Ben Wills-Eve | Lancaster University
A visitor to the 1901 Pan-American Exposition in Buffalo, New York, could expect to find many examples of technological progress in various grand buildings that hosted exhibitions displaying inventions like electric cars and a medical X-Ray machine. Lighter educational entertainment could be found on the Midway, including various racist exhibits like the ‘African Village’, alongside shops and sideshows. One of these sideshows exemplified the curious mix of education and entertainment on offer, the ultimate expression of man and machine working in harmony. ‘Infant Incubators’ offered paying visitors the chance to see tiny premature babies being nursed to health inside gleaming glass and metal incubators. Martin Couney, the self-styled ‘Incubator Doctor’ who ran the exhibit, would spend the next forty years providing perhaps the finest medical care in the world to babies born prematurely, regardless of their race or religion, at exhibitions and amusement parks in America and around the world. He is thought to have saved over 7,000 babies that otherwise would have died. From a modern perspective this state of affairs seems both bizarre and morally wrong, especially as ‘Dr Couney’ was not really a medical doctor at all (despite his claims in later life), yet it highlights the complex relationships between technology, society and medicine where ethics and economics can become entangled in extraordinary ways. The story of the infant incubator’s journey from Paris Zoo to New York sideshow is a prime example.
The first infant incubators had been invented in France thirty years earlier by Dr Stéphane Tarnier, who supposedly got the idea of using incubators for babies after visiting Paris Zoo and seeing the large egg incubators used to hatch chicks. This link between incubation and eggs was already present in the public consciousness and the choice of the term ‘incubator’ (or ‘couveuse’ in French) would have been more reminiscent of increasingly technological animal husbandry than medical care in a hospital. Indeed, when incubators were first exhibited at the Berlin Industrial Exposition of 1896 the exhibit was literally translated as ‘The Child Hatchery’ and the incubators themselves described as ‘artificial foster mothers’. Some particularly incredulous visitors to Martin Couney’s incubator sideshows even wondered whether the tiny babies had been born inside the incubators, somehow hatching from (artificial?) eggs.
Although the first incubators used at the Paris Maternité hospital by Dr Tarnier were rudimentary affairs, little more than a wooden box with a lid heated from below by warming pans that needed to be regularly refilled, they prompted a subtle shift in the caring relationships between babies, mothers and nurses. With their offspring now enclosed in boxes that kept them warm, mothers began to feel more disconnected and nurses spent as much time tending to the incubators as to the babies themselves (this feeling of ‘nursing the machines’ is still common amongst nurses working on the highly technological Neonatal Intensive Care Units (NICUs) of today). When Tarnier’s assistant Dr Pierre Budin succeeded him at the Maternité, the most notable change he made to the incubators was to increase the amount of glass used in their construction so that mothers could see as much of their babies as possible. He focussed far more on encouraging and nurturing the mother-baby bond than on the technological development of the incubators, which both improved survival rates and decreased the number of babies who survived but were promptly abandoned at the Foundling Home around the corner.
This issue of incubator technology apparently replacing the need for a mother, or at least distancing her from her baby, leading to disconnection and abandonment was also noted by Martin Couney. He insisted that any parent who brought a baby to be cared for at any of his incubator sideshows had to leave a verified address so that babies could be returned to them when healthy, regardless of whether they were still wanted or not; he would sometimes appear on a family’s doorstep, babe in arms, to repatriate the infant and remind parents of their responsibilities.
While Dr Budin was still relying on heated wooden boxes to regulate babies’ temperatures, Dr Alexandre Lion of Nice was taking an altogether more technical approach. Similarly inspired by egg incubation, Dr Lion set about making an incubator that would maintain a constant temperature with minimal human oversight. The result was a gleaming metal and glass cabinet raised up on legs that had a metal flue to draw in air from outside, which was then filtered and warmed via a heating apparatus that could be powered by either gas or electricity. It was capable of maintaining a closely regulated temperature fully automatically, allowing a nurse, or even a mother, to concentrate on caring for the infant within. Although undoubtedly an impressive feat of engineering, Lion’s incubator, like many such technological advances, was expensive to build, install and run. Dr Budin purchased some of these new incubators for use at Paris’ Maternité hospital, but the practical issues of installing the large metal flues, the running costs and inconsistency of Paris’ gas supply all meant that he ended up reverting to the relatively simple wooden boxes and warming pans. State medical institutions simply could not afford, and were not set up to use, such technology. This fact was not lost on Dr Lion, who had already taken a new approach to funding incubator care.
A visitor to Nice in 1891, wandering down shop-lined streets, may have stumbled across a curious establishment which called itself ‘The Baby Incubator Charity’. For a small donation, the visitor could step inside and admire the row of incubators and the babies contained within them. Charitable donations and paying visitors meant that anyone could bring their baby to Dr Lion’s charitable establishment and they would be cared for at no financial cost to the parents. What the doctor did not expect was the popularity amongst visitors, some of whom would return day after day to check up on their little favourites, perhaps attending far more religiously than some of the parents. The charity turned such a profit that there were soon branches in cities across France, and a couple in Belgium, which could operate solely from entry fees and did not need other donations to survive.
Amidst this growing popularity, Dr Lion was invited to exhibit his incubators at the 1896 Berlin Industrial Exposition, but he decided that simply showing off the incubators themselves would not do his devices justice. To capture people’s imagination they needed to be seen in action, and so the premature babies of Berlin’s charitable maternity hospital, for whom there was little hope of survival, were transferred from hospital to fairground. The majority would be nursed to health, watched by thousands of paying visitors, and the exhibition became so popular that each evening the Exposition’s beer hall would reverberate to the sound of songs about the tiny babies in their strange machines. A curious mixture of medical facility, charity and hugely profitable enterprise, the ‘incubator sideshow’ was here to stay, as were the incubators themselves which Dr Lion donated to a new children’s hospital in Berlin.
