NeoReviews Vol.9 No.1 2008 e5
© 2008 American Academy of Pediatrics
Historical Perspectives
Perinatal Profiles: Alexandre Minkowski: Founder of "Biology of the Neonate"
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Introduction
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Almost every country boasts pioneers in the field of neonatology. Most neonatologists in the United States are familiar with the role that the French obstetricians Stéphane Tarnier and Pierre Budin played in promulgating the use of incubators for preterm infants. In addition, Budin wrote about umbilical cord clamping and outlined many important principles of the care of newborn infants in his book "Le Nourisson" (The Nursling), which was published in French in 1900 and in English in 1907. However, the person in France who arguably exerted the greatest influence on neonatology in the 20th century is the pediatrician Alexandre Minkowski.
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The Early Years
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Minkowski was born in Paris in 1915 to two Jewish psychiatrists, Euge
e and Françoise Minkowski, who originally were from Poland. His secondary education was at L'Ecole Alsacienne, and he attended medical school at the University of Paris. During the Second World War he joined the resistance movement in Paris in 1941 and subsequently was awarded the Medaille de la Résistance as well as the Croix de Guerre 39–45 (1939 to 1945 War Cross).
Immediately after the war, he was awarded a Rockefeller Foundation Bursary to study with Clement Smith at Harvard from 1946 through 1947. He was one of many international pediatricians who spent time with Clem Smith in Boston learning about fetal and neonatal physiology. He remained in the United States for some time after this, assimilating knowledge about clinical neonatology from pediatricians interested in the field such as Julius Hess in Chicago and Sam Levine in New York. He returned to Paris in 1950, where he supervised the nurseries at Hôpital Baudelocque.
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Assembly of a Formidable Group
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Starting in 1955, he became the Director of the Centre de Recherches Biologiques Néonatales at Hôpital Port Royal, which is immediately adjacent to Hôpital Baudelocque. This unit was under the auspices of INSERM (Institute National de la Santé et Recherche Medicale) from 1964 until the end of Minkowski's tenure in 1985. Of interest, the clinical unit (neonatal intensive care unit) was on the 4th floor and the research unit on the 5th floor, in accord with Professor Minkowski's desire that research activity be closely linked to clinical care. I was fortunate enough to spend some time with him in 1969, at which time he had managed to assemble a formidable array of talent, mostly women, sometimes referred to as his "harem." Among this talented group were Suzanne Sainte Anne-Dargassies (who collaborated with the developmental neurologist Andre Thomas), Colette Dreyfus-Brisac and Nicole Monod (electroencephalography experts, who described the phases of sleep), Jeanne-Claudie Larroche (eminent perinatal pathologist), and the young Claudine Amiel-Tison (who trained with Sainte Anne–Dargassies, but emerged as an important developmental neurologist in her own right). Biochemistry and bacteriology were prominent and neonatal cardiology was represented by Michelle Monset-Couchard, recently returned from University of California Los Angeles (UCLA). Also on his team was a young neonatologist who had recently returned from the United States, where he worked both at UCLA and with Mildred Stahlman in Nashville, Tenn., Jean-Pierre Relier, who would succeed Alex Minkowski as Chief of the Neonatology Service at Port-Royal and also as Chief Editor of Biology of the Neonate.
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Foundation of Journals and Recognition of Research Center
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In 1969, Alex Minkowski already had had a substantial impact on European neonatology, having established a journal, Etudes Néonatales, in 1957, which was published in French, before becoming the founding editor of Biologia Neonatorum in 1959. Biologia Neonatorum was published in both French and English for a few years, but starting in 1962, the articles were published only in English, although summaries were provided in French, English, and German. Biologia Neonatorum was published by Karger and later (in 1983) changed its name to Biology of the Neonate and very recently (January 2007) became Neonatology: Fetal and Neonatal Research. Minkowski continued as Chief Editor until 1985.
