A Patron of the Preemies

By A. J. Liebling

Originally published in The New Yorker, June 3, 1939, pages 20-24.

Reprinted by the permission of Russell & Volkening as agents for the author.
Copyright © 1939 by A. J. Liebling, copyright renewed 1967 by Norma Stonehill.


A fondness for youthful company is not uncommon among adults. Few, however, carry the thing to such extremes as Dr. Martin A. Couney, who is known alike to amateurs of world's fairs and flâneurs   on the Coney Island boardwalk as the Incubator Doctor. For the last forty-three years, Dr. Couney has spent all his time between early May and late October in the company of prematurely born infants, to whom he customarily refers as the "preemies." This summer, for instance, he is living out on the World's Fair grounds in Flushing in the pink-and-blue building which houses his current crop of preemies, their nurses, and their incubators.

A sign above the entrance proclaims in large letters, "All the World Loves a Baby." This is a human idiosyncrasy for which Dr. Couney is duly grateful, since it has enabled him to earn a comfortable living for many years while working in the medical field that most pleases him. Normal, full-term babies usually weigh at least six pounds; Dr. Couney takes little interest in an infant that weighs more than three. "From three pounds down," he likes to say, "comes in the skill in raising." There are no comprehensive statistics on the survival of babies as small as that who do not receive specialized attention, but pediatricians concede that the percentage is extremely low. In all, Dr. Couney has had about 8,000 preemies under his care since the day in 1896 when he opened, in Berlin, his first public showing of babies in incubators, and he has saved the lives of about 6,500 of them. Responsibility for the existence of so many additional human beings might crush a misanthrope, but the Doctor bears the burden lightly. "They are good, normal, respectable people, all of them, I bet," he says with conviction. "I get letters every year from people who their parents told them they were raised in my incubators. I never yet got a letter from a jail."

His quarters in the U-shaped incubator building, which was designed by Skidmore & Owings, architects for eight of the larger exhibits at the Fair, are comfortable enough, and he has all the members of his small, year-round household with him, so he does not mind staying on the grounds. The Doctor has a bedroom, living room, and bath for himself, and a private garden. His daughter, Hildegarde, a strapping young woman in her early thirties who spent the first three months of her life in one of the Doctor's incubators, has a suite of her own and plays an important rôle in the incubator organization. Madame Louise Recht, the head nurse, a Frenchwoman who has been Dr. Couney's chief aide for forty-one years and always lives with the Couneys, has an adjoining room and bath. The Doctor's colored chauffeur and cook are also with him. In addition to these steady companions, five wet nurses, who provide milk for the babies, and fifteen trained nurses, who work in eight-hour shifts, live in the building. Occasionally the Doctor gets away to visit the Ballantine Tavern across the road for a glass of beer, but even then he is on calls. Raising preemies has certain points of affinity with a six-day bike race.

If any of the babies brought to normal size in his incubators had become celebrated, Dr. Couney would be glad to tell about it. He concedes a trifle regretfully that this hasn't happened. There isn't a genius in the lot. One member of his first American crop of incubator babies, a boy whom he looked after in Omaha in 1898, won the Croix de Guerre during the World War and wrote to Dr. Couney about it; two other old prematures are practicing medicine in the Middle West and correspond with him. Prematurely born girls seem to get married as frequently as any other kind, and every year Dr. Couney receives about a dozen announcements of weddings of incubator alumnae. One preemie who made a deep impression on the Doctor is a fellow named Jeremy Waitwood, who, after he grew up, became an electrician and got a job at Steeplechase Park on Coney Island. Waitwood liked to spend his spare time around the incubator concession, became acquainted with one of Dr. Couney's trained nurses, and married her. They sometimes visit the Doctor out at the Fair. So do a good many other old incubator babies -- adults who ask for Dr. Couney and, when he appears, divulge their identity with prideful excitement. A few seem disappointed because he doesn't recognize them. Incubator graduates are apt to be fat, since their parents, who think of them as delicate, overfeed them all through childhood.

