license.≥≥
A closer look at the rhetoric and the practices of the New England Hospital thus o√ers an unusual glimpse at a mid-nineteenth-century social welfare institution created with the intention of fulfilling a radical agenda; at the same time, it allows us a deeper understanding of the di≈culties and limitations that accompanied such a project, for the radicalism of the institution did not last. By 1872 the hospital had moved out to the suburbs and was trying to attract a
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‘‘better’’ clientele; by the end of the century, its radical, even charitable, dimen-sions had all but disappeared. To be sure, hospitals throughout the nation were changing from largely charitable institutions to acute-care facilities, defined increasingly by new technological developments and surgical interventions, and catering more and more to the middle class and wealthy.≥∂ Yet since few had started out with as radical an agenda as the New England Hospital, few had been so utterly transformed.
Thus, national trends, as important as they may have been, cannot alone explain Zakrzewska’s abandonment of her earlier radicalism; one must also take into consideration her personal limitations and aspirations. However committed she may have been to social justice for the poor, she came up against three obstacles that led her to redefine the hospital’s mission: financial di≈-
culties, a growing disillusionment with the increasingly Irish (Catholic) makeup of the patient population, and the realization that poor, chronically ill women did not best serve the needs of a modern teaching hospital. As with other middle-class reformers, Zakrzewska’s actions revealed her class prejudices, coupled, in her case, with an extreme hatred of the Catholic Church. Given this, and given that her true passion had always been to open the doors of the medical profession to women, she had little incentive to continue a project that threatened to jeopardize that cause.. . .
As a result, Zakrzewska’s hospital has not gone down in history as an example of an institution that provided justice to poor women; its claim to fame is rather through its role in opening the medical profession to women. Historian Mary Roth Walsh even dubbed the New England Hospital for Women and Children a ‘‘Feminist Showplace’’ because of its central role in demonstrating to the public women’s ability to practice medicine, provide clinical instruction, and run their own hospital.≥∑ Like other all-women’s institutions founded in the second half of the nineteenth century, whether clubs, colleges, or political organizations, the New England Hospital came into existence because of women’s exclusion from the institutions that prepared men for work in the public sphere.
Indeed, the founding and success of the institution depended, in Walsh’s words, upon ‘‘the material and psychological support’’ Zakrzewska received from a network of women committed to advancing the cause of their own sex. ≥∏
The New England Hospital also relied upon the goodwill of a large number of men who were committed to advancing women’s rights. Significantly, Zakrzewska’s decision to found an all-women’s hospital did not mark her embrace of
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a separate women’s culture. On the contrary, her ultimate goal was full integration, and she hoped she was doing her part to convince society that women practiced medicine as e√ectively as, and certainly no di√erently than, men. She may have distinguished herself in this regard from some of the founders of all-women’s clubs and colleges, who often used their culture’s insistence on a separate woman’s identity to expand their role in society, but Zakrzewska was not alone. Indeed, many of her peers who presided over all-women’s medical institutions shared her preference for integration as well. Thus Elizabeth and Emily Blackwell, who founded the Women’s Medical College of the New York Infirmary in 1868, did so only after they had failed repeatedly to open the doors of all-male institutions to women. For these women, the best way to advance the cause of their sex was to insist that, whatever di√erences might exist between men and women, they still needed to be trained in identical ways.≥π
Some of these pioneers also believed that training had to be in regular medicine. Thus Zakrzewska made sure to align herself and her institution with the elite medical community in Boston, joining other regular women physicians, such as Ann Preston and the Blackwells, in rejecting irregular practices.≥∫ Histo-
rians of medicine have argued convincingly that by midcentury the di√erences between orthodox and unorthodox approaches may have been as much rhetorical as substantive. Homeopathic physicians, who emphasized both the e≈cacy and painlessness of their infinitesimal doses, had often received training in regular institutions, whereas orthodox physicians, whose therapeutic practices consisted largely of bloodletting, purgatives, emetics, and tonics, had become more conservative in their approach.≥Ω Still, all di√erences had not disappeared, and by aligning the New England Hospital with regular medicine Zakrzewska was announcing her allegiance to the established medical profession and to traditional medical practices; at the same time, she sought to introduce some of the new scientific methods that were emerging from the German laboratories and clinics. Thus, not only did interns at her hospital learn standard medical practices, but they also charted their patients’ temperature, pulse rate, and rate of respiration; they performed chemical and microscopic analyses of bodily fluids; and they witnessed the occasional autopsy. Although by modern standards this may seem unimpressive, few other hospitals—even those committed to regular medicine—did this much.∂≠ In this way, Zakrzewska gained the respect and the support of elite physicians, but she also distanced herself from the large number of women practitioners who received their degrees from irregular schools.
