When she accepted the o√er, Zakrzewska must have believed that she would be riding a wave of reform. She was, however, soon disappointed. As she was to learn, too many obstacles remained in place for her to succeed in building a medical curriculum around the natural and clinical sciences, ensuring that her female students received an education comparable to, if not better than, that available to men.
The Standard of the School
Was below Par
Zakrzewska spent most of the three years she was on the faculty at the New England Female Medical College fighting with the school’s director, Samuel Gregory (1813–72). Gregory, who was critical of the way the basic sciences were beginning to alter the practice of midwifery, had founded the college in 1848
because of his hope that women’s natural abilities to care, comfort, and nurture would keep medical science at bay. In contrast, Zakrzewska insisted time and again that, more than anything else, a capacity for scientific thinking had to mark the true physician. There is a certain irony to the battles they waged over the years: Gregory, a man, spoke disparagingly of medical science and hoped that female practitioners would help keep medicine a healing art, whereas Zakrzewska rejected any notion of special female virtues, insisting instead that all practitioners, whether male or female, had to receive rigorous training in the sciences. Put di√erently, where Gregory accepted the contemporary link between science and masculinity, even if only to argue against the masculinization of medicine, Zakrzewska rejected this link, challenging the gendering of science and rationality and casting them instead as universal traits.
The battles between Zakrzewska and Gregory had much to do with markedly di√erent views of science and of the role women should play in medicine.
Perhaps Zakrzewska should have anticipated running into problems with the school’s director. Gregory had already earned a reputation as a controversial figure, largely because of several pamphlets he had published vociferously attacking man midwifery. In addition, he lacked a proper medical degree. Although he possessed both a Bachelor of Arts and a Master of Arts from Yale, his
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formal medical knowledge amounted to one summer of lectures on anatomy and physiology at that institution. (In 1853, the eclectic Penn Medical College granted Gregory an honorary medical degree, but he never practiced medicine.) All of this might very well have given Zakrzewska cause for concern. On the other hand, recent changes in the college, especially its receipt in 1856 of a state charter granting it the right to confer the medical degree, suggested that other reforms might soon be under way. Moreover, Gregory had initially been enthusiastic about her hire, sharing the trustees’ belief that she would ‘‘add to the reputation and usefulness of our Institution.’’∞ Thus although Zakrzewska may have had reason to be cautious, there were also signs that Gregory, the board of trustees, and the board of lady managers were ready to implement pedagogical reforms that would place the institution on a par with the best medical schools in the country.
Indeed, the plan to found a teaching hospital, which led to Zakrzewska’s hire, was evidence itself of the school’s aspirations. As we have already discussed, medical schools did not as a rule o√er clinical instruction until later in the century. Although they were often adamant about teaching only ‘‘practical’’
subjects, by which they meant topics such as anatomy, materia medica, therapeutics, pharmacy, chemistry, surgery, and obstetrics, instructors rarely deviated from the format of the lecture. Practical exercises or clinical instruction of the kind Zakrzewska had received at the Berlin school of midwifery, or that she had taught at the New York Infirmary, had not yet become a part of the American medical curriculum.≤ Thus the college’s decision to incorporate a clinical department into its medical curriculum was an innovative move. One can only speculate that its commitment to training not only physicians but nurses and midwives as well may have inspired this decision. Certainly midwives, if they had any formal training at all, tended to acquire their skills through apprenticeship. Perhaps the clinical department was meant to replicate in a controlled setting the model of apprenticeship taking place outside its walls.
The idea for a teaching hospital had surfaced as early as 1848, but su≈cient funds were not raised until the school altered its administrative structure in 1856, establishing both a board of trustees and a board of lady managers and giving the latter responsibility for establishing the hospital.≥ Among the lady managers were Abby May, Ednah Dow Cheney, and Zakrzewska’s friend Caroline Severance, all of whom traveled in Boston’s liberal circles. These women saw in this hospital an opportunity to further their social agenda, both by providing medical care for the poor and by advancing the education of women.
