Paris Expo 1900 – Cosmos

“Les Couveuses d’enfants” (Infant Incubators), signed E. A., Cosmos, no. 816, 15 September 1900, pp. 333–337, figs. 1–6. Machine translation. See original for figures.

Premature infants, born before the normal term fixed by nature, together with those who, though carried to term, weigh no more than 2,500 g and are classed with the former because of their delicacy and weakness, make up 15 to 30% of all births, depending on region and social milieu. If one considers that this total is about 850,000 a year for France, and takes the lowest proportion given by the statistics as a basis, one finds that premature infants among us reach the considerable number of 127,000 each year.

At a time when depopulation is causing alarming havoc, it was legitimate to attempt an effort to save so many lives compromised by excessive fragility, and those who conceived this effort deserve praise, even though the beings their zeal snatches from death are nearly all condemned to a vital inferiority hardly favourable to the regeneration of the race. When one has no choice of means, one must seize whatever presents itself, and since the birth rate in France tends to decline year after year, it is at least indispensable to try to preserve the greatest possible number of the children who are good enough to take the trouble to be born.

To achieve this aim, it is essential above all to combat the rapid hypothermia that strikes premature infants and is the principal cause of their death. Efforts must be concentrated on this point. The temperature of these infants falls below 37° almost immediately after birth; it continues to fall progressively, and the faster the younger they are, and it can be maintained at a sufficient level only by artificial means. If the loss of heat cannot be checked, the capillaries contract under the influence of cold, and circulation is severely impeded, since the volume of the blood corpuscles blocks their passage through the narrowed vessels. The result is insufficient respiration and tissue oxidation, cyanosis, oedema, sclerema. To improve the chances of saving these frail creatures, it is therefore absolutely necessary to place them as soon as possible at the temperature that suits them.

Until recently (and one must still resort to it in the countryside and in towns that have no asylums for newborns), the means used to preserve the life of premature infants consisted solely of wrapping them in cotton wadding and placing them in a cradle fitted with three hot-water bottles, one at the feet and one on each side. But this method, which it must be admitted is the only one applicable in most cases, gives only unsatisfactory results. Apparatus have therefore been devised that artificially create the conditions needed to bring an overly feeble infant to normal size, and that keep it at a uniform, suitable temperature while allowing it to be taken out when necessary for cleaning, care and feeding.

Because of their purpose, these devices have been named couveuses. They can currently be seen in operation at two places in the Exposition: beneath the Eiffel Tower, and at the corner of the quai d’Orsay and the avenue de La Bourdonnais, inside the grounds. The first of these installations is that of the Maternité Sainte-Anne of Brussels. It occupies the upper floor [premier étage] of a rather graceful chalet, whose ground floor, open on three sides, houses a counter selling refreshments. The French public, which is simple-minded, immediately assumes the two floors are connected, and this association disconcerts it somewhat. We do not know how matters stand, but if the connection does exist, one would be wrong to be surprised: we are in Belgium here, the classic land of the estaminet.

The other installation, more austere in appearance, aims to acquaint visitors to the Exposition with the couveuses and the method of rearing used at the Maternité Lion (1), founded in Nice in 1891, which has an establishment in Paris at 26 boulevard Poissonnière. Let us hasten to say that meticulous cleanliness reigns in both, and that the nurses in charge of the infants watch over the frail babies with constant attention. In both, too, one feels a certain satisfaction on entering: despite the apprehension aroused by the sight of the nurses’ white antiseptic smocks, one is spared breathing the carbolic fumes that fill the air of hospitals.

Visitors are always numerous in the two halls, and we thought we noticed that many give generously. So much weakness elicits pity. The ladies especially take a great interest in this spectacle, but the gentlemen too lean very willingly over the glass cages in which, warmly swaddled, little red, puny, wrinkled beings sleep with clenched fists, unless they prefer to squirm and wail. They have as yet no right to live, and already they must be tended like princes.

This living object lesson shows the public clearly the efforts being made to save newborns whose weakness demands special precautions; but visitors, passing quickly in front of the couveuses, can gain only an incomplete idea of how they work and how they are built. We believe it of some interest to describe both, and even to glance at the successive phases in the construction of these apparatus.

A first system was devised in 1857 by Dénucé of Bordeaux. It consisted of a kind of zinc incubator-cradle formed of two nested tubs, between which hot water circulated. But the true inventor of the modern couveuse is Professor Tarnier, who in 1881 conceived a model that he later simplified and improved. Today the Tarnier couveuse consists of a wooden box with a glazed lid. On the edge of the lid is a small propeller [hélice] above a 45 mm opening, through which an air current is established whose presence is shown by the propeller’s rotation. The interior has two levels separated by a partition carrying a mattress on which the infant lies. The required temperature, which should be 32°, is obtained by hot-water bottles, or moines, placed beneath the partition.

