On October 15 2019, a Facebook post with images relayed a purported history of neonatology and the role of a man named Dr. Martin Couney, who created a sideshow of tiny infants as a way of covering the costs of saving premature babies:
Black-and-white images of a man, nurses, and small babies appeared alongside text that claimed in part that “thousands of premature infants” survived solely due to a “Coney Island entertainment sideshow”:
At the time premature babies were considered genetically inferior, and were simply left to fend for themselves and ultimately die.
Dr Martin Couney offered desperate parents a pioneering solution that was as expensive as it was experimental – and came up with a very unusual way of covering the costs … Couney created and ran incubator-baby exhibits on the island from 1903 to the early 1940s.
Behind the gaudy facade, premature babies were fighting for their lives, attended by a team of medical professionals.To see them, punters paid 25 cents.The public funding paid for the expensive care, which cost about $15 a day in 1903 (the equivalent of $405 today) per incubator.
Couney was in the lifesaving business, and he took it seriously. The exhibit was immaculate. When new children arrived, dropped off by panicked parents who knew Couney could help them where hospitals could not, they were immediately bathed, rubbed with alcohol and swaddled tight, then “placed in an incubator kept at 96 or so degrees, depending on the patient. Every two hours, those who could suckle were carried upstairs on a tiny elevator and fed by breast by wet nurses who lived in the building. The rest [were fed by] a funneled spoon. The smallest baby Couney handled is reported to have weighed a pound and a half.
His nurses all wore starched white uniforms and the facility was always spotlessly clean.
An early advocate of breast feeding, if he caught his wet nurses smoking or drinking they were sacked on the spot. He even employed a cook to make healthy meals for them.
The incubators themselves were a medical miracle, 40 years ahead of what was being developed in America at that time.
Today, one in 10 babies born in the United States is premature, but their chance of survival is vastly improved—thanks to Couney and the carnival babies.
According to the text, Couney tried repeatedly to share his purported developments with hospitals of the time, but he was rebuffed. The poster linked to a New York Post book review as a source, and credited another Facebook user for the text. That article was published in July 2018 with the headline, “Fake doctor saved thousands of infants and changed medical history.” It read in part:
What little is known about Martin Couney is that he was born in Prussia in 1869 as Michael Cohn and changed his name after immigrating to New York at 18.
He does not appear to have had any medical credentials, and while he often claimed to be a protege of the world-renowned French doctor Pierre-Constant Budin, who popularized incubators in Europe, there is no evidence for this claim.
What is true is that whatever his motive, he spent 40 years as the only medical hope for parents of babies born too early in New York City and beyond. [Author Dawn] Raffel estimates he saved between 6,500 and 7,000 lives.
Incubators were invented in Europe in the late 19th century, the evolution of innovations from Russia, Germany and France. Couney claimed that in 1896, Budin, an actual pioneer in the field, sent him to display incubators at the Great Industrial Exhibition of Berlin. Rather than stand next to empty machines, Couney, referring to the displays as “child hatchery,” said he realized how much more effective it would be if they housed actual babies being saved for the public to see.
Citing the book, the paper added:
A reporter for the Brooklyn Eagle newspaper, in a story headlined “Strangest Place on Earth for Human Tots to be Fed, Nursed and Cared For,” wrote that the idea of “haranguing the passing throng in an effort to divert its shekels for a spectacle so serious, not to say sacred, strikes one as questionable, almost repellent.” But by the end of the piece, the author’s impression had turned positive, praising the care the children received.
In August 2016, author Claire Prentice wrote a piece for Smithsonian.com about Couney, noting of her research into his credentials that his career had always been controversial:
Many in the medical professional viewed the “incubator doctor” with suspicion, others with outright hostility. The New York Society for the Prevention of Cruelty to Children had repeatedly accused Couney of exploiting the babies and endangering their lives by putting them on show.
