Baker, S. Josephine (1873–1945)

American physician who became a major figure in public health reform and helped save infants of poor and immigrant women in the tenements of New York City. Name variations: Sara Josephine Baker. Born on November 15, 1873, in Poughkeepsie, New York; died of cancer on February 22, 1945, at New York Hospital; daughter of Orlando D.M. Baker (a lawyer) and Jenny Harwood (Brown) Baker; attended public school in Poughkeepsie; graduated Women's Medical College, New York Infirmary, M.D., 1898; graduated Bellevue Medical College (New York University), Doctor of Public Health, 1917; lived with Florence Laighton; never married; no children.

Moved from Poughkeepsie to New York City to attend medical school (1894); after a one-year internship in Boston, opened private practice in New York (1901); began work with health department (1902); appointed assistant to Commissioner of Health (1907); appointed director of the Bureau of Child Hygiene of the New York Department of Health (1908-23); founded American Child Hygiene Association (1908); founded Children's Welfare Federation (1911); lectured on child hygiene at Columbia and New York universities; became consultant to the U.S. Public Health Service Children's Bureau; served as an infant welfare activist throughout her life.

Selected publications:

Fighting For Life (an autobiography, 1939); Healthy Mothers (1920); Healthy Children (1920); Healthy Babies (1920); The Growing Child (1923); Child Hygiene (1925).

In the early 1900s, when Sara Josephine Baker began her medical work in the slums of New York City, babies died at the rate of 1,500 a week during hot summer weather; one-third of all deaths in the city were of children under five years of age. During World War I, according to Baker, it was "six times safer to be a soldier in the trenches of France than to be born a baby in the United States." In her autobiography, Fighting for Life, the physician who became a leader and a reformer in the field of child health describes the experiences that led her to realize how many such deaths were unnecessary, the result primarily of ignorance, neglect of basic cleanliness, and general urban despair. During her career, she would save the lives of thousands of babies.

Born in Poughkeepsie, New York, on November 15, 1873, the child who was to become known as the physician S. Josephine Baker was the daughter of Orlando D.M. Baker, a lawyer, and Jenny Harwood Brown , who was in the first class to graduate from Vassar College. Baker's maternal grandmother was Arvilla Danforth Brown , descended from a prominent Boston family involved in the founding of Harvard College.

In the small city of Poughkeepsie, Baker grew up among the conventional traditions of a moderately wealthy family. In Fighting for Life, her memories are of a happy childhood shared with a brother and two sisters, one of whom died at a young age, and parents who were involved in their community and closely associated with Vassar activities. Students from the college were often guests in the Baker home, and once, when Josephine was ill, the Amherst College Glee Club came to her house to sing for her.

Until age 16, Josephine, who always went by her middle name, assumed that she would attend Vassar. When the unexpected death of her father and brother left an inheritance too small to support her, her mother, and her sister who was in poor health, she decided to bypass the possibility of attending Vassar on scholarship. Instead, she chose to use $5,000 of the family inheritance to support herself while going to medical school.

In an era when few women became physicians and women in medicine were not held in high regard, Baker welcomed the challenges of her chosen field. As she wrote later, "I am thoroughly convinced that obstacles to be overcome and disapproval to be lived down are strong motive forces." After taking a year to study for the New York Regents Exam, which was required for medical school entry, she enrolled at the Women's Medical College at New York Infirmary

in 1894, when she was 21. Headed by Emily Blackwell , M.D., sister of Elizabeth Blackwell , who had been the first woman medical graduate educated in the United States, Baker's chosen school was known for its high standards. She graduated in 1898, one year before the school merged with Cornell University Medical School and became coeducational.

In the summers during her medical school years, Baker worked as a laboratory technician at a sanitarium in a town not far from Poughkeepsie, where she had spent her childhood summers. At medical school, she became friends with her classmate Florence Laighton , with whom she was to work and live for the rest of her life. After graduation, both went to Boston, where they did one-year internships at New England Hospital for Women and Children, one of the few institutions where women were accepted as interns. It was during this period that Baker became aware of the problems of poverty-stricken women living in the Boston slums, a foretelling of her later work in New York City.

In 1900, Baker and Laighton returned to New York and opened a general medical practice together. On the excuse that it would be needed for house calls, Baker bought her first automobile, a Prescott steamer, but the car also proved to be a joyous adventure for the two young women. In 1901, because the practice was not generating much money, Baker applied to the New York City Department of Health for the job of a medical inspector. With the recommendation of a lawyer acquaintance, she was hired to inspect school children for contagious diseases by what was then a highly corrupt city government at Tammany Hall.

In 1902, a new commissioner began the political cleanup and reorganization of the city's health department. Baker was offered a more secure position, at first as a summer job, in which she searched out sick babies in the area of New York City known as Hell's Kitchen. Spending a part of each day visiting families and examining babies from tenement to tenement, Baker eventually realized that many of the medical inspectors who preceded her had lied about visits they didn't actually make. Shocked and frustrated by the high death rate among her infants and the seeming impossibility of doing anything about it, she gained some understanding of the corruption not only in the Tammany Hall administration but throughout the ranks of the city government.

The force behind New York's public health campaign against infant mortality was S. Josephine Baker.

—Richard Meckel, 1990

In 1907, Baker saw her opportunity to make changes after she was given the title of assistant to the commissioner of health. In Fighting for Life, she relates her duty as a self-described troubleshooter, particularly in tracking down and arresting "Typhoid Mary" (Mary Mallon ), a woman who became notorious as a typhoid carrier and the source of a number of outbreaks of the disease in New York. While this success gained Baker some notoriety in the New York newspapers, she remained primarily interested in child health and in attempts to reduce and prevent infant death.

In the summer of 1908, Baker held the title of chief of the Division of Child Hygiene when she conducted a successful demonstration of ways to reduce infant death rates. She employed city school nurses, available for the summer season, to visit all newborns in the district with the highest infant mortality. By summer's end, she was able to show a record of 1,200 fewer infant deaths in the district than the previous year. The success assured her financial and political support for her new division, which Baker continued to head from 1908 to 1923. By the time she retired, the goal the doctor had set for herself—that all the country's 48 states would have set up divisions of Child Hygiene—had been achieved.

Under Baker's direction, New York's division initiated many activities. It set up Baby Health Stations as support centers for helping immigrant mothers to care for their infants, combining the distribution of free or low-cost milk with the education of the women about healthy ways to feed, clothe, and care for their babies. In response to the problem of "the girl child of the poor forced by poverty to take over the care of the next youngest child because the mother is working," as she describes in Fighting for Life, Baker instituted Little Mothers' Leagues, where the young girls were taught lessons in care they could take back to their working mothers. Baker made sure that midwives were registered and taught to apply eye drops to prevent eye infections in newborns, and also developed a baby dress pattern, later picked up and sold by McCall's patterns, for lightweight clothing that simplified the dressing of newborns and avoided the tight swaddling traditional among many immigrant mothers. The innovation was considered so beneficial that Metropolitan Life Insurance Company ordered 200,000 of the patterns to distribute to its policyholders.

In another dramatically successful experiment, Baker tackled the problem of the high death rates among the orphaned, premature, and abandoned infants assigned to foundling hospitals. Though well taken care of in a hygienic setting, the babies were dying, nevertheless, at rates of about 50%. Baker began placing the foundlings in foster homes. Under the supervision of the Bureau of Child Hygiene, poor tenement mothers, experienced in raising healthy families, were paid ten dollars per month for the babies' care. Within four years, the death rates among these high-risk cases had dropped to 30%.

In 1911, Baker's division sponsored an infant welfare exhibition that demonstrated baby bathing, maternal hygiene, home sanitation, infant clothing, and other hygiene measures, which became the model for similar events held in other cities. The idea of "educated motherhood" was also spread through the sponsoring of Baby Weeks throughout the country. Popular magazines began to feature articles on mothering, and, in 1922, Ladies' Home Journal contracted with Baker to do a monthly advice column on baby and child care. The activities of the Division of Child Hygiene were not always met with approval by the medical community in New York City. When the institution was criticized for reducing the business of doctors through such programs as school physicals, Baker responded that the complaints were a great compliment to her division's success.

Outside of her medical work, Baker also became active in women's suffrage. She belonged to Heterodoxy, a New York club made up of women from various social and economic movements, including Fannie Hurst and Mabel Dodge Luhan , who held luncheon meetings to hear lectures on topics of current significance. Although not an outspoken leader on the issue of suffrage, Baker participated in the Fifth Avenue suffrage parades and was seen by some as a radical, to the degree that she was blacklisted by the Daughters of the American Revolution. She became the first woman lecturer at the Bellevue Medical College-New York University.

In 1917, Baker received a Doctor of Public Health degree from Bellevue Medical College. Her thesis, on school ventilation and the transmission of respiratory diseases, led the following year to the adoption of practices to prevent the spread of influenza among school children.

In 1923, Baker followed her retirement, at age 50, from the Division of Child Hygiene with lecture tours around the country on topics of child care and continued to write her column for the Ladies' Home Journal. She wrote books on child care in 1923 and 1925, before taking up her autobiography, published in 1939, where she reviewed her successes along with those areas of effort where she had achieved less success, particularly in child labor. Baker felt an urgent need for more stringent child labor laws to protect the health of older children; she was also deeply concerned about the continued high infant mortality in the U.S. compared to other countries. In 1934, she made a three-month trip to the Soviet Union, where she was impressed with the health of children she saw but also noted the regimentation and lack of spirit among the population. Attracted to what she called "state medicine" in the ideal, she had serious second thoughts about some of the negative aspects of its implementation.

Josephine Baker lived for many years in Belle Meade, New Jersey. By the time she died of cancer at age 71, in 1945, her ideas on child care and prevention of illness in children had become commonplace among the uneducated poor as well as the educated middle class.

sources:

Baker, S. Josephine. Fighting for Life. NY: Macmillan, 1939 (reprinted by NY: Arno Press, 1974).

Duffy, John. A History of Public Health In New York City. NY: Russell Sage Foundation, 1974.

Meckel, Richard A. Save The Babies. Baltimore, MD: Johns Hopkins University Press, 1990.

Lois A. Monteiro , Professor of Medical Science and Associate Dean, Brown University School of Medicine, Providence, Rhode Island