We studied the association between very early separation and later development of schizophrenia or other psychoses in a unique data set. METHOD: The index cohort consisted of 3020 subjects born in 1945-1965 in Finland who were temporarily isolated from their family immediately after birth to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. The Finnish Hospital Discharge Register was used to identify subjects with schizophrenia and other psychoses arising from childhood to middle age, between January 1, 1971 and December 31, 1998. RESULTS: The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort (rate ratio 1.01, 95% CI 0.75-1.37). The incidences of other psychotic disorders were 1.5% and 1.3% (RR 1.11, 95% CI 0.79-1.58), respectively. CONCLUSION: Separation at birth was not found to be associated with either schizophrenia or other psychotic illness. Temporary placement to adequate nursing homes in the first year of life is unlikely to increase the risk for schizophrenia or other psychoses.

Rooming-in: redesigning hospitals and motherhood in cold war America.

Rooming-in, a model of maternity care that placed newborns in their mothers' rooms instead of central nurseries, appeared in American hospitals in the early 1940s, advocated by physicians and mothers as an antidote to the emotional sterility of the modern maternity ward. It has been cited as a successful illustration of health-care reform, in which practitioners and patients redesigned postpartum care to make it more fulfilling. However, factors other than visionary leadership contributed to the establishment and popularity of rooming-in. First, wartime changes in the medical care of postpartum patients, including antibiotic therapy and early ambulation, paved the way for a system in which mothers played an active role. Second, rooming-in effectively solved two hospital crises: a nursing shortage, and an epidemic of infections in newborn nurseries. Finally, it achieved notoriety far beyond its actual prevalence because it resonated with trends in mass culture: a wariness of technology, interest in the causes and prevention of neurosis, and the "feminine mystique." This article suggests that changes in health care depend less on reasoned planning than on coincidental events inside and outside the hospital.

The role of the French midwives in establishing the first special care units for sick newborns.

At the end of the 19th century, under Dr. Tarnier's direction, the first trials of incubators were performed at the Paris Maternity. The success led to the construction of a special pavilion for sick newborns. The midwife-in-chief, Mrs. Henry, raised the funds for the construction. The results of the initial trial are reported. In 1892, the successor of Dr. Tarnier, Dr. Budin, the Chair of Obstetrics, did not approve of the condition of the nursery. Mrs. Henry left abruptly. The unit was placed under medical direction in order to bring a scientific approach to the care of the sick newborns. Stepdown units called pouponnieres were created to assure the transition of the infants to the home and decrease neonatal mortality.