"Once Seen, Never Forgotten": Nursing, Ethics, and Technology in Early Premature Infant Care, 1898-1943

No comprehensive account of early twentieth century premature care has been told from a nursing viewpoint, particularly examining the role of agency in the dissemination of incubator technology. Both the Institute of Medicine and National Institute for Nursing Research have highlighted the importance of a nursing perspective in the integration of technologies to improve the delivery of care. Evidence from nursing history can demonstrate how nurses have previously approached and integrated technology into their practice, and offer guidance for addressing current and future concerns in an increasingly high-tech and ethically challenging healthcare system.
The purpose of the study was to examine the role of nursing in the process of technology transfer for advanced care techniques for premature infants in the United States from 1898 to 1943. Traditional historical methods with a blended social history and social construction of technology framework were used. Analysis involved constructing the sociotechnical networks of the Premature Infant Station and the Infant Incubator Company for comparison, and identifying, describing, and evaluating the role of nursing in the transfer of new technologies for premature care during the time period of interest. Critical analysis of social, political, and economic context, as well as the state of the art of nursing and medicine, was also performed.
Primary source data was collected and analyzed from the Julius H. Hess Collection at the University of Chicago’s Regenstein Library, the Century of Progress Collection at the University of Illinois at Chicago, the New York World’s Fair 1939-1940 Collection at the New York Public Library, the Pediatric History Center at the American Academy of Pediatrics, and the Coney Island History Project. Secondary sources were also used.
The introduction of the infant incubator in the late nineteenth century symbolized a changing medical attitude toward premature infants. Despite significantly reducing mortality, incubator technology did not become a widespread and integral part of premature care in the United States until the 1930s and 1940s, after Julius Hess, MD demonstrated dramatically improved outcomes with hospital-based care. Interestingly, most of the treatments Hess used were identical to those in use at widely popular incubator-baby sideshow exhibits at world’s fairs and amusement parks beginning as early as 1898. Both systems relied on specially trained nurses to provide all treatment to the newborns under their supervision, and these nurses played a significant role in promoting and integrating the incubator and other advanced techniques to enhance the quality of treatment for preterm infants in the early twentieth century. Nursing care was undoubtedly a key factor in the high survival rates experienced by premature babies in their care. The relative success of the Premature Infant Station in elevating public opinion of both premature infants and incubator technology in relation to that of the Infant Incubator Company may have been a result of the status of nurses within the system, the flexibility of power relationships, and the way nursing care itself was communicated to different audiences.