Book Review: The Strange Case of Dr. Couney: How A Mysterious European Showman Saved Thousands of American Babies (Dawn Raffel)

Reviewed by Shane Neilson

Dawn Raffel's creative nonfiction work on "Dr." Martin Couney, a non-medical charlatan responsible for saving the lives of thousands of premature infants, makes for an engaging read. Before I discuss the book's strengths and weaknesses on my way to unpacking what I feel are some central paradoxes and ironies at work in ableism, I will explain the premise of the book so that the paradoxes and ironies have some foundation to stand on.

Martin Couney is a historical figure responsible for training physicians who would become key contributors to the nascent field of neonatology in the United States from the period extending from the turn of the twentieth century until about the early 1940s. Raffel first came across his beckoning story at the Coney Island Museum and this encounter sparked her investigation into his life. Relying upon partial (but essential) biographical work done by that lovable species of physician, the amateur medical historian, Raffel pieces together accounts, haunts archival spaces, and interviews the dwindling number of living graduates from Coney's proto-neonatal intensive care units called, more unassumingly, "nurseries." She cultivates these living sources by using groups on social media.

The postcard stamp version of Couney's story is this: a young Jewish man from a town in Poland immigrates to America after acquiring some experience with incubator technology that was then at the cutting edge of medicine. This technology was controversial, expensive, high maintenance, and relatively untested. Accumulating some experience in Europe through an association with its inventor, Couney understood how he could make a living by saving children who were, up to that point, left for dead by the medical establishment.

Couney's nurseries operated as sideshow concessions financed by gate or by donation. These concessions functioned only during the summer and were usually, although not always, run within the world fair phenomenon that occurred through the late 19th century and first half of the 20th century. Couney hides his Jewish origins and uses the title of "Dr." in order to increase his chances for success. The story also involves Couney's wife, Maye, his daughter, Hildegarde, and other nurses who were crucial parts of Couney's plan.

What Raffel is able to piece together is quite limited in biographical terms.There are many reasons for the limitations that are not her responsibility. First of all, Couney and his circle are long dead. Such records that remain are scattered widely. The parents of the children placed in Couney's care are also long deceased. What Raffel had to rely on were the materials available, and though she discovered a great deal, the unfortunate truth is we'll never really know much about Martin Couney as a person– there will never be, for example, a convincing interiority created for the man based on primary sources. Another limitation is that Couney lived in prevailing conditions of anti-Semitism and elided his Jewish identity so that he could be successful. His work with premature infants was so controversial that it was an understandable tactic to avoid additional scrutiny and organized resistance.Therefore Couney was somewhat mysterious about his own origins. Add in the fact that he fabricated a medical provenance for the purposes of showmanship and legitimacy, and one has the makings of a man who prefers not to be known for who and what he is.

This often means that Raffel resorts to speculation about what Couney might have thought on a particular day, adding to the relatively anemic prose account but adding to the historical record not at all:

We can imagine the scene: The courtly European, well known to the mâitre d', and the Cleveland-born doctor linger over rare gigot and no few glasses of wine. The room begins to empty for the evening. Martin Couney has cleaned his plate of every delectable morsel, soaking the juices into the final iota of chewy bread. He waxes passionate about saving the tiniest lives, invokes his French mentor – the great Pierre Budin! – and at the mention of his late wife, Maye, sheds a tear into a linen handkerchief, weepily sentimental in old age (22).

The passage goes on. Some readers might like this fancy, but there are a couple of other problems – all related to the lack of primary materials – that suggest an account straining for its own substance. Including the epilogue and prologue, there are 45 chapters in a text that is, minus notes, 229 pages long. Some chapters constitute a single page despite almost half that space given to chapter title. If you interpret such numbers as meaning that the chapters do not tell a linear tale and instead are small fragments that Raffel was able to glean, such as peripheral accounts of how one of Couney's babies turned out late in life, for example, or instead are small stories-about-getting-the-story in which Raffel discusses whom she spoke to and why rather than weave the information she was able to glean into a more comprehensive narrative, then you're right. Even the strong contextual material she provides on American politics during the period covered comes off as padding, which is a shame. Seen from a different perspective, Raffel could be said to be writing a cultural biography. In this light she acquits herself better, if not with depth. For example, speaking of Couney's voyage to America, Raffel writes:

The New World was their destination, but the old one they were leaving was in a transformative period. In Turin, forty-four-year-old opium-addicted Friedrich Nietzsche would enter his last productive months. The year before, he had completed On The Genealogy of Morals, a text that Benito Mussolini would later twist to his own ends. In Silesia, Gregor Mendel was dead, but the seeds of the science of genetics – and reposing within them, eugenics – had been planted. In Arles, Vincent van Gogh was ripping visual paradigms; in a year, he would sever his ear. In Paris, Gustave Eiffel was constructing something exceptional for the next Exposition Universelle. Elsewhere in the City of Light, Étienne Tarnier was tinkering while his interns, former and current, eyed succession. And at the port of Hamburg, an eighteen-year-old from Krotoschin was boarding the Gellert, steerage class. His name was [Martin Couney.] (33-4)

The background information is fascinating, but the larger cultural moment is glossed as opposed to systematically constructed. Furthermore, because the focus is the search for Couney and not a comprehensive investigation of the intersections between anti-Semitism, ableism, medical intransigence, and freak shows in America, we're treated to those themes but not given an account with any real depth. It's popular history, but a popular history spread thin.Add to the mix compelling anecdotes about cruelty to circus animals and one realizes that though the individual pieces are interesting, the many threads of prejudice are never woven into a meaningful analysis.

