Hutinel and Delestre, Les couveuses aux Enfants-Assistés – English Summary

Hutinel V. & Delestre, “Les couveuses aux Enfants-Assistés.” Annales de médecine et chirurgie infantiles, tome 23 (1899), pp. 881–884 and 906–911. Communication to the Société d’Obstétrique, de Gynécologie et de Pédiatrie. (Bylined “P. Hutinel” as printed; the author is Victor Hutinel, physician to the Hospice des Enfants-Assistés, with M. Delestre, interne des hôpitaux.) The Hospice des Enfants-Assistés where Hutinel and Delestre worked was on the Left Bank in the 14th arrondissement, on the rue d’Enfer — lenamed rue (later avenue/boulevard) Denfert-Rochereau.

Writing roughly two decades after incubator care was systematized at the Paris Maternité in 1881, Hutinel and Delestre offer a sceptical clinical audit rather than an endorsement. They accept that the device cut mortality of newborns under 2,000 g from 66% to 36% (Auvard’s figures), then ask whether that floor can be lowered by using the incubator more discriminatingly.

Their central argument is to narrow the indication. The incubator, they insist, does one thing — protect against sustained cold — and should be reserved for premature infants with hypothermia. Incubating any small or feeble infant on the basis of low birth weight, or placing sick, infected, or athrepsia-threatened infants inside, they regard as an abuse. To make the point they classify incubator deaths into four groups: the non-viable; those with lethal malformations or hereditary disease (e.g. syphilis); previously well infants who fall ill days later; and — the instructive group — apparently sound prematures who deteriorate and die after a few days. Such deaths were historically dismissed as “congenital weakness”; the authors argue they are in fact infections, most often streptococcal or coliform but also staphylococcal or B. pyocyaneus, with Delestre repeatedly finding pyogenic organisms in the blood hours before death. The newborn’s defences against these infections they describe as rudimentary.

This leads to their best-known doctrine: “Tant vaut le milieu, tant vaut la couveuse” — the incubator is only as safe as the environment it sits in. Drawing on Marfan’s objections and on Bertin’s thesis* from their own service, they hold that the warm, enclosed device behaves like an incubating oven for organisms, and that a contaminated ward makes a contaminated incubator. Their evidence is observational: crowding the ward raised infection rates, and moving an incubator into a clean adjacent room let infants recover and regain weight; paired prematures (one incubator, one cradle) exposed to ward broncho-pneumonia saw the incubator infant die and the cradle infant survive. They note incubator infants infect more readily than cradle neighbours, and accordingly remove any infant at the first sign of infection. Heated rooms (chambres de chauffe) are rejected as a substitute — hard to keep aseptic and no protection against infection.

On physiology, they describe the premature as “a warm-blooded animal that does not make enough heat”: it does thermoregulate, but along a characteristic parabolic rise (about +1° in the first day, then progressively smaller increments toward normal). Non-viable infants stay at 21–25° even in a 33–35° incubator and die — evidence that the infant, not the box, sets the temperature. The incubator’s purpose is therefore not to reheat but to spare the infant the fight against cold until it reaches normal temperature; once rectal temperature holds at 37° for 36–48 hours the device offers nothing further and only adds infection risk, so the infant moves to a cradle with cotton wool and hot-water bottles in an aired, sunlit room at 18–20° — the “cure d’air.”

The Enfants-Assistés apparatus itself is deliberately rudimentary: an enamelled faience basin with its floor replaced by a perforated galvanized plate, sitting on a metal box into which three hot-water bottles slide through a side door, closed by a screw-adjustable thick-glass lid, on iron feet, with an oat-husk mattress; disinfection is a daily sublimate wipe. Hot-water-bottle heating is chosen specifically to avoid the temperature swings of gas-heated, poorly regulated incubators. Within a reorganized four-room garden pavilion (healthy prematures, “doubtful,” infected, and nurses’ quarters, one nurse per ~8 infants, tiled floors, open windows, cradles wheeled into the garden), they report 21 infants under 2,000 g admitted since May with 3 deaths — 14% mortality versus 36% previously — despite at least 10 of the 18 survivors arriving already ill.

Five rules close the paper: use an easily disinfected system with stable temperature; place the incubator only in a healthy environment; incubate only hypothermic newborns; remove them once rectal temperature fixes at 37°; and never incubate an infected infant, often withdrawing one that sickens. The throughline — asepsis of surroundings, a narrow temperature-based indication, and early graduation to fresh air — reads as a recognizably modern reaction against incubator overuse and cross-infection.

* Bertin, Georges. Contribution à l’étude des infections des nouveau-nés dans les couveuses. Thèse de médecine, Faculté de Paris, année 1898–1899.

Last Updated on 07/01/26