Nothing makes Dr. Couney angrier than the imputation that because he charges admission to his exhibit of babies, he is merely a showman. "All my life I have been making propaganda for the proper care of preemies, who in other times were allowed to die," he says. "Everything I do is strict ethical." This is the twenty-second exposition in which the Doctor has participated. He has always preferred to speak of his concessions as "institutions," and often has had to scold the lecturers he hires to guide visitors through his concession for failing to do their work solemnly. Dr. Couney has written a sober, factual speech for them, but every now and then they inject what he calls smart-aleck wisecracks. Most of the lecturers are former actors and can't seem to help ad-libbing. This preoccupation with the professional niceties does not prevent Dr. Couney from feeling the satisfactions of an ordinary showman. He loves to watch the crowds flocking into his concession and to listen to the people's comments as they come out. The natural propensity of people to exaggerate wonders they have seen gives him pleasure. A woman leaving his concession will exclaim to her friends, "Did you see the first one? Its head was no bigger than a plum!" Of course, neither Dr. Couney nor anybody else has ever seen a live baby as small as that, but such a remark is good for business.

Brother physicians take Dr. Couney more seriously than do the laymen who pay their two-bit pieces to gawk at his protégés. Doctors understand the technical difficulties of reconstructing, in the outside world, an environment equivalent to the mother's womb. The incubators provide only a small part of the environment. "What is an incubator?" Dr. Couney sometimes demands rhetorically, and answers himself by saying, "A peanut roaster." The physician's vigilance and experience are more important than any incubator to the survival of a premature baby. Dr. Couney has handled at least four times as many of these babies as any other man in America. Dr. Julius Hays Hess of Chicago, the leading American academic authority on premature infants, probably ranks next in experience. As a young man he learned much from Dr. Couney (a debt which he goes out of his way to acknowledge), and he has been directing a premature-infant station in the Sarah Morris Hospital in Chicago since 1922. Dr. Couney has never even had a competitor at expositions or amusement parks. He has never taken a cent from the parents of a child under his care. The quarters paid at the gate maintain his establishment. It is evident, however, that through the years many more quarters have come in than have gone out, and Dr. Couney is not ashamed of that. During his lifetime he has earned more than the average general practitioner, but on the other hand decidedly less than a fashionable surgeon or internist.

The Doctor is a heavy, solid man with a pronounced stoop. He has the firm but gentle grasp that a man might have after a life of handling canary birds. His hair and mustache are gray, and his clothes combine richness with dignity. He goes in for dark broadcloth and spats and in the street always wears a derby and carries a crook-handled cane. He is an affable man who prides himself on mixing a good Bacardi cocktail and who likes a gigot   rare and garlicky, in the French manner. Between seasons, for the last twenty four years, he has lived in substantial if not glittering style in a house he owns at Seagate, west of the Coney Island boardwalk. He is known by sight to every winter resident of the Island, and policemen there have a friendly indulgence for his peculiarities as a driver. He never drives to downtown Brooklyn or Manhattan; the chauffeur takes the wheel on these long journeys. The Doctor has no financial backer; the $35,000 building at Flushing was, he says, a considerable strain on his resources. Other long-time residents of Coney Island rate him "a solid man."

Dr. Couney has no babies under his care during the winter. At the close of the exhibition he returns whatever prematures he has on hand to their homes as soon as they reach standard weight and refuses to accept any more until the next spring. "I work hard enough in the season," he says when asked about this. "Twenty-four hours a day in attendance." He has another reason for abstention from regular medical practice. Other Brooklyn doctors have always sent him premature babies to be brought to normal size in his Coney Island incubators. If he competed with these men and took their patients away from them, they wouldn't send him any more babies. So he is content to hibernate at Seagate with his daughter, Hildegarde, and Madame Recht. Hildegarde is a registered nurse and for many years, with the help of a local doctor, used to manage a Couney exhibit of incubator babies at Atlantic City, but she won't this season because her father needs her at the Fair. Mrs. Couney, who died three years ago, was a registered nurse, too, and a practical expert in the care of premature babies.

The Incubator Doctor was born in Alsace a few years before the Franco-Prussian War. After the war his parents moved to Breslau, in Silesia. He studied medicine there and in Berlin and Leipzig, taking a degree, and then went on to Paris to do graduate work with Pierre Constant Budin, at the time one of the great pediatricians of Europe. Budin was the leader in developing a technique to save premature babies. Like a good Frenchman, he abhorred waste. A premature, in medical parlance, is a baby born at least three weeks short of the normal forty-week period of gestation. Such a birth may result if the mother is involved in an accident or if she is suffering from malnutrition or illness. If the baby is born after the twenty-eighth week of pregnancy, it is a complete human being with a chance for life, but is very weak. Its body heat is low; its organs function so feebly that sometimes it just stops breathing; it is unable to take milk from the breast or from a bottle. A good incubator provides the necessary heat, thermostatically controlled, and a flow of filtered air enriched with more than the usual amount of oxygen. Some of the latest models of incubators are wondrous things, but much simpler contrivances will serve. The Dionne quintuplets survived in an incubator heated by hot water -- a type used before the discovery of electricity. Budin and his colleagues devised a system, known as gavage, for feeding weak prematures. This involves the insertion of a long, flexible tube down the throat and directly into the stomach. It is almost like threading a needle and requires dexterity on the part of the operator.