Yet some stories are what they are and they can't be more than what they are; some stories are meant to be exactly as they are. I think this is such a story, based on the extreme challenge set in writing an account of an obscure figure like Martin Couney who was allergic to negative attention because it threatened his business and the good work he was doing.Couney needed to strike a difficult balance. He needed publicity to keep earning an income but he also needed to be tremendously discreet so that his lack of medical credentials and his Jewishness did not become targets. Couney was periodically attacked by people who claimed to be acting in the name of morals (the neonates were housed next to heavily stigmatized members of society, which was objectionable to many), but should they have succeeded in shutting Couney down, that act would have severely impeded the development of neonatology and many neonates would have died. I therefore wonder if the form of the story connects in some way with the nature of dis/ability, of episodic understanding and pressures placed on identity and personhood by ableism. Is it possible, in other words, to reconstruct a full account of a historical figure from the early twentieth century who was under tremendous pressures like ableism (especially), anti-Semitism, and the animus of professional medicine? Are the fragments simply not meant to be reassembled into a coherent, complete account because those fragments and the resultant form of this narrative enact the troubled tale of care for disabled persons generally?

For a more comprehensive story of how Couney saved many infants in an era of medical ineptitude concerning premature infants – the fact is indisputable based on the very high profile Couney enjoyed amongst several important physicians of the day and their corroborating accounts – I encourage you to read Raffel's book. I see no benefit to extensively retailing the book's more colorful moments and thereby recapitulating her text. To make a pun: Raffel's book is worth the price of admission.I am now going to unpack some of the paradoxes inherent to the tale that occur under the sign of ableism.

The first paradox is the most visible one. Couney had to mount his nurseries on the midway as sideshow concessions. This was the only way for him to do the work and to make a living himself. What this meant is the shows were often mounted close to sex work: "Infant Incubators with Living Babies' – the sign so big you'd have to be dead to miss it. Just next door, inside the Streets of Paris, Sally Rand was doing her scandalous fan dance that made her look naked" (8). Because Couney had to operate his nurseries next to shows like this, the moral police would object to the presence of babies in immoral environments even though the babies would have died without Couney. The other negative effect with this proximity was association with the stigma afforded non-normative bodies – the "freaks" – and I confess some misgivings with regards to Raffel's prose on this subject. There is a sensationalistic aspect to her prose throughout the text, and when she covers Betty Lou Williams on page 183, for example, in addition to providing a photograph, I am conflicted about the motivations behind reproducing spectacle:

At Ripley's Odditorium on the midway, a two-year-old named Betty Lou Williams was causing a sensation. One of fifteen children born to an impoverished sharecropper parents in rural Georgia, Betty had a beautiful brown face, an extra arm, and a pair of stunted, helpless legs emerging from the left side of her torso. Rich or poor, in 1934 no surgery could have made Betty resemble other children. Her choices were to live in isolation or make a substantial fortune as a freak. After the fair, she traveled the country and her income shot up to as much as $500 a week. Betty provided for her siblings, putting them through college, before she died at the age of twenty-two. In the most famous photo of her, Betty is hugging herself. She looks as if she has somebody else alive in her body, craving escape. (183)

I celebrate the mention of this body but am worried about what a picture of this non-normative young black body is meant to do on the next page when, thinking contextually, the tale focuses on premature infants. At any rate, it is true that, based on their shared spatial context on the midway premature babies were equated with so-called abnormal and monstrous bodies. This juxtaposition says quite a lot about ableist society in the first place and, for me, serves as a kind of parable about how we conceive of the human body. Premature infants are the most powerless members of society, doomed to die without specialized care. That the only way they could be cared for was for them to be relegated to a sideshow speaks volumes about how Americans valued life at that time. Their valuation on life was capitalistic, for such premature infants were often born to indigent parents. People who could not afford the rare opportunity for specialized care more often than not ended up requiring Couney's services. Yet not only the indigent needed Couney, bringing to bear another paradox: Couney was often the only hope for survival. Medical dogma at the time was that premature infants weren't worth saving because of their supposed hopeless prospects of survival. There was no knowledge of how preemies might be cared for, and Raffel provides several anecdotes of families being convinced of the necessity of allowing their premature infants to die. Ableism underwrote this practice, for the cultural discourse at the time was that such neonates would contribute to the weakening of the genetic strength of the nation. Thus the tragedy was that babies could indeed be saved, and Couney and his nursing team were saving them, but organized medicine preferred, in its ignorance, to not bother to heed or to invest in caring for these children out of ignorance in the best case and out of a eugenics slant in the worst. Here is an opinion Raffel dug up from the Buffalo Medical Journal:

The question naturally presents itself as to whether this is worthwhile; whether the race as a whole does not suffer from the preservation of these weaklings to perpetuate their kind […] Medical science is a little illogical in respect to the results obtained, and in its efforts to preserve the individual it forgets to consider the effects of such action upon the race as a whole. Every stock raiser appreciates the necessity of healthful environment, abundant food and fresh air in maintaining a breed of animals in a state of high physical development; and sanitary science insists upon the necessity of these conditions for the physical uplifting of the human race. The stock raise [sic], however breeds only from the most sound, healthy and perfect animals, and thus secures a physical conformation and constitution upon which the conditions of environment can act most advantageously. Medical science, on the other hand, does not hesitate to undo the advantages gained by the hygienic rules it has promulgated, by preserving the weakling, the deformed, and the tuberculous, and placing these defectives – who would otherwise surely have perished in an active struggle for existence – in a condition to transmit their deficiencies, deformities and vices to generations as yet unborn. (68-9)

In contrast with this opinion, Raffel makes a compelling case that the field of neonatology in America owes the illegitimate Couney for its own birth. She demonstrates that key physicians like Dr. Julius Hess, men who built the field, attribute him as their mentor and thought of him highly. Thus, in one of the many ironies in the text, Martin Couney, the illegitimate doctor, was responsible for training legitimate physicians to care for neonates and thereby change the philosophy of medicine from within. Two of Raffel's interview subjects, twins, explain their surprise after learning they were part of a sideshow exhibit:

"We'd always assumed we were in the Science Hall," Jean said. "We were in our forties or so when we went to an exposition that showed all of the world's fair. And we were on the midway! Like a freak show! We were so shocked to find out." But that shock was amused: a funny midlife treat, like a surprise in a Christmas stocking. (79)

That they assumed they were in a scientific exhibition makes perfect sense. But in the Science Hall was, much more likely, a display extolling eugenics. This brings us to the final paradox: Couney's nurseries often ran in the same fairs that had eugenics exhibits in their Science Pavilions.These directly advocated for selective breeding and the extermination of humans born with non-normative bodies. Rather than invest in saving children that could be saved with relative ease, society positioned premature infants to require the services of a circus showman while creating pseudoscientific exhibits nearby that were designed to reinforce – even militarize – ableism.

All of these problems are enduring ones. I do not consider them to be settled or to be of historical interest only. As set up by Raffel in the past, these same problems define how we look at non-normative body-minds today, yet with the more sinister spectre of euthanasia and Medical Assistance in Dying. In this sense, the book is a morality tale – mythic, even. A good man immigrates to America in the hopes of achieving the cliched American dream. He lies about his background and qualifications. He stages a successful series of medical interventions in the lives of premature infants via his nurseries year after year. Thousands of children live full lives even considering the strictest dictates of ableism: they work, marry, and have children. In fact, children do better in his nursery than they do years later in the medical settings his work made possible because Couney did not, as physicians did, oversupply them with oxygen and thereby cause blindness. Medicine eventually comes around to Couney's way of thinking because of his impressive persistence in the face of unsavoury surroundings, institutional harassment, and institutional intransigence. He hides his true identity in fear of racism (shown by Raffel in a rare moment to work hand in hand with ableism) and his own lies, making his enterprise even more precarious. He dies in decline.

He's a flawed hero, but around him, much bigger problems raged. Indigenous people were represented as "freaks" on the midway. Non-normative bodies were offered as spectacle (albeit this was a form of income for them, as well as community, and not so easily indicted). The eugenics debate had a material reality in regular society as exhibits and baby contests in these fairs. The Nazis admired American ingenuity in this regard and later put into practice American ideas.

Abstracted out of this tale is a simple truth: we treat badly the things we fear. We don't appreciate the beautiful things that are valuable in and of themselves. We don't want to be inclusive because that takes work, we only want things that will work for us. We are ignorant. The dis/abled will always be at risk from such a society, and Raffel's tale bears this out, page after page. Yet disability might also be the state or condition that redresses these problems in the end. That is the paradox I'm really pulling for.

Title: The Strange Case of Dr. Couney
Author: Dawn Raffel
Publisher: Blue Rider Press
Publication Date: 2018


Shane Neilson is a Canadian poet, physician, and critic from New Brunswick who is completing his PhD in English at McMaster. He published Dysphoria, the final volume in his affect trilogy, with PQL in 2017 and won the Walrus Poetry Prize in the same year. In 2018, Neilson will publish Constructive Negativity: Prize Culture, Evaluation, and Dis/ability in Canadian Poetry

with Palimpsest Press."