The incubator

MAS Ahmed, FRCPCH
Queen’s University Hospital, UK Barts

Natasja Vandepitte
The London School of Medicine and Dentistry, London (Summer 2014)

 Incubator of wood and glass from The Nursling, by Pierre Budin
The Nursling, by Pierre Budin, translated by William Maloney.
London: Caxton Publishing Co.; 1907.

 

The incubator is a common sight in every Neonatal Intensive Care Unit (NICU). Its history is of interest because of its influence on patient care and on the ensuing societal change. Babies were an exclusively female domain, and it was up to the mothers to take care of their newborns, including those born prematurely. The incubator heralded a change in this belief, medicalizing the care of babies and introducing male physicians into this area.

In 1880s France, the obstetrician Stéphane Tarnier, inspired by an incubator for bird’s eggs in the Paris zoo, created a model for babies on his wards in the Maternité hospital.1The model initially housed several infants at a time, heating them with a warm water reservoir; this was subsequently scaled down to cater for a single infant, using hot water bottles to heat by convection.1 Similar approaches were already in use by midwives and mothers (using heated water and blankets in baskets to keep babies warm),1 but Tarnier’s creation brought the focus onto the premature infant who until then would often die in his mother’s care.

A second model was in use in Germany concurrently, called the Permanent Bath. Also invented by an obstetrician, Franz Winckel, it housed the infant in a closed wooden bathtub with circulating warm water while its head protruded from an opening.2 This model was inspired by the infant’s suspension in amniotic fluid in the mother’s womb;2however it was Tarnier’s model that gained popularity and was reproduced around the world.

The incubator used at the Maternité hospital in Paris halved the mortality rate of premature babies.2 Initially the focus had been on the heating element, as the main cause of death for premature babies was heat loss, but with Louis Pasteur’s work on microbes occurring at the same time, there was a shift to create new designs that would protect the infant from infection.1,2

Pierre Budin succeeded Tarnier as head of the Maternité and worked with the latter to improve the incubator’s design – an alarm and regulator were built in to allow medical staff to be alerted to any unwarranted changes in temperature.2 Budin also noted the essential role of the mother while the infant was in an incubator, ensuring both adequate supervision and that the infant and mother were accustomed to one another on leaving the hospital.3 This is similar to current practice of encouraging parents to spend time with their infants while they are on NICU.

Alexandre Lion was the physician who brought the incubator into the public consciousness by establishing permanent exhibitions from 1891.2 The infants were under medical care, but a paying public was able to enter and observe the infants in their glass incubators. Martin Couney, a German doctor who worked with Lion on managing his exhibitions, set up his own display at the 1896 Berlin Exposition in order to demonstrate the treatment of premature infants.5 This display was a resounding success and led to many more displays in shows around the world, including the 1897 Victorian Era Exhibition at Earl’s Court.2 Couney moved to the United States in 1896 and became the first doctor there to offer specialized care for premature infants.4 Between 1903 and 1943 there were incubator displays with premature infants set up in the Coney Island amusement parks.5 The infants were managed free of charge to their parents, while visitors paid to see the infants and receive explanations from Couney or his assistants.5 It was not until 1943 that the first neonatal ward for New York was opened, marking the end of the exhibitions.5While the idea of placing infants on display is controversial, not least because it entails a violation of privacy, the exhibitions served to educate the public while providing free healthcare for a group often disregarded before the invention of the incubator. This education in neonatal medical management may have contributed to the incubator’s wider acceptance and the development of specialized neonatal units, but historians have argued that the exhibitions in fact served to delay the use of the incubator in medical practice in the United States.5 This was due to the exhibitions being promoted as entertainment, masking its value as a pioneering demonstration of medical advancement.

The incubator’s initial invention came some fifty years before its use started to become commonplace. It opened the door to treating a new and previously neglected group of patients: premature and low birth weight infants, heralding the introduction of male physicians and indeed politics into what had hitherto been exclusively a female concern. Despite initial showcases of the device seeming exploitative to modern eyes, its ubiquity in modern neonatology has greatly increased the survival of vulnerable patients.

References

  1. Baker JP. “The Incubator and the Medical Discovery of the Premature Infant.” Journal of Perinatology 2000; 5:321-328.
  2. Greene G. “The ‘Cradle of Glass’: Incubators for Infants in Late Nineteenth-Century France.” Journal of Women’s History 2010; 22(4): 64-89.
  3. Dunn PM. “Professor Pierre Budin (1846-1907) of Paris, and modern Perinatal Care.” Archives of Disease in Childhood 1995; 73: 193-195. Doi:10.1136/fn.73.3.F193 (accessed 30/11/2013).
  4. Lussky RC, Cifuentes RF, Siddappa AM. “A History of Neonatal Medicine – Past Accomplishments, Lessons Learned, and Future Challenges. Part 1 – The First Century.” Journal of Pediatric Pharmacological Therapy 2005; 10: 76-89.
  5. Webel S. Kinderbrutanstalt. “Leisure Space and the Coney Island Baby Incubators”. Text, Practice, Performance 2003;V: 1-21.

MAS AHMED, MD, has been a consultant pediatrician with interest in childhood neurology at the Queen’s University Hospital since 1998. He received training in pediatrics and in particular pediatric neurology at different teaching hospitals, including York Hill Hospital Glasgow and Great Ormond Street Hospital in England. His particular interest is childhood epilepsy and childhood headaches. He has taken different clinical and managerial pediatric responsibilities, including Pediatric Medical Student Lead, Pediatric Research & Development Lead, Pediatric Audit Lead, Royal College of Pediatric and Child Health Tutor, and Pediaitric Clinical Director at the Queen’s University Hospital.