One of the strangest features of the early history of neonatology has been that of the so-called incubator infant shows: public displays featuring living premature infants.1 Most accounts of this phenomenon have centered on the self-proclaimed incubator showman, Martin Couney, who exhibited infants on Coney Island and several world fairs throughout the first half of the 20th century.2 Yet, more recent historical work has begun to recognize that the idea of incubator shows actually originated with a French inventor named Alexandre Lion.3,4 This article will use new sources from the European literature to examine how and why Lion did so, and argue that incubator shows, at least in their earliest form, should not be dismissed as mere side-shows.
The invention of the infant incubator by French obstetricians has been recounted in detail.5,6 In brief, infant mortality was a major concern in 19th century France. The country faced a declining birth rate and had lost many young men in the Franco–Prussian war of 1870 to 1871. The vast majority of infants were born at home and some authorities claimed 15% to 30% of all French births were premature.7 When the Parisian obstetrician Etienne Tarnier saw the egg incubator designed by Odile Martin, engineer of the Paris Zoo, he perceived its possibilities to save the lives of prematurely born children. In 1880, he introduced an infant incubator in his maternity wards.8 The device reduced the mortality of premature infants <2000 g who had been born in the hospital by nearly half. Tarnier’s successor, Pierre Budin, attempted to treat these infants through a special nursery with incubators and wet nurses. It was a disaster; hospitals were widely regarded as deadly to infants at this time, and mothers were reluctant to part with them until almost all hope was lost. Either a new technology, or a new institution, had to be developed. A certain Alexandre Lion offered both.
At first sight, Alexandre Lion (1861–1934) would appear to be an unlikely choice to become a champion of infant incubators. He was an inventor, not a medical doctor, who had grown up in a farming family in rural France and specialized in egg incubators, for which he was nicknamed “Lion les poulets” (chicken Lion).9 Lion lived near Marseilles in 1886 when Tarnier’s collaborator, Odile Martin, demonstrated his own poultry incubators at a farmer’s exhibition, as well as his infant incubator with a cardboard infant inside.10 It is possible that Martin’s display may have spurred Lion to create and display his own incubator. In 1889, Lion designed a device capable of hatching 5000 eggs, which he displayed to the public on 1 of Marseille’s main avenues as an educational family attraction. For an entrance fee of 25 centimes, spectators could admire chicks hatching.11 There was nothing amiss here; exhibitions were standard ways to promote technology.
Just half a year later, in May 1890, Lion took the more controversial step of developing a public incubator exhibit featuring live infants.12 The incubator in question was his own device, technically more sophisticated than Tarnier’s version, featuring reliable thermostats, a water-based gas heating system, an electrical alarm, and a ventilation system to guarantee entry of fresh and filtered outside air. Ventilation was regarded as essential to prevent infection and fortify the infant’s vitality. It was set up in the same pavilion in Marseilles he had used for his chicken incubator. His first occupant was infant Piana, who, when brought in, weighed only 965 g after a reported gestation of just <7 months.13 The public loved it. Many people paid to see her and more infants were brought in. Parents preferred Lion’s nonclinical institute to the high mortality hospital surroundings. By November 1890, 6 prematures had been admitted.14 Coverage in the press was remarkably positive, and virtually no surviving accounts raised the question of exploitation.15 Soon, Lion constructed an elegant, silver metal exterior with glass windows that looked more professional than the previously constructed wooden incubators.16
In November 1891, Lion expanded his exhibition of infants in incubators to Nice, where wealthy donors provided him with funds.7 For his new institute, he chose a busy spot in the town’s center, charged entrance fees, and sold and leased his incubators, mainly to middle- and high-class families. Since most children were born at home, Lion wanted to lower the threshold to use incubators. This way, he hoped to strengthen the bond between infant and mother. He even donated 20 incubators to the Parisian health authorities for domestical use by the poor.17 His incubators, he claimed, functioned automatically and needed no technical care; they could be used everywhere, by everyone.
In Nice, Lion founded a philanthropical organization called the Oeuvre Maternelle des Couveuses d’Enfants (the Maternal Charity of Infant Incubators).18 Its goals were to offer free care in incubators to all newborns who needed it, whether premature or affected with medical disorders and to set up institutes all over France, where parents could bring their preterm infant or “weakling” if they were poor, and they did not have to pay. Lion accepted them without formalities.19 His results were quite satisfactory. In 2 medical studies of that period, survival rates in Lion’s institutes were 63% and 74% (Tables 1 and 2).
