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Book Review

Fighting for Life by S. Josephine Baker, M.D.

(New York Review Books, 2013, 304 pages)

Reviewed by Katherine Ellington

Dr. Sara Josephine Baker (1873-1945) was a pioneer American physician, the first woman to earn a doctorate in public health from Bellevue Hospital Medical College and New York University. Fighting for Life details Dr. Baker’s battle to succeed against the odds stacked by her family, colleagues, and society. Baker wrote Fighting for Life in 1939, and the book was recently reissued by the New York Review of Books as part of its NYRB Classics imprint.

In 1894, Baker graduated with a class of eighteen from the Women’s Medical College of New York, founded by physicians and sisters Elizabeth Blackwell and Emily Blackwell. Baker joined the 1930s suffrage movement; she was an active feminist and openly lesbian, but while at work in the New York City Health Department her official correspondence read “Dr. S. J. Baker” for gender disguise.

She writes: “…I did not start out as a feminist at all. But it was impossible to resist the psychological suction which gradually drew you into active participation in the great struggle to get political recognition of the fact that women are as much human beings as men are… Deep down what held us together was our sense of how unfair and absurd it was that the male half of the world should possess responsibilities from which we were excluded.”

Because of her expertise on the subject of children’s health, Baker was invited to lecture at NYU’s school of public health. In turn, she asked if she could enroll in the school as a doctoral student, but was turned down because regulations “forbid women in any courses.” A male lecturer with the requisite expertise could not be located, so NYU acquiesced and allowed Baker both to lecture and to pursue her doctorate.

Nevertheless, as the only woman in the all-male classrooms, she was met with “flat, contemptuous whacking rhythms” of hand clapping before and after every lecture she gave from 1915 to 1930.

The self-talk of personal narrative occasionally slows the pace of Fighting for Life, but as a public health journal it offers fascinating cases written with wit and diplomatic sensibility. Filled with researcher-like field notes, the book shows how Baker made a compelling case for public health efforts.

Baker is best known for successfully catching Typhoid Mary (twice), but her storytelling offers detail and insight into her quieter, and ultimately long-lasting accomplishments. She made striking connections between poverty, sickness, and city life. Baker created a blueprint of still relevant health programs from her experiences working with poor and immigrant families on the lower east side of Manhattan.

The short list of her accomplishments includes promoting breastfeeding, educating mothers (and older siblings) on safe practices for babies, inventing a nutritious infant formula so that mothers could go to work, creating professional standards and licensure for midwives to decrease maternal mortality, educating about hygiene to prevent dysentery (which, at its peak, killed 1,500 infants per week), creating a sanitary method of administering silver nitrate drops to newborns to prevent gonorrhea-associated blindness, creating a school lunch program and public “milk stations” to address childhood malnutrition, placing nurses and doctors within schools to tame childhood scourges such as trachoma and tuberculosis. It is estimated that her public health efforts saved more than 90,000 lives.

Both the slums and the affluent neighborhoods of New York City began to emerge from the shadows of relentless death and disease during Baker’s tenure as the first director of New York’s Bureau of Child Hygiene. In her book, public health emerges as a profession uniquely suited to building and sustaining cities.

Baker was prolific, writing more than fifty journal articles, two hundred articles for public media, and six books. She writes with confidence; her analytical voice sure, yet balanced. She brushes off fears not with a focus on trailblazing, but on work that must be done. While this autobiography reads as her personal and professional diary, Sara Josephine Baker’s compassion and commitment are evident, as she doggedly surpasses the innumerable obstacles. This book is a testament of the power of public health, tenacity, and storytelling.

Katherine Ellington is a physician in training and an advocate for global health equity. She blogs at World House Medicine.