JOSEPHINE BAKER: PHYSICIAN AND PUBLIC HEALTH WORKER 1873-1945
Marsha Lakes Matyas
The American Physiological Society
of the Times
In the late 1800s and early 1900s, infectious diseases
were a major concern of both physicians and researchers.
In larger cities such as New York and Boston, sanitation
was poor. The rotting bodies of dead horses lay in
the streets and unpasteurized milk was sold from rusty,
open cans. Dysentery, smallpox, and typhoid were major
health problems. Although we are often unfamiliar
with these diseases today, they caused horrible suffering.
Dysentery caused severe diarrhea and loss of fluids.
The bodies of smallpox victims were covered in painful
sores. Typhoid resulted in high fever, delirium, and
intense headaches. These diseases were especially
common and deadly among young children. In New York
City, one-third of all deaths were among infants less
than one year old. In New York's Hell's Kitchen 1,500
infants died each week during the summer of 1902,
primarily due to dysentery.
During the same period, preventative medicine was
almost unknown. It was only when a person became ill
that medical treatment was sought. There were no public
health nurses and few large-scale public health programs
or policies. It was also a time of social change.
Women were marching in the streets to gain the right
to vote. Certainly, female physicians were a rarity
at this time; they accounted for less than 1% of all
physicians. Few medical schools were open to women;
it was very different from today when nearly 39.2%
of medical school graduates are women.
Josephine Baker's Personal Background
Baker did not intend to become a physician. At the age
of 16, she was preparing for studies at Vassar by attending
Misses Thomas' School for Young Ladies in Poughkeepsie,
New York, when her father died of typhoid fever. In
order to support her mother and family, she decided
to study medicine instead. She knew of only one school
that would accept women: the Women's Medical College
of the New York Infirmary for Women and Children, founded
by Drs. Elizabeth and Emily Blackwell. She was the next
to the last class at the college; Emily Blackwell closed
the school the following year because Cornell University
had opened its medical college to women the same year.
After finishing medical school, Josephine Baker interned
at the New England Hospital for Women and Children
in Boston and also worked at an out-clinic in one
of Boston's worst slums. There she learned how poorly
medical science was serving the crowded city populations.
Working at the Department of Health in New York
superintendant of nurses, Ms. Lina Rogers, inspecting
the turn of the century, Dr. Baker began her life's
work with the New York Department of Health as a medical
inspector. Her first job was to examine children in
a public school; she was allotted one hour for every
three schools and could send home any child who was
sick. Unfortunately, the truant officers were just as
likely to send the sick child straight back to school.
Her work in the schools led to the establishment of
a city-wide school nurse program. The program worked
so well that cases of head lice and the eye infection
trachomaonce extremely prevalent in the schoolsdropped
to nearly zero.
Baker helped to establish some of the first programs
in preventative medicine and public health. In order
to curb the enormous death rates among infants in the
city, Dr. Baker used school nurses in the summer of
1908 to visit the homes of newborns to teach mothers
how to take care of their babies. There were 1,200 fewer
deaths that summer than the previous one (O'Hern, 1985).
Soon after, the Division of Child Hygiene (later the
Bureau of Child Health) was established and Josephine
Baker was appointed its chief. Her other accomplishments
long and successful battle to allow midwives to be
licensed by the city;
-the development of a foolproof dispenser for administering
silver nitrate to newborns' eyes to prevent gonococcal
infections and subsequent blindness;
-the development of a newborn formula by adding water,
calcium carbonate, and lactose to cow's milk; and
-the controversial development of the Little Mothers
Leagues where eight- to nine-year-old girls were taught
how to take care of younger children while their mothers
were working to earn a living to support the children.
Many protested that the Leagues were "enslaving
the young girls so their mothers could be irresponsible,
go to the movies, or get drunk".
1894, just before entering medical college.
is difficult to realize today how innovative and radical
these programs were. In testimony before a Congressional
committee, one physician opposed Baker's Little Mothers
Leagues, stating, "If we're going to save the
lives of all the women and children at public expense,
what incentive will there be for a young man to go
into medicine?" (O'Hern, 1985, p. 27). When the
Bureau of Child Hygiene was formed, a petition was
signed by more than 30 Brooklyn physicians and sent
to the mayor demanding that the bureau be abolished
because "it was ruining medical practice by its
results in keeping babies well" (p. 27). Dr.
Baker told the mayor that the letter was a compliment
to the Bureau. There was no doubt that some social
norms were about to change!
