The Engineer and the Newborns

by W. A. Nelson M.D. and Paul L. Toubas M.D.

Mr. Alexander Lion, an ingenious French engineer, was the son of an inventor. The cufflinks that his father invented were patented. Nobody knows how Alexander Lion came to design an incubator for eggs, equipped with an electro-automatic thermostat. The patent was registered in Marseilles on October 28, 1889 (1). The patent established June 26, 1890 was valid for 15 years.

The incubator described by Lion in the handwritten manuscript was a big machine since five thousand eggs could be incubated at once. The device was very ingenious for its time and included multiple thermometers to insure an homogenous temperature. When the apparatus reached the appropriate temperature, an electric bell sounded and automatically adjusted the admission of gas. Lion mentioned that his incubator could function with alcohol, petroleum and other combustible substances. He guaranteed that 97% of the eggs would hatch. A sponge suspended in the incubator provided the appropriate humidity.

In the same document, Lion mentioned that “the incubator may be applied to preserve maternal heat for infants born before term (fig. 1). I tried it successfully at home on an infant born at six months of gestation. Without it, the infant would have died. This represents a new application of my system to infants born before term and to weaklings who need regular, constant and uniform heat to survive.”

Other types of incubators had previously been described to be used for weaklings, among them the Tarnier-Auvard incubator, a very simple system designed in 1885, functioning with hot water bottles. The problem with these rudimentary boxes was their unstable source of heat: “exposing the infants to the risk of burns and hypothermia” (2). Pierre Budin, the creator of the first nursery for premature infants, however, did not share this opinion. Despite their obvious technological advances, the Lion incubators were energy source dependent. In his handbook of practical nursing (3), Budin, after describing the advantages of the wood and glass incubator, explains the problems involved with the Lion system: “The Lion incubator siphons the air from the environment. This air, heated by gas, circulates around the infant. This device requires a complex system of pipes for air and gas. The high cost cannot be borne by many families. At the Maternity, we had to remove infants often from this type of incubator. The coldest season of the year is winter. Nights are very long. The gas consumption increases massively at this time of the year. Since the air is colder, it takes more gas to heat the incubator. At the end of the night, the gas pressure is very low and insufficient to heat the incubator; the temperature of the infant cannot be maintained.”

After missing his Parisian debut in the very modern maternity of Dr. Budin because of the unstable gas pressure in Paris, the Lion incubator found a stable home in the south of France in the city of Nice. This pleasant town, located on the French Riviera, enjoys a mild winter. Citrus fruits grew in the gardens of the casino. Big hotels were built fast and the economic boom brought by tourism created the appropriate environment for the establishment in 1891 of the Oeuvre Maternelle des Couveuses d’Enfants. Dr. Ciaudo, physician inspector of facilities for the protection of infants of the city of Nice, exposed the results obtained in this maternity from 1891 to 1894 (4). One hundred and eighty-five premature infants were placed in the incubators with a weight ranging from 800 to 2900 GM. The surprisingly good outcome was encouraging since 133 infants survived in good condition; 48 infants died, among them were eight infants weighing less than 1000 GM. The survival rate was 72%. According to Dr. Ciaudo, “the type of incubator used in Nice appears to be very advanced; heat is provided by an ordinary oil or petroleum lamp. The heat is constantly maintained at 37°C. An electric regulator provides an automatic regulation of the temperature.

In the Fall of 1896, the Lion incubator made a comeback to Paris. An anonymous letter published in Pediatrics (5) describes the event: “The latest attraction of the Paris boulevards is an exhibition of an improved system of incubators which have recently been introduced to the capital, after a trial of several years by a philanthropic society of Nice. The premises occupied by this new hospital for premature infants consist of a shop on the ground floor, and its dependencies and the public are admitted on the payment of a small fee, which goes paying towards the general expanses.” Fig. 2

The Lion incubator was presented at the National Swiss Fair in Geneva. The report in 1896 to the Geneva Medical Society by Dr. Maillard was very favorable (2). Twenty-two infants were treated, fourteen survived. In his comments, Dr. Maillard shows his preference for incubators at home rather than in a special maternity. The reason was the high risk of bacterial contamination of premature infants by infected infants. The other reason was the need for breast milk to feed the premature infant. Cow’s milk at this period was frequently contaminated and a high source of infant mortality. Dr. Maillard mentions that the incubator functions appropriately on gas. Dr. Maillard, at the end of his report, adds: “This incubator (the Lion incubator) is an indispensable instrument…it will render the previous heavy wood and glass incubator obsolete (the Tarnier incubator)…only the archives of maternities could tell us how many infants have been burned or frozen by the antique system of pushing hot bottles in a wooden box!” This message announced the arrival of the technology of the 20th century in the care of premature infants.