The mortal intricacies of the surgical theatre and the laboratory work on which it depends are the centerpiece of Steven Soderbergh’s TV series “The Knick,” set in a downtown Manhattan hospital in 1900. Soderbergh (who does his own camera work) films it thrillingly, but his greatest inspirations unfold the details—intellectual and physical, analytical and gory—of medical practice. Closely bound to the show’s unstinting view of scientific progress is the bureaucratic wrangling—in effect, the backstage business—that makes stunning medical productions possible. Clearly, Soderbergh and the screenwriters, Jack Amiel, Michael Begler, and Steven Katz, did their historical research. But, for a real-life, “Knick”-like account of the grim spectrum of sickness in turn-of-the-century New York that pierces the screen of dramatic artifice and shows the sort of visionary practicality that it took to change things, there’s a very worthwhile read: “Fighting for Life,” the 1939 autobiography by S. Josephine Baker (1873-1945), which was reissued last year by New York Review of Books Classics.
Baker was a doctor who started working as an inspector for the city’s Department of Health in 1901, and soon rose to become the first head of the Department of Child Hygiene. But, following the chronological convention of autobiography, she buries the lede; it takes fifty-eight pages to get to the heart of the matter, a description of her first tour of duty in Hell’s Kitchen:
The primary cause of this disease was unpasteurized milk: “the bulk of the milk supply that these babies were fed on was drawn from rusty cans and the milk was dotted with flies as well as full of bacteria.” Her solution was simple: opening “baby milk stations” in storefronts throughout the city, which provided clean milk at prices below market rates. She coupled this with educational outreach, mainly to poor families in overcrowded neighborhoods, to overcome traditional resistance to pasteurized milk, which many considered less nutritious because it was “cooked.” This, along with her other prescriptions for improved child care—including ventilation (overcoming traditional worries about drafts), lighter baby clothing, and a modified diet, helped to reduce the city’s rate of baby deaths, she writes, “from fifteen hundred a week to around sixty a week.”
Baker had an epiphany in the course of her work, and it gave rise to an enduring shift in the very nature of medicine: “The way to keep people from dying from disease, it struck me suddenly, was to keep them from falling ill.” She suddenly conceived her mission as “teaching people how to stay well,” or, in other words, "preventive medicine"—which, she wrote, "had hardly been born yet and had no portion in public-health work” when she took the helm of the newly founded Department of Child Hygiene, in 1908.
Baker’s account of city life at the time of her entry into government work is appalling. Working in public schools soon after her Department of Health appointment, she found that four out of five children were infested with lice, contagious skin diseases were almost as endemic, and “one out of five, some 20 per cent, had trachoma, that highly infectious eye-disease which constitutes so serious a risk of blindness that the immigration authorities no longer allow any case of it to enter the country.” She oversaw a program to delouse children, to treat skin disease, and to maintain separate classes for children afflicted with trachoma—and, in the process, began an over-all effort for in-school medical care for children that led to the now familiar institution of the school nurse.
Baker’s early duties with the Department of Health involved such intrepid tasks as “invading Bowery lodging-houses, the ten-cents-a-night kind, for instance, to vaccinate the patrons against small-pox in the very early hours of the morning.” Soon, she found herself—perhaps I’m burying the lede, too—helping another physician, George A. Soper, to solve the mystery of a typhoid epidemic among a seemingly unconnected group of well-to-do families. Of course, the culprit was a cook, Mary Mallon, now known as Typhoid Mary. The story of her capture is terrifically detailed and cinematic: “Mary was on the lookout and peered out, a long kitchen fork in her hand like a rapier. As she lunged at me with the fork, I stepped back, recoiled on the policeman and so confused matters that, by the time we got through the door, Mary had disappeared.” What followed was a search that implicated her fellow domestics (whose closing of ranks in her defense fascinated Baker) and a chase that involved slapstick elements.
These adventures were a far cry from Baker’s seemingly idyllic childhood in Poughkeepsie; her father was a prominent attorney, her mother was one of Vassar’s first graduates, and her tales of romantic outdoorsy exuberance, with clambakes and boat racing, ice skating and "ice-yachting," cheerful excursions and teeming family gatherings, are reminiscent of Orson Welles’s “The Magnificent Ambersons.” She also relates anecdotes replete with strange, resonant details, such as a story about one Dr. Jackson, who “made, and had his patients eat, what I believe was the first prepared breakfast food: a really delicious concoction called ‘granula’ ” (i.e. granola).
