Occupational Health's Dynamo

BY MICHAEL PURDY

Photos courtesy of the Alan Mason Chesney
Medical Archives of the Johns Hopkins
Medical Institutions and others

When Anna Medora Baetjer's remarkable life drew to a close in 1984, and friends and family gathered to remember her, the first speaker, Carol Johnson Johns, then an associate professor of medicine at Hopkins, recalled the motto of Wellesley College, where she and Baetjer had studied as undergraduates: Non ministrari, sed ministrare — not to be ministered unto, but to minister. The motto has relevance to any career in public health, but Anna Baetjer's devotion to helping others in both her professional and personal lives was extraordinary.

Baetjer, a petite, wiry woman with the energy of a dynamo, was a leader for decades in efforts to get society to consider the twin questions of how the workplace environment might harm worker health, and what could be done to prevent or greatly reduce that harm. Her steadfast determination to accept only scientifically proven links between causes in the workplace and effects on worker health won her considerable influence in what were then the male-dominated worlds of industry and academia.

The safety standards she helped put in place — to protect workers from exposure to carcinogens and other toxins, and to mitigate the effects of stress, heat and humidity, and other hazards — helped prolong the lives of millions around the world.

"She was really of the old school — the most polite, civil woman you could ever think of," says Peter Lees, PhD '86, who studied under Baetjer and is now an associate professor of Environmental Health Sciences at the School. At the same time, Lees says, "Anna was very insistent. She had her ideas. Although always very pleasant and polite in presenting them, she was dogged." Baetjer was, according to Lees, someone who was rarely seen without a hat and gloves in public but who "could still wear blue jeans on an industrial visit with the best of them."

Among her students, colleagues, and family members, Baetjer's sense of compassion was legendary. "Anna didn't judge whether you were rich or poor or whatever," says Katharine Baetjer, wife of Anna Baetjer's cousin, Howard. "You had to be honest, you had to be clear-thinking, you had to be real, and then if you were all of those things, and if you were in trouble, particularly if you were in trouble not of your own fault, she would go out of her way to help you."

Katharine Baetjer recalls how Anna met a Czech psychologist, Walter Ehrlich, at an industrial hygiene meeting in Prague in 1964. Ehrlich was desperate to escape the repressive Communist government with his family, and finally succeeded in 1966, fleeing to Rome. Anna used her influence in her department to push for an appointment at the School of Hygiene and Public Health for Ehrlich, and when the family arrived she helped them in many other ways, including helping Ehrlich's wife get a job at Hopkins.

"She did things in such a way that it was comfortable…so acceptable, so kind," Ehrlich would tell Katharine Baetjer decades later. "Her care was not for show. She had nothing to gain."

Born in Baltimore on July 7, 1899, Anna Baetjer came to the Johns Hopkins School of Hygiene and Public Health in 1920 after graduating from Wellesley with majors in English literature and zoology. There were female researchers at the School at the time, but sexism kept most stuck on a semi-permanent basis in low-paying junior positions. Friends discouraged Baetjer's interest in enrolling as a graduate student, but Baetjer talked to William Howell, a professor of Physiological Hygiene who would later succeed William Henry Welch as the School's second director. She applied and was accepted. When Baetjer received her ScD four years later, Howell offered Baetjer a faculty position at the School, but reportedly only after adding another challenge to the low pay and rank.

"I was told that he said to Anna she could come on staff but only if she promised not to marry," says Edyth Schoenrich, MD, MPH '71, professor of Health Policy and Management.

Baetjer never did marry. It's impossible to know whether that was because of Howell's request or for personal reasons (her dedication to her work, perhaps), but Baetjer spent all but the last few months of her life living with her sister Ruth in the family home in Baltimore's Roland Park neighborhood.

At the time Baetjer became a faculty member in 1924, state health departments were becoming interested in how the home, the factory, and the streets made people ill. "A lot of people talked about it, and there was a lot of speculation and guesses, but nobody really knew…what happened inside the body," Baetjer would later say in a June 9, 1979, interview with the Baltimore Sun. "It became clear we needed a lot of basic research."

The mission of the Department of Physiological Hygiene was temporarily interrupted when Howell retired in 1931. The School, like the rest of the nation, was at a financial low point, and the department was not in favor with the School's leaders, who preferred applied research and thought Physiological Hygiene's scientific agenda was too basic and lab-oriented. An associate professor was let go, leaving only Baetjer, who had an associate appointment, and Janet Howell Clark, an associate professor and daughter of Howell. As four years passed and no director was appointed, and frequent consideration was given to folding Physiological Hygiene into another department, Clark eventually departed, leaving only Baetjer in the department.

