Framing a Professional, Medical Identity in Fighting for Life

I’m starting a new research project, one that I hope will lead to a published paper on Fighting for Life, a 1939 autobiography by physician and vanguard public health official Sara Josephine Baker. My first step in this process is presenting my work at a conference. Moving toward that goal, I will, as usual, be blogging my research.

Fighting for Life chronicles Baker’s early childhood, decision to attend medical school, and her transition from private practice to public health work in early-twentieth century New York City. Baker’s public health interventions are legion. In addition to establishing and directing the city’s Bureau of Child Hygiene, she was a champion of preventative medicine, instituting “free milk centers” and placing nurses in public schools. 100 years later, American society still benefits from her path-breaking strides.

This post is about the tensions in Fighting for Life within Baker’s characterization of medicine, or tending to the well-being of others: is it a career choice or a moral call of duty? 

In an earlier post on Fighting for Life, I introduced Baker the writer, provided an overview of her career, and considered two widely published reviews of the autobiography, including one written in 1939 on the occasion of the text’s first publication.

"Mrs. Larocca making willow plumes in an unlicenced tenement. Found nine families at work making feathers. When our investigator made her first call there she found the whole tenement in much worse condition. Children had bad skin trouble and fever, etc. New York City." Photograph by Lewis Hine. Courtesy of Wikimedia and the National Archives and Records Administration.

“Mrs. Larocca making willow plumes in an unlicenced [sic] tenement. Found nine families at work making feathers. When our investigator made her first call there she found the whole tenement in much worse condition. Children had bad skin trouble and fever, etc. New York City.”
Public domain photograph by Lewis Hine. Courtesy of Wikimedia and NARA.

Among Baker’s many accomplishments, she often is credited with “saving 90,000 babies,” and contemporary and historical reviews of Fighting for Life as well as the back cover of the paperback’s 2013 re-release all note this specific feat.

When Baker herself invokes this statistic in chapter two of Fighting for Life (26), she clarifies her chief purpose in the text as well as an issue to which she returns over and overexplaining how “saving 90,0000 babies” came to pass. That is, why did she study medicine? And what led her away from private practice towards public health and preventative social medicine?

Baker’s pursuit of answers to these questions demonstrates her awareness of specific autobiographical conventions. She admits that her memory is not perfect but she has endeavored to tell the truth. Moreover, any factual mistakes she may have reproduced do not detract from the significance of her story or any other truth-claims she may have made in the course of telling it. This is especially true of her narration of her earliest days to age 17 when she decided to study medicine.

In explaining her medical school matriculation and all that came after, builds a professional identity that legitimizes and subverts fin de siècle expectations of gender. At the heart of this persona lies a tension between two prevailing conceptions of physicians, which Regina Morantz-Sanchez labels in Sympathy and Science as poles of a spectrum (200). At one end, caring for the well-being of others was seen as a moral call of duty governed by specific sentimental obligations. At the other end, medicine was viewed as a career path leading to financial success and personal renown.

Baker is aware of these narrative frames and their attendant gendering, and she places her professional persona in Fighting for Life within both. In doing so, she rejects other, conventional narrative frames commonly ascribed to female doctors, such as the notion that she pursued medicine as the result of her own or family members’ illnesses.

Resisting a simplistic account of her professional persona, Baker creates a complex identity in Fighting for Life that combines characteristics traditionally viewed as “masculine” and “feminine.” In some respects, her professional identity is resoundingly masculine. She chose medical school over Vassar to achieve long-term financial stability, and she implies that her ambition, choices, and alliances all positively shaped the movement of her career.

Still, Baker does not discount the import of inborn, altruistic traits—seen as the province of women—to this trajectory. It is telling, after all, that Baker’s opening anecdote in Fighting for Life describes her stripping naked as a six year-old to offer her Sunday best to a “little colored girl…wearing only a ragged old dress the color of ashes” (1). Baker’s only explanation for this act that she felt compelled, presumably by some internal force, to do it.

Although Baker attributes her success to relying on masculine and feminine traits, she also sees it as a product of ingenuity, a somewhat gender-neutral trait in Fighting for Life. Importantly, ingenuity in the text becomes a tool that reaps greater individual and social gains, all at once.

