by Dawn Raffel
At this point he was honest: “No.”
“Why not?”
“We couldn’t get space.”
“Why don’t you answer the question about money?”
“Showmen have tried to get into this affair, and we feel it would be wrong to say what this affair can take in, because it would give them, as it were, a line on what this proposition could do. We think it will be a success in St. Louis, not alone from the ethical point of view, but we will make a success of it financially.”
“We are not prepared to accept your simple statement. . . . We don’t know whether the thing is profitable or unprofitable, other than what you say that, ‘It was quite profitable at Buffalo.’”
“We considered it was profitable, because of a great number of concessions in Buffalo that were a failure,” he said. “We were able to pay for the installing, pay for the running expenses, and still have a little money to divide among those concerned in it.”
“The relative comparison, we cannot understand what you mean by this statement.”
“When we saw the failures of others I think we did well. Under our method of operation the affair is placed in charge of your Medical Board and then it goes into the hands of the physicians of the city. When we receive a child, we don’t know where it comes from, it may come from a hospital or from a wealthy family. . . . When it is ready to be discharged, the physician is notified.”
“How many deaths did you have in Buffalo?”
“We saved eighty-five percent. If we have a child for seven days in our charge we never lose it if it lives that long. Most of the cases we lose as a rule we lose within twenty-four or forty-eight hours after we receive it. The reason for that is that a child of that nature is subject to bronchial trouble, and if we receive it in time, by placing it in the apparatus and keeping it at the proper temperature we overcome that.”
Apparently, the committee was tired of talking about the welfare of the children. They shifted the conversation abruptly.
“Are we to understand that your application is withdrawn?”
“Oh, no. You don’t want to lose this as a feature of the Exposition.”
“It doesn’t seem to be what we want.”
“We have grown grey in this matter, we have spent many years of our life with this affair in Expositions, and I know you don’t want to miss having this as a feature of your Exposition. That is what it is going to be.”
“This Committee decided at the beginning that any concession . . . will have to be paid for on the basis of a percentage, not as a fixed sum.”
“I want you to consider this as not a simple show concession.”
“We regard it as such.”
“You ask any of our physicians how they would regard one of your uniformed men standing at the gate of our concession taking a percentage of the gross receipts.”
“While we desire the approval of the Medical World, and do not wish to antagonize them, we feel that we have a proposition before us that does not pertain to them, and we must decide upon what lines it will meet with our approval and not how the Medical Profession is going to like it. If you think it is a medical affair, take it to the Medical Department; but we don’t think it is.”
At last, they dismissed him, but the interrogation wasn’t done. John Dunnavant came next. He was there to make his bid for Over and Under the Sea. Martin knew him from Buffalo. The committee wanted John’s opinion of Schenkein and Coney. He mentioned “a little difficulty” with the investor McConnell, but mainly he praised them. “There is no question but what they will fix it up right and run it absolutely so that it has the sanction of every physician in the country, and I don’t think you could deal with better people to take a thing of that kind,” he said.
To no avail.
On January 22, 1903, Sam made another desperate pitch, but he wouldn’t bend the flat fee. The committee ended up taking bids from seven concessionaires, among them Mrs. Hattie McCall Travis, who was hoping to run both an incubator show and a daily bullfight, and their former investor Emmett McConnell himself. By August, Sam blinked, offering 25 percent of the gate. But Bayliss, the man with a hand inside, had partnered with a local physician named Joseph Hardy and bested them all, promising 40 to 50 percent, depending on receipts. While he was at it, he made a successful bid for an amusement called the Magic Whirlpool.
* * *
—
Edward M. Bayliss must have wondered why it had taken so long to wrap this up. Now that he’d won, he had no intention of laying a finger on an infant, nor did he plan to stand around shaking grubby hands and indulging ridiculous questions. He would design an ornamented building, turn it over to Hardy, and tune his ear to the beautiful sound of money rushing in.
Joseph Hardy was fully licensed and apparently utterly ignorant of how to care for a preemie. Bayliss, to his credit, purchased Lion-type machines. They were still being manufactured, but doctors were turning against them. With too few specially trained nurses and what little staff they had stretched thin, it was hard to reap the benefits.
Hardy wasn’t worried. To start with, many of his patients were orphans. No parents to breathe down his neck. Once the show opened and word got out, mothers and fathers started calling from all over town for an ambulance to take their newborn to the concession; others boarded trains with their day-old preemies. Most often, the babies died en route. As for the rest, their parents would need to be grateful for whatever help they got. The public ate it up. And the committee licked their lips.
The first child to die had been sick on arrival. Not Hardy’s fault. Another baby followed, and another, and another. Infected. In the muggy Missouri summer, machines were overheating. Perfect petri dishes, with no one competent to make adjustments. Plus, Hardy fed the patients cow’s milk, not breast, and it soured with contamination. As the body count rose, the good doctor up and quit.
