The Machine in the Nursery

TECHNOLOGY AND CULTURE Book Reviews 177 standards for all pesticides without the need to justify the costs asso­ ciated with stricter standards. Wargo also points to other compli­ cations associated with the development of U.S. pesticide policy, including a division of authority between the Environmental Protec­ tion Agency (EPA), the Food and Drug Administration (FDA), and the U.S. Department ofAgriculture (USDA); flaws in the way regula­ tors sample for pesticide residue; conflicting goals and approaches set by different laws; the inability of current law to deal satisfactorily with the cumulative effect ofpesticides; the global transport ofpesti­ cides; and the difficulty of measuring health risks. Anyone seeking to understand the strengths and weaknesses of current U.S. laws and regulations aimed at limiting exposure to pesti­ cides will find this book informative, balanced, and authoritative. As an example ofhow laws and regulations can affect the development of science and, to a much lesser extent, technology, this volume serves as an illustrative case study without the author’s attempting to support a specific theoretical model of scientific or technological change. Hugh Gorman Dr . Gorman is assistant professor ofenvironmental policy and history at Michigan Technological University. The Machine in the Nursery: Incubator Technology and the Origins ofNew­ born Intensive Care. ByJeffrey P. Baker. Baltimore: Johns Hopkins UniversityPress, 1996. Pp. x+247; illustrations, tables, notes, bibli­ ography, index. $45.00 (hardcover). Infant incubators have appeared in many guises, ranging in com­ plexity from simple warming jackets to completely enclosed boxes designed to provide a mechanically controlled artificial environ­ ment. Baker follows the infant incubator from its introduction by the French obstetrician Etienne Stephane Tarnier, in 1880, through periods of public support and medical derision, avid adoption and devastating consequence, to 1922, when Julius Hess’s device, vastly different from Tarnier’s, was installed in the first permanent Ameri­ can premature nursery. It is tempting to view infant incubators as an example ofa seminal technology, developed in response to the medical challenge of pre­ mature babies, that prompted the development of a specialty prac­ tice, in this case neonatology. Baker’s tale of the waxing and waning fortunes of infant incubators and those who advocated their use in France and the United States instead demonstrates how convoluted the path was. The design and dissemination ofinfant incubators pre­ ceded any medical designation of prematurity as a particular medi­ cal problem, or any distinction between premature infants and other 178 Book Reviews TECHNOLOGY AND CULTURE fragile infants. In fact, infant incubators helped define premature birth as a dangerous phenomenon and the premature infant as one requiring special care different from the care required for other ill infants. Although the infant incubator metwith bursts ofenthusiasm, disil­ lusionment, abandonment, and readoption in both France and the United States, the fundamental tenets supporting its use in the two countries differed. As Baker shows, Tarnier’s relatively simple infant warming device was designed and adopted in France as a means of promoting a mother’s role in nurturing her infant, whereas Ameri­ can incubators of various designs were promoted on the basis that scientific control of the environment and nutrition for frail infants was vastly superior to the mother’s care in ensuring their viability. Tarnier’s efforts to maintain viable infants (and their mothers for future childbearing) resonated well with French national sentiment, verging on hysteria by the 1880s, about their population decline. In the United States, more so than in France, the incubator served as a professional battleground between obstetrics and pediatrics, both newly emerging medical specialties tentatively encroaching on the traditional turf of the mother. American obstetricians, unlike their French counterparts who dominated maternity hospitals, had litde institutional base for their practice and little clout in inducing hospi­ tals to commit substantial funds and personnel to incubator nurser­ ies, where the obstetrician could provide short-term acute interven­ tion for a temporarily fragile but otherwise healthy infant. Although American pediatricians had institutional bases in infant hospitals, their perspective was formed by devastatingly high mortality rates among chronically malnourished and diseased infants, often or­ phaned or from impoverished families who came under their care in charity hospitals, rather than by any experience with healthy infants in temporary

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