Bulletin of the History of Medicine

With the advent of antibiotics, medicine seemed to be on the verge of curing everything. A dark cloud appeared on that promising horizon in 1969, however. Newspapers and magazines carried descriptions of “crib death.” Americans learned that up to fifteen thousand babies died annually in the United States for indiscernible reasons. Rest Uneasy is the history of the medical community’s response to those deaths from the late nineteenth century to the present. Drawing primarily on medical journal articles, but also newspaper and magazine articles; government hearings, studies, and statistics; medical conference papers; organizational records; and physicians’ papers, Brittany Cowgill’s history of “SIDS medicine” (p. 7), as she labels it, describes how physicians failed both babies and parents.

In the last hundred years, theories of what caused the sudden deaths of previously healthy infants have abounded. In the mid-nineteenth century, doctors suspected that oversized thymus glands suffocated babies. In the late nineteenth and early twentieth centuries, physicians blamed “careless . . . indolent and . . . drunken” mothers for “overlaying” (p. 11) their infants. In coining the moniker sudden infant death syndrome (SIDS) in 1969, doctors finally bestowed a medical label on the longtime mystery that they now described as an infant death “unexpected by history and in which a thorough post-mortem fails to demonstrate an adequate cause of death” (p. 29). In the wake of the new name and definition, so many additional theories appeared in the 1970s that physicians joked about creating “the theory of the month club” (p. 55). Cows’ milk allergy, respiratory infection, environmental toxins, the DTP vaccine, and prenatal drug use all fell [End Page 290] under suspicion. Then doctors fingered sleep apnea as the culprit. None of the theories panned out.

Of these latter-day hypotheses, sleep apnea received the most attention, and Cowgill devotes an entire chapter to the episode. Physician and researcher Alfred Steinschneider proposed that apnea caused SIDS in what became an oft-cited article published in Pediatrics in 1972. The article almost single-handedly created the apnea-monitor industry. Steinschneider’s theory was debunked ignominiously twenty-five years later; two of the five infants in his original study had been murdered by their mother. Cowgill argues the monitors popularized by Steinschneider “obscured rather than clarified SIDS’ causes, reshaped rather than removed sources of guilt, and displaced rather than dissolved anxieties about SIDS” (p. 116).

Eventually, parents of SIDS victims created grassroots organizations to force SIDS onto the national stage. The National SIDS Foundation defended SIDS as a “real disease” (p. 97), enhanced public awareness, and argued that SIDS could neither be predicted nor prevented. Awareness spurred congressional action; funding for SIDS education and research first became available in 1974. Before then, the American Academy of Pediatrics had counseled against disseminating any information about SIDS, fearing that it would exacerbate parents’ fears.

The first bona fide SIDS preventive measure did not appear in the United States until the 1990s with the Back to Sleep campaign. The incidence of SIDS deaths worldwide had always been inconsistent. China had by far the lowest rate in the world—0.036 deaths per thousand babies. And most Chinese parents, unlike parents in the United States, put their babies to sleep on their backs. The most compelling evidence of all that sleep positioning was a cause of sudden infant death came from the Netherlands. Like the Chinese, the Dutch had one of the lowest SIDS rates in the world before the 1970s. And like the Chinese, Dutch infants slept on their backs until researchers suggested in 1971 that there were physiological advantages to putting babies to sleep on their stomachs, like in the United States. SIDS rates in the Netherlands instantly doubled. After the American medical community introduced the Back to Sleep campaign, SIDS halved in the United States.

American physicians now advocate that a separate category for SIDS be created for infant deaths that occur during shared sleeping. This proposed category would effectively revert, once again, to blaming parents for SIDS. Cowgill concludes, “In many ways, this tease—a partial resolution sullied by undesired facts—is emblematic of SIDS history” (p. 160). Cowgill’s book is a comprehensive account of the history of the medical theories purporting to explain the sudden deaths of presumably healthy infants. [End Page 291]