Minkowski's Centre de Recherches Biologiques Néonatales attracted visitors from around the world, in much the same way that his mentor Clement Smith had attracted visitors to Boston. For example, during my 3-month visit, there were visitors from Brazil, Greece, Spain, and Scandinavia. The year 1969 was something of a watershed in the development of assisted ventilation. Minkowski organized a conference in Paris on the subject, which attracted several prominent researchers in the field, including Mildred Stahlman (Nashville), Paul Swyer (Toronto), Leo Stern (Montreal), and Leonard Strang (London). The proceedings were published as a special issue of Biologia Neonatorum in 1970. The big question was whether we were doing more harm than good with ventilation because reports of bronchopulmonary dysplasia and other complications had been published recently and were uppermost in people's minds at the time. Clearly, further progress in assisted ventilation was forthcoming.
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Personality, Interests, and Beliefs
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Much of the success of the center in Paris was due to the strength of Minkowski's personality. He was a dynamic leader, who was able to accomplish things through the force of his personality. His life was not without controversy, however. He identified strongly with socialism and visited communist regimes in China, Cuba, and North Vietnam at a time when they were not on the itineraries of most Western physicians. He was close to such left-wing politicians as Pierre Mendes-France and Michel Rocard and advised "Medicins sans Frontières" (Doctors without Borders). He joined Bertrand Russell and Jean Paul Sartre at the International War Crimes Tribunal in Copenhagen in 1967, testifying "On Chemical and Biologic Warfare in Vietnam." Jean-Pierre Relier has noted that he was "at odds with the greater part of the university world."
He apparently had an exceptional memory and a wide range of interests, particularly music. His son Marc was a bassoonist who became a well-respected conductor of French baroque music and opera. In addition to editing Biology of the Neonate for many years, his indefatigable nature led him to travel extensively throughout the world and to write several books, both medical and nonmedical. These included "Un Juif pas très Catholique" (A Jew not very Kosher, 1980), "L'Art de Naître" (The Art of Giving Birth, 1987), "Pour Les Enfants du Monde" (For the World's Children, 1991) and his autobiography "Le Mandarin aux Pieds-Nus" (The Barefoot Mandarin, 1975) written in collaboration with Jean Lacouture.
The first of these books includes an oft-quoted citation, which reads (my translation) "In France, it suffices to affirm something with authority, to have one's word believed." This kind of comment did not always endear him to his colleagues!
According to Relier, "He ceaselessly questioned knowledge acquired and most of all that concerning the mother and child." He fought to protect children in war zones from Vietnam to Palestine and, despite the fact that he was a Jew, he opposed Israel's war against Lebanon in June 1982. He was a strong proponent of humanitarian aid for children of the developing world, as exemplified by the last (to my knowledge) medical article that he wrote, based on a lecture given in 1999 and published in Acta Pediatrica in 2000, whose title was "Protection of the young child's brain: personal observations and thoughts in post-war stress syndrome and in natural catastrophes."
The diversity of his interests also is attested to by his election to the French parliament in 1992 at the age of 76 to represent the environment party "Géneration Ecologie," although he resigned the following year, apparently because of lack of organization within the party.
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Final Word
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After his death in May 2004, at the age of 88, Jacques Chirac, the French president, called Alex Minkowski "one of the consciences of the 20th century," who was a "great doctor, scientist andfounder of French neonatal research."
Alistair G.S. Philip, MD, FRCPE*
* Emeritus Professor of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, Calif
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Footnotes
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Author Disclosure
Dr Philip did not disclose any financial relationships relevant to this article.
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Suggested Reading
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Andrieu B. The research on the premature brain as a multidisciplinary model at the Baudelocque de Paris Clinic, 1942–1962. [Published in French].
Hist Philos Life Sci. 2001;23
:259
–277[Medline]Lagercrantz H. Presentation of Professor Alexandre Minkowski.
Acta Paediatr. 2000;89
:1154[CrossRef][Medline]
Minkowski A. Protection of the young child's brain: personal observations and thoughts in post-war stress syndrome and in natural catastrophes.
Acta Paediatr. 2000;89
:378
–385[CrossRef][Medline]
Relier J-P. Alexandre Minkowski, 1915–2004.
Biol Neonat. 2004;86
:183[CrossRef]
For books by and photographs of Professor Alexandre Minkowski, please go to: www.livrenpoche.com/auteur/Minkowski-Alexandre/9875.html. Books are in French.
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Introduction
The Early Years
