top of page
  • Writer's pictureDale DeBakcsy

‘I Doubled My Fist’ Sara Josephine Baker and the Fight for Child Hygiene

How deep can hopelessness go? Is there a lower limit, a solid floor against which we can push and thrust ourselves back into some semblance of striving humanity? Or does it just keep going down? Perhaps that hard line comes with the having of children – that no matter how much you have lost hope for yourself, nonetheless you will keep trying and struggling with whatever fight is left in you to keep those children alive and well.

Would it were so, but the bottomlessness of despair even amidst dizzying prosperity is something we only have to look back a century to behold in all of its fetid glory: to the early 1900s, and the tenements of New York. Six thousand souls crammed into a block of tin-shack housing with workers sleeping in shifts on piles of insect-ridden and rotting hay, dulling the pain with drink and oblivious to anything but the wear of the day, while sore-ridden pregnant and physically abused mothers lay in dank rooms waiting to give birth to children likely to die in a matter of weeks. Here hope was in slight supply. Infant mortality spiralled to levels unknown anywhere in the developed world while corrupt public health officials declared the problem unsolvable and therefore not worth wasting effort or resources upon.

It was into this world of calamitous infant death and official indifference that Dr Sara Josephine Baker (1873–1945) arrived like a meteor at the turn of the twentieth century. Efficient and incorruptible, she drummed out health workers who refused to sully themselves with tenement work and established the world’s first Bureau of Child Hygiene and along the way erected a string of institutions that formed the basis of modern infant care. All told, her efforts are estimated to have saved at least 90,000 babies directly, and her programmes became the model for child hygiene the world over.

For all the direct confrontation with death and disease that would form the heartbeat of her adult life, Baker’s early years were the idyllic stuff of a Norman Rockwell painting. Born in Poughkeepsie, New York in 1873 in a well-off but not grotesquely wealthy family of Quaker stock to a lawyer father and a mother who was one of the first attendees of Vassar College, she enjoyed access to the example of educated women and the social calendar of Gilded Age youth. She alternated trips to New York City with rollicking country vacations featuring clam bakes, toboggan rides and drives in the back of hay wagons while singing ‘Tea for Two’ with groups of chums.

She even boasted a great aunt, a secret radical Quaker, who gathered the children about her while their parents were away to read them Bible stories in a dramatic voice only to, at the end, close the book with a thump and declare: "Now children, that is a very silly story. I am an old, old lady and I want all of you to remember what I am saying. It is a silly story and there is not a word of truth in it. Do not ever let anyone tell you that stories like that are true … Jane! Cookies!" At which point cookies duly appeared and the children revelled in the sugar and the exposure to a grand old woman instilling in them the courage to think for themselves in spite of the Generally Accepted Truths.

Had life continued in that vein, Baker would have gone to Vassar, and comfort, and distinction of a certain sort, but fate dealt its long-delayed haymaker at last in her sixteenth year as she lost in quick succession her only brother and then her father. In an instant, the family went from sure economic comfort to a clawing panic as the household of women worried over what was to be done. Baker’s sister was a virtual invalid, so Sara took it upon herself to find a job that would support the family. Giving up her dreams of Vassar, she scooped up what remained of the family’s money and put it towards a seemingly mad plan to become a medical doctor by studying at the New York Infirmary Medical College.

All her acquaintances and relatives advised against the plan, but that only stiffened her stubborn resolve to see it through. Living in cheap rooms and eating as inexpensively as possible, she applied herself to the task of learning medicine at the establishment that had been founded a short three decades before by none other than Elizabeth and Emily Blackwell to provide medical training for women. It was a hard road, with ultimate financial success anything but certain, but after graduating in 1898, Baker found her niche relatively quickly, her practice growing as much by virtue of a youthful optimism that does not know what Can and Cannot Be Done as her own enterprising spirit.

While building up her private practice, in 1901 Baker entered the profession that would become her life’s work when she accepted a job as a Department of Health medical inspector and came face to face with the insufficiency of the government’s child health monitoring. School inspection programmes were farcical in their lack of thoroughness, and when illness was discovered, there were no resources to follow through on the cases. School nurses did not exist. Tenement inspectors routinely dodged their duties by making up rosy data about slum children in order to avoid having to do anything about it. Infant blindness ran rampant. Milk was not routinely pasteurised, and mothers would ladle it directly from store vats that crawled with bacteria only to then serve it from rusted cans. In the summer months, 1,500 babies died weekly from dysentery related diarrhoeal dehydration.

Baker resolved to do her job as it was meant to be done, in spite of the protests from her fellow inspectors that her conscientious thoroughness was ruining their system. She went into every building and viewed with horror the indifference to life all around her, the mothers so used to the deaths of their children that they could not be roused to efforts in caring for the next one in line. One episode from her autobiography speaks to the general tenor of her experience as an inspector:

I thought I already knew something about how filthy a tenement room could be. But this was something special, particularly in the amount of insect life. One dingy oil lamp, by the light of which I could barely make out the woman in labor, lying on a heap of straw in the corner. Four stunted children, too frightened to make any noise, huddled together in a far corner. The floor was littered with scraps of food, too old to be easily identifiable, but all contributing to the odor of the place. Cockroaches and bedbugs crawled about everywhere. The only thing to wash up in was, as usual, an old tin basin, rusted and ragged at the edge. All of it was the nth power of abject, discouraged squalor. But the ugliest detail was a man, also lying on the floor because he was apparently too drunk to get up. But he was all too capable of speech.

The moment I approached my patient I discovered that her back was one raw, festering sore. She said that her husband had thrown a kettle of scalding water over her a few days before. That accusation brought him to his feet crazy with rage, threatening me and her, toppling and lurching all over the place.