This incubator has one drawback: like all wooden apparatus, it is difficult to disinfect. The Auvard couveuse, now very widespread, does not differ essentially from Tarnier’s; instead of bottles, heat comes from a metal cylinder beneath the partition holding ten litres of hot water. The Henry couveuse marks an advance on both: it is made entirely of glass and is therefore easy to disinfect.

The Lion couveuse in operation at the Exposition is of a somewhat more complicated type, but it retains the essential arrangement of the Tarnier apparatus. It consists of a metal parallelepiped mounted on a stand. The front wall has a glazed double-leaf sash closed by an espagnolette [crémone]. On the left side is another sash, which also opens, allowing the nurse to watch the interior and remove the infant when necessary. The floor slides out in grooves, like the tray of a birdcage.

Ventilation is provided by a tube 80 mm in diameter, opening at one end at the base of the apparatus and ending at the other in a draught chimney fitted on the outside with a propeller whose speed of rotation indicates the strength of the air current. Special piping brings outside air, purer than indoor air, directly into the apparatus and filters it before it enters the couveuse. This arrangement protects the infant from the dangers that crowding could pose; it also allows medicinal gases to be added to the air: oxygen, ozone, various balsamic essences.

The infant lies in the middle of the couveuse on a wire-mesh hammock around which warm air circulates freely. Heat is supplied by hot water circulating in a coil connected to a reservoir placed alongside. This thermosiphon may be heated by gas, petroleum or electricity alike. The temperature is held constant by a lever that automatically increases or reduces the flow of heat according to signals from a regulator.

According to modern thinking, the results obtained with couveuses are usefully reinforced by forced feeding of newborns, gavage. This operation is indicated only when the infant, too weak to swallow the milk given it, regurgitates it. It is most often done with a 20 cm tube fitted to a glass cup that receives the liquid food. With the infant held almost upright, the tube is passed into the mouth over the back of the tongue to the back of the throat; the infant, by instinctive swallowing movements, draws it into the pharynx, and it is then pushed gently into the oesophagus. To reach the stomach the tube must travel 15 cm, mouth and oesophagus included. The milk poured into the cup then falls into the stomach by its own weight. The dose is 8 grams per hour, but it must be adjusted to the infant’s weight gain and reduced if indigestion or tissue oedema occurs.

In the Lion system, gavage is done through the nose with a special spoon, very deep and narrowed to a channel at its tip. With the infant held upright on her knees, the nurse inserts the tip of the milk-filled spoon into one nostril and pours gently. Swallowing occurs without difficulty, because the milk is drawn in naturally by the breathing movements, and the upright position keeps it from entering the nasal cavities. It thus passes directly from the nostril to the oesophagus. Its descent through the pharynx and oesophagus is aided by reflex contractions of the pharyngeal muscles, visible as slight movements of the thyroid region, which represent a rudiment of swallowing.

Statistics published by Tarnier showed that mortality among premature infants at the Maternité de Paris, which before the use of couveuses was 100% for those born at six months and 12% for those born at eight and a half months, fell with the combined use of the apparatus and gavage to 84% and 4% respectively, with a proportional decrease at intermediate ages. These results are satisfactory; but it must not be concealed that they are achieved only with difficulty, because operating the apparatus requires constant solicitude, meticulous and unceasing care, true devotion: conditions met only exceptionally, and which only the numerous and well-trained staff of a specialized establishment can provide.

E. A.

Figure captions

• Fig. 1. Pavilion of the Maternité Sainte-Anne of Brussels at the Exposition. (Signage legible in the photo: “COUVEUSES D’ENFANTS AVEC BÉBÉS VIVANTS” on the frieze; “COUVEUSES D’ENFANTS EN FONCTIONNEMENT” in the gable.)
• Fig. 2. Partial view of a room at the Maternité Lion.
• Fig. 3. Nasal gavage.
• Fig. 4. The Lion couveuse.
• Fig. 5. Vertical section of the Lion couveuse. Principal parts: C, draught chimney with propeller; O, sliding glazed sash; P, adjusting screw controlling the regulator; X, shutter cone; R, thermosiphon water vessel; R³, exhaust channel; E, water; T, air intake pipe; D, sliding floor; I¹, Bunsen burner; I², any lamp; I³, device for electric heating; Y, articulated stand.
• Fig. 6. Special spoon for nasal gavage.

Citation: E. A., “Les couveuses d’enfants,” Cosmos: Revue des sciences et de leurs applications, no. 816 (15 September 1900): 333–337, figs. 1–6. Digitized by Google.

Last Updated on 10/05/26