Fighting for Life
SARA JOSEPHINE BAKER (1873–1945) was born in Poughkeepsie, New York, and attended the Woman’s Medical College of the New York Infirmary. As the first director of New York’s Bureau of Child Hygiene from 1908 to 1923, Baker’s work with poor mothers and children in the immigrant communities of New York City dramatically reduced maternal and child mortality and became a model for cities across the country. On two occasions she helped to track down Mary Mallon, the cook who came to be known as Typhoid Mary. Baker wrote fifty journal articles and more than two hundred pieces for the popular press about preventive medicine, as well as six books: Healthy Babies, Healthy Mothers, Healthy Children (all 1920), The Growing Child (1923), Child Hygiene (1925), and her autobiography, Fighting for Life (1939). In the 1930s Baker, along with her partner of many years, the novelist Ida Wylie, and their friend Dr. Louise Pearce, moved to a two-hundred-year-old farm in New Jersey, where she lived until her death.
HELEN EPSTEIN is a writer specializing in public health and an adjunct professor at Bard College. She has advised numerous organizations, including the United States Agency for International Development, the World Bank, Human Rights Watch, and UNICEF. She is the author of The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa and has contributed articles to many publications, including The New York Review of Books and The New York Times Magazine.
FIGHTING FOR LIFE
S. JOSEPHINE BAKER
Introduction by
HELEN EPSTEIN
NEW YORK REVIEW BOOKS
New York
THIS IS A NEW YORK REVIEW BOOK
PUBLISHED BY THE NEW YORK REVIEW OF BOOKS
435 Hudson Street, New York, NY 10014
www.nyrb.com
Copyright © 1939 by S. Josephine Baker
Introduction copyright © 2013 by Helen Epstein
All rights reserved.
Cover image: George Bellows, The Cliff Dwellers, 1913
Cover design: Katy Homans
The Library of Congress has cataloged the earlier printing as follows:
Baker, S. Josephine (Sara Josephine), 1873–1945, author.
Fighting for life / by S. Josephine Baker; introduction by Helen Epstein.
p. ; cm. — (New York review books classics)
Includes index.
Reprint of: Baker, S. Josephine (Sara Josephine), 1873–1945. Fighting for life.
New York: The Macmillan Company, 1939. 264 p.
ISBN 978-1-59017-706-8 (paperback: alk. paper)
I. Title. II. Series: New York Review Books classics.
[DNLM: 1. Baker, S. Josephine (Sara Josephine), 1873–1945. 2. Physicians—New York City—Autobiography. 3. Child Mortality—history—New York City. 4. Child Welfare—history—New York City. 5. History, 19th Century—New York City. 6. History, 20th Century—New York City. 7. Public Health—history—New York City. WZ 100]
R690
610.92—dc23
[B]
2013020026
eISBN 978-1-59017-707-5
v1.0
For a complete list of books in the NYRB Classics series, visit www.nyrb.com or write to:
Catalog Requests, NYRB, 435 Hudson Street, New York, NY 10014
CONTENTS
Biographical Notes
Title page
Copyright and More Information
Introduction
FIGHTING FOR LIFE
Dedication
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
Photographs
INTRODUCTION
The Lower East Side of New York was one of the most densely populated square miles on the face of the earth in the 1890s. The photo-essayist Jacob Riis famously described it as a world of bad smells, scooting rats, ash barrels, dead goats, and little boys drinking beer out of milk cartons. Six thousand people might be packed into a single city block, many in tenements with sanitary facilities so foul as to repel anyone who dared approach. City health inspectors called the neighborhood “the suicide ward”; one tenement was referred to—in an official New York City Health Department report, no less—as an “out and out hog pen.”[1]
Diarrhea epidemics blazed through the slums each summer, killing thousands of children every week. In the sweatshops of what was then known as “Jewtown,” children with smallpox and typhus dozed in heaps of garments destined for fashionable Broadway shops. Desperate mothers paced the streets trying to soothe their feverish children, and white mourning cloths hung from every story of every building. A third of the children born in the slums died before their fifth birthday.
