Research at the Paris Foundling Hospital, Part 1: Until and during the Revolution.

BACKGROUND: The Paris Foundling Hospital was a breeding ground for neonatal medicine, but little is known about its research. During the century preceding the Revolution, admission of newborns rose dramatically, making this institution the largest infant hospital in the world. A total of 3,162 infants were admitted in 1742, of whom 40% died in the hospice and another 20% with the nurses. During the Revolution (1789-1804), monasteries were transformed into jails or hospitals, and the foundling hospital became a teaching institute. Students flocked to the capital, and those believed to qualify for hospital positions were selected through competing publications.

SUMMARY: A major research focus was trials of artificial nutrition, motivated by the fear of transmitting venereal disease to wet nurses via breastfeeding. Cows and goats were held on the premises, but milk was kept without refrigeration. A research branch of the foundling hospital was in Vaugirard, directed by François Doublet. In 1781, he treated syphilitic newborns by wet-nursing them from syphilitic nurses treated with mercury. Another approach requiring considerable logistics was sending thousands of infants to the countryside for wet-nursing. In 1769, Joseph Raulin analyzed the mortality at the hospice and found that thrush, diarrhea, marasmus, suffocation, and inflammation were the major causes of death. Foundling hospital surgeon Jean-Abraham Auvity published prize-winning treatises on thrush and sclerema in 1786. He related skin hardening (sclerema) to postnatal hypothermia and developed warming techniques for premature infants.

KEY MESSAGES: During the Revolution and Terror, meaningful research was conducted at the foundling hospital but failed to lower mortality.