Results of the Maternité Lion in Marseille, May 1890–August 1891
. | Alive . | Deceased . | Total . |
---|---|---|---|
Weight, g | |||
<1000 | — | 6 | 6 |
1000–1500 | 3 | 2 | 5 |
1500–2000 | 9 | 2 | 11 |
2000–2500 | 7 | 2 | 9 |
>2500 | 3 | 1 | 4 |
Total, n (%) | 22 (63) | 13 (37) | 35 (100) |
. | Alive . | Deceased . | Total . |
---|---|---|---|
Weight, g | |||
<1000 | — | 6 | 6 |
1000–1500 | 3 | 2 | 5 |
1500–2000 | 9 | 2 | 11 |
2000–2500 | 7 | 2 | 9 |
>2500 | 3 | 1 | 4 |
Total, n (%) | 22 (63) | 13 (37) | 35 (100) |
Source: Roux J. Étude sur l’élevage artificiel des enfants nés avant terme ou nés à terme, mais faibles. Thèse. Montpellier: Imprimerie Gustave Frimin et Montane.
Results of the Maternité Lion in Nise, October 1891–December1894
. | Alive . | Deceased . | Total . |
---|---|---|---|
Weight, g | |||
<1000 | — | 8 | 8 |
1000–1500 | 19 | 17 | 36 |
1500–2000 | 54 | 19 | 73 |
2000–2500 | 50 | 4 | 54 |
>2500 | 14 | — | 14 |
Total, n (%) | 137 (74) | 48 (26) | 185 (100) |
. | Alive . | Deceased . | Total . |
---|---|---|---|
Weight, g | |||
<1000 | — | 8 | 8 |
1000–1500 | 19 | 17 | 36 |
1500–2000 | 54 | 19 | 73 |
2000–2500 | 50 | 4 | 54 |
>2500 | 14 | — | 14 |
Total, n (%) | 137 (74) | 48 (26) | 185 (100) |
Source: Ciaudo J. La Maternité Lion de Nice pour enfants nés avant terme ou débiles. Nice: Imprimerie et Stéréotypie Spéciale du “Petit Niçois”; 1895.
Lion’s next step was to attend international exhibitions. Typically, he would set up a pavilion with a number of incubators inside and people were invited to bring in their prematurely born infants. Food and care were given by wet nurses; admission fees covered the costs.
Lion started in 1894 in France, where Lyon was the stage of the Exposition Universelle et Coloniale. His first international undertaking was the World Exhibition in Amsterdam (The Netherlands) in 1895.20 He became more famous with the Gewerbeausstellung in Berlin in 1896.21 However, these foreign experiences showed that, in other countries, reactions were far more mixed. The Dutch, unlike the French, were overpopulated and less concerned about saving premature infants. In contemporary newspapers, one can still hear the voices of the visitors.22 They vary from admiration and praise, to criticism, eugenic views, and rejection. In Berlin, his representative faced huge difficulties convincing the German authorities that it was safe and not unethical to display living infants in incubators. Only after two highly esteemed German professors gave their blessings could the show open.23 Martin Couney was one of the visitors and recognized the commercial and humanitarian possibilities of the show.
As incubator shows continued to evolve over the early 20th century, their exploitative aspects became harder to ignore. Yet, Lion’s story reveals that they began as an educational exhibit. They later evolved into a philanthropic institution and ended as a commercial business and side-show with >25 incubator institutes and >60 national and international exhibitions with incubator pavilions between 1894 and 1914. Lion, as an inventor, showed to the general public not only his advanced incubator, including living infants, but also the practice of incubator care in a nonclinical setting. His institutes and exhibition pavilions provided a relatively safe alternative to the hospital and allowed millions of people, among them many doctors, midwives, and nurses, to get acquainted with a new way of caring for preterm children. Thus, Lion helped to draw attention, in both medical and nonmedical circles, to this group of children that could benefit from specialized incubator care. His impact was not only direct but, thanks to imitators such as Couney, also indirect.
Acknowledgments
The author thanks Dr Lawrence M. Gartner, professor emeritus of pediatrics & OB/Gyn of the University of Chicago; Dr Jeffrey P. Baker, professor of pediatrics and history, Duke University; Nynke van der Zee; Dawn Raffel; and the municipality of Solliès-Pont.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLAIMER: The author has indicated he has no conflicts of interest relevant to this article to disclose.
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