It was natural that the French should take the lead in this live-saving. Their falling birth rate was already worrying them in the nineties. But in the world of science, nothing really counted in those days until it had received German approval. Professor Budin saw in the Berlin Exposition of 1896 a chance to publicize the conservation of prematures. He chose his young Alsatian disciple, Couney, to demonstrate his discoveries. It was during one of several periods of international rapprochement; the German doctors were eager to collaborate in the demonstration. Couney set up a pavilion with six incubators. Professor Virchow, the distinguished head of the Berliner Charité Hospital, gladly loaned him six prematurely born infants from the maternity ward. This was considered a small risk, since they were expected to die in any case. Before the exposition opened, Couney had to think of a German title for the exhibit. He hit on Kinderbrutanstalt, meaning literally "child hatchery."

The hatchery was celebrated in comic songs and music-hall gags in Berlin even before the Exposition opened, so that from the first day of the Exposition the pavilion was thronged with sentimental German women and men who paid a mark each to look at the sweet babies. What had begun as a sober scientific demonstration became a crowd show that outdrew the Congo Village, the Tyrolian Yodellers, and the sky rides. The crowds didn't bother the babies, because prematures neither see nor hear what goes on around them. From a medical point of view, the demonstration proved a success, too. Dr. Couney graduated several batches of preemies that summer. He brought each infant to a weight of five pounds or more, which gave it as good a start as a normal baby, and he did not lose one during the entire Exposition.

Long before the show closed, a British impresario came to Dr. Couney and asked him to present a similar exhibit in Earl's Court, in London, the following summer. When the time came, the conservative London hospitals declined to loan Couney babies. The young Doctor hurried back across the Channel to Paris, where his patron, Budin, came to the rescue. Budin took Couney to a foundling hospital and showed him fifty or sixty prematures. "Prenez ce que vous voulez!" the generous Professor said, and Couney returned to England with three washbaskets full of French babies. Prematures, since they are almost insensible to their surroundings, have less trouble traveling than normal infants. Pillows placed over hot-water bottles in a basket make an adequate bed. It is unnecessary to feed them during a journey of as much as twenty-four hours.

By the time Earl's Court closed, Dr. Couney had acquired a taste for show business, and he saw that the exhibits stimulated interested in the care of prematures. He was equipped with letters from leading British pediatricians when he made his first visit to the United States in 1898, to put on a preemie show at the Omaha Trans-Mississippi Exposition. Dr. Couney had to bring on babies from Chicago for that one, because a city the size of Omaha could not be depended on for enough preemies to keep a show going. The Doctor returned to Europe for the Paris Exposition of 1900, then came here again for the Buffalo fair in 1901. After that he decided to settle in the United States and become a citizen. There seemed to be a world's fair in this country every summer. Also, there were amusement centres, like Coney Island in New York and White City in Chicago, which provided good incubator sites for any summer season. Dr. Couney opened his first Coney Island concession at Luna Park in 1903. In 1911, when the resort was near the crest of its prosperity, he had two shows simultaneously, one at Luna and one at another amusement park, called Dreamland, a couple of blocks away. It was fortunate for the Dreamland preemies that there were two concessions, because when Dreamland burned down late one summer night, the Doctor and his assistants hurried their charges over to the Luna Park establishment and saved them all. The babies had to double up in some of the incubators for a while, but preemies don't take up much room, anyway. In years when Dr. Couney has attended fairs elsewhere, he has kept the Coney Island place open in charge of subordinates. This is the first season since 1903 that there have been no incubators at Coney Island. Dr. Couney is concentrating on the World's Fair.