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Some historians have judged Zakrzewska harshly for this, seeing her alliance with the orthodox profession as a failure on her part to show support for other women. Others have viewed her rejection of alternative medical practices, coupled with her attack on women’s sympathetic natures, as predominantly strategic. ∂∞ But these interpretations fail to acknowledge Zakrzewska’s own perception of her move as radical, not strategic or conciliatory. Zakrzewska did not embrace orthodox medicine because she believed women would succeed only if they excelled in a man’s world; she embraced it both because she rejected the gendering of that world and because it came closest to embodying the principles of science in which she believed. To be sure, Zakrzewska was not ignorant of the rhetorical power of laying claim to science and to orthodoxy, but when she set out to create a hospital that would best advance the cause of women physicians, she was also operating from a conviction that training in orthodox scientific medicine produced the best physicians: ones who could think for themselves, make their own deductions, and provide the truest and thus most humane care. In short, for Zakrzewska, science and orthodox medicine went hand in hand with moral actions and radical politics.
. . .
Zakrzewska’s story thus draws our attention to the multiple meanings of science in the nineteenth century and to how one very public woman embraced a particular view of science as democratic and revolutionary in order to try to bring about radical change in gender relationships.∂≤ It is also a story that provides greater insight into the challenges women physicians faced as the century progressed and the practice of medicine underwent substantial changes. When Zakrzewska first began practicing medicine, medical care still took place largely in the home; the medical instruments available to physicians amounted to little more than forceps, microscopes, and thermometers; Louis Pasteur had not yet spoken of the germ theory; Joseph Lister had not yet developed antiseptic techniques; and no one had yet linked microbial agents with specific infectious diseases. By the time Zakrzewska began pulling back from hospital a√airs in the early 1890s, shortly after she turned sixty years old, the world of medicine looked radically di√erent. Bacteriology was a rapidly expanding field, the search for vaccines and antimicrobial agents was well under way, asepsis
had already replaced antisepsis, new instruments were constantly being invented (the X-ray would soon be developed), and at least the larger hospitals were building laboratories and a≈liating with elite medical schools.∂≥
Scholars of women in medicine have long emphasized the di≈culties that
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arose for women physicians as a result of these changes. In addition to the logistical problems of financing an ever longer and more expensive period of training, women had to struggle with the new image of a medical world that glorified everything exact and scientific while ignoring the caring, more human side of medicine.∂∂ This posed, of course, less of a problem for Zakrzewska, who had never embraced a notion of women as uniquely caring. Thus, she experienced little, if any, conflict between an image of herself as a woman and the emerging model of the physician-scientist. Indeed, given her lifelong advocacy of the natural sciences, one might very well have expected her to be among the loudest proponents of the changes taking place.
That was not, however, the case. Instead, by the 1880s Zakrzewska was voicing deep reservations, saving her harshest words for what seemed to her an obsession with bacteriology, gynecologic surgery, and the tendency to view disease as nothing more than the pathophysiological changes of the body. In their stead, she promoted prevention, hygiene, and moral education, thus embracing an older style of medical practice that many, in the last decades of the century, gendered female and contrasted with masculine practices located in the laboratory and the surgical theater.
It is tempting to see Zakrzewska’s apparent change of heart as evidence of her move toward the notion of unique female traits, the sign of a mature woman who no longer needed to prove to men that she could function in their world.
This is not the interpretation that I present in this book. Zakrzewska may have shortened the distance between herself and those who argued that women had a unique contribution to make to the reform of society, but she did so without couching her criticisms of modern medical practices in gendered terms. Most important, she did so without abandoning her staunch advocacy of science, rationality, or materialism. Central to her vision of good medical practice remained the scientifically trained physician, who had been taught how to dissect problems in order to best guide her or his patient toward recovery. At a time, however, when so many promoted the laboratory as the final arbiter in medical decision making, Zakrzewska’s vision appeared to look backward rather than forward, no longer finding much resonance among the young physicians coming of age.
. . .
In the end, Zakrzewska’s life stands as a reminder of the problems inherent in reifying certain attributes as feminine or masculine, for inevitably one ends up with individuals who must be classified as ‘‘others’’ when they fail to fit the
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models being proposed. The story I tell is not, however, intended to raise doubts that the values associated with science—rationality, precision, objectivity—were gendered masculine at the time. They most definitely were. Over the past decades, feminist scholars have demonstrated convincingly that the image of the modern scientific method was and to a great extent remains masculine and that this gendering of science came about through a long historical process. They have also shown how the masculinization of science functioned to exclude women from professional scientific activity by setting up a contrast between the rigors of scientific thinking and appropriate feminine behavior. ∂∑ But feminist scholars have also been emphasizing that as science became identified as a masculine activity, what it meant to be male and female was being redefined as well.∂∏ The huge amount of ink spilled in the nineteenth century proclaiming women’s inability to engage in scientific activity testifies to the instability of these categories and the anxiety generated by the di≈culty of fixing in place the boundaries of a moving target. But if the instability caused anxiety for some, it opened up possibilities for others, allowing individuals like Zakrzewska to embrace and perform alternative positions. This book is about Zakrzewska’s twin battles against the gendering of science and the restrictive definitions of her gender; it is also about why those battles mattered in the past and continue to matter today.
