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Sister Jean Ward, phototherapy, and jaundice: a unique human and photochemical interaction

Journal of Perinatology volume 35, pages 671–675 (2015)Cite this article

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Cremer and RW Perryman, a biochemist, went on to demonstrate that, when exposed to daylight, sunlight and artificial light, bilirubin levels in icteric sera decreased rapidly and, in 1958, they published their seminal observations 3 demonstrating that both sunlight and blue light (delivered by their home-made phototherapy unit consisting of eight 40-W ‘light blue’ fluorescent tubes) would decrease bilirubin levels in jaundiced newborns (Table 1). Indeed, after a hiatus of some 56 years, sunlight is again being used to treat hyperbilirubinemia.4 Later the same year, Franklin5 described his experience with 12 jaundiced infants and 13 controls. The bilirubin levels declined in the jaundiced infants but Franklin stopped using phototherapy because, as he noted, ‘… there is no information about the nature or toxicity of the material elaborated from bilirubin by the action of these light waves; and secondly, because it seems unlikely that the quantitative effect will be great enough to be a substitute for exchange transfusions.’

Table 1 Effect of sunlight and fluorescent light on jaundiced newborns
Full size table

Nevertheless, pediatricians in Brazil, Uruguay, and Chile, and subsequently in Italy, France, and England, were bold enough to continue Cremer’s experiment. In September 1960, Ferreira et al.6 described their experience with 77 jaundiced infants and were the first to coin the term ‘phototherapy.’ Following the 1958 publications of Cremer et al.3 and Franklin5 no less than 21 papers, largely case series, were published documenting the efficacy of phototherapy in jaundiced newborns, but it was not until 1968 that Lucey et al.7 published the first US phototherapy study. Why did it take 10 years for this to happen? One might expect that, following documentation in a prestigious, peer-reviewed journal of an effective, simple, noninvasive and cheap(!) method for treating jaundiced newborns, neonatologists in the USA would want to confirm or refute these findings. That they did not is almost certainly because, of the 21 papers published following Cremer’s 1958 study, only one8 was in English. Whatever those of us in the USA are celebrated for, it is not for our facility with other languages. As a result, the papers documenting the efficacy of this intervention were neither read nor appreciated by US pediatricians.

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Acknowledgements

I am grateful to Drs Jon Tyson, Tom Newman, Thor Hansen and Henk Vreman for their input and critical review of this manuscript and to Dr. Jerold Lucey for reviewing the manuscript and for many discussions over some 40 years about phototherapy and the jaundiced newborn.

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  1. Beaumont Children’s Hospital, Royal Oak, MI, USA

    M J Maisels

  2. Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

    M J Maisels

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Correspondence to M J Maisels.

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Based on the Thomas E. Cone Jr, MD, Lecture on Perinatal History, given at the Section on Perinatal Pediatrics, American Academy of Pediatrics National Conference and Exhibition, Orlando, FL, 26 October 2013.

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Maisels, M. Sister Jean Ward, phototherapy, and jaundice: a unique human and photochemical interaction. J Perinatol 35, 671–675 (2015). https://doi.org/10.1038/jp.2015.56

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