Science Has No Sex
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a man of higher education and broader views,’’ Zakrzewska lamented, ‘‘the school might have been taken up by the men standing highest in the profession.’’
However, Boston’s elite physicians, such as Henry I. Bowditch and Samuel Cabot, kept their distance and refused their support. One reason, as Zakrzewska recognized, was that Gregory had alienated many members of the medical profession by launching vociferous attacks on man midwifery. But more than anything else, Zakrzewska insisted, these physicians withheld their support because they believed ‘‘the standard of the school was below par.’’∞π
Gregory, together with many of the trustees, did seem willing to keep the school’s requirements low in order to increase the number of students in attendance. Like many other schools of the time, the New England Female Medical College relied upon student fees, and this arrangement worked against strict entrance requirements and a rigorous course of study. Still, as Martha Gardner has recently argued, the institution’s course of study was as rigorous as that of most other medical schools of the day. Moreover, Gregory’s opposition to the Latin requirement Zakrzewska wanted to impose had more to do with an attack on the elitism of the medical profession than a disregard for high standards.∞∫ In
short, we must avoid the temptation to permit Zakrzewska to set the terms of the debate and recognize that much more than a simple disagreement over standards was involved. The antagonists also held markedly di√erent assess-ments of ‘‘woman’s nature,’’ of the nature of science, and of the relationship between the two. Where Gregory viewed women as more caring and nurturing than men, turning to them in the hope that they would help keep medicine a healing art, Zakrzewska promoted an image of women as capable of rational thought and mental and physical fortitude, hoping thereby to open doors that would allow them to engage in the pursuit of scientific knowledge.
. . .
Gregory developed his views on the necessity of female practitioners most fully in two essays: Man-Midwifery Exposed and Corrected (1848) and Letter to Ladies, in Favor of Female Physicians for Their Own Sex (1850). Gregory’s argument in both essays centered on the impropriety and ‘‘unnaturalness’’ of men’s attendance at childbirth. Embracing and exploiting the image of women as chaste and modest, he decried the a√ront to ‘‘female delicacy’’ perpetrated by male physicians’
entry into the birthing room. Their presence, he insisted, made women tense and nervous, with the result that contractions that had been occurring regularly often stopped. For this reason, physicians frequently had to intervene in the birthing process; drugs and instruments had become necessary in order to undo
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the damage male physicians had done when they stepped into the room. ‘‘If physicians . . . would pay some regard to the laws of propriety,’’ Gregory admonished, ‘‘and refrain from unnecessary intrusion into the lying-in room, and permit the ladies to assist each other,—protracted, distressing, and exhausting labors would be less frequent, fewer stillborn children would be reported in the bills of mortality, much less need would there be of ether, and ergot, and ointment, and antimony; and knives, hooks, and forceps, perforators, excavators, and other obstetric implements, would for the most part be permitted to rust in peace in their green baize bags.’’∞Ω
Gregory filled both essays with horror stories of women whose babies were murdered in utero through the unnecessary and uneducated use of instruments; women who were physically damaged when physicians, in their haste, extracted the uterus, and even the intestines, along with the baby; and women who hemorrhaged to death because of the ruptures, tears, and lacerations caused by instruments. One cannot help but wonder whether his rejection of microscopes and thermometers may not have stemmed from his general distrust of instruments. Citing another physician, Gregory advised physicians who relied heavily on instruments ‘‘to practise butchery rather than midwifery, for in that case they could sell what they slay.’’≤≠
The message may have been the same in both essays, but only in the earlier one did Gregory directly impugn the character of physicians who attended women in childbirth. In Man-Midwifery Exposed he accused them of greed, deception, and immorality. Searching for reasons why male physicians would continue to engage in practices that seemed to him so self-evidently calamitous for mother and child, he insisted that pecuniary benefits must be the main driving force. Physicians frightened families into believing that childbirth required a male attendant so that they could reap the monetary rewards; they even made ‘‘a di≈cult or instrumental labor out of a natural one’’ just so they could charge a higher fee. As if this were not serious enough, Gregory also accused physicians of seeking out midwifery cases in order to satisfy lustful desires. Arguing that the intimacy that develops between a male attendant and the parturient woman encourages sexual intimacy, Gregory blamed adultery, infidelity, and even the increase in prostitution on the tolerance of male midwifery, holding it responsible for the erosion of ‘‘domestic and social happiness, and the moral welfare of society.’’≤∞
Gregory thus built his argument around a radical separation of the sexes, seeking to reverse a trend that had begun in the late eighteenth century when
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male physicians first developed an interest in replacing female midwives as attendants during normal childbirth. At that time, physicians realized that the greatest challenge they faced was overcoming charges of impropriety and im-modesty. They countered these concerns by emphasizing that their knowledge and skills were superior to those of midwives and by insisting that safety must come before all else.≤≤ No wonder Gregory’s writings infuriated so many of his professional colleagues. He was directly attacking their rationale for disrupting traditional gender boundaries by insisting that male physicians, their claims to the contrary, actually endangered the lives of mother and child. Moreover, while trying to reinscribe that boundary, Gregory was threatening to disrupt another one, namely, the boundary that kept women out of the practice of medicine.