None of the complaints was sustained, and by the 1930s, Couney was finally being taken seriously as a medical pioneer. Couney’s professional collaboration with Hess marked a key stage in his habilitation.
But while doing research for my radio documentary Life Under Glass, which is being broadcast on NPR stations around the country this August, and my book, Miracle at Coney Island, I made an incredible discovery about a man who has a claim to have changed the course of American neonatal medicine.
Couney never actually qualified as a medical doctor … In the 1910 U.S. census, Couney listed his career as, “surgical instruments.” Though Couney claimed to be the inventor of an incubator, I have been unable to find any evidence that he registered an incubator patent in the U.S. More likely Couney was a technician. Yet by 1930 he was describing himself in the census as a “physician.”
Prentice reported that Couney claimed to have saved around 6,500 premature babies facing nearly certain death at the time his sideshow act was in operation. Although she said that there was no real way of validating those claims, Prentice added that “pediatricians today acknowledge that the team of doctors and nurses which Couney assembled was highly skilled, ensuring the babies got the best care available in America at that time”:
For this reason, Dr. Lawrence Gartner, pediatrician and professor emeritus at the University of Chicago believes Couney was an important figure in American medical history.
“I wouldn’t dismiss Martin Couney at all,” says Gartner. “Martin Couney was well-respected by the medical community at that time. His operation was highly respected and well-known to physicians.”
Prentice’s work was also profiled in a May 2016 BBC article, which featured some of Couney’s “graduates” and emphasized the detail of his operation — clinically sterile environments, starched white uniforms, and so on. That coverage noted that Couney wasn’t entirely averse to the “show” aspect of being a sideshow:
Yet Couney was not averse to adopting a few showman’s tactics himself. He instructed the nurses to dress the babies in clothes several sizes too large to emphasize how small they were. A big bow tied around the middle of their swaddling clothes further added to the effect.
A common thread in histories of medicine and premature infants was an historical lack of available technology to “save” them until relatively recent decades, and a broader notion that such neonates were “destined” to die because they were genetically “inferior.” (That belief has not been abandoned entirely, albeit with broader ranges.) A University of Pennsylvania Nursing history page corroborated some of this, mentioning Couney:
At the turn of the twentieth century, a baby born prematurely (before thirty-eight to forty weeks gestation) had dismal prospects for survival. Except for a few scattered pockets of medical interest, the knowledge, expertise, and technology necessary to help these infants was not available. “Preemies” who survived more than a day or two were often labeled “weaklings” or “congenitally debilitated” implying an inherent frailty that did not bode for their future. Survival of these tiny infants depended on many factors, chief of which were the degree of prematurity and the infant’s weight at birth.
French physicians introduced the closed infant incubator in the 1880s in response to governmental mandates to decrease the overall dismal French infant mortality rate. (Politicians feared the lack of sufficient soldiers for future wars). In Europe, displays of premature infants in their incubators began appearing in the late nineteenth century at national fairs and exhibitions. Dr. Martin Couney brought the shows to the United States in the late 1890s, and they continued until the 1940s. The small size of the infants, their placement in a machine similar to those used on farms for poultry incubation, and the encouragement of carnival style barkers stimulated the interest of the fair-going public.
As the page indicated, the sideshow aspect engaged a public unaware of advances in preventing infant mortality. But those connotations also dissuaded the physicians of the time from embracing developing newer protocols, and doctors sometimes became misinformed about the novel life-saving measures:
While entertaining, the incubator exhibit’s identification as a side show and location among midway entertainment spectacles initially prevented mainstream physicians from embracing incubators as substantive progress. Their faulty design also posed serious problems. Over- or underheated incubators caused potentially fatal errors. Many physicians, relying on anecdotal rather than statistical evidence, dismissed the incubator as ineffective and even dangerous. Some hospitals provided care for preemies using other means of providing warmth, including open incubators and more traditional methods such as warm bricks in cradles and rooms heated to ninety degrees or more.