In the European farming villages where many of these immigrants came from, people spent most of their time outdoors in the fresh air and sunshine and seldom encountered more than a few hundred people in the course of lifetime. “Crowd diseases”—measles, dysentery, typhoid, diphtheria, trachoma, and so on—were rare, and the immigrants had little idea of how to prevent them. Some parents vainly tried to administer folk remedies; others just prepared the little funeral shrouds in silence.
It was in the 1890s that Sara Josephine Baker decided to become a doctor. Not the Josephine Baker who would become celebrated as a cabaret star and dance at the Folies Bergère in a banana miniskirt but the New York City public health official in a shirtwaist and four-in-hand necktie, her short hair parted in the middle like Theodore Roosevelt, whom she admired. By the time Baker retired from the New York City Health Department in 1923, she was famous across the nation for saving the lives of ninety thousand inner-city children. The public health measures she implemented, many still in use today, have saved the lives of millions more world-wide. She was also a charming, funny storyteller, and her remarkable memoir, Fighting for Life, is an honest, unsentimental, and deeply compassionate account of how one American woman helped launch a public health revolution.
Baker grew up in a modestly prosperous Poughkeepsie family and studied medicine at the Women’s Medical College in Manhattan, which was run by Emily Blackwell, the sister of the more famous Elizabeth, America’s first woman doctor. Baker graduated second in her class. The only course she failed was The Normal Child, taught by Dr. Annie Sturges Daniel, a pioneer health educator who also campaigned for better housing conditions for the poor. Baker had to retake the class and in studying for it became fascinated with “that little pest, the normal child” whom she would go on to make the focus of her career.
After graduation, Baker took an internship at the New England Hospital for Women and Children in Boston and then returned to establish a private practice in New York. She once examined the actress Lillian Russell, but most of her patients resided in the tin squatters’ shacks of Amsterdam Avenue and couldn’t pay her. In need of money, she applied for a job with the Department of Health and was hired in 1902.
Medicine in those days required a certain daring. While still in Boston, she almost killed a drunk who was beating his pregnant wife as Baker was trying to deliver their baby. As a New York City health inspector, she administered smallpox injections to snoozing hoboes in Bowery flophouses, fielded calls from Tammany politicians requesting that she hire their cast-off mistresses as nurses (she declined), and chased down the notorious cook Typhoid Mary through the streets of Manhattan. Baker had to sit on Mary all the way to the hospital to keep her in the ambulance.
Modern readers might be put off by Baker’s tendency—common in those days—to generalize about the various ethnic groups she encountered in the city’s variegated slums. Blacks come off well; the Irish all seem to have been slapstick drunks. However, she clearly understood that their misery and dissolution were part of a wider culture of official corruption and indifference to the poor, which afflicted even her own Health Department.
In the tenements of Hell’s
Kitchen, Baker “climbed stair after stair, knocked on door after door, met drunk after drunk, filthy mother after filthy mother and dying baby after dying baby.” Most of her fellow health inspectors didn’t bother to make rounds at all; they just forged their records and went on their way. Baker, who might well have been fired for making everyone else look bad, was lucky to have the support of the Tammany-affiliated but nevertheless reform-inclined mayor George McClellan, elected in 1903. He appointed a new health commissioner who dismissed the other inspectors and promoted Baker. In 1908, she was put in charge of the Health Department’s new Bureau of Child Hygiene, the first of its kind in the country.
There she changed the way we think about public health. Until then, the Health Department had sought to track down sick children and refer them to physicians, a mostly futile endeavor in the absence of antibiotics and other tools of modern medicine. Baker decided that the new bureau’s mission would instead be prevention. The city had an established and efficient system of birth registration. As soon as a child was born, her name and address were reported to the Health Department. Baker reasoned that if every new mother were properly taught how to feed and care for a baby and recognize the signs of illness, the mother would have a much better chance of keeping the child alive.
