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The Doctor Who Made a Revolution

Drawing by Edward Lear

But Baker didn’t agree that the fate of these infants was inevitable. She had noticed that though infant mortality had plummeted in the slums thanks to the bureau’s efforts, it hadn’t budged in wealthier neighborhoods. “Sometimes,” she writes, “it really looked as if a baby brought up in a dingy tenement room had a better chance to survive its first year, given reasonable care, than a baby born with a silver spoon in its mouth and taken care of by a trained nurse who knew all the latest hygienic answers.” Intrigued, she decided to experiment. She boarded out the sickliest newborns in the hopeless ward to a corps of gushing Italian mothers on the Lower East Side who had been trained in child care by the bureau’s visiting nurses. “Offhand it sounds like murder,” Baker confesses. “Moving these poor little potential ghosts out of this ward where everything was light and sterile and spic and span, into tenement rooms on Hester and Orchard streets.”

Once again the results were astonishing: the death rate of these vulnerable babies was cut in half. Baker had hit upon a truth that we now take for granted. At the time, medical opinion held that mothers should train their babies early to be independent by feeding them at regular intervals and ignoring their cries and babbles. Doing otherwise was thought to damage them psychologically. We now know the opposite is true. Emotionally sensitive and responsive human contact is essential for normal child development. Without such care, children may be physically stunted, mentally retarded, or even die.5 Baker had no children of her own, but she saw clearly that though a baby

may still be unable to talk, walk or do anything but feed and cry and kick,…he nevertheless needs that sense of being at home in a new world…. Even more than he needs butterfat and fresh air and clean diapers…he also needs the personal equation to give him a reason for living.

That Baker’s decisive work is so little known today is probably due to its great success: much of what she taught us now seems self-evident. She also died in 1945, when the mystique of technology was at its height. The extraordinary burst of technical innovation that occurred in midcentury brought us not only the horror of the atom bomb but also better vaccines, pesticides, antibiotics, and such mass-produced labor-saving devices as vacuum cleaners and washing machines and the first plastics and computers. These new technologies changed the world forever. But demographic studies show clearly that Baker’s methods of common sense and compassion, dispensed not by machines but by real human beings, probably saved more American children’s lives than anything else.6

The neglect of Baker’s contributions to public health may also be political. In the 1950s and 1960s, America once again faced the challenge of integrating millions of disenfranchised citizens into its systems of public education, health, and social welfare, but this time those citizens were impoverished blacks, most of whom had been left behind by the public health revolution of the early twentieth century. They occupied, in demographer Samuel Preston’s words, “a separate caste” in US society. Their living conditions were much worse than those of whites, they had poorer access to whatever medical care was available, and black women with infants were much more likely to work outside the home—and for much longer hours and in much worse conditions than white women. This would have made it difficult for them to take advantage of the new health education and provide the kind of care their children needed.

Civil rights legislation and new programs like Medicare, Medicaid, and Head Start helped many people, both black and white, but they could not shield children from the steadily worsening poverty of the 1970s and 1980s. In 1971, a group of Washington officials and their allies in the civil rights movement drafted the Comprehensive Child Care and Development Act, which would have created a nationwide system of high-quality day-care, preschool, and home-visiting programs that resembled the national system of child health programs envisioned by Baker and other reformers fifty years earlier. It passed both houses of Congress with strong bipartisan support, but right-wing Republicans, using language similar to that used to quash the mother and baby care programs, pressured President Nixon to veto it.7

As described in the excellent forthcoming documentary series The Raising of America: Early Childhood and the Future of the Nation, Nixon’s adviser Pat Buchanan encouraged conservative journalists to write commentaries with headlines such as “Child Development Act—To Sovietize Our Youth,” which Buchanan would then present to Nixon in his morning press digest, as if it represented mainstream conservative opinion.8 Even though polls suggested that most Americans supported the bill, large numbers of letters denouncing it—some even comparing it to the Hitler Youth programs—poured into the White House.

Edward Zigler, head of Nixon’s Office of Child Development and one of the main architects of the bill, read through many of them. Most seemed to him to be form letters, and he suspected that the campaign had been orchestrated by a small number of conservative opponents. Nevertheless, the president got the message and vetoed the bill. This campaign gave rise to the “Family Values” movement, which has since attempted to thwart just about every legislative proposal to support American families. Today, nearly every other industrialized nation on earth provides some form of guaranteed support to families with young children. That America still does not is considered by many to be a national disgrace.