Clearly, this was not the spectacle Bayliss and his cronies had in mind. In the beginning of August, with a young physician hired more out of desperation than for any qualifications, the committee sought the opinions of other medical practitioners. One doctor who had been sending orphans to the show expressed confidence that nothing was the matter: “I have never at any time had reason to think that the place was not admirably conducted,” he wrote. In view of the sharply different assessment of others, the question arises as to whether he was enjoying a kickback. A second doctor cited “serious objections,” including the fact that the babies were given sunbaths two feet away from “garbage boxes filled with filth.”
The most damning report listed dangerously hot machines, poor ventilation, flies buzzing freely, and worse. “The feeding of the babies betrayed the grossest ignorance. . . . For instance, cereal foods and egg albumen were being used for these infants, although it is well known that they cannot assimilate such foods.” This letter was signed “City of St. Louis, Health Department.”
Still the show went on. The babies kept dying.
A scathing letter, dated September 17, 1904, was sent to the fair’s president, David R. Francis:
Dear Sir,
The Humane Society has been investigating the condition of the show at the World’s Fair known as the “Infant Incubator.” Our officers have made a quiet investigation in the last few days, and we found that everything that has been said about this “show” was and is the truth. We found that for ten days this “morgue” was run without any medical attendance whatever. That the [new] Doctor in charge, O’Neill by name, graduated last May and that since he took charge he has issued about 19 death certificates. That between August 8th and August 19th, ’04, ten deaths were reported from this place. Now I want to say to you that the Humane Society is going to press this matter to the full extent of the law, and unless this “Charnel House” is closed at once I will send the officers of this Society out there and close this place by force. This must be done withi
n 24 hours after you receive this letter. I also intend to submit the facts in the case to the Circuit Attorney of St. Louis and also to the Attorney General. Now Mr. Francis if you will see that this place is closed and closed at once there will be no further trouble but if it is not then we will see that it is and the people responsible for the horrible conditions that exist at this place must suffer the consequences. Since this place has been running they have had 43 babies and 39 have died. What do you think of that for a “scientific exhibition.” There can be and there is no doubt about the character of this place and that the babies are deliberately murdered through neglect and carelessness, and it must be stopped at any price no matter who has money in this show.
I wish you would give this matter your personal attention and give me an immediate reply so that I may know what further steps to take in this matter.
Yours very truly,
(signed) Rozier G. Meigs
On September 19, a response went out to Rozier Meigs, written on behalf of President Francis, “who is unable to take time for an immediate reply.” The fair’s management contended that the allegations “come as a complete surprise” and that, with some recent improvements, all was now perfectly well and good at the infant incubators.
* * *
—
Martin, getting wind of it, was livid. Had he not pleaded with the committee to view the treatment of premature infants as a medical matter, not just a money machine? Now he took aim with his weapon of choice. His open letter in the New York Evening Journal was prefaced with an editor’s note commending it to David Francis, adding for good measure: “It is horrible to think of these delicate babies shut up in carelessly overheated compartments, exposed to the flies during their brief hour of escape from their hothouse and dying like flies with the curious looking at them.” Martin’s letter followed:
Dear Sir,
The crime of the decade is being committed here at this World’s fair. Under the guise of science and in the name of humanity more than a score of innocent, helpless little human beings have already been done to death, and the dread work still goes on. Protest has been of no avail. Men of prominence fear to take action for fear of scandal, that it may hurt the exposition, etc. What I tell you can be verified by prominent physicians of New York and Chicago who have investigated the matter. The accounts recently published in several of the New York papers do not even begin to do justice to the horrible conditions existing.
This “concession,” for political and other reasons, was put in the hands of people who did not know the difference between an incubator and a peanut roaster. I see now but two ways to bring this affair to the light of day and have justice meted out and responsibility placed where it belongs—one is an appeal to the United States commissioner to the World’s fair; the other is publicity and a demand for an unbiased investigation and immediate closing of the place by the Hearst papers.
The first would be a slow process, and in the meantime other innocents would be sacrificed. The second will have an immediate effect and accomplish its work over night.
The first demonstration of the “infant incubator” was made at the Berlin exposition in 1896, since which time it has been demonstrated at all of the great international expositions.
Now, here is the point that makes this “the crime of the decade”: Thousands of columns have been published by the press of this country in commendation of the infant incubator. Therefore, to place this affair in the hands of ignorant people, not one of whom has any technical knowledge or experience in this line of work, is to deceive the mothers of this country, whom they send back with nothing but corpses.
Do they have any healthy graduates? When Dr. Hartung made his protest it threw them into confusion. They did not want to increase their mortality rate. A little more than two weeks ago they sent home a child that they had had for many weeks, who, from the treatment received, could not last much longer. Here’s what Sister Vincent of St. Anne’s Hospital, said:
“The child came back in terrible condition on Friday, and died on Sunday.”
