The late 19^th and early 20^th Century was a time of optimism about many things, but not about premature babies. In an era that celebrated healthy babies, with Better Baby contests, awarding prizes to the biggest, fittest, best-looking babies, there was little to offer tiny premature infants. They were viewed as “weaklings,” and it was felt they could not possibly survive. Some doctors even went as far as to say these “runts” might pollute the gene pool if they lived. Babies who were too small to stay warm, and too weak to breastfeed usually died.

Into this vacuum stepped Dr Martin Couney. As a young man in Europe in the 1890s, he studied with the famed obstetrician, Dr Budin who developed successful incubators at Paris Maternite, a large obstetrical hospital. These initial incubators were inspired by chicken incubators at the Paris zoo. France was suffering from a population decline and focused on decreasing childhood mortality. So, they were several decades ahead of the US and other countries in premature infant care.

In 1896, Couney traveled to Berlin, to the Great Industrial Exposition, where he showed the newfangled incubators in an exhibit called Kinderbrutanstalt (child hatchery). In a flash of inspiration, he filled them with real neonates, obtained from the director of the Charite Hospital in Berlin, Dr Rudolph Virchow. All six babies were premature and not expected to live. All six survived. Over 100,000 visitors paid to see the exhibit. People were amazed, and Dr Couney was invited to mount a similar exhibit at Queen Victoria’s Diamond Jubilee in London. The premature babies he brought with him from France traveled across the English Channel in wicker baskets with hot water bottles. He then traveled to the United States, where he showed up at various fairs and amusement parks with his incubators and premies.

Initially, the medical community and the general public were divided in their opinions about the “See the Babies!” exhibits. In general, mainstream medicine had little to offer tiny premies, and kept quiet about that fact. Very few hospitals even had one incubator, and none of the hospitals were staffed for the intensive nursing required for these tiny babies. No one felt the expensive resources needed were worth it. But many doctors bristled at the sensational side-show atmosphere, with premature infants exhibited on the midway, right next to the fan-dancing ladies and the beer parlors.

The public, on the other hand, was enchanted. Tens of thousands happily paid their 25-cent admission. They were captivated when the head nurse (who eventually became Mrs. Couney) slid her diamond ring all the way up the tiny arm of a baby. They loved seeing the babies taken out of the incubators every few hours for snuggles by the nurses. The premies were so tiny people couldn’t believe they were alive. The exhibits were smash hits.

Couney may have started out as nothing more than a carnival barker, but he morphed into someone who loved the premies and was a stickler about the excellent care needed for these impossibly small babies. He traveled with doctors and nurses as well as wet nurses. The incubators were meticulously maintained, and the facility was spotlessly clean. They followed strict sterilization procedures. He controlled everything, including the healthy diet he insisted the wet nurses eat, so their breast milk would be nutritious for the infants. Every two hours, babies were whisked away from the exhibit to nurse, or if they couldn’t suckle, to be carefully spoon or bottle fed. The care was very advanced for the time. Couney and the other doctors who worked for him wore white coats, and the nurses wore starched white uniforms. He wanted everything to look very professional, not like a freak show.

As the years passed, he had a permanent baby exhibit at Coney Island, and temporary exhibits at the Panama-Pacific International Exhibition in San Francisco, the Chicago Century of Progress Exposition and the New York World’s Fair, and many other fairs. Between 1896 and 1943, he cared for more than 8000 infants, over 6,500 of whom lived.

Where did the babies come from? Sometimes, doctors who knew they did not have the skill or the incubators to care for premies, sent them to Dr Couney. Sometimes parents who had heard of him brought their newborns directly, racing to him with their tiny tots in shoe boxes. Couney sometimes visited hospitals to talk with new parents of tiny premature infants, to encourage them to bring their baby to his exhibit. And Couney was willing, even eager, to keep them until they had grown big enough to go back home, or until the exhibit closed for the season.

True, Dr Couney was a smooth, cultured showman who was fluent in English, French and German. True, he made a lot of money, charging for admission to his baby exhibit. But he plowed all the money back into the care of the babies. (By his records, it cost $450/day in today’s dollars to care for a premie). He never charged the desperate parents of the premature infants; he relied solely on admission charges. He never revealed the names of the infants or parents. By all accounts, he was tremendously dedicated and loved the babies. He sometimes held reunions, throwing big parties for children who had been his premies and had grown up. He even developed the first dedicated neonatal transport ambulance which he used to bring newborns from hospitals to his incubator facility at the Chicago Exposition. He donated it to the Chicago Department of Health in 1934 after the Chicago Exposition closed.

There were questions, however. By his accounts, he was born in Poland, studied medicine under the well-known and respected Dr Budin, and came to the US at age 19. That seems young, doesn’t it? He was never able to show any documentation of his medical degree, and current-day researchers have never found any proof he went to medical school. He was mocked by the medical profession for his amusement park displays, but no one could argue with his results. As the years passed, he finally became credible. He shone a light on the issue of the care of premature babies, and advanced that care far more than anyone else had, whether he had a true medical degree or not. In fact, Dr Julius Hess, widely acknowledged as the father of American neonatology, backed Couney’s show at the Chicago’s Century of Progress. When Hess published the first neonatology textbook, Premature and Congenitally Diseased Infants, in 1922, he cited Dr. Couney’s expertise in the preface of his book, thanking him “for his many helpful suggestions in the preparation of the material for this book.” 

Couney always said he was going to continue his exhibits until hospitals started buying incubators and saving premature infants. It wasn’t until 1943 that Cornell Hospital in New York opened the first dedicated premature infant unit. By that year, Couney’s wife (and head nurse) had died, he was 70 years old and broke, and attendance was down at the baby exhibits. He closed his last exhibit in 1943, and died in 1950.

Was he an evangelist who saved thousands of premies’ lives? Or was he a huckster and showman who created his own legend? Both, I believe. He was controversial, but he left a legacy of 6,500 babies who lived, grew up and had families of their own. He advanced science, even though his methods were unorthodox. Here’s to Dr Couney!