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From the beginning it was intended to provide women of all classes ‘‘during sickness and in childbirth, a comfortable home, with medical attendance by their own sex.’’ Free beds were planned for those without means, moderate accommodations for those who had some disposable income, and ‘‘private apartments’’ for well-to-do women. As far as educating female physicians was concerned, the lady managers, in reaching out to the Boston public for donations, made it clear that the issue ‘‘has been so long before the community, that it seems not necessary, now, to argue its importance, but merely to present its claims.’’∂
In addition to founding a hospital, the New England Female Medical College was also seeking to move out of rented quarters into its own building. This finally occurred on 1 May 1859, when the college occupied new premises on Springfield Street. There was nothing grandiose about the new accommodations, but there was adequate space to set up a dispensary and a small pharmacy on the first floor. The rooms on the second floor were used for lectures, instruments, chemical work, a library, and meeting rooms and o≈ces. The stationary clinic was on the third floor. Soon to be called the ‘‘clinical department,’’ it had six rooms (two beds in each), three for paying patients and three for charity cases. The students lived on the top floor. (Zakrzewska lived there briefly as well before buying her own home.)∑
The clinical department was clearly a small operation. The New York Infirmary, which Zakrzewska had just left, had twenty-four beds. The New England Hospital, which she would establish three years later, would expand to forty beds not long after it opened. Still, the arrangement at the college seemed large enough to serve Zakrzewska’s pedagogical needs. Most important to her was the small group of highly motivated students she trained during her tenure at the college. Among them were Lucy Sewall, Emily Pope, Augusta Pope, and Helen Morton, all of whom would eventually join the sta√ of the New England Hospital. The strong camaraderie that developed among these women led one contemporary to refer to them as a ‘‘charmed circle, banded together for life, for the defense of the hospital.’’∏ Zakrzewska, who later in life often accused young interns of selfishly pursuing their own goals, spoke repeatedly and longingly of the spirit of loyalty that seemed to characterize the students she taught during the early years of her career.
At first, everything must have seemed rosy to Zakrzewska. She had, after all, come a long way toward fulfilling her dream of o√ering quality education to members of her own sex. In addition, she had a position with much greater
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independence than any she had occupied before. There were, of course, the lady managers and trustees overseeing her work, but since among them she counted some friends, more than likely she did not anticipate any di≈culties. As already mentioned, she might even have expected to get along with Gregory, who had been championing women’s entry into the medical profession for more than a decade. Zakrzewska had thus every reason to believe that the college would agree to implement the reforms she deemed necessary in order to place it among the better medical schools in the country.
That is not, however, what happened. Duri
ng the three years Zakrzewska remained at the college, Gregory blocked many of her pedagogical reforms, including her attempt to introduce classes in microscopy and thermometry. The constant battles they fought have frequently been portrayed as disagreements over standards, which they were in part, but the two educators were also staking out radically di√erent positions on two fundamental issues that were being hotly debated at the time: whether knowledge of the basic sciences should be a part of medical education, and whether women had a special role to play in the
medical field.π
. . .
One cannot understand these battles without taking into consideration the di√erences that existed between the German and American medical communities around midcentury. As we have seen, when Zakrzewska had been a student of midwifery in Germany, the vast majority of university-educated physicians had been united in their demands that greater attention be paid to the natural and clinical sciences in medical school. Thus when she arrived in America, she had brought with her both a conviction that more attention to the natural and clinical sciences would make better practitioners and an awareness that with this knowledge came cultural legitimation and authority. What she found in her new country, however, was a medical community that was neither organized nor in agreement as to what made a good practitioner. Indeed, an attempt on the part of the fledgling American Medical Association (formed in 1847) to institute such curricular reforms as a longer school year, along with increased emphasis on anatomical dissections and clinical training, proved largely unsuccessful. The problem was not simply that medical practitioners were endlessly divided among, in Zakrzewska’s words, ‘‘the many schools of the Al-lopathists, Homoeopathists, Electropathists, yes even Indianopathists’’; even regular physicians di√ered with one another over the kind of knowledge necessary to be a good practitioner.∫
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One of the most controversial issues was the relevance of the natural sciences for practice. By and large, Americans viewed with skepticism developments taking place in the European clinics and laboratories, which, they believed, too often placed the interests of science before the good of the patient. It is true that a small, powerful, and very vocal group of elite physicians advocated loudly for French clinical empiricism. From their vantage point, the French emphasis on the numerical method and on studying symptoms at the bedside and in the autopsy room provided a necessary antidote to the speculative medical systems, such as Benjamin Rush’s heroic therapeutics, that had flourished around the turn of the century. But even this group did not look favorably at developments taking place across the Rhine. Indeed, only a handful of individuals joined Zakrzewska in promoting German approaches to the study of disease before the 1870s. In general, Americans were unable to reconcile the German emphasis on laboratory investigations—which, they felt, conceptualized disease as an ab-straction—with their view of patients as individuals, each one su√ering from his or her own peculiar diseased state. They were also troubled by the Germans’
foregrounding of a rational approach to medicine, which, to them, brought back the specter of therapeutic practices being derived not from careful observations at the bedside but rather from vacuous theories.Ω
For a number of reasons, Zakrzewska did not share her American colleagues’
anxieties about German approaches to medical practice. For one, the attack on theory-driven medical systems had taken place in Germany twenty years earlier. At that time, young physicians, trained in the school of natural history, had waged a battle against the highly speculative nature philosophers. By the time Zakrzewska had begun her midwifery training, the next generation of physicians was trying to distinguish themselves from the empiricism of the natural historians by emphasizing the necessity of grounding one’s medical practices in knowledge derived not just from the bedside but also from the laboratory. They referred to this approach variously as ‘‘rational,’’ ‘‘physiological,’’ or ‘‘scientific’’
medicine. For Zakrzewska, in fact, and in contrast to her American colleagues, the term ‘‘empiric’’ was interchangeable with the label ‘‘quack.’’∞≠
Zakrzewska would not, moreover, have accepted American characteriza-tions of German medicine as insensitive to the peculiarities of the individual case. In fact, in promoting their approach to the study of disease, German physicians actually criticized the French on this very point, blaming them for placing so much emphasis on ‘‘counting’’ that they lost sight of the individual.