It is unclear how Martin Couney got wind of this infant incubator idea – much of his early life is shrouded in uncertainty and his claims of being medically trained are not backed up by any records – but once he did he ran with it. After purchasing a new set of Lion incubators, manufactured by Paul Altmann in Germany, Couney ran a series of sideshow exhibits at various expositions in Europe and the USA, including the 1901 Pan-American Exposition. In 1904, he eventually found a permanent home for his incubators in New York City at Coney Island’s Luna Park, then the largest amusement park in the world, which would open every summer season for nearly forty years. Although Couney was actually a showman rather than a medical doctor, he saw the incubator shows not only as a chance to save babies’ lives, but more importantly as an opportunity to spread ‘propaganda for preemies’ to advocate for their care and, in an era of eugenic science, their worth to society.
Others, however, were less scrupulous. The popularity and profitability of first Lion’s and then Couney’s exhibits were plain for all to see, and there was soon a string of imitators setting up similar incubator shows across Europe and the USA. Many of these exhibits did not understand, or simply overlooked, the important fact grasped by both Lion and Couney that the key to infant survival was not just the incubators, but also the quality of the nursing care provided. Louise Recht, the head nurse at Couney’s Coney Island shows for their forty-year run, was an expert trained under Dr Budin at Paris’ Maternité hospital. This kind of knowledge and experience was not available to rival imitators, leading to tragic occurrences such as a diarrheal epidemic at a sideshow in the Louisiana Purchase Exposition of 1904 which led to the deaths of half the infants nursed there. Such mistakes were the results of human error and emphasised the point that skilled, knowledgeable and experienced staff were more valuable than the incubators themselves. However, such setbacks tarnished the incubator’s reputation amongst the medical establishment, particularly in the US, and hospitals turned away from using them, leaving Couney’s sideshows as the only places where high quality incubator care was available.
Couney had always seen his work as scientific and educational and resented being confined to the populist attractions of the Midway. However, over the years his main aim changed from being solely about saving lives, which he could only achieve on a very limited scale, to raising awareness and promoting the care of such premature babies - his ‘propaganda for preemies’ mission. The need to both educate and entertain was something that, while seen by some as distasteful, the showman and publicist in Couney relished in sometimes contradictory fashion. For example, he would ensure that the barkers (who promoted the sideshow to passing visitors) strictly followed a script highlighting the incubators’ scientific merit, firing any who dared to deviate from it, whilst simultaneously instructing his nurses to wear over-sized rings that they could take off and slip along the babies’ arms to demonstrate their tiny size and put on a show for visitors.
These contradictions were inherent in the odd juxtaposition of this educational exhibit alongside the usual Midway entertainments, which sometimes created its own problematic publicity. One year at Coney Island a rather racy burlesque show occupied the concession next to the infant incubators. One night the show was raided by the police after reports of ‘indecency’, causing the manager to complain that her girls wore more clothes than the babies next door. In 1911, at Coney Island’s most recent amusement park called ‘Dreamland’, where there was now a second incubator exhibit, the aptly-named ‘Hell’s Gate’ ride started a fire which gutted the entire park. Despite a narrow escape, during which all the babies were moved to the incubators in neighbouring Luna Park, the disaster gave Couney’s critics the chance to decry his shows and alienate the incubator from ‘serious’ medical practice. Combine this with a growing eugenics movement that saw premature babies as genetically weak aberrations, and the opinion of the medical and scientific communities, whose appreciation and acceptance he yearned, was very much against Couney’s mission. His frequent offers to donate incubators to hospitals were denied as the machines were deemed both unnecessary and unhelpful.
Over the next thirty years the tide of medical opinion slowly turned, due to the decreasing acceptance of eugenic theories and the increasing reputation of both Couney and incubator care, primarily achieved by the work and support of Dr Julius Hess, who invented portable incubators for transporting babies and established the first premature infant nursery at Michael Reese Hospital in Chicago. Hess worked with Couney at his incubator show during the 1933 Chicago World’s Fair, bolstering Couney’s reputation amongst the medical community. In 1937, the New York Medical Association even presented Couney with a platinum watch in recognition of his service to the medical community, many of whom had sent him babies to look after or sought his advice over the decades that he had been present at Coney Island. But perhaps the greatest achievement of them all came in 1943 when Couney finally closed his Coney Island show for good because New York’s Cornell Hospital had just opened its own premature infant nursery. With infant incubators and high quality care now in mainstream hospitals, Couney proudly stated that he had completed his mission and ‘made enough propaganda for the preemies’.
The strange early history of infant incubators, and the complex character of their chief exhibitor, shows that technological progress is never as straightforward or inevitable as it can seem with hindsight. Similarly, individual narratives of mavericks and malefactors may nicely fit the ethical and moral perceptions of today, but the intricacies of societal and scientific thought rarely fit into such binary constructs and need to be carefully dissected within their changing historical contexts. Such tensions are still inherent in medical care today; as artificial wombs are touted to replace incubators, what will this mean for motherhood? As was the case a century ago, it is unclear where the relationship between mother and machine may go next.
Further Reading:
Dawn Raffel, The Strange Case of Dr Couney (London: Penguin 2019).
Claire Prentice, Miracle at Coney Island (2016).
Martin Couney on Neonatology.org http://www.neonatology.org/pinups/couney.html
The Coney Island History Project https://www.coneyislandhistory.org/
Ben is a History PhD student at Lancaster University studying the role of automation, algorithms and AI in online public engagements with the past. He is also our Digital Humanities Editor - read more about his research here.
Twitter: @wills_ben