The exposition officials would tell you that they have recently made changes both as to the place and the people in charge, and that everything is now all right. A St. Louis dispatch published recently in one of the New York papers said that a secret conference was held, in which half a dozen representative physicians participated. “It was said afterward that it had been agreed that the management of the Pike attraction was doing the best it could, and, with the changes suggested, it was the opinion of the conference that the incubators would do fairly well.” The dispatch added: “Several children have died in the incubators lately.”
This is incriminating in itself, as it shows that things were wrong. Now that they say it is “all right,” I want to ask you: Is the World’s fair a place for an experimental station where human life is at stake?
Very truly yours,
Dr. M. A. Couney
Two things are notable about Martin Couney’s letter. First, he didn’t make any claim to having shown the machines in Berlin. Second, regarding St. Louis, he was right. True, he was a showman who’d lost out to the competition. True, he was dramatic. But he was also in a position to understand that the babies in St. Louis were dying from egregious negligence. While others were hoping to keep this unsavory piece of business politely discreet, he was more than willing to cause a ruckus.
* * *
—
Despite Martin’s outrage and the Humane Society’s threats, the concession wasn’t closed. Dr. John Zahorsky had stepped into the “Charnel House” shortly before Martin wrote his letter. Eager not only to save the day but also to win the admiration of the East Coast medical elite, Zahorsky slowed the march of death, pouring ice water into the coils of the machines when they overheated, sterilizing equipment, feeding the infants breast milk as often as he could, and calibrating feedings. He carefully recorded the weight, the protocol, and the outcome for each infant in his care. When the fair closed on November 30, with the concessions committee’s coffers full, he published a series of articles in the St. Louis Courier of Medicine. These were compiled into a book—published, to his disappointment, locally by the Courier of Medicine, instead of by a major national house.
Zahorksy’s words reflect the work of a principled man of science, one well aware of Pierre Budin’s recent teachings stressing cleanliness and breast milk. He also cited Harvard’s Thomas Rotch, who, despite the failed machine of 1893, remained a powerful force, especially if one had institutional ambitions. (Rotch, unlike Budin, believed “modified” cow’s milk was fine; Zahorsky disagreed and had five wet nurses on-site.)
A late-season addition of a glass partition went up between the public and the incubators, on the recommendation of the board of health. Previously, Zahorsky wrote, the babies were subjected to “obnoxious effluvia from thousands of sight-seers.” Plus, “the nurses were constantly annoyed by questions.” (Martin Couney had no such wall, and questions were encouraged.)
Using graphs and charts, Zahorsky offered detailed recommendations for optimal caloric intake based on weight. Yet he found nasal feeding unmanageable, occasionally mixed “modified” cow’s milk (including whey) with breast milk when he faced a shortage, and enumerated numerous blow-by-blow cases of infants dying of vomiting and diarrhea. It’s hard to read his accounts and not wonder whether Louise and Maye could have saved more of these children.
Perhaps from a sense of professional courtesy, perhaps from the prudence of ambition, John Zahorsky chose to defend his predecessor on the Pike. Despite acknowledging the overheating machines, “some blunder in the milk supply” and “certain proprietary foods,” which he himself discontinued, he still gave Hardy a pass; in fact, he did him the favor of not printing his name. Instead, he picked an easy target, employing a you-know-who-I’m-talking-about plural: “Certain ‘specialists’ in incubator exhibitions, probably chagrined by the fact that they h
ad not obtained the concession, although they had experience in many other expositions, began to assail the management in every conceivable way.” In contrast to the figures stated by the Humane Society, he claimed the mortality rate up to September 1 was only about half. “Consequently,” he wrote, “these scandalous vituperations were uncalled for.”
The greater damage lay in his assessment of the treatment itself. Zahorsky hedged his bets. “The feeling of the medical profession is against the show of incubators, of this there can be no doubt,” he wrote. “On the one hand there is a prejudice that showmen can not have the proper sentiment toward these little ones and may sacrifice proper requirements of care for show purposes; on the other hand, we feel it degrading to human sentiment to make an exhibition of human misfortunes, especially in the shape of tiny infants.” Then he countered with some positives: The show provided free care to indigent patients, it educated the public that “effort should be made to save premature infants and not allow them to die as a matter of course,” and careful record keeping would add to scientific knowledge. Fair enough.
But in the end, he blamed the St. Louis debacle on “the catastrophe of hospitalism”—the spreading of germs in an institutional setting—rather than malpractice. (“It was hospitalism that made the mortality so high before I took charge, and it was operative for some time even after radical changes were made in the management.”) He concluded that unless a baby’s parents were indigent with no other options, the child shouldn’t be in an incubation institute—not on the midway and not in a hospital, either. Tiny preemies were better off, he said, at home.
Fear of hospitalism combined with the horrifying specter of St. Louis helped scare the medical profession off the use of incubators. It gave doctors another reason to dismiss a labor-intensive technology they’d been finding hard to maintain. Their disinclination would linger long after the decade in which the crime was committed.