But Baker’s father died when she was sixteen and she became, by default, the sole means of her family’s long-term support; renouncing her long-planned matriculation at Vassar, she went to New York to study medicine at the Women’s Medical College of the New York Infirmary, at Stuyvesant Square and East Fifteenth Street (just four blocks north of Knickerbocker Hospital). Graduating in 1898, she became an “interne” at New England Hospital, in Boston, a city that also had pockets of horrific poverty. Her description of an emergency delivery at which she assisted in a fetid tenement features the harrowing comedy, sincere compassion, and cold clinical detachment that tinges much of her writing.
When she returned to New York, she opened an office on the Upper West Side: “In those days, Amsterdam Avenue … was filled with squatters’ shacks made of hammered-out tin cans and waste lumber, inhabited by ne’er-do-wells and swarming with goats.” The early years of medical practice were, as she had been warned, lean; she applied for work with the Department of Health not out of any sense of public-spirited mission but because the pay was thirty dollars a month, or, as she writes, “A dollar a day: about double my first year’s rate of income.”
Baker’s book is studded with sharply ironic reflections on the wider implications of the medical world. She writes of her preference for dealing with the backroom wheeler-dealers of the Tammany Hall machine rather than with “reformers”: good-government advocates subjected her projects to extended study and careful cost accounting, whereas party hacks cut through red tape and got things done. “At bottom they were thoroughly corrupt and cynical, a sort of government cancer,” she writes, but they nonetheless saw the interest (and self-interest) in helping the poor by means of programs that they financed shadily—“this baffling mixture of official incompetence explained to me, in part at least, Tammany’s hold on the people: large spending and innate humanity.”
She spent decades crusading against child labor, proposing in vain a constitutional amendment against it; at the time of her writing, in the late thirties, she found the practice happily less prevalent: "We have made some progress, due largely I think to the adult need of the jobs that children used to get with little or no trouble." If children had the Depression to thank for their improved condition, they could also thank the Great War, which she called "a backhanded break for children" due less, she thought, to their status as "the hope of the nation" than as "future supplies of cannon fodder." She also writes of a political-hack supervisor who, during the war, told her, "By the way, I am changing the name of German measles. Hereafter it will be known as 'Liberty measles.' " (She adds, "And it did bear that extraordinary title for the duration of the war.")
Baker discusses her visit to the Soviet Union in the early nineteen-thirties—which she undertook with mitigated enthusiasm and a clear recognition of the chill of purges and the weight of dogma. (In a ward filled with silent babies, a nurse told her, "Why should a Soviet baby cry? There is nothing to cry about.") Yet her observations there led to her advocacy of "state medicine," although with "safeguards and concessions to our democratic ideal," as, for example, to insure the choice of doctors, as well as her hint at an endorsement of legal abortion.
And she was a leading campaigner for women’s suffrage, for which she gave speeches and even met with President Woodrow Wilson as part of a compact delegation seeking (and winning) his support. Yet she called the passage of the Nineteenth Amendment, in 1920, "at once a great victory and a great deprivation. When the enemy was routed, the woman's suffrage army was disbanded and we lost all that sense of solidarity and comradeship." She described the trouble she faced, early in her career, in getting men to accept a female boss, and decried the enduring obstacles that stood in the way of women's full participation in public life.
As for her private life, Baker was as frank as could be expected for a popular author of her time. She wrote of her medical-school friend Dr. Florence M. Laighton, "with whom I lived and practiced for many years." ("Dr. Laighton and I had made enough money to take a house for ourselves, a four-story affair which had been built for Rose Coghlan, the great actress, on a side street off Central Park.") In her later years (as Helen Epstein writes in her introduction to the book), Baker shared a house in Princeton with the screenwriter and novelist Ida Wylie (whom Baker mentions in passing) and the scientist Louise Pearce.
There are no female doctors in "The Knick"—at least, not in the first seven episodes—and no horrific squalor and endemic disease akin to what Baker observed and combated. The series features a health inspector who makes his rounds, one who is perhaps analogous to Dr. Soper, but there's no Dr. Baker at his side (though another woman at his side is an important enough character on her own). But there's a second season coming.
