Sometime in the late 1870s, a Parisian obstetrician named Ste- phane Tarnier took a day off from his work at Maternite de Paris, the lying-in hospital for the city’s poor women, and paid a visit to the nearby Paris Zoo. Wandering past the elephants and reptiles and classical gardens of the zoo’s home inside the Jardin des Plantes, Tarnier stumbled across an exhibit of chicken incubators. Seeing the hatchlings totter about in the incubator’s warm enclosure triggered an association in his head, and before long he had hired Odile Martin, the zoo’s poultry raiser, to construct a device that would perform a similar function for human newborns. By modern standards, infant mortality was staggeringly high in the late nineteenth century, even in a city as sophisticated as Paris. One in five babies died before learning to crawl, and the odds were far worse for premature babies born with low birth weights. Tarnier knew that temperature regulation was critical for keeping these infants alive, and he knew that the French medical establishment had a deep-seated obsession with statistics. And so as soon as his newborn incubator had been installed at Maternite, the fragile in fants warmed by hot water bottles below the wooden boxes, Tarnier embarked on a quick study of five hundred babies. The results shocked the Parisian medical establishment: while 66 percent of low-weight babies died within weeks of birth, only 38 percent died if they were housed in Tarnier’s incubating box. You could effectively halve the mortality rate for premature babies simply by treating them like hatchlings in a zoo.
Tarnier’s incubator was not the first device employed for warming newborns, and the contraption he built with Martin would be improved upon significantly in the subsequent decades. But Tarnier’s statistical analysis gave newborn incubation the push that it needed: within a few years, the Paris municipal board required that incubators be installed in all the city’s maternity hospitals. In 1896, an enterprising physician named Alexandre Lion set up a display of incubators—with live newborns—at the Berlin Exposition. Dubbed the Kinderbrutenstalt, or “child hatchery,” Lion’s exhibit turned out to be the sleeper hit of the exposition, and launched a bizarre tradition of incubator sideshows that persisted well into the twentieth century. (Coney Island had a permanent baby incubator show until the early 1940s.) Modern incubators, supplemented with high- oxygen therapy and other advances, became standard equipment in all American hospitals after the end of World War II, triggering a spectacular 75 percent decline in infant mortality rates between 1950 and 1998. Because incubators focus exclusively on the beginning of life, their benefit to public health—measured by the sheer number of extra years they provide—rivals any medical advance of the twentieth century. Radiation therapy or a double bypass might give you another decade or two, but an incubator gives you an entire lifetime.
In the developing world, however, the infant mortality story remains bleak. Whereas infant deaths are below ten per thousand births throughout Europe and the United States, over a hundred infants die per thousand in countries like Liberia and Ethiopia, many of them premature babies that would have survived with access to incubators. But modern incubators are complex, expensive things. A standard incubator in an American hospital might cost more than $40,000. But the expense is arguably the smaller hurdle to overcome. Complex equipment breaks, and when it breaks you need the technical expertise to fix it, and you need replacement parts. In the year that followed the 2004 Indian Ocean tsunami, the Indonesian city of Meulaboh received eight incubators from a range of international relief organizations. By late 2008, when an MIT professor named Timothy Prestero visited the hospital, all eight were out of order, the victims of power surges and tropical humidity, along with the hospital staff’s inability to read the English repair manual. The Meulaboh incubators were a representative sample: some studies suggest that as much as 95 percent of medical technology donated to developing countries breaks within the first five years of use.
