Incubators and Preemies: How it all Began

It's an interesting and curious story: the Birth of the Incubator.

I was watching the History channel on my break on nightshift last week and a woman asked one of the researchers on the show the origins of a silver cup with her name on it.

It had an extraordinary history behind it. Some would even hazard to say bizarre.

Wiki photo: 1909, Seattle WA
Baby Incubator

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Back in 1904, if a baby was born prematurely, more than likely it would die an early death - either from cold, disease or inability to feed.   (You remember my story of a baby my Grandmother delivered in the prairies that she set on the door of a woodstove to warm!)  Death rates in the first two weeks of life ranged between 30-40%!

The move towards trying to save these babies started in the 1870's when France's population was ravaged by famine and post-war casualties.

In an attempt to boost the French population, Dr. Tarnier, an esteemed obstetrician and a pioneer neonatologist,  decided that steps should be taken to improve the survival rate of prematurely born infants.  

His attendance at a poultry farm where chicks were raised in a warming chamber sparked an idea.  Why not develop a similar setup for human babies? 

The Zookeeper of the Paris Zoo was commissioned to build the first baby incubator for a local Paris hospital in 1880 - the first in the world.

Under Dr. Tarnier's tutelage was a Dr. Budin, who further championed the advancement of the use of incubators for neonates.    Specializing in the study of neonatology,   he wrote papers and published books on the subject. 

He introduced "nasal feedings" (oh my!-take a look!) and intermittent gavage.

He worked on the problems of infection as well, and developed strict hand washing and the isolation of sick babies and separating the infants into well baby/sick baby groupings. He addressed the problem of proper storage of milk to prevent spoilage.  

He advocated using "wet nurses" to procure human milk as this was found to produce better results.

He came up with an unusual and bizarre method to publicize his theories on Neonatology and spread the word about baby incubator use:  Baby Exhibits.

A young associate of Dr Budin was assigned to accompany an Exhibit of "a child hatchery" to Berlin.  The display was so successful, it was extended not only to England, but also into the United States.

This young associate was Dr. Martin Couney. 

He immigrated to America in 1903 and for 40 years plus,  presided over the Coney Island exhibit.

In this unlikely environment,  circus "barkers"  would shout out to the crowd to encourage them to go through the exhibit. (Interestingly enough, one of these was Cary Grant - at that time, a young actor waiting for a part on Broadway)   The incubators were lined up like little wood stoves in a row.

In the early days, to view the preemies - adults would pay 10 cents,  children - 5 cents.  Lines - mostly women -  would line up in droves to view the nurses at work with the babies, some of which were only one and a half pounds. 

Although based in Coney Island, occasionally Dr Couney would go out to other cities - Chicago, Portland OR, San Francisco - to oversee displays there.   The one in San Francisco alone took in over $72,000 in the 10 months it was open.

MDs from all over the country would send Dr Couney little preemies for his exhibit.  He was awarded a platinum watch in recognition of his efforts.

However, not everyone was happy with the "showmanship" of the preemies.  One nurse recalled feeling disdain, but she did concede that the infants did get very good care.  

Dr. Couney himself was disheartened to see the disconnect between the infant and the parents who, after so many months separated from their baby, would hardly come and visit and were actually reluctant to take them home when they "graduated".  He consoled himself with the fact that not one parent had to pay a penny for the care of these babies - the exhibit itself was self-supporting.

In a Canadian twist: Dr. Couney was invited to be the MD in charge of the famous Dionne Quintuplets born in Ontario, but declined because he stated that they were going to die and he didn't want to have the bad publicity that would be a fallout of a probable highly publicized failure.

As it was, these were one year's results, near the end of the era of the exhibit:

Mortality Experienced at Exhibit during New York World's Fair 1939-1940 (Medical News: New York City. JAMA 115:1648, 1940.)

Gestational Age (mo.)	Admitted	Died
6	9	0
6 1/2	18	4
7	37	6
7 1/2	9	0
8	20	0
8 1/2	1	0
Unknown	2	0
Total	96	10

By 1940 the depression had eaten away at the profits and the now 25 cents admission charge did not cover the costs.   The Health Department stepped in and continually criticized the setup.  The public were bored with the exhibit in an ever increasingly modernized world. 

The first premature infant ward opened up in Cornell's New York Hospital and the Preemie Exhibit folded.

He (Couney) told his nephew, "I made propaganda for the preemie. My work is done." Twenty years after his death a bronze tablet was placed on the wall next to the entrance of the Holiday Inn on the boardwalk in Atlantic City to mark the site of his old shows. It noted that "Dr. Couney was the first person in the United States to offer specialized care for premature infants."

A final commentary at the end of this story makes an interesting comparison to today's medicine:

"But I find it hard to ignore the resemblance between the theatrics of the side-show exhibits and the dramatic actions in present-day neonatal intensive care units. In both cases, I find a disturbing detachment from reality"
"The feeble infant is plucked up and deposited in a theatre-like setting in which superb technical experts make all-out efforts to support life. And when this has been accomplished successfully, the infant graduates. But no comparable effort is mounted to deal with the enormous problems which face the graduate at home and in the community. Future historians may look back with some fascination at the tunnel vision in the incubator-show era and in the present day. I can almost hear the comment (in French, of course, since the movement did begin in France): Plus ça change, plus c'est la même chose."

One thing the exhibition did - it promoted the need for earlier and improved prenatal care.

Oh - and that silver baby cup with the woman's name engraved on it mentioned at the beginning of this blogpost? It was part of a gift given to a group of "1933-34 preemie graduates" and their parents at a 1940 reunion of the Exhibition Babies from Coney Island's "Century of Progress" World's Fair.

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Here is a March of Dimes video showing preemies birth and the work they do. It's an ongoing fight: