This blog is based on the presentation given on 8 November 2018, as part of the History at Northampton Research Seminars series at the University of Northampton. It explores the origins of perinatal (premature baby) care in the UK from 1947 to 1965, using recently available archival material for Northampton, made possible through the generosity of the family of Dr Isaac Henry Gosset (1907-1965).
Isaac Gosset (known as Harry) was the son of the noted statistician William Sealy Gosset who wrote under the pseudonym ‘Student’ who developed the ‘t-Test’. Isaac received his education at the Dragon School in Oxford and Rugby School, then on to Magdalen College at Oxford before gaining his medical degree at St Thomas’s Hospital in London.
He held various medical posts in London and around the Home Counties including a period in the RAF during the Second World War. By the time of his demobilisation he was working as Senior Medical Specialist at RAF Cosford, one of the largest RAF general hospitals, and had attained the rank of Wing Commander.
Dr Gosset was appointed the first consultant paediatrician for Northampton General Hospital in 1947. He had extensive clinical responsibilities for Northampton and the southern part of the county, together with part of north Oxfordshire, and following the creation of the National Health Service in 1948 also Kettering General Hospital and the northern part of Northamptonshire.
He was a pioneer in the development of exchange transfusions ‘undertaking exchange transfusions for sick neonates with hydrops only one year after the first published description of this technique by Diamond in 1947’. This was a decisive, life-saving intervention by the paediatrician in the delivery room, an area previously felt to be the sole realm of the of the obstetrician and midwife.
The first premature baby unit in the UK was opened at the Sorrento Maternity Hospital in Birmingham by Dr Mary Crosse in 1931, the second unit opened at the Southmead Hospital in Bristol by Dr Beryl Corner in 1946. During the 1950s several hospital teaching centres set up premature baby units. The General Hospital in Northampton was an early adopter of premature baby units as the first one here predated 1950. This unit was deemed to be too small so in 1950 Dr Gosset helped in planning and setting up the new premature baby unit at Northampton by the conversion of the old labour ward in the hospital’s maternity home.
In neonatal practice he designed the ‘Gosset icterometer’.
It was made of Perspex, and manufactured initially by Modern Fittings, a local Northampton firm, and subsequently by Ingram’s of the Santos Works at Birmingham, it allowed accurate estimation of serum bilirubin without a blood test. The icterometer was trialled in both Northampton and Birmingham and both studies were published in the Lancet in 1960.
These are amongst the very earliest neonatal care research papers in such a prestigious journal and reflect that at the time icterometers were an important advance. Dr Mary Crosse and her team at the Sorrento Maternity Hospital, also in Birmingham, were using Gosset’s Icterometer too, so successfully that they were wearing the paint off their device.
Professor Peter Dunn, Emeritus Professor of Perinatal Medicine and Child Health, at the University of Bristol, and Southmead Hospital, Bristol, said of the icterometer ‘…[he] used the icterometer all the time when he was paediatric registrar at the Birmingham Maternity Hospital 1959-1962 and onwards’. He said further that ‘Not only was the icterometer an effective clinical tool, equally importantly it saved valuable time when paediatric staffing was minimal. I rate this instrument as the most valuable I had at that time and still is useful today especially for those working outside hospital’.
Icterometers were used for many years afterwards, but having been superseded by transcutaneous electronic bilirubin meters and microsampling of blood samples enabling blood tests to be undertaken more quickly and requiring less volume, they are no longer supported by current NICE guidelines for use in the UK. However Icterometers are still in use today in many countries around the world with recently published (2017) studies validating their use in China and Nigeria.
In April 1965 the new premature baby unit which Dr Gosset helped to design was opened. In this he was a generation ahead of his time, which even in the 1970s saw such units as being restricted to teaching centres.
Sadly in March 1965, Dr Gosset died of a coronary thrombosis aged only 57 on his way home from his usual Thursday afternoon clinic at Kettering General Hospital. The Premature Baby Unit was immediately renamed the ‘Gosset Premature Baby Unit’ a name which it still proudly bears to this day.
‘The Gosset Collection’ is unique in the UK in having extensive archival material covering premature baby care in the pre-ventilation era. Using ‘The Gosset Collection’ the full premature baby care pathway of the 1950s and 60s can be reconstructed, the history of the development of the icterometer can be explored and both can be placed in the context of a rapidly evolving area of paediatric medical care.
Fred O’Dell and Andrew N Williams, Northampton General Hospital, United Kingdom.
The photographs are taken from the Dr Isaac ‘Harry’ Gosset Collection and were originally provided by Dr Gosset’s family.