Ultimately, Baker’s Fighting for Life prompts contemporary readers to reflect on historical conceptions of gender as they relate to the study and practice of medicine. The text also encourages students who are entering health-related fields to consider the extent to which these beliefs govern medicine and public health today as well as how they affect practitioners, patients, and society.

Works Cited

Baker, S. Josephine. Fighting for Life. 1939. New York: New York Review of Books, 2014. Print.

Morantz-Sanchez, Regina. Sympathy and Science: Women Physicians in American Medicine.  1985. Chapel Hill, NC: U of North Carolina P, 2000. Print.

***

Curious about the image used in this post? I found the Lewis Hine photograph in the Wikimedia repository. It had been added to Wikimedia by the National Archives and Records Administration. Since 2012, NARA has uploaded hundreds of thousands of images to Wikimedia and has plans to digitize more creative-commons licensed material.

Posted in Blogging My Research, Creative Non-Fiction, Lifewriting, Medical Humanities

Sara Josephine Baker’s Autobiography, Fighting for Life

In December, I read a review in the New York Times about Fighting for Life, a 1939 autobiography by Sara Josephine Baker that recently was re-released. A medical doctor and New York City public health official, Baker is said to have saved “90,000 babies.”

I was intrigued. I’m a scholar and teacher of the medical humanities; I have a keen interest in memoir and autobiography in which illness and contagious disease are at the forefront; and I was weeks away from having my first child.

I finished Fighting for Life and I’m working out my critical interpretation of the text. I hope to share that work soon in a more formal setting, such as a conference. For now, I’ll begin to untangle my thoughts here. I often “blog my research” because it helps me organize ideas during the beginning of a project. This post is the first of a multi-part series on Fighting for Life. You can read subsequent posts here.

Cover of the re-release of Fighting for Life by the New York Review of Books.

Cover of the recent re-release by the New York Review of Books.

In this post, I introduce Baker the writer, provide an overview of her career, and consider two widely published reviews of Fighting for Life, including one written in 1939.

In the second post, I discuss the tension between two conceptions of medical and public health work in her text: “careerism” and “moral calls of duty.”

Baker the Writer?

In addition to Baker’s autobiographical writing, she was an accomplished scientific and lay writer, having authored “50 journal articles and more than 200 pieces for the popular press about issues in preventive medicine, [including] five books” (Parry).

That Baker left a large and genre-spanning textual legacy is interesting. I’d venture to say that people know more about her contributions to public health policy and practices than her writing. At least, this is true of me. I was aware of her public health work, largely because of my dissertation. Chapter one in part focused on Jacob Riis’s How the Other Half and Claude McKay’s Home to Harlem and required substantial research on late-nineteenth and early-twentieth century public health initiatives in New York City. I also regularly teach a module in my advanced composition course that centers on Mary “Typhoid Mary” Mallon; Baker was infamously involved Mallon’s case. Despite all of this work, I had never come across references to her books, including Fighting for Life.

Baker published Fighting for Life in 1939, six years before her death in 1945. I wonder what prompted Baker to turn from writing about public health to writing about herself within the context of medicine and preventative care. We may never know, at least in Baker’s own words. Helen Epstein in her illuminating introduction to the 2013 reissue of the autobiography notes that Baker destroyed all of her personal papers (xviii).

Without the aid of Baker’s personal papers, Epstein nevertheless offers an interesting theory about the authorship of Fighting for Life. It’s possible that Baker collaboratively wrote at least part of the autobiography with her partner Ida Wylie. Wylie was a prolific Hollywood scriptwriter who herself wrote an autobiography. While Baker and Wylie’s books necessarily differed in subject matter, similar turns of phrase appear in both, including  the eponymous “fighting for life” (Epstein xvii).

Baker’s Medical and Public Health Career

Baker earned her medical degree in 1898 and opened a private practice with a friend in 1899 but eventually abandoned it to pursue a position in New York City’s public health division. In 1907 she became the Assistant Commissioner of Public Health and in 1909 was appointed as the Director of the Bureau of Child Hygiene.

