I commented recently on the book The Strange Case of Dr. Couney — How a Mysterious European Showman Saved Thousands of American Babies by Dawn Raffel. At that point I hadn’t read it, but now, through a generous gift, I have.

Read. This. Book.

Dr. Martin Couney was mysterious because he changed his name several times, and had no “proper” credentials as a doctor. However, he saved the lives of at least six thousand premie and underweight babies, using incubators, careful feeding, perfect cleanliness, and loving touch. And then he was mostly forgotten. It’s hard to get that number in perspective, but it is more than twice as many lives as the number of people who died at Pearl Harbor, both soldiers and civilians. 

I was fascinated by the book and need to read it again, since I read it in one long gulp on a Saturday afternoon. In the meantime …

The book reminded of me of stories told about my grandfather. He was a pediatric physician at a prestigious northeastern hospital in the early and middle 1900’s. In one year, at this hospital, there were 33 cases of pyloric stenosis; he was responsible for diagnosing 22 of them. Pyloric stenosis is a newborn baby problem where a muscle improperly blocks food from entering the small intestine.* Babies who are not getting nourishment don’t do well. The answer is surgery. And back in Grandfather’s day, the diagnosis was confirmed by surgery, rather than by any imaging that we can do today. So if you got it wrong everyone knew, because there you were in the operating room with a baby who didn’t need surgery. Conversely, if you didn’t do surgery, the baby didn’t live but of course, lots of babies didn’t make it for lots of reasons. 

Grandfather’s surgery record was perfect, and his numbers were higher than the other doctors, which strongly suggests that some babies were not being diagnosed correctly. {Or, I suppose, we could hope that he was brought in to consult on difficult cases?} 

Grandfather said he could diagnose correctly because he knew how a baby behaved when it was in the kind of trouble caused by pyloric stenosis. In those days people spent a lot more time in hospitals, and he would go and single-mindedly watch his patients, to see how they moved and acted, in their troubles. Eventually, he could simply look at a baby and tell, by the way it held its body, whether it was pyloric stenosis or not.

The book on Couney mentions infant diarrhea and the various efforts at treating it. If the baby could survive for a few days, its body would fight off the virus or bacteria, but that survival required nutrients. Having correctly understood that the diarrhea was caused by contractions that sent food through the intestines far too quickly, Grandfather recommended beef tea and apple juice in quantity. His reasoning was, that if the opportunity for nourishment was short, then the food presented had to be as nutritious as possible. This was extremely messy since the diarrhea continued. He said that only mothers would do all that unpleasant and mucky work for the several days required. He had a point. Periodically, the recommendation for treatment was just to stop feeding the baby. That of course, did stop the problem, but it also killed the baby.

At some point in the 1940’s, Grandfather gave a talk about infant diarrhea, in Mexico City, in Spanish. He didn’t speak the language, but had his talk translated, and then memorized it. (Since, he certainly knew Latin and French this was either more or less appallingly difficult than it sounds.)

In the 1950’s his granddaughter was at a school in the ‘countryside’ and there was a fair amount of fever that swept the school from time to time. He finally told his daughter to check if the students were drinking unpasteurized milk. She said no-one would do such a thing, but as it turned out they were, and the students were getting undulant fever. Nowadays, raw milk seems to be a complex issue, but in that particular moment it was much simpler. Pasteurize or get sick.

At the end of Grandfather’s life he had liver cancer and wasn’t practicing in the hospitals anymore. But he would take on Medicare patients and go see them at home. (! I remember a doctor doing a house visit sometime in the early sixties…?!) He was visiting poor clients in walkup flats, and said that when he couldn’t walk, he would crawl up the steps. It wasn’t his brain that was sick, and these people needed help. 

Grandfather noticed colleagues at hospitals who were failing to wash their hands, even as late as the 1950’s. Part of Martin Couney’s success was his demand for absolute cleanliness. 

And part of Martin Couney’s success was that he loved the babies, and so did his nurses. 

I have no words …

*(https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/symptoms-causes/ )