The Incubator Doctor likes to say that he has "never solicited a baby." Ever since he opened his first show at Coney Island, more premature infants have always been offered him than he could possibly handle. Other physicians have often wished that he operated all year round, for the benefit of winter preemies. In the early years of the century no American hospital had good facilities for handling prematures, and there is no doubt that every winter many babies whom Dr. Couney could have saved died. Even today it is difficult to get adequate care for premature infants in a clinic. Few New York hospitals have set up special departments for their benefit, because they do not get enough premature babies to warrant it; there are not enough doctors and nurses experienced in this field to go around. Care of prematures as private patients is hideously expensive. One item it involves is six dollars a day for mother's milk, and others are rental of an incubator and hospital room, oxygen, several visits a day by a physician, and fifteen dollars a day for three shifts of nurses. The New York hospitals are making plans now to centralize their work with prematures at Cornell Medical Center, and probably will have things organized within a year. When they do, Dr. Couney says, he will retire. He will feel he has "made enough propaganda for preemies." Besides, he will be nearly seventy-five years old, and he wants to travel in South America. He says he has seen enough of Europe.

Sometimes Dr. Couney sends his daughter or head nurse to call for a baby, but more often he goes himself in his car, driven by his chauffeur. Once he called for a Swedish preemie and found the grandmother pulling it through a leg of its father's trousers -- a bit of peasant magic to imbue the child with the father's strength. Orthodox Jewish babies are handed over to him with a red string, called the nachora bendel, tied around the right arm as a protection against the evil eye; Italian infants wear amulets to ward off the malocchio, which is the same thing. Dr. Couney once received an Armenian preemie with a chain of garlic around its neck to make it robust.

One hot evening in Omaha, on Dr. Couney's first visit to this country, he was closing his concession for the night when a gangling fellow walked up to him carrying a hatbox and asked if the Doctor was still around. Dr. Couney, who thought the fellow wanted to sell him something, said the Doctor was out until morning. The fellow said all right and walked away. At eight the next morning he came back, still carrying the hatbox, and asked for the Doctor again. Dr. Couney admitted who he was. "Well," said the fellow, handing over the hatbox, "here is a baby my wife had yesterday about twenty miles from here. I been sitting up with it in the park." Dr. Couney opened the hatbox and found a live preemie. It did very well in an incubator and may be a prominent Nebraskan today for all Dr. Couney knows.

The Incubator Doctor has had a fair number of wealthy children in his charge. Twenty-five years ago, when he was operating a branch establishment at White City, he had on exhibition -- anonymously, of course, like all the other babies -- the daughter of James Keeley, the renowned editor of the Chicago Tribune. Keeley was very proud of her, Dr. Couney says, and used to bring most of the sub-editors of the Tribune out to White City to look at her. A couple of years ago, Dr. Couney received an announcement of her wedding.

He has had more difficulties inducing parents to take their children back than to trust them to him. As the Doctor explains it, a baby is a lot of trouble, and parents are sometimes more than willing to postpone the day of reunion. This hurts Dr. Couney's sense of decencies; it also does not help his business, since a normal-sized baby is useless for exhibition purposes. When the parents of such a child are balky, he takes the infant back to its parents' home and leaves it. He has never been stuck with one yet. Nor has he ever been accused of getting his babies mixed. Each has a little identification necklace, which is put around its neck when it comes in, and the necklace goes home with the baby. Grown persons sometimes turn up at the concession showing these necklaces as proof that they were once Couney preemies. They get in free.

Occasionally the newspapers report the birth of a fantastically small baby. Both as a physician and as a showman, Dr. Couney considers this outrageous. "There come stories out about babies weighing six ounces, nine ounces, God knows what, and the people who read them don't want to look even at a baby that weighs two pounds," he says. "They think it is a giant." He once had a colleague in Kansas City check up on a press-service report of a nine-ounce baby. It turned out to weigh two pounds and a half. The smallest the Doctor ever had under his care weighed 705 grams, which is about a pound and a half; the smallest reported in the medical literature to have survived weighed 600 grams, or about a pound and a quarter. Neither of these children could have weighed so little at birth, Dr. Couney says. All babies lose weight after they are born, and preemies lose proportionately more for a longer period of time than normally developed babies. He thinks that two pounds is about the minimum weight at birth for a viable child.

