Research at the Paris Foundling Hospital, Part 2: After the Revolution.

BACKGROUND: We know little about how neonatal research changed at the Paris Foundling Hospital following the revolution.

SUMMARY: The number of unwanted children rose, and 5,392 infants were admitted in 1826 - a quarter of all infants born in Paris; 26% of them died in the infirmary before transport. The infants' appalling mortality was associated with artificial nutrition, and transfer to mercenary nurses in the countryside was organized. In the 1830s sedentary nurses began to run short, and nearly all babies were fed artificially at some time. François Chaussier was director at the Maternity from 1804. He developed instruments to resuscitate newborns: mask-and-bag ventilation, silver endotracheal tubes, and oxygen tanks. He classified congenital malformations and described osteogenesis imperfecta. Marie-Louise Lachappelle trained midwives in forceps deliveries and the use of endotracheal intubation of newborns. Other researchers at the foundling hospital included Antoine Dugès, Jacques-François Baron, Gilbert Breschet, Louis Véron, Johann Heyfelder, Prosper-Sylvain Denis, and Charles Billard. The latter investigated neonatal cry in 1827 and associated expiratory grunting with poor prognosis in prematures. His Treatise on Diseases of the Newborn, based on many autopsies and meticulous clinical records, remained a neonatology standard for a century. It described peritonitis, megacolon, intestinal hemorrhage, pertussis, spina bifida, patent ductus, single ventricle, and various forms of tuberculosis.

KEY MESSAGES: Physicians were permanently employed from 1821; their research developed from autopsies. The fusion of medicine and surgery into a single faculty moved obstetrics (and thus newborn care) from the barbers' domain to research-oriented science.