Despite a letter of protest from Howell, the School's leadership in 1935 merged Physiological Hygiene, in the form of Anna Baetjer, into the Department of Chemical Hygiene, led by E.V. McCollum. Although Baetjer in a 1956 memo would criticize the disregard the move showed for the department and its importance to the School's mission, in other instances she described the change of status as liberating.

"I was left entirely alone," Baetjer told Elizabeth Fee in a conversation for Fee's history of the early years of the School, Disease and Discovery. "Dr. McCollum said to me, 'I don't have any time, and as long as you stay in the budget, you can do anything you want.'"

Baetjer would continue to be the sole Physiological Hygiene faculty member for 15 years, equipped only with a modest annual budget ($5,000 in 1935, down from the department's previous annual budget of $25,000) and a single research technician.

Despite the limited resources, Baetjer turned out a steady stream of research findings that had far-reaching impact. She first won national notice with a study she did for the Army. Concerned about the growing number of women in its ranks during the second World War, the Army asked Baetjer to study the effects of army workplaces on women's health. The National Research Council published her notable study in 1946 as a book, Women in Industry, Their Health and Efficiency.

In the book, Baetjer explained how the performance of female workers could be affected by physiological differences, such as lower average muscle strength, and sociological differences, like the household duties demanded of most women. Her recommendations included adjusting machinery and equipment to make it possible for female personnel to operate them without straining or overreaching, limiting the work week to six days or 48 hours per week, adjusting the work schedule for female employees on the basis of household duties (such as child and elder care), and teaching women to lift and carry loads properly.

The 1940s also saw the beginning of the body of research that other scientists would come to regard as Baetjer's magnum opus: her studies of the links between chromium and cancer. Perhaps motivated by early German epidemiological studies showing a higher risk of cancer for workers at chromium plants in the 1930s, Baetjer began to personally investigate the connections in a chromium plant and waste pile in Baltimore's Fells Point.

When she began, one of the dominant uses of chromium was for chrome-plating car parts, a use that has all but vanished now. Chromium is also found in stainless steel, in many paints and dyes, and in pressure-treated wood. "Chromium exists in several forms, several ionic states known by Roman numerals that represent the number of extra electrons on the chromium atoms," explains Peter Lees, who followed up on Baetjer's work with a study in the 1990s. "The difficult thing in studying chromium's effects on health is that chromium III is an essential micronutrient. You have to have it in your body because it's involved in metabolism of glucose. Chromium VI, however, is a great lung carcinogen. And the difference is three silly little electrons."

Through exacting lab and field work, Baetjer was able to draw indisputable links between chromium exposure and cancer. She advised companies around the world on the hazards of chromium, and assisted the World Health Organization in establishing workplace standards for chromium exposure.

By the 1950s, Baetjer was closely involved in helping the Fells Point Mutual Chemical Company rebuild its chromium processing plant. According to Lees, Baetjer made sure the company used state-of-the-art technology to minimize worker exposure to chromium dust.

In 1951, Anna Baetjer was elected president of the American Industrial Hygiene Association, the first female ever to be so honored.

How did she win such influence in a world run primarily by men?

Fearlessness probably played a part. Katharine Baetjer remembers Anna walking into "prison lockups" to measure the height of ventilation shafts, and notes, "If she was going to find out something, she was going to find it out."

Dorothy Scott, a lifelong friend of both Anna and her sister Ruth, describes Anna Baetjer as a globetrotting adventurer who dragged her and Ruth along on many exotic trips, which included seeing the Taj Mahal by moonlight; landing in a plane atop a glacier near Mount Cook (in New Zealand); and "motoring through" Iran, Cambodia, and Japan.

"Anna was into anything — it didn't matter what it was. And she made me more adventuresome because she made me try these things," says Scott, who in 1986 joined with Baetjer's estate to establish the Anna M. Baetjer Professorship in Environmental Health Sciences.

In all her exotic travels, Baetjer would only admit to being terrified once. In a 1979 interview with the Baltimore News-American, she described being "caught in the middle of a revolution" in Guatemala with her 80-year-old mother. They were on the second floor of a hotel that had first-floor gun turrets involved in the fighting.

Baetjer's formidable energy levels also contributed to her influence. "Dr. Baetjer raced everywhere she went," said Jacqueline Agnew, PhD '85, MPH '78, an associate professor of Environmental Health Sciences, at the memorial service for Baetjer in 1984. "She never did anything slowly." Agnew recalled an incident on a visit to an industrial plant with students from the course Baetjer created and taught for decades, Occupational Health. Baetjer believed an introduction to the subject couldn't be complete without field visits to industrial and military sites. She felt students needed to get experience in navigating and assessing workplace environments.