Tracking down "Typhoid Mary"
of Josephine Baker's most famous professional tasks
was tracking down Mary Mallon ("Typhoid Mary")
in 1907. The way Ms. Mallon's case was handled raises
some interesting questions even today about conflicts
between personal rights and public health:
Soper at the Department of Health Laboratories had
investigated seven family epidemics of typhoid going
back to 1900. He found that they were all linked
to the cook [Mary Mallon] in each family. Baker
was sent to collect specimens for culture. On her
first visit, Baker had the door slammed in her face.
The next day, when she returned with several policemen,
Mary answered the door and again tried to slam it
shut, but a policeman's foot was in the door. Mary
ran into the house and could not be found in a search
of the house. But looking out the rear window, Dr.
Baker noticed a chair against the fence and footprints
in the snow. Mary was found next door hiding in
a closet. She was most uncooperative and fought
against having blood taken so she was forcibly transported
in an ambulance to a hospital where specimens were
obtained. The blood and urine culture were negative
but the stool culture was teeming with typhoid bacilli.
Captured on March 20, 1907, Mary Mallon was confined
to Willard Parker Hospital for two years and 11
months during which every available remedy was tried
to rid her of the typhoid organisms. All efforts
failed. On the promise that she would return every
three months to the laboratory and take up some
occupation other than cooking, Mary was released.
She promptly disappeared and it was more than five
years later when her trail was picked up, once more
through epidemiology. She made no struggle against
the second capture. This time she was sent to North
Brother Island where she remained for 23 years,
to the end of her life in 1938, a special guest
of New York City.
Baker's success in reducing infant sickness
and mortality obviously created some enemies
for her. Not surprisingly, some resented the
fact that a female physician was in charge of
a city bureau, and, in 1919, there was considerable
pressure to remove her from her position. However,
she received great public support from the local
press and from mothers who marched to the mayor's
office to protest her possible dismissal. When
she was first appointed director of the division,
the six physicians who had been her peers as
medical inspectors "all resigned because
of the disgrace of working for a woman. She
persuaded them to try it for a month" (O'Hern,
1985, p. 28). All six stayed permanently.
the most discouraging discrimination she faced
was from the students she taught at the New
York University who were studying for the Doctor
of Public Health degree:
out for a day's work, circa 1912
stood down in a well with tiers of seats rising all
around me...and the seats were filled with unruly,
impatient, hard-boiled young men. I looked them over
and opened my mouth to begin the lecture. Instantly,
before a syllable could be heard, they began to clap
thunderously, deafeningly, grinning, and pounding
their palms together .
Baker roared with laughter to save face but, at the
end of the lecture, the clapping began again. She
endured this clapping for each of her lectures for
Interestingly, she was also a suffragette, that is,
a person who wanted women to have the right to vote
in elections. She was one of 500 who marched in the
first suffrage parade on Fifth Avenue and met with
President Woodrow Wilson at the White House along
with a group supporting women's suffrage. Finally,
she served as an officer, consultant, or board member
for a number of professional associations, most notably
as president of the American Child Hygiene Association
and president of the American Medical Women's Association.
She published five books and over 200 articles during
her professional career. In 1939, her autobiography,
Fighting for Life, was published.
with permission from Women Life Scientists: Past,
Present, and Future, Marsha Lakes Matyas and Ann
E. Haley-Oliphant, Editors (Bethesda, MD: American
Physiological Society, 1997).
A Child Care Revolution Begins
from Chapter One of Fighting
for Life, the autobiography of Sara Josephine
impulse to try to do things about hopeless situations
appears to have cropped out first when I was
about six years old, and it should be pointed
out that the method I used was characteristically
direct. I was all dressed up for some great
occasiona beautiful white lacy dress with
a blue sash and light blue silk stockings and
light blue kid shoesand inordinately vain
about it. While waiting for Mother to come down,
I wandered out in front of the house to sit
on the horse block and admire myself and hope
that someone would come along and see me in
all my glory.
Presently a spectator did arrivea little
colored girl about my size but thin and peaked
and hungry looking, wearing only a ragged old
dress the color of ashes. I have never seen
such dumb envy in any human being's face before
or since. Child that I was, I could not stand
it; it struck me right over the heart. I could
not bear the idea that I had so much and she
had so little. So I got down off the horse block
and took off every stitch I had on, right down
to the blue shoes that were the joy of my infantile
heart and gave everything, underwear and all,
to the little black girl. I watched her as she
scampered away, absolutely choked with bliss.
Then I walked back into the house, completely
naked, wondering why I had done it and how to
explain my inexplicable conduct. Oddly enough
both Father and Mother seemed to understand
pretty well what had gone on in my mind. They
were fine people, my father and mother.