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Public Health Through the Eyes of Dr The Pennsylvania State University The Graduate School College of the Humanities CREATING A NARRATIVE OF LIFE: PUBLIC HEALTH THROUGH THE EYES OF DR. SARA JOSEPHINE BAKER A dissertation in American Studies by Rebecca K. Cecala © 2016 Rebecca K. Cecala Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy December 2016 The dissertation of Rebecca K. Cecala was reviewed and approved* by the following: Charles D. Kupfer Associate Professor of American Studies and History Dissertation Adviser Chair of Committee Simon J. Bronner Distinguished Professor of American Studies and Folklore Program Director, Doctor of Philosophy in American Studies John Haddad Professor of American Studies and Popular Culture Anne Rose Distinguished Professor of History and Religious Studies * Signatures are on file at the graduate school. ii ABSTRACT During the Progressive era (1890-1920), New York City was the largest city in the United States and its bacteriological lab and health department helped pioneer American public preventative health. New York was likewise home to a rapidly growing population of immigrants made vulnerable to disease through the unlivable conditions of tenement housing and poverty. Living from 1873-1945, Dr. Sara Josephine Baker was director of New York City’s Bureau of Child Hygiene: the first woman to be appointed a municipal public health official in the United States. Baker witnessed the professionalization of the field of public health and participated in its transition from municipal sanitation to preventative medicine. Baker is chiefly remembered in scholarship for her role in the apprehension of typhoid carrier Mary Mallon (“Typhoid Mary”) and for using preventative health to reduce infant mortality. However, Baker’s perspective on the meaning of her work and the larger role of public health in American society has not been examined, and is relevant to twenty-first century preventative health strategies for mothers and infants. In this study Baker’s perspective on the role of public health in society is examined through her autobiography and public writing, couched within the cultural context of progressive reform, the professionalization of the fields of public health and medicine, and the national discussion surrounding individual vs. state and expert vs. non-expert responsibility for child welfare. Key issues to the development of public health are examined, putting Baker’s voice in conversation with other public health officials, reformers, physicians, and politicians of her time. Through Baker’s perspective the role of public health in society clearly emerges as a “narrative of life.” Utilizing Baker as a lens, this study argues that as a new field public health had an opportunity to help define modern industrial American society as one that demonstrated its value for life through the protection of its most vulnerable citizens: infants. Baker recognized that a public service requiring the cooperation of federal and local governments, families, public health workers, nonprofits and medical experts required a narrative that made the work meaningful to all stakeholders. For publicly funded preventative health to maintain the long-term support of those groups and to remain relevant to those it served, Baker believed that the narrative would have to be rewritten for each new generation. iii TABLE OF CONTENTS Introduction………………………………………………………………………………………………………………………………..1 Methodology………………………………………………………………………………………………………………..11 Chapter Summaries………………………………………………………………………………………………………12 Chapter 1. BAKER, PUBLIC HEALTH, AND NEW YORK CITY IN CONTEXT………………………………………………………..............................................................................20 The City and Its Narrative……………………………………………………………………………………………..24 The Individual and Society………………………………….…………………………………………………………29 Baker and Public Health………………………………………………………………………………………………..34 Conclusion………………………………………………………………………………………………..………………….41 Chapter 2. TYPHOID MARY………………………………………………………………………………………………………..45 Historical Context…………………………………………………………………………………………………………47 Bacteriology Reinvents Public Health……………………………………………………………………………52 Baker and Soper Compared………………………………………………………………………………………….65 Private/Public Boundaries of Public Health…………………………………………………………………..72 Conclusion………………………………………………………………………………………………………………..….83 Chapter 3. THE BUREAU OF CHILD HYGIENE.................................................................................87 A Woman Heads the Bureau of Child Hygiene.................................................................88 Babies Die in America’s Most Modern City......................................................................97 Baby Health Stations.......................................................................................................101 Little Mothers’ Leagues...................................................................................................107 Fostering Foundlings.......................................................................................................118 Conclusion.......................................................................................................................121 Chapter 4. THE MILK QUESTION..................................................................................................125 Rhetoric of Perfection.....................................................................................................130 The City and Sheffield Farms...........................................................................................135 Mothers’ Milk..................................................................................................................141 Conclusion.......................................................................................................................154 Chapter 5. BABIES AND SOLDIERS................................................................................................159 Child Welfare and the War..............................................................................................163 Wars on Multiple Fronts.................................................................................................174 The Power of Institutions................................................................................................187 Conclusion.......................................................................................................................197 iv Chapter 6. MAKING THE NARRATIVE OF LIFE NATIONAL............................................................203 Goals and Strategies of the Two Bureaus.......................................................................209 Experience and Expertise................................................................................................219 Sheppard-Towner: What Works for Crops Can Work for Babies....................................232 Conclusion.......................................................................................................................241 Conclusion. A NARRATIVE OF LIFE FOR THE TWENTY-FIRST CENTURY?......................................244 Bibliography.................................................................................................................................254 v INTRODUCTION The role and responsibility of science to public wellbeing has been frequently contested and continues to evolve in American society. Bridging medical expertise, politics, and culture, public health is one of the most publicly visible and straight forward examples of the use of science to benefit society. In the early twenty-first century the Zika and Ebola viruses and the growth of refugee camps from political conflicts have created globally visible public health crises on a scale requiring the cooperation of public health officials and aid organizations from multiple nations.1 The complex of environmental factors contributing to poverty and crime, and their threat to both individual and societal wellbeing are increasingly being addressed at the municipal level by public health.2 That public health organizations are available to respond to such crises is now often a given, but the infrastructure required to provide municipal, national, or international coordination in a globally connected world was in its infancy just a century ago. The professionalization of the social sciences, medicine, public health, and epidemiology, as well as discoveries such as healthy carriers and germ theory made the early twentieth century a key moment in the development of public health and the emergence of the medical expert to mediate individual and state responsibility for societal wellbeing.3 1 Geoff Manaugh and Nicola Twilley, “Ebola and the Fiction of Quarantine,” The New Yorker, August 11, 2014, accessed November 7, 2016, http://www.newyorker.com/tech/elements/ebola-fiction-quarantine. The American Public Health Association has a position paper addressing the myriad public health challenges faced by communities hosting refugees, and of particular relevance to this study, it notes that “women and their dependents constitute approximately 80% of refugees worldwide.” American Public Health Association, “The Health of Refugees and Displaced Persons: A Public Health Priority,” accessed November 7, 2016, http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy- database/2014/07/29/10/34/the-health-of-refugees-and-displaced-persons-a-public-health-priority. 2 Leana S. Wen and
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