Agnew remembered Baetjer leading breathless students around the plant at her usual breakneck pace, charging "over catwalks and up and down several steep sets of stairs."

"At the top of one of those very steep sets of stairs, a young male student, huffing and puffing, turned to her and said, 'Gee, Dr. Baetjer, I sure hope when I'm your age, I'm in your shape,'" Agnew recalled. "Dr. Baetjer just looked at him, not at all out of breath, and said, 'Why, how could you be? You're not in my shape now.'"

Many sources report that Baetjer, who had an office on the School's seventh floor, would never use the elevator, and instead always walked up and down the stairs to stay in shape.

"She did that every day, even after she was diagnosed with breast cancer," recalls Schoenrich. "There was never a dull moment with her. With Anna, adrenalin flowed."

Students, appreciating her enthusiasm and vitality, were eager to sign up for her courses.

"Her lectures were always incredibly clear, well-organized, and delightfully presented," says Lees. "She had an hour lecture and she would talk and talk at a million miles an hour — no fluff in there, you wanted to get it all down — and it would all come together at the end and then she would say, 'Well, I think I'm just about out of time.' And she would look at her watch for the first time in the entire lecture, and there'd be about 10 seconds left! And she did it all without a note. Without a single note. It was incredible."

But the biggest contributor to Baetjer's influence seems likely to have been her insistence that decision making about workplace hazards be based on hard scientific data.

Alexander Trowbridge, the president of the National Association of Manufacturers, spoke at the 1984 memorial. Trowbridge was a former vice chairman of Allied Chemical Company, which had bought the Mutual Chemical Company's chrome processing plant decades earlier and continued working with Baetjer on environmental health issues.

He said Baetjer was "sharply critical of sloppy science…She was equally scornful of alarmist propaganda from self-styled 'public interest' voices, and of disingenuous public relations on the part of industry."

"In a dispute, Anna brought out the facts, no matter which side they helped," says Katharine Baetjer. "She had a scientific mind. Anna depended on facts. If the facts didn't support it, the facts didn't support it."

Katharine Baetjer remembers with fondness the stories Anna Baetjer told her of a trip to Japan to testify in a court case in 1979. She testified not for workers but for industry; a number of people had joined a lawsuit against a corporation, and she didn't think they could reasonably lay claim to having been affected by chromium exposure.

Other 80-year-old women might have quailed at the task of testifying for industry in a male-dominated society like Japan, Katharine Baetjer said, particularly given the leeway the Japanese judicial system gave lawyers at that time to try to confuse witnesses or to interrogate them endlessly. But not Anna Baetjer, who endured six hours of questioning and ultimately won the case for the company.

Baetjer's work touched on subjects well beyond chromium. She showed that high temperatures and humidity could make animals excrete toxins less quickly, an invaluable finding for public health researchers puzzled by the increased rate of lead poisoning in Baltimore children in the summer months.

Concerned with the effects of complex chemicals on health, Baetjer in 1963 set up at Hopkins one of the first research and training programs in environmental toxicology. She was, as always, years — if not decades — ahead of the rest of the country.

"The thing that really impresses me," says John Groopman, PhD, Anna Baetjer Professor of Environmental Health Sciences and chairman of the department, "is that if you look at the papers that she published in the '20s and '30s, they're every bit as relevant today as they were [then]. They're tackling issues that we still view as being critically important: air pollution, heat and humidity, and stress, for example."

Baetjer became a professor emerita in 1970, but remained active in research and consulting up until shortly before her death in 1984. For example, in 1974 she made national news when a study she co-authored revealed that 1.5 million workers at pesticide plants were at risk of cancer through exposure to inorganic arsenic.

Nearly two decades after her death, Baetjer is still an inescapable presence in Groopman's department, the modern-day descendant of the division she single-handedly kept alive during the Great Depression. From the name of Groopman's endowed professorship to a prominent display of Baetjer memorabilia on the wall outside the chair's office; from the annual Anna Baetjer lecture to the room where the lecture takes place, the Anna Baetjer room, which features a portrait of Baetjer receiving an honorary Hopkins degree, Anna Baetjer is remembered with devotion and pride.

Baetjer, who assiduously avoided self-promotion, would have probably taken greater joy from other, less prominent ways of remembrance. Nearly two decades after she died, two of her former students, Peter Lees and Jacqueline Agnew, both faculty at the School since they graduated, are among the instructors for the class Baetjer originated and taught for decades.

That class is still formally known as Occupational Health, but Agnew and Lees don't call it that.

They call it "the Anna Baetjer course."

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