November 12, 2013
John DiTraglia MD
I just read “Fighting For Life,” Dr. S. Josephine Baker’s autobiography that was written in 1939 and just republished and reviewed by The New York Review of Books (1)- neat trick.
Josephine Baker, not to be confused as she was in her day with the famous dancer and movie star Josephine Baker, was one of the first woman doctors back when women couldn’t vote, much less become doctors. She is acclaimed, as the director of the New York Bureau of Child Hygiene, for saving many thousands of babies’ lives by convincing mothers in the crowded immigrant neighborhoods of turn of the century “Hell’s Kitchen” to do four simple things - Breast feed, - give babies lots of baths, - dress them in loose simple clothes, instead of multi layer or swaddling clothes, and - open the windows or take them outside for fresh air. I’m not sure what the fresh air did, and maybe less clothes prevented overheating and some Sudden Infant Death Syndrome but most of the benefit probably came from breast feeding instead of the dangerous milk available then and the baby baths probably resulted in the mothers’ hands being washed too. Most of the babies were dying of infectious diarrhea. However it worked, infant deaths went from 1,500 per week in those neighborhoods to 300 per week.
This book is full of great stories like how she managed the real “Typhoid Mary.” My Dad’s parents came off the boat and lived in New York City and probably were ministered to by Dr. Baker’s bureau. My Dad got pneumococcal pneumonia back when the chances of dying from it, before there was penicillin, were 50-50. So Dr. Baker’s colorful descriptions about these neighborhoods was reminiscent of my family’s stories. Many of the worries Dr. Baker writes about the practice of medicine back then sound like what we are still wrestling with today - the role of government - the over-reliance on specialists and too many blood tests and X-rays.
But the most interesting stories to me, the fat science mavin, were those she tells about the foundling orphanages, and the story of the infant death rate among the rich New Yorkers that was unremittingly higher than in the poor immigrant neighborhoods after her interventions.
Dr. Baker saw that babies in the orphanage died before one year of age at a rate of 50 percent, while babies in Hell’s Kitchen died at a rate of 12 percent. Inspection of the foundling hospital revealed that, “there was apparently absolutely nothing wrong. Intelligent, well-trained nurses carrying out the latest technique to the letter, absolute spotlessness and sanitation, approved feeding; nothing wrong except that the babies were dying like flies, poor little wretches.” So she did something that everybody thought was crazy. She took the babies out of the beautiful clean hospital and sent them to live with the poor mothers in the slums. This cut the death rate drastically. Then she got even braver and sent out the foundling babies who were premature. Again those foster immigrant mothers worked a miracle. “We reduced the death rate among these hopeless cases from practically 100 percent to a little over 50 percent in one year.”
The situation among the rich was similar. Rich babies were cared for by wet nurses. The wet nurses were good people but probably tired and disaffected and just not mothers.
I don’t believe in magic but there is something here that we have forgotten again. The modern medical literature about failure to thrive and also about obesity equates everything to a strict accounting of calories. This is incorrect. Dr. Baker “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.’” (1)
1. Epstein H. 2013 Introduction and review in NYRB.