Not long after Couney’s work gained public attention, formal medicine also began to take notice:
Through observation and clinical studies, physicians began to understand that premature infants needed individual attention and care. The addition of oxygen as a treatment for the respiratory distress prevalent in premature infants sealed the need for an individual approach to climate control.
Many elements of Couney’s story remained constant in profiles of his life’s work and the effects it had on underserved parents and communities of the time. In 2015, PBS reported:
Couney never charged parents for the care he provided, which also included rotating shifts of doctors and nurses looking after the babies. According to historian Jeffrey Baker, Couney’s exhibits “offered a standard of technological care not matched in any hospital of the time.”
… Was Couney an evangelist or a showman? Medical historian Jeffrey Baker calls this “the essential question about Couney. I suspect he had a bit of both in him.” (For example, Couney was known to occasionally dress his preemies in overly-large baby clothes to emphasize how tiny they were.)
For his part, Couney bristled at the idea that just because his work was on Coney Island, it wasn’t in the interest of childrens’ health. “All my life I have been making propaganda for the proper care of preemies, who in other times were allowed to die,” he told The New Yorker’s A.J. Liebling in 1939.
Liebling’s 1939 New Yorker profile of Couney, published while neonatology was still nascent in medicine, contrasted Couney’s then-current efforts with public perception and provided background about the acclaim Couney received from medical authorities of that time:
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 …
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.
In August 1979, nearly three decades after Couney’s 1950 death [PDF], Pediatrics published an editorial by William Silverman about his impact on neonatology. In 1997, Silverman and several doctors submitted a letter to the editor of that journal, casting doubt on Couney’s influence and the originality of his ideas:
Seventeen years ago, one of us [Silverman] reported the odd story of Martin Couney, the “incubator doctor,” who exhibited premature infants in side shows for 50 years beginning in 1896 at the “Berliner Gewerbe Ausstellung,” a trade fair. Couney claimed that Pierre Budin of Paris, the famous pioneer in premature infant care, sent him (Couney) to the Berlin exposition to exhibit a newly modified convection-ventilated incubator. A caveat was noted in the 1979 article in Pediatrics: “… the search has taken 28 years (so far), and some loose ends remain.” Sure enough, a short time after publication, Couney’s account began to unravel. Felix Marx, a reader in Bonn, Germany, saw the article and wrote to call attention to a relevant piece in a popular British magazine published in 1896. The profusely illustrated magazine article reported that Alexandre Lion of Nice invented a forced-air ventilated incubator in 1891, and exhibited premature infants to the public in “infant charities” in his city and in Paris, Bordeaux, Marseilles, and Lyons. The British story discredited Couney’s claim of priority in the bizarre activity; and this “adjustment” to the story was duly reported to the readers of Pediatrics in a letter to the editor.
Now additional clouds of doubt have been cast over the story. Leonore Ballowitz of Berlin, shortly before her untimely death in 1994, searched through the public archives in her city. She found the name of Lion, but was unable to find any mention of Couney.
By all accounts, Couney’s legacy and his life-saving slideshow is polarizing. Many modern histories have focused on his credentials, and critiques published in journals have queried whether credit for the development of technology is accurately attributed to him.
Fairly recent books about Martin Couney and his work seemed to focus on the effects of his “preemie sideshow” on the public versus the more analytical and semantic perspective adopted by academics. Researchers have said that Couney was most likely not a credentialed doctor, a claim that was corroborated by census data submitted by Couney himself. Although he may not have personally developed the technology used in the treatment of preemies, he described himself as a “propagandist” for them, and by all accounts saved thousands of lives — at no cost to parents. While modern doctors have viewed Couney with a critical eye, doctors of his day lauded his efforts as well as his ability to share his knowledge and advocate for neonates. Couney was quoted as saying that his “work [was] done” when modern medicine and hospitals began adopting the techniques he popularized.