They need not have worried too much, for throughout Gregory’s career he remained highly ambivalent about the status of the female physician. Indeed, in Man-Midwifery Exposed, he mentioned female physicians only once—in a brief section in which he discusses the inappropriateness of male physicians attending women for their ‘‘female complaints.’’≤≥ This essay is thus largely an argument against male midwives and in support of a school at which female midwives could be ‘‘instructed and diplomatized [ sic]’’; it says little in favor of women’s entry into the elite medical profession.≤∂ Perhaps this is not surprising. In its early years, the college trained many more midwives than physicians; not until 1856 did it formally receive permission to grant the medical degree. At the time he wrote Man-Midwifery Exposed, Gregory even promoted the kind of dual system that existed in Europe and Asia, where female midwives were trained to handle all normal cases, leaving only the problem cases to the more highly trained male physicians and surgeons.≤∑
Letter to Ladies, written two years later, addressed in greater detail the need to train women as both midwives and physicians, yet even here Gregory failed to maintain a clear boundary between the two. Thus, although he tackled head-on the usual criticisms of female practitioners, insisting that they had the physical strength and could acquire, through proper education, the ‘‘coolness of judgment’’ and ‘‘firmness of nerve’’ necessary for handling di≈cult cases, he rarely discussed the practice of medicine outside midwifery.≤∏ Indeed, one of the strategies Gregory employed to convince his readers that women would make good practitioners was to sing the praises of the French master midwives ( mâitresse sage-femmes) Madame Boivin and Madame Lachapelle. What he lauded was the small number of cases under these midwives’ care in which some kind of instru-
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mental or surgical intervention had been necessary. He also commended them for having ‘‘comforted, cheered, [and] sustained so many of their sex through their hours of fear and su√ering as none but women can; for they have sympathies in common, a language and sentiments which seem to be made for the purpose; their sorrows and joys are the same.’’≤π Gregory seemed to care less about women’s possession of medical knowledge. In fact, his most telling comment, aimed at convincing male physicians to abandon midwifery, was his insistence that ‘‘physicians of good intellectual and scientific attainments do consider it [midwifery] beneath their qualifications; and when circumstances permit they are glad to be rid of it, and devote themselves to departments better calculated to exercise their mental capacities.’’≤∫
Despite his promotion of female physicians, Gregory pictured the medical profession as fundamentally hierarchical, with female physicians occupying not simply a separate but also an inferior position in that hierarchy. His obvious coolness toward the cause that most impassioned Zakrzewska remained evident as late as 1862, the last year Zakrzewska spent at the college. In an article entitled ‘‘Female Physicians,’’ Gregory, who continued to blur the boundary between female physicians and midwives, showed no reticence at all in distinguishing sharply between male and female physicians. ‘‘The writer,’’ Gregory stated, in reference to himself,
has as little disposition to see women in men’s places as men in women’s.
He is not one of those who take extreme views on the question of ‘‘women’s rights,’’ so called. . . . Even the matter of the title should not be disregarded: the masculine appellation of Doctor belongs exclusively to men, and the feminine correlative, Doctress, both convenience and propriety assign to the lady physician. But to take the ground that it is indelicate and unfeminine to study the structure of the human system, with a view to understand its conditions of health and diseases, and thereby to alleviate su√ering and save life, is more fastidious than sensible.≤Ω
Gregory’s final sentence was a direct challenge to the likes of John Ware, who insisted that women’s nature rendered them incapable of practicing medicine.
To Gregory, in contrast, this ‘‘nature’’ was exactly what qualified women for the practice of medicine. Yet exactly what would distinguish female from male physicians, other than their subordinate status and the patients they treated, remained totally unclear.
It is not di≈cult imagining Zakrzewska’s reaction to the sentiments Gregory
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expressed in this paragraph. She would have challenged the subordinate position in which he wished to hold female physicians. She would have been just as troubled by his insistence that women practiced medicine di√erently than men because their gentler natures translated into greater compassion for their patients. For Zakrzewska, nothing mattered more than to ensure that women physicians receive an education every bit as rigorous and scientific as that of men, which would allow them to earn the respect that was their due. Thus her di√erences with Gregory were really twofold: not only did she have a less conflicted assessment of scientific training in and of itself, but she also sought to make women active participants in the development of a medical science, not protectors of the healing art.
. . .