Prestero had a vested interest in those broken incubators, because the organization he founded, Design that Matters, had been working for several years on a new scheme for a more reliable, and less expensive, incubator, one that recognized complex medical technology was likely to have a very different tenure in a developing world context than it would in an American or European hospital. Designing an incubator for a developing country wasn’t just a matter of creating something that worked; it was also a matter of designing something that would break in a non-catastrophic way. You couldn’t guarantee a steady supply of spare parts, or trained repair technicians. So instead, Prestero and his team decided to build an incubator out of parts that were already abundant in the developing world. The idea had originated with a Boston doctor named Jonathan Rosen, who had observed that even the smaller towns of the developing world seemed to be able to keep automobiles in working order. The towns might have lacked air conditioning and laptops and cable television, but they managed to keep their Toyota 4Runners on the road. So Rosen approached Prestero with an idea: What if you made an incubator out of automobile parts?
Three years after Rosen suggested the idea, the Design that Matters team introduced a prototype device called the NeoNurture. From the outside, it looked like a streamlined modern incubator, but its guts were automotive. Sealed-beam headlights supplied the crucial warmth; dashboard fans provided filtered air circulation; door chimes sounded alarms. You could power the device via an adapted cigarette lighter, or a standard-issue motorcycle battery. Building the NeoNurture out of car parts was doubly efficient, because it tapped both the local supply of parts themselves and the local knowledge of automobile repair. These were both abundant resources in the developing world context, as Rosen liked to say. You didn’t have to be a trained medical technician to fix the NeoNurture; you didn’t even have to read the manual. You just needed to know how to replace a broken headlight.
Before his untimely death in 2002, the evolutionary biologist Stephen Jay Gould maintained an odd collection of footware that he had purchased during his travels through the developing world, in open-air markets in Quito, Nairobi, and Delhi. They were sandals made from recycled automobile tires. As a fashion statement, they may not have amounted to much, but Gould treasured his tire sandals as a testimony to “human ingenuity.” But he also saw them as a metaphor for the patterns of innovation in the biological world. Nature’s innovations, too, rely on spare parts. Evolution advances by taking available resources and cobbling them together to create new uses. The evolutionary theorist Francois Jacob captured this in his concept of evolution as a “tinkerer,” not an engineer; our bodies are also works of bricolage, old parts strung together to form something radically new. “The tires-to-sandals principle works at all scales and times,” Gould wrote, “permitting odd and unpredictable initiatives at any moment—to make nature as inventive as the cleverest person who ever pondered the potential of a junkyard in Nairobi.”
You can see this process at work in the primordial innovation of life itself. We do not yet have scientific consensus on the specifics of life’s origins. Some believe life originated in the boiling, metallic vents of undersea volcanoes; others suspect the open oceans; others point to the tidal ponds where Darwin believed life first took hold.
Many respected scientists think that life may have arrived from outer space, embedded in a meteor. But we have a much clearer picture of the composition of earth’s atmosphere before life emerged, thanks to a field known as prebiotic chemistry. The lifeless earth was dominated by a handful of basic molecules: ammonia, methane, water, carbon dioxide, a smattering of amino acids, and other simple organic compounds. Each of these molecules was capable of a finite series of transformations and exchanges with other molecules in the primordial soup: methane and oxygen recombining to form formaldehyde and water, for instance.
Think of all those initial molecules, and then imagine all the potential new combinations that they could form spontaneously, simply by colliding with each other (or perhaps prodded along by the extra energy of a propitious lightning strike). If you could play God and trigger all those combinations, you would end up with most of the building blocks of life: the proteins that form the boundaries of cells; sugar molecules crucial to the nucleic acids of our DNA. But you would not be able to trigger chemical reactions that would build a mosquito, or a sunflower, or a human brain. Formaldehyde is a first-order combination: you can create it directly from the molecules in the primordial soup. The atomic elements that make up a sunflower are the very same ones available on earth before the emergence of life, but you can’t spontaneously create a sunflower in that environment, because it relies on a whole series of subsequent innovations that wouldn’t evolve on earth for billions of years: chloro- plasts to capture the sun’s energy, vascular tissues to circulate resources through the plant, DNA molecules to pass on sunflower- building instructions to the next generation.
Johnson, S. (2010). Where good ideas come from: The natural history of innovation. Penguin UK.