After the veto, some experts continued to pursue the vision of comprehensive child care services. During the 1970s, David Olds, now a professor of pediatric psychiatry at the University of Colorado, was working in a Baltimore day-care center for preschoolers. Many of the children came from homes wracked by poverty, drug abuse, domestic violence, and other problems. Realizing that there was only so much the center could do to help them, he eventually went on to create the Nurse Family Partnership, a home-visiting program in which trained nurses taught poor mothers how to provide a safe, secure, stimulating environment for their children, and helped them envision a better future for themselves.

Twenty years later, Olds found that the children of mothers who received the visits were not only healthier but were also less likely to have been abused or neglected and more likely to finish school, get jobs, and stay out of jail than a similar group of children whose mothers had not received the visits. Economists now estimate that every dollar invested in high-quality home-visiting, day-care, and preschool programs results in $7 in savings on welfare payments, health care costs, substance abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.9

In the early 1930s, Baker toured Soviet Russia. Unlike the United States even now, the Soviets already had a comprehensive system of day-care centers and preschools. Maternal and child health care were free and pregnant women were given paid leave from their jobs. Baker was well aware of the purges, labor camps, deliberate mass starvation, and other horrors of the Soviet system, but the national dedication to the care of the young impressed her. Still, as she toured these programs, she noticed something odd. None of the children ever seemed to fight or cry, and she never saw children laughing, except on propaganda posters. “They just sat and looked at you like so many little Buddhas,” she writes. Play activities were rigidly organized and even potty behavior seemed to be governed by Soviet methods of synchronized regulation.

Since its inception, the Soviet Union had been preparing for another world war, and Baker suspected that there was a connection between this and the child development programs. “You could not talk to any Intourist guide for ten minutes without hearing something about the Red Army and impending war,” she wrote, “and, from sickening experience, I know it is no accident that, in 1934, the two groups of Russians that looked really well fed were the soldiers and the children.”

In some respects, contemporary America is not all that different. It turns out that there is one group of Americans that receives high-quality government-subsidized child-care services, including day care, preschool, home-visiting programs, and health care: the US military. Unlike the Soviet version, these comprehensive programs aren’t designed to create obedient little soldiers. Instead, they use a play-oriented approach to help bring out children’s individual cognitive and social capacity. This may help explain why military children score higher on reading and mathematics tests than public school children, and why the black/white achievement gap is much lower in military families than it is in the general population.10 Since the military child-care program was created in 1989, the government has repeatedly declined requests to fund an in-depth evaluation, perhaps because if the effects were known, all Americans would demand these programs for their children too.

Baker appears to have destroyed all her personal papers, so little is known about her life except what’s in her memoir. After retiring from the Bureau of Child Hygiene, she lived in Princeton, New Jersey, with the novelist and Hollywood scriptwriter I.A.R. (Ida) Wylie, who was the author of more than a dozen romantic novels, many of which were adapted for film, including Torch Song with Joan Crawford and Keeper of the Flame with Spencer Tracy.

The witty, detached, sometimes hilarious but always morally decent tone of Fighting for Life resembles Wylie’s own memoir, My Life with George.11 Although the books tell totally different stories, some phrases, including “fighting for life,” appear in both, and it’s likely that Wylie ministered to Baker’s prose. Their third roommate was Louise Pearce, a Rockefeller University scientist who helped invent the cure for sleeping sickness and then traveled alone to the Belgian Congo in 1922 to test it. Around Princeton they were referred to as “the girls,” but otherwise, gossip appears to have been restrained. They must have been wonderful to know. Read the first page of Fighting for Life and you’ll see.

  1. 5

    Karen Weintraub, “Structural Brain Changes Found in Romanian Orphanage Children,” CommonHealth, July 23, 2012, available at commonhealth.wbur.org/2012/07/brain-changes-orphanage; René A. Spitz, “Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood,” The Psychoanalytic Study of the Child, Vol. 1 (1945); and Wayne Dennis, Children of the Crèche (Appleton-Century-Crofts, 1973). 

  2. 6

    Preston and Haines, Fatal Years

  3. 7

    The Raising of America: Early Childhood and the Future of Our Nation (California Newsreel, 2013). 

  4. 8

    Edward Zigler and Sally J. Styfco, The Hidden History of Head Start (Oxford University Press, 2010). 

  5. 9

    James J. Heckman and Dimitriy V. Masterov, “The Productivity Argument for Investing in Young Children,” Working Paper 5, Invest in Kids Working Group (Committee for Economic Development, October 2004). 

  6. 10

    Michael Winerip, “Military Children Stay a Step Ahead of Public School Students,” The New York Times, December 11, 2011, available at www.nytimes.com/2011/12/12/education/ military-children-outdo-public-school-students-on-naep-tests.html?pagewanted=all. 

  7. 11

    Kessinger, 2007. 

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