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Nursing, Ethics, and Technology in Early Premature Infant Care in the United States, 1898-1943

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Nursing, Ethics, and Technology in Early Premature Infant Care in the United States, 1898-1943 “Once Seen, Never Forgotten”: Nursing, Ethics, and Technology in Early Premature Infant Care in the United States, 1898-1943 Michelle Chambers Hehman Sugar Land, Texas BA, Stanford University, 2002 MSN, DePaul University, 2006 A Dissertation Presented to the Graduate Faculty of the University of Virginia in Candidacy for the Degree of Doctor of Philosophy Department of Nursing University of Virginia May, 2016 © Copyright by Michelle C. Hehman All Rights Reserved May 2016 Abstract 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- i 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. ii TABLE OF CONTENTS Abstract……………………………………………………………………………………………………….... i Dedication…………………………………………………………..…………………………………………. v Acknowledgements……………………………………………………………………………...………… vi Chapter 1: Introduction and Methods………..……………………………………………………. 1 Chapter 2: Background and Setting…………………………………………………………………. 34 Chapter 3: Nurses as Performers in the Infant Incubator Company…………………... 101 Chapter 4: Nurses as Experts in the Premature Infant Station…………………...……... 168 Chapter 5: Conclusions…………………………………………………………………………………… 225 Appendix A: Figures and Photographs…………………………………………………………….. 250 Appendix B: Tables and Diagrams…………………………………………...……………………… 276 Appendix C: Institutional Review Board Protocol Application………………………….. 280 iii Dedication It is with a grateful heart that I dedicate this project to my fellow neonatal nurses, those who devote their lives to healing the smallest and most vulnerable among us with endless grace and humility. May our work always be seen, so that our stories will never be forgotten. “It is not how much you do, but how much love you put in the doing.” Mother Teresa iv Acknowledgments This long and challenging journey began years ago, and this project is the result of hard work and dedication from so many individuals. Words cannot express my sincere appreciation to everyone who so graciously and generously offered their support throughout the research process. First and foremost, I would like to thank my advisor and dissertation committee chair Dr. Arlene Keeling, for introducing me to the power and potential of nursing history research, and for guiding me through my first project from beginning to end. I have appreciated your mentorship, your encouragement, your amazing ability to keep me focused, and most importantly, your time. It has been an absolute honor and privilege to be able to work with you. Special thanks go to my committee for their helpful insight and flexibility as I completed this research from a distance. Dr. Beth Epstein has been with me since the beginning of my time at the University of Virginia, and I am so thankful for her continued support and poignant observations on ethics and morality in neonatal care. Thank you to Dr. Mary Gibson for valuable commentary on the importance of context and culture for understanding vulnerable patient populations, and to Dr. Barbra Mann Wall for her constant enthusiasm and expertise in the method of textual analysis. I am so grateful to Dr. Bernie Carlson for transforming my understanding of technology in healthcare, and whose non-nursing perspective offered richness and diversity to this project. v I am also indebted to the wonderful and talented archivists at the University of Virginia Claude Moore Health Sciences Library, the American Academy of Pediatrics (AAP), the University of Illinois at Chicago Libraries, and the New York Public Library. A very special thank you to Ms. Veronica Booth, head archivist of the Pediatric History Center at the AAP, who went above and beyond in assisting me in my quest for primary data on nurses. She facilitated introductions with other archivists and researchers, and ultimately discovered my most prized possession- rare video footage of nursing care provided at the infant incubator exhibits. Other members of the University community have helped keep me motivated along the way. A special thank you goes to Dr. Linda Bullock for refusing to let me give up, and for helping me find real and practical solutions to seemingly insurmountable obstacles. Your steadfast belief in me carried me through the times I’d lost faith in myself. To Dr. Connie Lee, I am forever appreciative of the gifts of your mentorship and honesty, and for the opportunity to gain firsthand experience with the many facets of collegiate instruction. Thank you for your trust and your friendship. And to my fellow doctoral students over the years, I am particularly grateful to have shared this experience with such a remarkable group of scholars. Your thoughtful critiques and sincere feedback helped refine and develop this research, and the friendships I have gained gave me the encouragement to push through to the very end. Finally, though they may not have had a hand in the actual writing of this work, I could never have accomplished something of this magnitude without the support of my family. A lifetime of gratitude goes to my amazing parents, Patrick vi and Vicky Chambers, who taught me to dream big, work hard, and fight for the things that are important to you. I owe so many of my accomplishments to your unwavering support, and this is no exception. To my children, Michael, Emma, and Matthew, thank you for being the greatest source of inspiration and my most important distraction. Watching your faces as we figured out I was graduating from the 23rd grade will be a memory I cherish forever. I love you all more than you could ever know, and while I am immensely proud of this project, it pales in comparison to the joy and wonder of watching you grow each day. You three will always be my greatest works. And last, but certainly not least, I need to thank my husband Mike, the first Dr. Hehman in our family. Even though you may never read this, I need the world to know how much you mean to me. Everything with you is simply more- more fun, more beautiful, more brilliant, and more worthwhile. Thank you for sharing your love and your life with me. vii Chapter 1: Introduction and Methods Introduction Advances in medical technology aimed at improving the quality, safety, and efficiency of patient care continually change the provision of health services. Particularly in the field of neonatology, where technological developments have been the most transforming force in the evolution of care, nurses struggle to balance the human element of nursing with the ethical use of new equipment and procedures.1 The
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