In her first year at the Bureau of Child Hygiene, Baker sent nurses to the most deadly ward on the Lower East Side. They were to visit every new mother within a day of delivery, encouraging exclusive breast-feeding, fresh air, and regular bathing, and discouraging hazardous practices such as feeding the baby beer or allowing him to play in the gutter. This advice was entirely conventional, but the results were extraordinary: That summer, 1,200 fewer children died in that district compared to the previous year; elsewhere in the city the death rate remained high. The home-visiting program was soon implemented citywide, and in 1910, a network of “milk stations” staffed by nurses and doctors began offering regular baby examinations and safe formula for older infants and the infants of women who couldn’t breast-feed. In just three years, the infant death rate in New York City fell by 40 percent, and in December 1911, The New York Times hailed the city as the healthiest in the world.
Articles about Baker’s lifesaving campaigns appeared in newspapers from Oklahoma to Michigan to California. In the late 1910s, she and other reformers drafted a bill to create a nationwide network of home-visiting programs and maternal and child health clinics modeled on the programs in New York. But the American Medical Association—backed by powerful Republicans averse to spending money on the poor—claimed the program was tantamount to Bolshevism. Baker was in Washington the day a young New England doctor explained the AMA’s position to a congressional committee:
“We oppose this Bill because, if you are going to save the lives of all these women and children at public expense, what inducement will there be for young men to study medicine?” Senator Sheppard, the chairman, stiffened and leaned forward: “Perhaps I didn’t understand you correctly,” he said; “You surely don’t mean you want women and children to die unnecessarily or live in constant danger of sickness so there will be something for young doctors to do?” “Why not?” said the New England doctor, who did at least have the courage to admit the issue; “That’s the will of God, isn’t it?”
Baker’s public health innovations were numerous. In addition to the home-visiting programs and community baby clinics, she established the position of the school nurse, developed special capsules for delivering silver nitrate to the eyes of newborns to prevent blindness due to congenital gonorrhea, invented a window board for improving ventilation in houses, and created a more efficient method of medical record keeping. She even designed a set of baby clothes that was more convenient and comfortable than the swaddling traditionally used in the immigrant ghettos.
The massive declines in child mortality that Baker helped bring about are frequently attributed to improved nutrition and a general improvement in working and living conditions, and to the availability of vaccines and antibiotics. However, demographers who have studied this subject in detail have concluded that it had little to do with any of these things. Most vaccines and antibiotics weren’t available until after World War II and the “general uplift” in nutrition and living conditions occurred at the end of the nineteenth century, decades before the mortality decline. This may have set the stage for the drop in the death rate that followed, but the survival of babies didn’t substantially improve until safer milk supplies became widely available and, even more crucially, campaigns like Baker’s had helped women understand germs and how to avoid them, so they could provide better care for their children.[2]
But safe milk and hygiene aren’t the only things children need to survive. Baker was the first to prove scientifically that they also need love. In an era when reliable birth control was unavailable and abortion was unsafe and illegal, hundreds of newborns were abandoned each year in New York City. Babies turned up in parks and alleyways or on the doorsteps of fashionable houses. These foundlings were assumed to be illegitimate and until 1870 weren’t even welcome at Catholic charity orphanages. Most ended up in squalid municipal almshouses with the paupers, drunks, and insane; nearly all of them died. But in 1915, a foundling hospital opened on Randall’s Island under the direction of Baker’s Bureau of Child Hygiene. There trained nurses provided the babies with state-of-the-art care and feeding. Nonetheless, close to half of them still died. In what Baker’s nurses referred to as the “hopeless ward,” where the most premature, sickly babies lay in tiny boxes lined with cotton wool, virtually none survived.
At the time, many doctors would have been unconcerned about this. While the deaths of older infants and children might be attributed to inadequate hygiene and nutrition and prevented accordingly, eugenically minded child health experts believed that the deaths of newborns, defined as children aged under a month or so, were due to their inborn “sub-normality”; there was nothing doctors could do for them. For the benefit of racial hygiene, it was probably better not to care for them. After all, they’d only grow up and pass their sickly genes on to the next generation.
