Report on the Couveuse (Lion) or “Child Incubator Institution” (Kinderbrutanstalt)

Bericht über die Couveuse (Lion) oder „Kinderbrutanstalt“. Excerpt from Berlin und seine Arbeit: Amtlicher Bericht der Berliner Gewerbe-Ausstellung 1896, published in 1898 by Verlag von Dietrich Reimer (Ernst Vohsen), Berlin.

A newborn child is termed “mature” (reif) when it weighs 3000–3600 g. If a child weighs less, it is either poorly developed or immature, i.e. born too early. The precise discussion of how one may, under the circumstances, decide whether a child is merely poorly developed or “immature” does not belong here. It is established that children born from the beginning of the eighth month onward can be kept alive. Such newborns have a weight of 1500 g. From the seventh month, where the weight of the fetus is 1000 g, it has thus far not been demonstrated with certainty that such a fetus has been kept alive. We therefore call only fetuses of 1500 g weight, and perhaps somewhat below that, “viable” (lebensfähig).

For a long time now it has been the task of medical art to keep alive children born weighing between 1400 and 2500 g. The first and most important question here is the manner of feeding these children, which is all the more difficult because they are usually not able to suck at the breast. The second question is the maintenance of the body temperature necessary for life. In prematurely born children this is far below normal because of deficient nutrition and respiration, since heat loss is greater than heat production. The faster this imbalance grows, the faster the child perishes.

The matter here cannot be the discussion of how best to feed children born immature, but only the regulation of temperature conditions.

Long before the deficient heat production of the premature-born had been scientifically established, efforts were made to limit the heat loss of those born too early as much as possible through careful wrappings and packings. This was achieved to greater advantage by warming bottles, by cots whose walls were doubled and contained warm water, and similar devices. Only since devices have been contrived that are able, on the one hand, to seal off the space in which the newborn finds itself as far as possible from the outer air, and on the other hand to maintain in this space a permanently and uniformly raised temperature, has that task really been solved.

All these apparatuses had hitherto suffered from the difficulty of maintaining, by a mechanical device, the uniformity of the temperature — that is, of achieving the self-regulation of the apparatus’s temperature at least in the upward direction, and thus making constant observation unnecessary. Of the apparatuses known thus far, only Lion’s couveuse has accomplished this.

This couveuse is a box consisting of sheet iron and nickel-plated copper, whose walls at the front and on the left side are of glass, in order to observe the child in the apparatus sufficiently. The child lies on an iron grating suspended freely from hooks. The air enters from outside through a tube of 8 cm diameter on the left at the bottom of the box and is cleaned by a cotton-wool filter. A draft chimney 1 m in length at the top of the apparatus serves to draw off the air. Warming is provided by hot water, which circulates in a copper coil beneath the child’s bed; the pipe is connected to a water reservoir on the right side of the apparatus. The heating of the water can be effected with any kind of fire. The regulation of the temperature — and indeed automatically, which is the chief advantage of this apparatus — now proceeds in the following manner. The heating body stands beneath a copper cylinder clad in wood, whose double wall forms the water reservoir, which communicates with the warming coil in the couveuse.

At the upper right in the interior of the apparatus there is a copper spiral filled with spirit of wine (Weingeist), to whose end a two-armed lever is attached. It leads out of the apparatus and carries, on a thin metal chain, a float of double-cone form. By means of a screw at the fulcrum of the lever, the chain with the float can be set for any temperature one wishes to give the couveuse (that is, from 30 to 37° C) such that the float rests tightly on the hollow cylinder. If the temperature of the air in the couveuse now rises even by only 1/10° C above that for which the float has been set, the copper spiral expands internally, the attachment point of the lever on it shifts, and the chain with the float rises. Thereby a part of the heat escapes past the float through the upper end of the hollow cylinder to the outside. Through this a cooling of the water in the warming coil and a fall of temperature in the couveuse takes place. The temperature in the couveuse can be read at any moment on a thermometer. The moisture content of the couveuse air can be checked at all times on a hygrometer in the apparatus, and is kept uniform by a water-level vessel in the interior of the couveuse.

Concerning the arrangement of this apparatus and its functioning in the exhibition, the physician supervising the institution, Dr. Alfred Marcuse, has kindly placed the following report at my disposal.

The “Child Incubator Institution at the Berlin Trade Exhibition” was able to come into being only on 9 August 1896, after overcoming manifold difficulties. Equipped with five couveuses — of the Lion system — the institution pursued a double purpose. On the one hand it was to convey to wider circles the knowledge of these apparatuses, which are of great importance for keeping alive children born too early or in a weakly condition. Alongside this, it wished to grant to a number of these tender beings, for the duration of the exhibition, the benefit of couveuse treatment, without drawing on the parents to bear the costs.

