By Hannah Johnston, Library Volunteer

This the first entry in our series on female New York Academy of Medicine (NYAM) Fellows and their contributions to society. Please also see our biographical sketch of Mary Putnam Jacobi, the first female Fellow.

A pioneer in public health and champion of preventative medicine, New York Academy of Medicine Fellow Dr. Sara Josephine Baker (1873–1945) had a significant impact on the landscape of maternal and infant health outcomes in the early twentieth century in New York City. Throughout her long career as a physician and health inspector, Baker introduced and supported numerous measures to reduce maternal, infant, and child mortality and morbidity, particularly in immigrant and low-income communities within the city. Her work saved countless lives and had substantial influence within the larger structure of medicine and public health in New York and beyond.^[1] Baker and her career were exceptional in many ways, but in particular, she engendered greater public trust in the medical profession by encouraging greater reliance on doctors while still allowing for and expecting continued trust in other sources of knowledge.

Portrait of Sara Josephine Baker. In S. Josephine Baker, Fighting for life (1939). NYAM Collection.

Baker, who was often referred to affectionately as “Dr. Jo,” earned her medical degree from the Women’s Medical College at the New York Infirmary, which was founded by early female physicians Elizabeth and Emily Blackwell.^[2] Following her graduation, she began practicing in New York while serving as a medical inspector for the New York Life Insurance Company and as a part-time medical examiner for the city. In 1907, she was appointed Assistant Commissioner of Health, and by the following year was named the first director of the Bureau of Child Hygiene.^[3]

The doctors and nurses of the Bureau of Child Hygiene in 1909. In S. Josephine Baker, Fighting for life (1939). NYAM Collection.

Among Baker’s chief concerns as director were those regarding the high infant mortality and morbidity rates in the city, especially in communities with low rates of access to sanitary medical care. In her 1939 autobiography Fighting for Life, she noted the high rates of infant blindness, illness, and deaths in the city, and attributed them to overreliance on the unqualified advice of neighbors and friends as well as a lack of sanitation of spaces and materials.^[4] In 1913 she wrote a pamphlet for new mothers, in coordination with the New York Milk Committee, titled “Talks with Mothers,” instructing them on how to best prevent these and other issues, as well as urging them to consult with medical professionals whenever possible.^[5] Additionally, Baker lamented high rates of infant, child, and maternal mortality in New York. Many of her public health and preventative care efforts were directed toward lowering these mortality rates, particularly by improving access to pasteurized milk and sanitary medical care. Sanitation was not Baker’s sole focus, however; she marveled at how babies living in tenements seemed to be doing better than foundlings living in sanitary hospitals, and concluded that “personal care from a maternally minded mother” was as important for a baby’s survival as sanitation.^[6] She then implemented a program where “tenement mothers” fostered foundlings from the hospital, which led to a drastic drop in the mortality rate among these babies — from 50% to 33% generally, and from 100% to 50% among “hopeless cases.”^[7]

A firm believer in social medicine, Baker formed her opinions and efforts regarding public health around the needs and circumstances of the communities she served. Her commitments to serving immigrant and low-income communities can be clearly seen in her considerations of the practice of midwifery in the city and of the needs of working mothers. Despite feeling that midwives in the U.S. were largely “very clumsy [practitioners] indeed who had got into the profession as [amateurs] and stayed in to make a living,” Baker recognized that many women, especially those who had grown up in countries where midwives were more widely respected and utilized, were uncomfortable with the “American” practice of (male) physician-attended birth.^[8] Positing that without midwives women might put themselves at further risk by seeking the help of unqualified neighbors and friends before seeking a doctor (if they could even afford to), Baker became focused on implementing a system to regulate the practice of midwifery in the city to ensure higher standards of care. This stance put her at odds with many of her peers, and in Fighting for Life, she described a “hot discussion” with her colleagues at the New York Academy of Medicine over the matter.^[9] In order to ensure the well-being of infants whose mothers were in the workforce, a common occurrence particularly in low-income households at the time, Baker developed the Little Mothers League to educate older children on the proper care of infants. Since older daughters were often tasked with caring for their siblings while their parents worked, Baker believed it was important to ensure that everyone caring for babies was prepared to do so. The education girls received from the Little Mothers League, Baker reasoned, also had the positive side effect of larger-scale understanding of the proper care of children, as the “Little Mothers” shared their new expertise with their parents, friends, and communities.^[10]

Sara Josephine Baker’s long, wide-ranging, and impressive career saw significant improvements in the well-being of mothers and children in New York City and beyond. Aside from her efforts to improve the care of infants, she championed preventative healthcare for toddlers and school-aged children and mothers, and was instrumental—twice—in catching the first known asymptomatic carrier of typhoid, “Typhoid Mary” Mallon.^[11] By the time she retired in New Jersey with her partner Ida Wylie and their friend Louise Pearce in the mid-1930s, New York City had the lowest urban infant mortality rate in the United States.^[12] Sara Josephine Baker’s social and preventative approach to medicine engendered greater and more widespread public trust in medical professionals while respecting the need for other sources of knowledge and care, and made New York City a healthier place.

References

^[1] Manon Parry, “Sara Josephine Baker (1873-1945),” American Journal of Public Health 96 No. 4 (2006), pp. 620–621.

^[2] Ibid.

^[3] Ibid.

^[4] Sara Josephine Baker, Fighting for Life (New York, NY: The Macmillan Company, 1939), 116–119, New York Academy of Medicine Library, New York, NY, Special Collections, Call No. WZ 100 B168 1939, Film 8865 no. 5.

^[5] Sara Josephine Baker, “Talks with Mothers” (New York, NY: The New York Milk Committee, for the Babies’ Welfare Association of New York City, 1913), New York Academy of Medicine Library, New York, NY, Pamphlet Collection, Box 97, Call No. 115239.

^[6] Baker, Fighting for Life 119–121.

^[7] Ibid. 120.

^[8] Ibid. 112.

^[9] Ibid. 114.

^[10] Ibid. 132–137.

^[11] Parry.

^[12] Ibid.