The greatest mistake Dr. Couney ever made from a publicity point of view was when he declined to fly to Callander, Ontario, to offer his services to the Dionne quintuplets. He had returned to Chicago for the second summer of the Century of Progress Exhibition when the quintuplets were born. William Randolph Hearst wanted to charter a plane and dispatch Dr. Couney into the wilds with a reporter, a photographer, and an exclusive contract for the infants, but the Incubator Doctor says he felt his first responsibility was to the thirty preemies then under his care in Chicago. Also, he admits, he was sure the quintuplets would die. "I was wrong, like bigger men than I am," he says. "This may not repeat itself in a millenium." He has never had a chance at quadruplets, but has had eighteen sets of triplets in his care. Of these he saved six complete sets, losing one or two out of the remaining trio. "There is almost always one weak triplet, like a runt puppy," the Doctor says with regret.

An essential in saving prematures is a steady supply of mother's milk of uniform quality. Dr. Couney engages four or five wet nurses at the beginning of each season. Each woman has a baby of her own, usually a full-term child, and they all live at the concession from one end of the season to the other. Dr. Couney is very kind to them, doing his best to protect them from any experience which might make them nervous and thus affect their supply of milk. The wet nurses eat virtually all day -- good, milk-producing food. If Dr. Couney catches one having a hot dog or an orange drink outside, he fires her. He wouldn't care to use milk which is available now at the mother's milk bureaus operating in most large cities, because, he says, the social workers who collect the milk have no control over the mothers' diet. Dr. Couney's wet nurses' surplus milk, expressed by hand, is boiled to get rid of excess butter fat. Before being fed to the babies, it is diluted according to a formula which differs for each patient. A preemie, if all goes well, should gain about twenty grams a day, or a pound every three weeks. The majority of Dr. Couney's trained nurses have been with him for many seasons. He pays the regular union wages. They work on private cases during the winter and come back to him each spring. Most of the nurses are fascinated by the incubator babies, because making one grow is a kind of vicarious motherhood. The summer is a long competition among the nurses, with weekly prizes of stockings for those whose charges gain the most weight. Dr. Couney, when he wishes to spur the nurses on, is found of pointing to his daughter, who weighs 160 pounds. "Look at her!" he likes to say. "You wouldn't believe that back in 1907 I had her in an incubator!"

The backbone of Dr. Couney's business is supplied by the repeaters. A repeater becomes interested in one baby and returns at intervals of a week or less to note its growth. Repeaters attend more assiduously than most of the patients' parents, even though the parents get in on passes. After a preemie graduates, a chronic repeater picks out another one and starts watching it. Dr. Couney's prize repeater, a Coney Island woman named Cassatt, visited his exhibit there once a week for thirty-six seasons. Repeaters, as one might expect, are often childless married people, but just as often they are interested in babies because they have so many children of their own. "It works both ways," says Dr. Couney, with quiet pleasure.

It would be hard for him to ignore the financial side of his enterprises even if he were more altruistic than he is. His daily overhead at Coney Island in recent years amounted to $140, which meant he needed seven hundred customers a day to break even; two years ago, because of hard times he cut the rate of admission to twenty cents. It is back at a quarter for the World's Fair. Like all other concessionaires, he must turn over twenty-five per cent of the gross receipts to the Fair authorities.

Dr. Couney did well at both seasons of the Century of Progress. The incubator babies were right next to the Streets of Paris, and on good days the concession took in as much as $1,500. It was a sort of Jubilee for Dr. Couney, because Chicago is the home of Dr. Hess, the premature-baby specialist. After the Exposition, the city of Chicago established a free premature station that is bigger than the one Dr. Hess has been directing there for so long. For once Dr. Couney's incubator show received a flattering amount of attention from the medical associations, and Dr. Couney left Chicago bolstered in self-esteem as well as pocket.

When he is not exhibiting babies, Dr. Couney lives very quietly in the house at Seagate, a squarish shore-resort sort of villa with a fine view of the ocean from the windows on the upper floor. Part of each day he gives over to making plans and transacting business for the coming summer. (Last winter and early this spring, for example, he was out at the Fair grounds almost every afternoon.) Brooklyn doctors occasionally call him for advice about a baby which is hard to feed or is losing weight. Sometimes Hildegarde and Madame Recht take the Doctor to a movie, although he always falls asleep when he gets there. For the most part, however, he stays in the house, enjoying the somewhat overheated comfort of his home and the sensation of being slightly overfed. His chief solaces are warmth and food. In that respect, Dr. Couney is exactly like a preemie.

-- A. J. Liebling

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