The Machine in the Nursery: Incubator Technology and the Origins of Newborn Intensive Care (review)

Abstract

Reviewed by: The Machine in the Nursery: Incubator Technology and the Origins of Newborn Intensive Care Joel D. Howell Jeffrey P. Baker. The Machine in the Nursery: Incubator Technology and the Origins of Newborn Intensive Care. Baltimore: Johns Hopkins University Press, 1996. x + 247 pp. Ill. $45.00. In 1878 the noted French obstetrician Etienne (Stéphane) Tarnier visited the poultry section of the Paris Zoo, where he observed an incubator for young chicks. Inspired by what he saw, Tarnier arranged for a similar warming device to be constructed for young humans—what he referred to as a couveuse, or “brooding hen.” That artifact, later called the incubator, is the subject of this important, well-written book. Jeffrey Baker examines the incubator within France and the United States up to the 1920s. He asks how the incubator was created within a complex social web, what it was meant to do, who was meant to run it, and where. In concert with the very best writing about the general history of technology, he examines its invention and reinvention in a variety of settings, contrasting obstetricians and pediatricians, home and hospital, general hospital wards and premature-infant nurseries, and France and the United States; all of these settings were, of course, changing over time. After Tarnier’s description, incubator supporters in France worked to make the device less complex, hoping to make it more easily used by people with little [End Page 550] technical expertise. This choice was partly driven by national concern about a falling birthrate, a particularly salient issue when premature infant mortality in some of the Paris hospitals routinely exceeded 70 percent. In the United States—perhaps always a nation of tinkerers—the incubator became instead a more complex, highly technological device for re-creating and regulating an artificial environment, an object for public display (complete with babies) at high-profile expositions such as the Buffalo Pan-American Exposition of 1901 and the Louisiana Purchase Exposition of 1905. In France, newborn care was dominated by obstetricians, primarily working in maternity hospitals; in the United States, pediatricians tended to care for newborns in infant hospitals. French obstetricians favored simple devices that would maintain warmth and would encourage maternal involvement in infant care; American pediatricians emphasized complex devices to maintain a carefully defined environment. In both countries, physicians were stimulated by the new incubator to try to define the clinical concept of the premature infant. In this discussion (as well as elsewhere) the author’s perspective as both a historian and a clinician serves him well. He notes that obstetricians tended to observe premature infants as relatively young infants with acute conditions, whereas pediatricians tended to observe premature infants as somewhat older infants with more chronic conditions. The two groups came to different conclusions about precisely what was a “premature infant.” They also differed in their opinions about where infants could be best cared for (at home or in the hospital) and who should care for them (mothers or medical personnel). Such issues were often negotiated in terms that reveal a great deal about conceptions of gender and class. A great strength of this book lies in the author’s refusal to accept a linear, progressivist model for early-twentieth-century medical technology. To take only one example of many, he nicely explicates the use of oxygen for infants in incubators. While one might easily view this application as presaging a late-twentieth-century approach to the care of premature infants, an oxygen-rich environment for children with immature lungs, Baker shows how the oxygen was instead used within a nineteenth-century therapeutic model, as a short-acting stimulant. Indeed, despite the widespread attention paid to the device by some of the most prominent practitioners of the day, at the end of the 1920s the history of the incubator is revealed, not as the birth of neonatal medicine, but as a short-lived therapeutic adventure. There are rich, thick descriptions throughout the book, and the complex nature of the overarching dichotomies sketched above is explored in some detail. But the book does not often stray far afield. It is to the author’s credit that the book at times leaves the...