I knew that could not go on. I had to get him out of the way. As he wavered toward me, waving his clenched fist and uttering verbal filth, I ran out into the hall. He followed as I had intended. I had thought of running in quickly again and seeing if the door would lock. But then, as he lurched after me, he crossed the stair-head and, with instinctive reaction, I doubled my fist and hit him. It was beautifully timed. I weighed hardly half as much as he, but he was practically incapable of standing up, and this frantic tap of mine was strategically placed. He toppled backward, struck about a third of the way down the rather long stair and slid to the bottom with a hideous crash.

The man survived, but was knocked out long enough to allow Baker to continue the delivery in peace. And that was but one episode on one day. Baker’s reputation for honestly assessing and reporting the state of the tenements, while infuriating to her co-workers, caught the eye of her superiors, and she was slowly promoted to positions of higher authority until she had at last the power to act in substantial ways to improve the lives of infants and children, culminating in her role as director of the newly created Bureau of Child Hygiene from 1908 to her retirement in 1923.

Her accomplishments during these years represent a cavalcade of good sense pushed vigorously forward in the face of governmental confusion and medical resistance. Her insight was fundamental: if we devote resources to educating mothers about practices that prevent childhood diseases, we will not always be caught trying and failing to cure those diseases at their critical end stages. She argued with the city to fund projects in what we would now call preventive care, only to be derided by officials guffawing at the idea of spending money to cure people who were not sick.

She pushed on regardless, securing money from private industry when government would not come through, and working the strings of Tammany Hall like a virtuoso when the situation called for it. She established a corps of visiting nurses to educate new mothers about hygienic practices, especially about access to fresh air and cool clothing in the summer months. Result: a decline in summer infant deaths by 1,200.

She wrangled some funding from private industry to create milk stations where mothers could get Grade A pasteurised milk at lower prices than they could buy Grade B from the stores, and while they were there she made sure the staff taught them about the nutritional differences between cow’s milk and breast milk, and how to supplement a child’s diet if you did not breast feed. Result: the programme proved so successful and popular that the government was shamed into not only funding the existing stations but creating new ones as well.

She created a licensing system for midwives that gradually increased the training standards of that profession and allowed her to introduce the use of silver nitrate into midwife birth procedures which cut the instance of infant blindness from 300 cases yearly to three.

She took on the phenomenon of Little Mothers with sense and compassion. At the time, mothers who were breaking their backs to make ends meet often relied upon their eldest daughters to take care of the younger children in the family, with often tragic results. Baker started school programmes that met on Saturdays where these girls could learn more about how to take care of children properly, and how to address their own natural frustrations when things went wrong. The children learned, and were proud to pass their knowledge on to their parents and anybody else who would listen.

She also encouraged the first experiments with keeping nurses on staff at schools who were trained to deal with emergency situations and recognise illnesses that required the attention of specialists. She put a stop to a health board programme that invaded schools, lined the children up against the wall, sliced out their tonsils without anaesthetic or explanation, and then released them with blood flowing from their mouths, and replaced it with a series of centres that informed the child about the procedure, used anaesthetic and made her comfortable for a day afterwards in a nice bed with plenty of ice cream. In the face of the great influenza epidemic of the war years, she argued that keeping the children in schools was the best way to keep them from infection, and as a result, not only was New York the only city with open schools at the time but dramatically fewer children died of influenza.

Her success in the fields of preventive medicine, child nutrition, and disease recognition and treatment were so great that she brought the medical establishment on her head on a number of occasions, including this encounter which is so fantastically absurd in its bare admission of venality that it is worth a full reading:

I have already described two or three occasions when my colleagues insisted on getting in our way for what seemed to us the worst of all possible bad reasons. But I never saw the short-sighted psychology of a certain type of doctor, when confronted with public health work, better brought out than by a representative of a New England medical society testifying before a Congressional committee which was considering the appropriation of funds for the newly founded Federal Children’s Bureau. I was down there testifying too – on the other side. This New England doctor actually got up and told the 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 that 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?’

These are but some of the institutions created from nothing by the insight and willpower of Sara Josephine Baker, and some of the prejudices she faced, both as a woman (her entire doctoral staff came to her when she was nominated director of the Bureau and threatened to resign en masse in protest for having to take orders from a woman until she talked them down) and as a worker for infant health in the face of large medical and governmental interests. And that is but a part of her story – she was also the person who tracked down Typhoid Mary on two separate occasions; a suffragist who addressed sceptical crowds on street corners; an international observer who shamed America with an account of the superior scale of Soviet efforts to ensure the health of children; and a fashion icon whose uniform of a man’s suit topped with a four-in-hand tie and a pair of TR pince-nez earned her the nickname of Dr Joe. A keen devotee of Theodore Roosevelt’s advocacy of The Strenuous Life, she filled her time with work and public service, and her efforts attracted observers from every corner of the globe to see how much could be accomplished by a society dedicated to the proposition that infant life is of fundamental value.

She retired in 1923 from her directorship of the bureau and settled on a New Jersey farm in the 1930s with her partner, the Australian novelist Ida Wylie. Here she wrote her autobiography, Fighting for Life, in 1939, and a string of popular articles on health and child care besides. She died of cancer in 1945, having lived to see the experimental shoestring and moxy programmes of her youth and middle years become the standard practices of a nation, and a world.


Fighting for Life (1939) is that rare bird – a scientific autobiography of almost irresistible literary charm and dash. It is among the greatest science memoirs of all time. Its depiction of Gilded Age New York sizzles with electricity, just as her portrayals of tenement living are tone poems of dehumanisation. It is a book to read and then reread every decade or so to remind yourself of what we once were and how far we have come.

Baker's story is also one of 140 stories of women in Medicine I told in A History of Women in Medicine and Medical Research, available on Amazon and from Pen and Sword books US or UK!



bottom of page