Aspiring Bourgeoisie
Marie Elizabeth Zakrzewska was born at home with the help of a midwife in 1829. At the time of her birth, her father, Martin Ludwig Zakrzewski, earned a modest salary as a quartermaster in the Prussian army; her mother, Caroline Fredericke née Urban, was a housewife. Over the next eighteen years, her mother would give birth to seven more children, one of them stillborn. Struggling to provide for their growing family, the Zakrzewskis decided that they could no longer manage on a single income. Caroline Fredericke thus entered the workforce when Marie was just six years old, first as a trader in porcelain and then, drawing on her own experiences with childbirth, as a midwife. Martin Ludwig’s eventual move into a civilian position in the Prussian Ministry of Culture brought the family some financial relief, but only with the additional income Caroline Fredericke provided were they able to maintain a lifestyle that would count them among the newly emerging German bourgeoisie.∞
And this was something to which they very much aspired. To belong to this class marked one as a member of the new elite.≤ Largely a product of legal, educational, and administrative reforms that were intensified following Germany’s devastating defeat at the hands of Napoleon in 1806, the Bildungsbürgertum (urban educated elite) came to embody the values that would supposedly transform a rigid absolutist system based on estates into a civil society held together by a constitution. These values included, among others, hard work and industriousness, faith in rationality and the legal system, and the importance of education and economic security. For many men of Martin Ludwig’s generation a position in the rapidly expanding Prussian civil service came to be seen as the most promising way to gain entry into this new social elite. As one
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contemporary later commented, by the 1820s ‘‘everyone looked to the state for his advancement.’’≥
The Zakrzewskis struggled throughout their lives, however, to di√erentiate their lifestyle from that of a ‘‘wage laborer’’ and to secure for their family membership in the ‘‘middling’’ bourgeoisie.∂ Martin Ludwig’s inability to achieve the economic security that would have guaranteed at least minimum standards of education for all his children posed one threat to their membership in this class; Caroline Fredericke’s entry into the workplace posed another. The bourgeois lifestyle, in theory if not in practice, was predicated on a sharp separation between the female, reproductive, private sphere of the home and the male, productive, public sphere of employment. Like the bourgeoisie itself, this recon-figuring of social space was relatively new, developed as a means of excluding women from a political transformation designed to grant greater rights to men.
The most vocal ideologues of the new bourgeois lifestyle coupled a theory of sexual di√erence grounded in nature with a redefinition of the family as the
‘‘natural’’ expression of such di√erences. Thus, according to one encyclopedia author in 1848, women’s greater ‘‘dependence, uncertainty, sacrifice, [and]
sympathy’’ led them ‘‘naturally’’ to confine their labors to the home, providing a moral education for their children and a safe haven for their husbands. Men, in contrast, were marked by ‘‘self-confidence, independence, power and energy, completeness, [and] antagonism,’’ traits that sent them catapulting out into public spaces to engage in productive work.∑
When Caroline Fredericke left the privacy of her home to enter the workforce, she thus broke with the ideal in a dramatic way. Other bourgeois women may have entered public spaces, extending their new position as moral guardians of their families by volunteering in religious or social welfare organizations, but it was another thing entirely to seek employment. Added to this, midwives traditionally came from the l
ower classes. For women of the middle classes who, in the early nineteenth century, needed to support themselves, the most respectable options were teaching or hiring oneself out as a governess, although these occupations were deemed appropriate for single women alone. Despite government e√orts to make midwifery more attractive for ‘‘cultivated women,’’ the Zakrzewskis struggled with the knowledge that Caroline Fredericke’s status as a working woman threatened to collapse the distance separating them from the working and artisan classes.∏
Many of the values and beliefs Marie Zakrzewska espoused as an adult reveal
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her deep roots in the bourgeois culture of mid-nineteenth-century Germany.
These include everything from her work ethic to her embrace of rationality and secularism, her desire for independence and economic security, her high estimation of formal schooling, and her awareness of her social class. Yet Zakrzewska also broke sharply with this culture in significant ways, most directly by challenging the sexual division of labor. She would, for one, follow directly in her mother’s footsteps by entering the workforce as a midwife and then—
because she aspired to a position of greater esteem—as a physician and hospital director. She thus defined her life in and around public spaces, ensuring that she would have the economic security that always seemed to elude her parents. She would not, however, try to combine this with marriage and children. Instead, rejecting entirely the rigid structure of the bourgeois family, she would fashion for herself an alternative family structure made up of close friends and siblings.
Science Has No Sex Page 3
