The "cradle of glass": incubators for infants in late nineteenth-century France.

This article examines the development of the incubator for premature infants in fin-de-siècle France. During a period of widespread anxiety in France regarding infant mortality and its implications for population growth, physicians in Paris developed and widely promoted the lifesaving technology. This article explores the ways in which the incubator reflected new scientific and symbolic approaches to creating hygienic spaces as well as how it reflected new scientific and symbolic approaches to the traditionally feminine project of infant care. By creating such an isolating and protective milieu around premature infants­an entirely new population of patients­the incubator, I argue, heralded a renegotiation of the boundary between motherhood and medical authority.

Lessons from the past.

This article considers errors of care in neonatology. In the 19th century errors that resulted in high infant mortality were shaped by the social environment, and in this setting the development of the incubator failed. In the early 20th century, with the emergence of the modern hospital as a technological, science-driven system, physicians had more control of patients' environments, and thus medical errors could occur from systematic care and affected larger numbers. Later in the 20th century, the development of randomized controlled trials and systematic reviews began to improve care and to decrease the risks associated with new treatment methods. Large variations in practice still exist between physicians as individuals and institutions. Considering these variations as risks has led to the use of institutional databases, benchmarking and clinical care guidelines. The efficacy and safety of these methods is unproven. Risks will never disappear from medicine. The question of what risks are 'acceptable' is, in general, unanswerable.

O advento das incubadoras e os cuidados de enfermagem aos prematuros na primeira metade do século XX / The advent of incubators and nursing care to premature babies in the first half of the twentieth century

O estudo tem como objetivos descrever os diferentes tipos de incubadoras existentes até a primeira metade do século XX, e relacionar os cuidados de enfermagem aos prematuros quanto à utilização das incubadoras. Trata-se de um estudo histórico. As fontes primárias são dois artigos existentes na Biblioteca Nacional e três artigos da Revista Brasileira de Enfermagem nos anos 40 e 50; e as secundárias são os livros e artigos de periódicos nacionais e internacionais relacionados à história da pediatria e da neonatologia. Os tipos de incubadoras são: fechadas, semifechadas e abertas. Quanto à assistência de enfermagem, constata-se dois momentos: os cuidados imediatos dispensados ao recém-nascido na sala de parto e o seu transporte para o berçário, preferencialmente em uma incubadora, e os cuidados mediatos relacionados à assistência no berçário. Conclui-se que a incorporação das incubadoras influenciou diretamente os cuidados prestados aos prematuros, uma vez que exigiu uma maior especificidade na assistência...

The objectives of this study are: to describe the different types of incubators that existed through the first half of the 20th century and to list the kinds of nursing care given to premature babies concerning the use of incubators. It is a historical study. The primary sources are two articles that are found in the National Library, and three articles that were published in the Brazilian Nursing Review in the 1940s and in the 1950s; and the secondary sources are books and articles of national and international periodicals on themes related to pediatric and neonatology history. The types of incubators were closed, semi-closed and open. As far as the nursing care is concerned, one noticies two moments: the immediate care, relating to the first care given to the newborn in the delivery room and its transportation to the nursery, preferably in an incubator, and the intermediate cares, relating to the care given in the nursery. We conclude that it has influenced directly the care given to the premature babies since it requires a more specific assistance...

El estudio de abordaje histórica que tuve como objetivos describir los diferentes tipos de incubadoras existentes hasta la primera mitad del siglo XX y relacionar los cuidados de enfermería a los prematuros en cuanto al uso de las incubadoras. Las fuentes primarias son dos artículos existentes en la Biblioteca Nacional y tres artículos de la Revista Brasileña de Enfermería de las décadas del 40 y del 50; y las fuentes secundarias son libros y artículos de periódicos nacionais e internacionais referentes a la Historia de la Pediatría y de la Neonatología. Los tipos de incubadoras son: cerrado, semi - cerradas y abiertas. En cuanto a la asistencia de enfermería, se verifica dos momentos: los cuidados inmediatos concedidos al recién nacido en la sala de parto y su transporte a la cuna de preferencia en una incubadora, y los cuidados imediatos relacionados a la asistencia en la cuna. Se concluye, que la incorporación de las incubadoras influenció directamente en los cuidados brindados a los prematuros, una vez que exigió una mayor especificidad en la asistencia brindada...

