Slumdoc Pioneer

Fighting for Life is the absorbing memoir of American doctor Sara Josephine Baker. She was a pioneer of public health in 1900s New York when the notion of preventive medicine scarcely existed. Her work began in the notorious ‘Hell’s Kitchen’ slums of the Upper West Side where summertime diarrhoeal epidemics killed one in three children before they were five. Such was the filth and destitution, the area was condemned as an ‘out and out hog pen’ by an official Department of Health report. Nevertheless, Baker took a job there and quickly established home visiting programmes, community baby clinics, and school nurses. She went on to invent silver nitrate capsules to treat babies with ophthalmia neonatorum as well as designing baby clothes that were more convenient to remove. In just 3 years the infant mortality rate fell by 40%. All this was at a time when being a female doctor was scarcely tolerable. She recalls the air being ‘sulphuric with comments’ after telling one of the most established GPs in New York about her intentions to study medicine. Baker went on to become the first director of the New York Bureau of Child Hygiene from 1908–1923 and became one of the most influential doctors of her generation.

Despite her successes, her observations are never grand, she describes the first few months of medical school as ‘half terrifying and half boring’, and the reader is gripped by her courage and wit and by the fascinating portraits of the people she meets along the way. As a fledgling doctor, Baker punched a drunk who was beating his wife while she was trying to deliver their baby. He fell down an entire flight of stairs and she thought she’d killed him. She was the one who finally tracked down the infamous and foul-mouthed Irish cook ‘Typhoid Mary’ and found herself having to sit on her in the police car in order to apprehend her.

She is drawn into suffrage and meets the Pankhursts and travels to Soviet Russia where she sees state-run abortions being performed without anaesthetic. She led a remarkable life and excelled at a time when medicine was not so much evidence-based as empirical and experimental. The book is a page-turning slice of social and medical history and both funny and inspiring.

• © British Journal of General Practice 2014