The medical profession and society did not recognize SIDS until the late twentieth century. And yet people from Biblical times onward described sudden unexplained infant deaths that matched the typical history of a SIDS death of today. Because the deaths almost always occurred at home or in private situations, and to seemingly healthy children, most people, including parents and caregivers, generally ascribed the cause of death to accidential or intentional smothering or suffocation. When discovering their infants, with whom they regularly slept, dead next to them after a night's sleep, with no signs of any disease or disturbance, and no cries during the night, parents believed that they had unknowingly overlaid and smothered their children. Or, if they had not slept with their infant, but found it lifeless where they had put it down for the night or for a nap, parents assumed the child had suffocated in its bed clothes. In either circumstance, parents blamed themselves for the tragedy. Worse, community members suspected not just parental negligence, but overt infanticide. Because SIDS leaves no telltale marks on its little victims, no one could determine if the infant's demise was truly accidental or if it was intentional. As a result, society assumed parental negligence and punished the parents or whoever was responsible for the child's care. Medical people were not consulted in these situations except perhaps to confirm the death. It was purely a societal matter dealt with by religious, and later by secular, authorities.

Perhaps the first recorded Western case of SIDS is found in the famous Bible story in 1 Kings 3:19 of the two women who went before King Solomon with claims to motherhood of an infant boy. One of the women had awakened, found her son dead, thought she had overlaid him, and secretly switched the child with another. Solomon's proposed solution was to cut the living boy in half so each mother could have part of the child. Medieval church rules enunciated specific punishments for those who overlaid their children, and forbade parents from taking infants to bed with them. As early as the sixteenth century, Florentine craftsmen designed a wooden arch that fit over, and kept blankets away from, the child, thus preventing potential suffocation with bed clothes.

The power of ecclesiastical courts began to wane in the Renaissance. As secular authorities gained power during the subsequent centuries, civil courts investigated cases of overlaying and smothering to determine causes of death. At this same time, medicine was learning more about human anatomy and physiology. In 1761 an Italian physician, Giovanni Morgagni, published his book On the Seats and Causes of Disease, which correlated specific autopsy findings with disease signs and symptoms during a patient's illness. The resultant development of pathological anatomy in the early nineteenth century helped medicalize the previously nonmedical conditions of sudden unexplained infant death. As autopsies of these children revealed large thymuses (actually a normal finding), physicians explained death on the basis that the thymus gland cut off the tracheal airway or overly reduced the size of the thoracic cavity in which the heart and lungs had to function. Such explanations relieved parents of blame for their children's deaths. Despite evidence presented by other physicians during the nineteenth and early twentieth centuries that neither an enlarged thymus nor a similar but more complex condition called status thymico-lymphaticus could cause sudden infant death (Cone 1979), many people, including judges in courts, used thymic death to absolve parents of guilt. By the end of the nineteenth century, medical people were divided over sudden unexplained infant deaths. For example, a police surgeon in Dundee, Scotland, in 1892 openly accused parents of neglect, ignorance, carelessness, and drunkenness in overlaying their children (Templeman 1892), whereas William Osier (1904) still wrote of thymic enlargement as a cause of sudden infant death in the 1904 edition of his influential and widely used textbook of medicine.

Recognition of the condition now known as SIDS began to occur in the 1940s and 1950s with the publication of studies (e.g., Werne and Garrow 1953)

demonstrating the extreme difficulty of overlaying a child or smothering a child in bed clothes, and the importance of performing full autopsies on these children. As medical scientists and epidemiologists gathered information during the 1960s and 1970s, they better characterized SIDS (Bergman 1986; Gun-theroth 1989). Public awareness and political campaigns since the 1970s have succeeded in removing much of the parental stigma associated with sudden infant deaths (Bergman 1986).

Todd L. Savitt

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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