According the National Library of Medicine’s  site devoted to Baker and other notable women in the medical field, Baker

developed programs for midwife training, basic hygiene, and preventive care. She also pioneered city-funded well baby stations, and the Little Mothers Leagues (beginning in 1910), to train girls age 12 and older in basic infant care…[She also] promoted health education in the city’s immigrant communities, distributed milk to children, and created a school health program that was copied in thirty-five states across America. By the time Baker retired in 1923, New York City had the lowest infant mortality rate of any major American city. (“Changing the Face of Medicine”)

Press for Fighting for Life, Then and Now

Fighting for Life in fact has been reviewed twice in the New York Times: by Rose Feld on May 14, 1939 when the book initially was published, and as I mentioned earlier, last December, when the New York Review of Books reissued the text with Epstein’s introduction.

The most recent review perhaps marginally qualifies as such, at least when the conventions of the genre are considered; Baker’s autobiography is referred to once in the review–and even then, never directly by title (Zuger). In comparison to the latest review, Feld’s gloss is anchored more firmly to Fighting for Life, as she often paraphrases and quotes from the text.

Such differences aside, the reviews do share some thematic similarities. In discussing Fighting for Life, both pieces emphasize two dimensions of Baker’s legacy. In one respect, the reviews marvel that many policy enactments Baker instituted, like the licensing of midwives, are still in place today. Also consider that at the time of Feld’s review, doctors and midwives around the world were still using equipment Baker invented to keep silver nitrate drops sterile. (The drops had been used to prevent eye infections in newborns since the late 1880s, but it was difficult to preserve their purity.)

The reviews of Fighting for Life in the Times also draw attention to Baker’s larger contribution to public health: preventative care. Baker believed helping well people stay healthy was as important to public health as treating those who were sick. That historical and contemporary reviews of Fighting for Life underscore Baker’s essential founding of preventative medicine within public health is revealing. This suggests that “treating the well” has been and continues to be controversial (and thus underfunded), despite it being a sound social practice.

In addition to focusing on Baker’s legacy, reviews of Fighting for Life also touch on how and why she came to medicine. Perhaps because Feld’s piece is more textually focused, it preserves the complexity of Baker’s decision to pursue a medical degree, as this event emerges in Fighting for Life. Feld explains that, according to the autobiography, Baker “became a physician because it seemed a good idea to her and because it didn’t seem a good idea to relatives.” Accordingly, Feld asserts that Baker “overturns the sentimental concept of a woman dedicating herself with mystic devotion to a vocation of saving human lives.”

For the most part, I agree with Feld’s assessment of Fighting for Life. Baker rejects sentimental and gender-norming characterizations of her career and women’s careers in medicine, more generally. At the same time, and as I’ll discuss in a follow-up post, Baker in Fighting for Life does not wholly abandon conceiving of her work a moral call of duty.

***

Works Cited

Baker, S. Josephine. Fighting for Life. 1939. New York: New York Review of Books, 2014. Print.

“Changing the Face of Medicine.” U.S National Library of Medicine. U.S. National Library of Medicine, 2005. Web. 27 June 2014. http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_19.html.

Epstein, Helen. “Introduction.” Fighting for Life. New York: New York: New York Review of Books, 2014. Print.

Feld, Rose. Feld, Rose. “Pioneering for Public Health.” New York Times 14 May 1939: n. pag. Print.

Parry, Manon. “Sara Josephine Baker (1873–1945).” Am J Pub Health 96.4 (2006): 620-21. National Library of Medicine. Web. 27 June 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470556.

Zuger, Abigail, MD. “A Life in Pursuit of Health.” New York Times. N.p., 28 Oct. 2013. Web. 27 June 2014. http://www.nytimes.com/2013/10/29/health/josephine-bakers-fighting-for-life-still-thought-provoking-decades-later.html?_r=0.

Posted in Blogging My Research, Books, Lifewriting, Medical Humanities
Amy Rubens
Amy Rubens

I'm an Assistant Professor of English at a state-sponsored university in South Carolina and have over ten years of experience teaching at the college level.

I regularly teach courses in composition, professional writing, creative writing, and American literature.

My primary research interest is the medical humanities, particularly the depiction of contagious disease in American literature and lifewriting. I also have research interests in digital writing, social media, and the ways electronic environments shape notions of health.

I'm inspired by the great outdoors and enjoy hiking and backpacking. When I'm not reading, writing, or hiking, I like to blog and spend time with my family members (both human and animal).

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