After training with Elizabeth and Emily Blackwell, Baker became a public health inspector, quickly rising through the ranks and becoming the chair of the new Bureau of Child Health in New York City. Within a decade, her simple but effective public health initiatives saved the lives of tens of thousands of children. Soon her ideas spread to every state in America and dramatically decreased childhood mortality in the United States.

S. Josephine Baker, the third daughter of a prominent Quaker lawyer in Poughkeepsie, New York, wrote that one of her “earliest resolves was to make it up to [her] Father for having been born a girl.” She did have a younger brother, who died of typhoid along with her father when she was only sixteen. She decided after their deaths that it was up to her to support her sisters and mother through a career in medicine.

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Elizabeth Blackwell (1821-1910) was the first woman to get an MD in the United States. When Blackwell tried to set up a practice in New York City, she saw how women around her struggled to receive training as physicians and nurses; to find work as physicians; and to find competent physicians to care for them as patients. Elizabeth and her sister Emily (1826-1910) started hospitals where women could learn, study, work and receive care – crucial, safe, women-only spaces for early women in medicine.

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In 1857, the Blackwell sisters started the New York Infirmary for Indigent Women and Children, attaching a Women’s Medical College in 1868; and in 1862 they started the New England Hospital for Women and Children with Maria Zakrzewska, MD (1829-1902) in Roxbury, Massachusetts.

Baker spent $5000 to attend the Women’s Medical College of the New York Infirmary, graduating in 1898. She then interned at the New England Hospital for Women and Children before starting private practice in New York City. She wrote, “because I knew of no other place to go, I had unwittingly put myself into direct contact with the fountainhead of all medical training for American women.”

Shortly after Baker started her practice, she saw a notice in the paper about exams to be a medical inspector for the Department of Health, which paid $30 a month – much more than she made from seeing patients. In 1901, she became a medical inspector, and soon she began inspecting children in schools, looking for contagious diseases and lice. She was then assigned to inspect tenements in the Lower East Side – one of the most densely populated areas on Earth at that time – reporting and cataloging sick infants. She excelled in this work, and soon she became the assistant to the Commissioner of Health.

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She was told to print her name on letterhead as “Dr. S. J. Baker,” so no one would know she was a woman – and Baker took this advice to heart. At work Baker always dressed in man-tailored suits, with stiff collars and ties. She called it “protective coloring” in the male-dominated profession of medicine. (When she was not working, she wore “feminine attire.”)

As the assistant to the Commissioner of Health, she was assigned to meet with Mary Mallon, “Typhoid Mary,” a cook who worked serially in family homes, leaving as soon as the family contracted typhoid. Mallon was a healthy carrier of the bacteria Salmonella typhi, which she spread through poor hand hygiene and food preparation. Mallon didn’t understand how the spread of disease could be her fault; when Baker arrived, she refused to give serum, stool or urine samples, and escaped the house. Baker helped police find her, and, as Mallon continued to resist detainment, Baker “literally sat on her all the way to the hospital” in the ambulance. Mallon was released after saying she wouldn’t take another position handling food. Years later Baker found her again, working in a hospital kitchen. Mallon was placed in a cottage on North Brother Island for the rest of her life. 

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In 1908, Baker was named Chief of the new Bureau of Child Hygiene. At that time a third of all deaths in New York City occurred in children under 5 years of age. A fifth of total deaths occurred in infants under a year, and of these, half died in the first month of life. Baker wanted to save these babies through prevention of illness. She sent nurses to visit mothers living in the area of the city with the highest mortality. The nurses showed up within a day of delivery and encouraged breastfeeding, fresh air and sanitation. This was a simple intervention, but that summer, over a thousand fewer children died in that district than in previous years. The Bureau implemented the home-visit program citywide.

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“Baby health stations” were set up around the city, staffed by nurses and doctors who examined infants and provided safe infant formula (and sold safe, pasteurized whole milk at cost). It became clear that preventative care needed to begin prenatally; so the Bureau set up a school for midwives, and required licensure in order for midwives to practice in New York. Within 3 years, the infant death rate fell by an astonishing 40 percent. In 1911, the New York Times called New York the healthiest city in the world. In 1915, the same paper trumpeted that 20,000 babies had been saved in the city over the last 8 years.

Baker founded the American Child Hygiene Association in 1909 (which would be merged with the Child Health Organization in 1923, under Herbert Hoover, and renamed the American Child Health Association). She became president of the association in 1918 – a year after she became the first woman to receive a doctorate in public health from the New York University and Bellevue Hospital Medical College.

Baker never married, and never had children of her own. After her retirement in 1923, she lived with the writer I. A. R. (Ida Alexa Ross) Wylie. While neither openly declared what they meant to each other, Wylie wrote many times that she preferred the company of women to men, and they are generally assumed to have been in a romantic relationship.  

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Baker’s legacy is astonishing. Encouraging basic hygiene and providing clean nutritious food for children is now an obvious and unremarkable part of public health - and it is impossible to calculate the number of children she saved with her simple, common-sense interventions. 

Baker, Sara Josephine. Fighting for Life. New York: The Macmillian Company, 1939.

Essay by Alison Christy, MD, PhD