But Baker didn’t agree that the fate of these infants was inevitable. She had noticed that though infant mortality had plummeted in the slums due to the bureau’s efforts, it hadn’t budged in wealthier neighborhoods. “Sometimes,” she writes, “it really looked as if a baby born in a dingy tenement room had a better chance to survive its first year, given reasonable care, than a baby born with a silver spoon in its mouth and taken care of by a trained nurse who knew all the latest hygienic answers.” Intrigued, she decided to experiment. She boarded out the sickliest newborns in the hopeless ward to a corps of gushing Italian mothers on the Lower East Side who had been trained in proper child care by the bureau’s visiting nurses. “Off-hand it sounds like murder,” Baker confesses. “Moving these poor little potential ghosts out of this ward where everything was light and sterile and spick and span, into tenement rooms on Hester and Orchard streets.”
Once again the results were astonishing: The death rate of these vulnerable babies was cut in half. Baker had hit upon a truth that we now take for granted. At the time, medical opinion held that mothers should train their babies early to be independent by feeding them at regular intervals and ignoring their cries and babbles. Doing otherwise was thought to damage them psychologically and create neuroses. We now know the opposite is true. Emotionally sensitive and responsive human contact is essential for normal child development. Without such care, children may be physically stunted, mentally retarded, or even die.[3] Baker had no children of her own, but she saw clearly that though a baby “may still be unable to talk, walk or do anything but feed and cry and kick . . . he nevertheless needs that sense of being at home in a new world. . . . Even more than he needs butterfat and fresh air and clean diapers . . . he needs the personal equation to give him a reason for living.”
That Baker’s decisive work is so little known today is probably due to its great success: Much
of what she taught us now seems self-evident. However, the neglect of her contributions may also be political. During the 1950s and ’60s, America once again faced the challenge of integrating millions of disenfranchised citizens into its systems of public education, health, and social welfare, but this time those citizens were impoverished blacks, most of whom had been left behind by the public health revolution of the early twentieth century. They occupied, in demographer Samuel Preston’s words, “a separate caste” in U.S. society. Their living conditions were much worse than those of whites, they had poorer access to whatever medical care was available, and black women with infants were much more likely to work outside the home—and for much longer hours and in much worse conditions than white women. This would have made it difficult for them to take advantage of the new health education and provide the kind of care their children needed.
Civil rights legislation and new programs like Medicare, Medicaid, and Head Start helped many people, both black and white, but they could not shield children from the steadily worsening poverty of the 1970s and ’80s. In 1971, a group of Washington officials and their allies in the civil rights movement drafted the Comprehensive Child Care and Development Act, which would have created a nationwide system of high-quality day-care, preschool, and home-visiting programs that resembled the national system of child health programs envisioned by Baker and other reformers fifty years earlier. Most Americans supported the bill and it passed both houses of Congress with strong bipartisan support, but right-wing Republicans, using language similar to that used to quash the mother and baby care programs, pressured President Nixon to veto it.[4]
His adviser Pat Buchanan encouraged conservative journalists to write commentaries with headlines such as “Child Development Act—To Sovietize Our Youth,” which Buchanan would then present to Nixon in his morning press digest, as if it represented mainstream conservative opinion.[5] Even though polls suggested most Americans supported the bill, large numbers of letters denouncing it—some even comparing it to the Hitler Youth programs—poured in to the White House. Edward Zigler, head of Nixon’s Office of Child Development and one of the main architects of the bill, read through many of them. Most seemed to him to be form letters, and he suspected the campaign had been orchestrated by a small number of conservative opponents. Nevertheless, the president got the message, vetoed the bill, and the “Family Values” movement—devoted to challenging all federal programs for the poor—was born. Today, nearly every other industrialized nation on earth provides some form of guaranteed support to families with young children. That America still does not is considered by many to be a national disgrace.