Reflections on errors in neonatology: I. The "Hands-Off" years, 1920 to 1950.

This series discusses errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years, 1920 to 1950; the "Heroic" years, 1950 to 1970; and the "Experienced" years, 1970 to 2000. In this article, the "Hands-Off" years, we discuss lowered thermal environment, supplemental oxygen, initial thirsting and starving, synthetic vitamin K, SMA formula, and diaper markings.

Stéphane Tarnier (1828-1897), the architect of perinatology in France.

Stéphane Tarnier studied medicine in Paris and became the doyen of obstetrics in France during the second half of the 19th century. He pioneered many advances and encouraged a perinatal approach to childbirth that was further developed by his disciples, Budin and Pinard.

Incubadoras e respiradores: influência na assistência de enfermagem à criança hospitalizada (1950-1979) / Incubators and mechanical ventilators: influence in nursing attendance to the hospitalized child (1950-1979) / Incubadoras y respiradores: influencia en laasistencia de enfermería al nino hospitalizado (1950-1979)

Este estudo tem como objeto a assitência de enfermagem às crianças hospitalizadas, que necessitavam de incubadoras e respiradores, inserida no contexto histórico, social e econômico no período de 1950-1979. Os objetivos são: descrever a utilização desses equipamentos pelas enfermeiras e analisar a influência dos referidos equipamentos na assistência de enfermagem à criança hospitalizada. Trata-se de um estudo histórico com abordagem qualitativa. As fontes primárias correspondem aos documentos de diferentes acervos, bem como os artigos publicados na Revista Brasileira de Enfermagem na década de 70, e as fontes secundárias: bibliografia referente à História do Brasil, política de saúde, sistema previdênciario e pediatria...

Neutral temperature range in incubators: performance of equipment in current use and new developments.

Low-birth-weight neonates should be nursed at thermoneutrality inside incubators. Thermoneutrality control is essential to enhance body growth and to reduce neonatal illnesses and mortality. Guidelines have been published to provide the thermoneutral range, but the recommendations did not always take into account all ambient and physiological parameters influencing thermoneutrality. In most marketed incubators, the heat supply is controlled through convective air flow (closed incubators) or through radiant power density (radiant warmer beds). The heating unit (on/off cycling or adjustable proportional control) is activated by an error signal calculated from the difference between a controlled temperature and a reference value preset by the clinician. The controlled variable can be either the incubator air or the skin temperature of the anterior abdominal region of the neonate. The neonate's size, thermal properties of the mattress and of incubator walls, air temperature and humidity, air velocity, incubator wall temperatures all influence the heat exchanges between the neonate and the surroundings, and, consequently, modify the obtention of thermoneutrality. Moreover, studies of the physiological mechanisms by which the neonate regulates body heat storage suggest that metabolic rate, behavior, vigilance level, nursing care, and heater control processes should also be taken into account. Little attention has been paid to these factors, and incubator performances are often disappointing. This article reviews the different factors that modify thermoneutral condition. An attempt is made to suggest new ways to design equipment incorporating these factors in algorithms controlling heater processes in order to reach the optimal thermal environment in which the neonate should be nursed.

Entertaining and instructing the public: John Zahorsky's 1904 incubator institute.

In 1904 American physician John Zahorsky managed an incubator institute at the Louisiana Purchase Expositiioon in St. Louis, Missouri. For Zahorsky the incubator became a focal point for organizing medical care, for evaluating existing practices and for developing new ones. His efforts resulted in markedly improved survival rates for premature infants. Despite his success, however, his findings never became part of the medical literature on prematurity. Zahorsky himself believed that physicians dismissed his work because of his association with showmen. This paper also suggests that his were not practical findings. The incubator was too heavy to be used for home births among middle class families and the equipment and nursing care were too expensive to be used with hospitalized infants from tenements. Zahorsky recognized that the incubator somehow diminished the humanity of premature infants, for parents sometimes did not reclaim infants lent to the exhibit. The infant on exhibit became a commodity at a time when babies were offered for sale by advertisement. The incubator institute illustrated the prevailing sensibility about infants, one context in which medical research took place, and the relationships among commerce, entertainment, medical practices, and medical science in the United States early in the twentieth century.