Keeping Victorian Preemies Warm: French Couveuse

Keeping Victorian preemies or babies warm was difficult up to the late 1800s. This inspired the creation of infant incubators and although French doctor Stéphane Étienne Tarnier did not invent the first infant incubator, he did invent what he called a “couveuse” or “brooder.” His baby warming device was inspired by devices used to incubate poultry. At the time, Dr. Tarnier was a well-respected obstetrician, and, today, he is often considered the doyen of French obstetrics of the late nineteenth century because of his many groundbreaking ideas related to this field. 

Dr. Stéphane Étienne Tarnier, Courtesy of Wikipedia

Dr. Stéphane Étienne Tarnier. Courtesy of Wikipedia.

Prior to Dr. Tarnier’s invention of the couveuse or brooder, Victorian preemies were kept warm by swaddling and were swaddled in the following manner:

Take a square baby-blanket and place it diagonally on the table or bed. Turn down one corner … four inches … to come up over the baby’s head. Spread over this blanket a lap of raw cotton. Have the baby’s napkin and binder on, and a flannel undervest. Make a cap out of the cotton, fitting it over the baby’s head and bringing it down … under the chin. Then roll the baby up in the cotton lap. Bring the blanket around this firmly, so as to hold it; the portion of the blanket on the baby’s right being brought over and tucked in on the left side, the portion on the left being correspondingly folded over toward the right. The corner of the blanket left at the feet is then folded up over the front, and the whole held in place by … a strip of muslin bandage or ribbon. The bandage is first applied beneath the chin, crossed under the back, again crossed in front, the end being brought forward [and fastened in a bow] … at the feet.[1]

Victorian preemies

Example of a swaddled Victorian preemie or baby. Public domain.

There were several problems with swaddled Victorian preemies. One problem was nursing, bathing, or changing the baby’s clothes and diaper because it regularly exposed the baby to cold air. Another problem was it was difficult to regulate the temperature of a swaddled baby whereas the couveuse could regulate a baby’s temperature more reliable. Additionally, Dr. Tarnier’s couveuse showed better results than swaddling because there was a 28% decrease in infant mortality over a three-year period at the Paris Maternité due to the couveuse, and because Dr. Tarnier’s couveuse was more appealing than swaddling, ordinary people began adopting it for home use.

Tarnier's couveuse for Victorian preemies and babies.

Tarnier’s couveuse for Victorian preemies and babies. Public domain.

Dr. Tarnier’s couveuse was essentially a wooden box that was heated with hot-water bottles. A more thorough description of his couveuse is provided below:

“It consists of a wooden box, whose interior is divided into an upper and lower compartment. There is a space about four inches wide at one end of the upper compartment which communicate with the floor below. Here two or three large sponges on a wire stem are placed. The lid of the box at the opposite end contains a chimney, in which a helix rests on a pivot.

The upper compartment of the box is intended for the baby; in the lower end are several stone jars, which are to be kept filled with very hot water. At the end of the box furthest away from the open space which communicates with the chamber above, a register is fixed, which may be opened or closed at will. The air enters through the register, is heated by passing over the hot stone jars, moistened by the wet sponges in the space between the upper and lower chambers, and finds it exit from the chimney, in which it keeps the little wheel revolving. The motion of this wheel indicates whether the circulation of air within the couveuse is perfect or not. A thermometer fastened to one side of the interior of the box assists in the regulation of the temperature, which should be kept at from 85° to 95º Fahr., according to the indications in each case. A frame containing a pane of glass forms the top of the box. Through this the record of the temperature and condition of the child can be watched.”[2]

To ensure proper use of Dr. Tarnier’s couveuse, an assistant to Dr. Tarnier, Dr. Pierre-Victor-Adolphe Auvard, provided the following directions:

  1. To keep an even temperature, one of the stone jars should be filled between every one to two hours.
  2. Avoid placing the couveuse in an area where there is a draught because it makes it more difficult to heat.
  3. If the temperature rises to quickly, slip the cover down or “the inferior register may be opened so as to admit a large quantity of air.”[3] To raise the temperature close the register to admit less air or add hotter water to the jars.
  4. Place the child in the upper compartment and when the child is removed for nursing, bathing, or toilette, make sure the room is sufficiently warm, approximately 70° to 75° Fahrenheit.
  5. The length of time a child should remain in the couveuse varies from “fifteen days to three weeks, a month, or more. It should not be removed permanently until it has acquired sufficient vigor to live in the ordinary atmosphere … To accustom the child to this atmosphere, it should, as it grows stronger, be removed from an hour at a time … during the warmest part of the day.”[4]
  6. Continue the use of the couveuse at night, even after the child becomes accustomed to be removed in the daytime and to the daytime temperatures.

In the 1880s, Dr. Auvard made modifications to Dr. Tarnier’s couveuse for Victorian preemies. These changes included:

  1. Replacement of the hot-water jars with a cylindrical reservoir of metal “filled by means of metallic funnel fastened to one end of the box and communicating with the cylinder through a metallic tube.”[5]
  2. The overflow was “a curved metallic tube at the lower part of the cylinder beneath the inlet through which the reservoir [was] filled.”[6]
  3. Air entered by “a register on one side of the couveuse instead of at the end, as in Tarnier’s apparatus.”[7]
Auvard's couveuse for Victorian preemies and babies showing exterior (left) and interior (right)

Auvard’s couveuse for Victorian preemies and babies showing exterior (left) and interior (right). Public domain.

Dr. Auvard’s incubator that he called “de la couveuse pour enfants” was inexpensive and used a simple design. In fact, one person wrote Dr. Auvard “would not have brought the machine before the Society were he not convinced that it was simple, cheap, and useful.”[8] Similar to Dr. Tarnier’s couveuse, Dr. Auvard’s device also became widely popular. In fact, his device was so popular it “greatly influenced incubator technology during the first half of the twentieth century in Europe and in the United States.”[9]

References:

  • [1] Handbook of Obstetric Nursing for Nurses, 1891, 217.
  • [2] Ibid, 211-212.
  • [3] Ibid, 213.
  • [4] Ibid 214.
  • [5] Ibid.
  • [6] Ibid, 214-215.
  • [7] Ibid, 215.
  • [8] Martin, Richard J., etal., Fanaroff and Martin’s Neonatal-Perinatal Medicine, 2014, 25.
  • [9] Transactions of the Obstetrical Society of London, Volume 26, 1885, 7.

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