My point is not that the Germans truly valued the individual, while the French
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did not, but that the accusation that the individual was being ignored flew back and forth in battles over the best way to practice medicine. Thus the Germans defended their ‘‘rational’’ approach to the study of disease by insisting that knowledge of the causes of disease and the laws governing the pathological process would allow a physician to determine the best course of treatment for each and every patient. This search for laws, they proclaimed, had nothing to do with the derivation of statistical norms (and certainly nothing to do with speculative system building). According to the German physician Carl Wunderlich, who founded a journal in 1842 entitled Archiv für physiologische Heilkunde (Archive for Physiological Therapeutics), ‘‘a law of nature cannot tolerate any exceptions.’’∞∞
In the 1850s, when Zakrzewska first joined the faculty at the college, her defense of German medicine made her unusual, if not unique. Small wonder she and Gregory went head to head so quickly. But had she promoted French clinical empiricism instead, she might still have encountered resistance, for Gregory’s concerns about the impact the natural sciences were having on medical practice were of a general nature, not directed at developments in a specific country. Nor was he alone. In fact, one of the more articulate critics of European medical science was the Harvard professor John Ware, who lamented the growing emphasis on anatomy, chemistry, microscopy, and pathology at the expense of studies that would educate good practitioners. The ‘‘habitual dissection of the dead body’’ worried him in particular, for he feared that through this practice the once revered human body would become nothing more than an object of study, akin to ‘‘the inorganic materials of the chemist’s retort.’’
Although vague about the exact nature of the studies he preferred, Ware stressed the importance of physicians possessing ‘‘a large fund of sound common sense’’; ‘‘a natural talent for nice observation’’; and ‘‘an intuitive quickness of perception.’’∞≤
Ware’s language highlights the extent to which the debates that flourished around midcentury over the kind of knowledge that should drive medical practice had a gendered inflection.∞≥ Indeed, in criticizing science, which was coded male, and praising intuition, which was coded female, Ware appeared to be opening the practice of medicine to women. That was not, however, his intent.
He thus sought other traits that would allow him to gender medicine masculine and found them in both the physical hardships that medical practice entailed and the mental hardships that kept a physician from getting ‘‘carried away by his strong sympathies.’’ Ware, who posed the rhetorical question of whether
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‘‘the nature of woman [was] competent to this,’’ went on to warn that women who did not live by their natures risked losing their gender identity. ‘‘Should we,’’ he asked pointedly, ‘‘love her as well if it were? Would she not be less a woman?’’∞∂
In arguing against women’s entry into the medical profession, Ware may have been representing a position that was widely held among his male colleagues, but neither Zakrzewska nor Gregory would have shared his fears or accepted his terms. To this extent, the two college professors perceived themselves to be fighting the same battle. But there the agreement ended. Before Zakrzewska’s first year was up, she tried
to fail two students who had performed dismally on their final examinations; to institute a Latin requirement for the students; and to include lessons in microscopy and thermometry in the curriculum. Gregory was not impressed. He is reputed to have dismissed microscopes as ‘‘another one of those new-fangled European notions which she tries to introduce’’ and to have claimed that thermometers were necessary only for those who could not otherwise diagnose illnesses.∞∑ By the year’s end, the two professors were declared enemies.
In the battles that ensued, Zakrzewska may very well have confirmed Ware’s suspicions that female physicians would upset traditional gender categories.
She assumed, for example, that her appointment had come with authority and voiced her anger when this proved not to be the case. Complaining directly to a board member during her second year at the college, she expressed her frustration that she ‘‘could not even do what has been in my power heretofore, namely, discountenance as physicians those women who do not deserve that name.’’ She found troubling the college’s willingness to enroll students who lacked any preparatory education and to grant them a diploma after several years simply because they had attended the requisite number of classes. ‘‘Were it the intention of the trustees,’’ she continued tartly, ‘‘to supply the country with under-bred, ill-educated women under the name of physicians . . . I think the New England Female Medical College is on the right track.’’∞∏
Evidently, Zakrzewska did not hold Gregory alone responsible for the school’s low standards; she blamed the trustees as well for refusing to limit admission to students with some preparatory education. But Gregory still received her harshest criticisms. Showing no inclination toward deference—or, for that matter, toward anything even approaching respect—she attributed most of the responsibility for the school’s low standards to Gregory. ‘‘Had the originator of the school (Samuel Gregory), an ambitious man, originally a missionary, been
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