BEHIND THE BOOK

Such was the common saying of Dr. Martin Couney, the man behind the institutionalization of the infant incubator at the turn of the twentieth century.

And such is the inspiration behind Miracle at the Sideshow: An Astounding Novel of the First Infant Incubators.

At that time in history, medical care for babies born prematurely was non-existent. In fact, with eugenics on the rise, premature babies were thought of as “weaklings,” and the majority left to die in their mothers’ arms. Attempts at saving them were looked upon as harming humanity with their “less than” genetics:

“The eugenics movement promulgated the idea that physically and mentally inferior people were far from being benign and interesting; rather, they were a danger...Human differences became medicalized as pathological—as ‘disease.’”

Freak Show, by Robert Bogdan, p. 62-3

“Obstetricians didn’t have much time or inclination to fuss over ‘weaklings,’ and the nascent field of pediatrics hadn’t quite gotten to them. They fell between the cracks, where they died.”

Dawn Raffel, Literary Hub, August 3, 2018

As a nurse who has worked in a neonatal intensive care unit (NICU), throughout my research I was amazed at the resemblance of modern incubators to those Dr. Couney used in the early 1900’s. From the warming and oxygen delivery systems to the methods of feeding premature babies, his inventions indeed paved the way for today’s care techniques that save preemies as young as 23 weeks gestation. As such, I had to write this story.

Of course, this is a work of fiction as far as what Dr. Couney said and did in the setting of my novel. He had one daughter (ironically also born prematurely), but she did not marry or have children, so there are no relatives that I could have interviewed. Instead, I read articles about adults who were Dr. Couney babies. I read books and journal articles about Dr. Couney (who most likely was not actually a physician) and medical care of the time. And I chose to set the timing of this story in 1911, the spring of two of the most famous fires in New York City. The first was the Triangle Shirtwaist Fire which killed tens of women seamstresses and paved the way for long overdue workplace safety. The second was the fire that burned Dreamland, the site of Dr. Couney’s Infant Incubator Exhibit, to the ground. Along with the protagonist, Sophie Rosenfeld, a young immigrant from Eastern Europe, all these events work together to tell a story of injustice and tragedy, but also one of great courage when people dared to change the world by doing things that made society consider them “crazy.”

If you are interested in all the details behind this story, I invite you to peruse some of the most pivotal books I read during my research listed in the “For Further Reading” section. They range from books about Dr. Couney to books about Coney Island and acrobats, the history of the sideshow and its marginalized “exhibits,” books about the foods and recipes common for immigrants of the time, and more.

I also highly recommend online and (if possible) in-person tours of The Tenement Museum in New York City (https://www.tenement.org/). This museum was life-changing for me, and I’m so grateful I had the opportunity to visit the first of March, 2020, just before the pandemic broke. The resources and stories there are incredible. I became enamored with New York’s Lower East Side history when I visited. The New York Public Library also has a fascinating and detailed booklet about the Lower East Side that’s worth a read if you’d like to learn more, at https://www.nypl.org/sites/default/files/lowereastsideguide-final.pdf.

In an article from the Library of Congress about Lower East Side immigrants at that time, they write:

“...the Lower East Side was still a very difficult place to live–and a crowded one. By the year 1900, the district was packed with more than 700 people per acre, making it the most crowded neighborhood on the planet. The reformer Jacob Riis described a visit to a typical tenement building occupied by Eastern European Jewish families: ‘I have found in three rooms father, mother, twelve children, and six boarders. They sleep on the half-made clothing for beds. I found that several people slept in a subcellar four feet by six, on a pile of clothing that was being made.” (https://www.loc.gov/classroom-materials/immigration/polish-russian/the-lower-east-side/)

In my novel, Sophie’s work in the shirtwaist factory leads her to meet Clara Lemlich, a small but mighty woman who made giant strides in improving conditions for workers in the garment industry. In an article by PBS’s American Experience, Triangle Fire: Clara Lemlich and the Uprising of the 20,000, they write:

“Like many Jewish and Italian immigrant laborers, Lemlich joined the textile-manufacturing workforce only two weeks after arriving in New York. At the Gotham shirtwaist factory, women worked 11 hours a day, six days a week, for starting wages of $3 a week — conditions that reduced workers ‘to the status of machines,’ wrote 17-year-old Lemlich. Appalled by these circumstances, Lemlich joined the executive board of a local chapter of the International Ladies’ Garment Workers’ Union (ILGWU), a relatively new organization gaining momentum in the fight for workers’ rights. In that role, Lemlich led picket lines, wrote opinion pieces, and organized strikes to improve factory conditions. Lemlich and her supporters were often physically harmed by policemen and thugs hired by factory owners. In one case Lemlich was hospitalized after a beating she received while standing in the picket line.”

(https://www.pbs.org/wgbh/americanexperience/features/biography-clara-lemlich/)

On November 22nd, 1909, Lemlich helped incite a strike that ultimately proved instrumental to industrial labor reform.

You can learn all about the Triangle Shirtwaist Fire, as well as Clara Lemlich, at the memorial website, https://trianglememorial.org/clara-lemlich/. The book Triangle: The Fire That Changed America, by David Von Drexel, is also a comprehensive work on the subject.

I’d also like to take a moment to acknowledge that many may find the sensationalism and voyeuristic methods Dr. Couney used with the incubator baby sideshows off-putting, even offensive. I would ask that you keep in mind that this was a very different time than we live in today. Several books and articles in my research indicate that this was indeed the only chance premature infants had to live. This is also true for the people who were subjects of the “freak shows” at the time:

“For the most part, if these people were not making a living in the sideshow, they’d be dying slowly in institutions.”

Carney Folk: The World’s Weirdest Sideshow Acts, by Francine Hornberger

“...the cultural undercurrent was clear—anyone imperfect, anyone who might grow up with an impairment wasn’t worth saving.”

The Strange Case of Dr. Couney: How a Mysterious European Showman Saved Thousands of American Babies, by Dawn Raffel, p. 159

While we may cringe at the means, exploitation was the only way some of the most marginalized people at the time could survive. To his credit, Dr. Couney never asked or accepted money from his infants’ families—and this despite the fact that a single incubator cost over one million dollars in today’s currency (https://maximumfun.org/episodes/sawbones/sawbones-baby-show/).

There are volumes I could write about all the things I learned while researching this book. Indeed, volumes have been written. What I hope most that readers will take away from this snippet of Dr. Couney’s contributions to history is that one person believing in the most marginalized can change the world when they have the courage to do something everyone thinks is crazy. Maybe this will inspire someone else to do the same, for the sake of the despised, the overlooked, the misunderstood, and the forgotten.