The eccentric engineer: ‘child hatching’ to save premature babies

Persuading old institutions to adopt new technologies hard, and when the Establishment turns against you, even the best ideas can be relegated to the ranks of side-shows.

In the 19th century, premature babies stood only about a 50 per cent chance of surviving due to their inability to maintain homeostasis. The first baby incubator was developed from Stéphane Étienne Tarnier’s idea that this might be controlled by isolation and a rigorous hygiene and feeding regime in a warm, humid environment. Tarnier introduced his prototype incubators, based on poultry incubators he’d seen at the Paris zoo, to the Paris Maternité in 1881. Simple devices – wooden boxes with glass lids, lined with hot water bottles – they reduced infant mortality at the hospital by 28 per cent.

Soon more sophisticated machines appeared. Alexander Lion of Nice’s 1891 design was a life support system with an iron frame, glass doors in the front, and hot water circulating through a pipe in the bottom. With its own air-circulation system and thermostatic controls, it was a huge improvement but very expensive.

Lion’s solution was to make the machines freely available to the poor. In return, parents would agree to their premature child being displayed in the incubator for a fee. By 1896 Lion had opened sites in four French cities where the babies were on display to the paying public.

This led to Infant Incubator shows as part of International Expositions that demonstrated new technologies. The first, the Kinderbrutanstalt (‘child hatchery’) at the 1896 Berlin Expo, saw 100,000 people come to see the babies.

Whether or not this show was organised by Alsatian medic Martin Couney, as he later claimed, it certainly gave him an idea. Couney was an enigmatic character with uncertain medical credentials, but he does appear to have worked for one of Tarnier’s successors, and in 1897 he brought his first incubator show to London for the Victorian Era Exhibition at Earl’s Court. Here his incubators were eagerly embraced by the crowd, but while The Lancet was enthusiastic about the technology, many were concerned about the whiff of ‘commercialism’ around the show.

Couney took his show to the USA firstly to a local event then, in 1901, to the Pan-American Exposition in Buffalo, New York, where his high-tech display led not to more sales but to more incubator shows. The public, it turned out, loved seeing these tiny, vulnerable infants, nurtured back to health with the help of the latest technology.

This left Couney in something of a quandary. As the medical profession turned a critical eye, the showman in Couney saw this as a way to advertise the benefits of incubators and pay for poor families to have treatment. So he gave up on hospitals and become the ‘babies’ Barnum’. In 1903 he opened his first permanent show at Luna Park on Coney Island, followed by one at Dreamland. Despite run-ins with the New York Society for the Prevention of Cruelty to Children, his exhibitions were clean, professionally staffed and used the latest and most expensive equipment – equipment most hospitals, and no average American, could afford.

Disaster would follow, not through Couney’s work, but at an independent exhibition at The Louisiana Purchase Exposition in 1904. At this show, an outbreak of a gastric pathogen in the exhibit led to a 50 per cent death rate among the infants – the same as expected in hospital. Medical opinion in the US rapidly turned against not just the shows, but even the incubators, which were blamed for ‘incubating’ disease among the infants. Incubators were, one physician announced, “passé outside of country fairs”.

The rejection hit Couney hard, his work at Expositions drying up. His Coney Island shows were now the US’s main source of incubator care. He persevered and continued to have an 85 per cent success rate among babies the hospitals had written off.

It was the 1920s before Dr Julian Hesse – the ‘Father of US Neonatal Care’ – began his rehabilitation, and another 20 years before Cornell Hospital opened the first dedicated neonatal unit. By that time Couney was almost bankrupt; but by the 1940s the era of the sideshow was also coming to a close and Couney shut his last two exhibits for the final time. He had, at his own estimation, saved 6,500 babies and, though poor, had finally achieved some recognition as the technological pioneer who, after the most painful birth of all, got neonatal care on its modern path.