A neat pavilion, built of wood and magnesite panels and situated in the middle between the main building and the building for welfare institutions, was ready as early as the month of May for the reception of children. The arrangement of the pavilion was simple and practical. The visitor stepped into the large central room and could approach to within 80 cm of the five couveuses, which stood side by side along the opposite long wall. Here a barrier prevented further advance and made it possible for the care and tending of the children to take place undisturbed and without regard to the spectators. Adjoining the central room on both sides were four rooms, one of which, provided with an iron stove and always kept well warmed, served as a feeding room for the children. A second room was fitted out as a kitchen; the others served as sleeping rooms.

The two tasks the institution had to fulfil, it has met. Well over 100,000 persons visited the pavilion in the short time of its existence. The apparatus with its automatic and exact regulation of temperature, and the children entrusted to it, aroused the searching and friendly interest of the visitors. From all parts of the city, numerous requests came through physicians and through parents for the institution to take in immature and weakly children. The greater part of these children had to be turned away for lack of space — a fact that argues urgently that this branch of infant care too deserves general participation.

Since the apparatuses could be occupied only from 9 August, the number of children who could be admitted was unfortunately only small. There were in all eight infants — five girls and three boys — of whom five were born in wedlock and three out of wedlock. All these children were premature-born; all weighed under 2400 g at their admission. The figures for the weakest among them were only 1210, 1420, and 1470 g. Of these eight infants, one perished in the couveuse from the consequences of an intestinal catarrh. A second was taken from the institution by the mother against medical advice. The remaining six could be kept alive. They were returned to their relatives in complete health, so advanced by the couveuse treatment that they could develop further outside just as any mature newborn does.

This success is to be attributed, alongside the couveuse treatment, to the good nutrition and the loving care that the children received. Five of the infants, who for the most part were at first unable to suck independently, were fed exclusively on breast milk, three on cow’s milk.

Already after a one-day stay in the couveuse all the children had normal body warmth, although some of them had come for admission with a temperature of 4–6° below normal. The weight gain of the infants, which was determined daily by the scale, varied according to their condition. The children, insofar as they remained in the couveuse without more serious disturbances, gained daily between 20 and 40 g. Thus one of them, which had been admitted at a weight of 1710 g and developed without any disturbance, was discharged after 35 days at 2725 g — that is, 1015 g heavier than at admission.

The small institution required an extensive staff for its operation. One physician had the medical direction of the pavilion and supervised the children and the wet-nurses. A friendly Frenchwoman, the directress of a maternité in Paris, saw to the care of the children. The mothers of two of the children and a wet-nurse, a nurse, and a night watch completed the nursing staff. Two, at times three, employees served solely the purpose of giving the visitors explanations about the apparatus and about the condition of the children. The economic part of the institution had, besides, its own staff.

Addendum by Dr. Gusserow

May I be permitted to communicate here also the experiences that I had occasion to gather at the obstetric clinic of the University at the Charité.

Twenty-three children were treated in the couveuse. Of these, one (1265 g) is to be excluded, since it was afflicted with congenital syphilis (Lues congenita) and died on the eleventh day. The remaining 22 were all fed with the milk of the mother or of a wet-nurse. Of these, fifteen children died, whose initial weight was:

1st child — 935 g
2nd — 1000 g
3rd — 1050 g
4th — 1085 g
5th — 1140 g
6th — 1230 g
7th — 1300 g
8th — 1410 g
9th — 1440 g
10th — 1550 g
11th — 1600 g
12th — 1605 g
13th — 1755 g
14th — 1830 g
15th — 1980 g

Of these children, then, according to what was said above, actually only six, perhaps eight at most, were to be designated as “viable” at all.

Of the seven remaining children, which left the couveuse alive, there were:

No. 1 — 1285 g, and was discharged after a ten-day stay in the couveuse at 1230 g;
No. 2 — 1670 g, discharged on the eleventh day at 1580 g;
No. 3 — 2030 g, discharged on the tenth day at 2020 g;
No. 4 — 2270 g, discharged on the tenth day at 2400 g;
No. 5 — 2400 g, discharged on the tenth day at 2325 g;
No. 6 — 2545 g, discharged on the tenth day at 2580 g;
No. 7 — 2760 g, discharged on the tenth day at 2850 g.

All these children were fed with mother’s milk.

We can thus summarize the overall result to the effect that in the arrangement of the couveuse we possess an important aid for keeping alive a number of human beings who would otherwise most probably perish. Among the couveuses known hitherto, the Lion one distinguishes itself particularly in that it possesses an apparatus functioning with absolute reliability, which provides the self-regulation of the interior temperature in the upward direction — and that is the most important thing. The regulation of the temperature in the downward direction would indeed also be desirable, but is so far readily dispensable, inasmuch as the maintenance of the temperature depends only on the maintenance of the heating device, which with gas heating, for example, presents no difficulties at all.

Professor Dr. Gusserow.

Last Updated on 07/07/26