Zakrzewska addressed these themes immediately upon her arrival at the New England Female Medical College. The occasion was the opening address she was asked to deliver in November 1859, at the start of the school year. Speaking to friends of the college, physicians, students, and other faculty members, the newly appointed professor centered her talk on the question of what should be expected from a physician. First and foremost, she emphasized, a person must have the proper motives for studying medicine, and these, she insisted, could only be ‘‘an inborn taste and talent for the practice of medicine’’ and ‘‘an earnest desire and love of scientific investigations.’’ Zakrzewska contrasted these objectives with those of a large number of women who, in her view, entered the medical field for no other reason than ‘‘to step out of daily domestic life’’ or to satisfy ambition. ‘‘To these two di√erent classes of women,’’ she went on, I must add a third, which belongs in part to both those already mentioned, but which is impregnated besides with a perpetual sentimentality, conceal-ing these other motives, and which bears on its banner the inscription of
‘‘Sympathy’’; sympathy with their fellow mortals of their own sex, with the su√ering sisterhood. However absolutely necessary a certain amount of sympathy and compassion may be, to qualify the physician for success in practice, it will never be the right motive from which the student must start.
This predominating, sentimentalizing sympathy, will dwarf or confuse the reason, the most necessary qualification for the study of human nature; and will be pernicious to logic, preventing even the most natural instinct from looking upon every thing [ sic] that is natural, and that belongs to the well-being of the individual, from the right stand-point.≥≠
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Without doubt, this represented Zakrzewska’s most explicit criticism of those who sought to open the doors of the medical profession to women by highlighting women’s greater capacity for nurturing the sick. Indeed, the passage sounds as though her target was not Gregory alone but anyone who placed too much emphasis on women’s compassionate natures rather than their capacity to engage in ‘‘scientific investigations.’’ Note that Zakrzewska was not ignoring the importance of ‘‘a certain amount of sympathy,’’ although she did not consider this to be a gendered trait. What troubled her—and it was the same message she communicated in her autobiographical sketch—was sentimentality. As she explained later in her talk, in comparison with sentimentalizing sympathy, ‘‘sympathy . . . never betrays weakness or timidity and . . . is firm and persevering, controlling every action that it may not become rashness.’’≥∞
The condemnation of sentimentality was a strategy widely employed in the postbellum period as practitioners of the health and social sciences, seeking credibility and legitimacy at a time of rapid professionalization, sought to sever their ties with the early nineteenth-century tradition of female benevolence.
This tradition had taken shape as female reformers across the political spectrum had eagerly embraced the casting of piety, purity, and domesticity as particularly feminine qualities. The new moral power they had thereby acquired legitimized their blurring of the supposed boundary between private and public and had inspired their involvement in what the historian Lori Ginzberg has called ‘‘the work of benevolence.’’ Whether battling drunkenness, redeeming ‘‘fallen women,’’ or reforming wayward children, female reformers had drawn strength from a rhetoric that emphasized their morally superior natures; they had also filled their writings with sentimental accounts of young women temporarily led astray by unscrupulous men whose salvation was made possible only through their own interventions.≥≤
Zakrzewska’s comments in her college address suggest that she stood at the beginning of the trend to replace the rhetoric of sentimental benevolence, maternalism, and salvation with the language of what was perceived to be a gender-neutral science. Later in the century, physicians would totally reject the notion of sympathy, replacing it with the concept of empathy, which they held to reflect more accurately the detached concern scientifically trained physicians needed to adopt toward their patients.≥≥ Writing in the early 1860s, Zakrzewska did not yet have such terminology, but her attempt to separate sympathy from sentimental sympathy, and to associate it with firmness and perseverance, suggests that she was groping her way toward a similar distinction.
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Title page from Zakrzewska’s Introductory Lecture. (Copied from the collection at the Boston Medical Library, Francis A. Countway Library of Medicine)
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Scholars who have studied the consequences of the late nineteenth-century attack on the tradition of female benevolence have drawn most attention to the way the professions became defined as men’s work, thus generating an antipa-thy toward women. In condemning not only this tradition but also female-coded traits, such as sympathy and sentimentality, aspiring professionals were undoubtedly expressing hostility toward certain definitions of feminine behavior in circulation at the time. Still, one must keep in mind that not all were in agreement as to what exactly defined woman’s nature.≥∂ Even within Zakrzewska’s immediate circle of peers, there was considerable variation. Thus while Elizabeth Blackwell, Sarah Dolley, and Ann Preston were inclined to ascribe to women nurturing traits, Mary Dixon-Jones, Mary Putnam Jacobi, and Zakrzewska had a greater tendency to downplay any di√erences between the sexes.
All, however, were trying in their own ways to advance women’s rights. For Zakrzewska, sentimentality conjured up images of mental confusion and excessive emotionality, both of which kept an individual subservient to others, whereas reason and objectivity stood for independence of thought and thus the ability to act on one’s own and for oneself.≥∑
Not surprisingly, then, Zakrzewska moved from her condemnation of sentimentality in her introductory lecture to the promotion of science. Painting a picture of the history of medicine, from ancient Greece and Egypt to the nineteenth century, as little more than a great battle between religion and rationality, she emphasized how the view of disease as a curse, the belief that the body’s restorative power sprang from an unknown and intangible supernatural power, and the priests’ use of secretive symbolic language to describe their remedies had all kept people ignorant and prevented medical progress. The consequences, she maintained, were often dire. Not hesitating to engage in melodrama when it served her own needs, Zakrzewska jumped from a criticism of the ‘‘mysticism of the oracles and astrologers’’ of ancient times, in which