‘‘everyone, except the priesthood,’’ was prevented from studying medicine, to a nineteenth-century case, in which a priest sent a young woman to her grave by recommending ‘‘the praying of beads’’ when, in Zakrzewska’s opinion, ‘‘a dose of quinine’’ would have been more appropriate. ‘‘This poor girl,’’ Zakrzewska told her audience, ‘‘died soon after I saw her, when she might have been saved, had she been less faithful to her priest and more faithful to a surgeon.’’≥∏
There is perhaps no other passage Zakrzewska wrote that so fully captured the worldview she adopted from the German scientific materialists. Religion versus reason, secretive versus public knowledge, backward versus modern, the
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priest versus the surgeon, death versus life—the contrasts all work to promote science not simply as the best foundation for the practice of medicine but also as the surest way to bring about a just and open society in which informed individuals made good choices. Until this point in her lecture, Zakrzewska had not, however, directly taken on Gregory’s contention that women had no place in this world of science and surgery, but she now turned specifically to the history of obstetrics to make her case.
Zakrzewska, who cast the history of obstetrics as a long battle to return to the principles of Hippocrates and integrate medicine with the other natural sciences, presented the eighteenth century as the critical turning point, when obstetrics finally achieved scientific footing. From that point on, she asserted,
‘‘the complaint has ceased to be heard, that abuse is the main demonstration of the practice of midwifery.’’ In other words, in stark contrast to Gregory, she was insisting that medical abuses were attributable not to the embrace but rather to the neglect of science. The individuals whom Zakrzewska named as contributors to this transition included the French master midwives Madame Lachapelle and Madame Boivin. This was a shrewd move on her part. Not only did it raise her own standing, given her own training in European midwifery, but these were, after all, the same midwives Gregory had lauded for their sympathy, compassion, and noninterventionist approach to medicine. Thus, where Gregory had cast the master midwives as the embodiment of women’s natural inclination to nurture, Zakrzewska has them defying traditional cultural stereotypes, indeed reaching ‘‘the heights of logical development.’’ This did not, she insisted, render them brutal; on the contrary, they remained ‘‘in every respect humane.’’ As far as Zakrzewska was concerned, their humanity developed not despite but because of their scientific training.≥π
Zakrzewska not only cast other female healers as rational human beings but also promoted this image of herself, frequently displaying her German roots and aligning herself with the style of scholarship that marked mid-nineteenth-century German medical science. ‘‘[W]orks like Kölliker’s Comparative Anatomy, later Virchow’s Cellular Pathology, and works on biology, embryology and his-tology became really the foundation upon which I built my practice,’’ she once announced. This allowed her to ignore the endless advice about how to treat specific cases and how much of which remedy to give. Instead, she explained, ‘‘I did my own reasoning, I made my own deductions, in as logical a method as possible as the cases revealed themselves to my understanding through physical or psychical symptoms.’’≥∫
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In promoting and embodying an image of women as logical and assertive, Zakrzewska was continuing to battle assumptions about women’s relationship to science and medicine from two sides. On the one hand, she fought to counter claims by the likes of Carl Mayer, Dr. Both, and John Ware that women lacked both the stomach and the intelligence to study medicine. On the other, however, she denied that women had something special to o√er medicine. In this way, she was trying to break the link between science and masculinity while also challenging the claim that women had greater a≈nity for sympathy and compassion than men. Women, she told her audience, had every bit as much ability as men to develop their faculties of reason and logic; this was the path they had to pursue if they wished to succeed as physicians. Indeed, much of what Zakrzewska wrote in these early years was aimed specifically at reclaiming for women traits that had been gendered masculine by her culture.
One is, of course, left with the question of why Zakrzewska would have found it necessary to educate female physicians at all. If they had nothing special to o√er medical practice, why not leave the field of medicine in the hands of male physicians? It seems surprising that Zakrzewska did not, at the very least, make an appeal to female modesty and insist that women, because of the delicate nature of many of their complaints, needed to have access to medical practitioners of their own sex. But Zakrzewska did not yet countenance any defense of women physicians that began from a position of di√erence. As she implied in her challenge to Dr. Both, she believed women had the right to study and practice medicine by virtue of being members of the human race. There were simply no grounds for excluding women from the practice of medicine or, for that matter, from any other traditionally male field of activity.
. . .
Clearly Zakrzewska did not share Gregory’s anxiety that too great an emphasis on science would lead the young physician astray, teaching him (or her) to care more about the results of scientific investigations than about tending the sick.
On the contrary, she embraced a vision of science, articulated most clearly in Germany around midcentury, that imagined an intimate relationship between scientific studies and medical practice. Seen in this light, the disagreement between Zakrzewska and Gregory over the value of microscopic studies was clearly about more than just standards. Indeed, Gregory’s dismissal of microscopes as ‘‘new-fangled European notions’’ was just the beginning of a larger point he was making about the relationship between science and practice: ‘‘It is my opinion,’’ he went on, ‘‘that we need a doctor in our medical department
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who knows when a patient has fever, or what ails her, without a microscope. We need practical persons in our American life.’’≥Ω
‘‘Practical persons’’ of the sort Gregory lauded did not, however, impress Zakrzewska. From her vantage point, they lacked the ability to think for themselves and make their own judgments. They were, in fact, the ‘‘empirics’’ and
‘‘quacks’’ she so looked down upon, focused on ‘‘curing disease’’ rather than on studying the scientific foundations of medicine.∂≠ By no means did she wish to
see anyone educated in this fashion, least of all women.
The antagonisms between Zakrzewska and Gregory finally escalated to such a degree that Zakrzewska informed the board of trustees in June 1861, just two years after she joined the faculty, that she would be leaving the college when her term of appointment expired the following spring. ‘‘My work as teacher in the college and as physician in the medical department,’’ she wrote to the board,
‘‘has not . . . given me satisfaction. Not one of my expectations for a thorough medical education for women has been realized.’’∂∞ Zakrzewska’s list of complaints covered almost every aspect of the school: she found it impossible to work with the director; the vast majority of her students lacked ‘‘superior educational training’’ and thus failed to show any interest in expanding their medical knowledge through clinical work; and neither the dispensary nor the hospital was flourishing, something she blamed on the hospital’s location in a ‘‘demi-fashionable’’ section of town, which reduced the demand for dispensary services among the local population. In short, Zakrzewska had come to believe that the New England Female Medical College could not provide her with the proper setting to carry out her goals. Thus in March 1862, at the close of the winter semester, she resigned her professorial position, and three months later she left her clinical position as well. ∂≤
Zakrzewska’s harsh assessment of the college was echoed in the
years to come by other women physicians. Indeed, in her review of the history of women in medicine, Mary Putnam Jacobi characterized the institution’s curriculum as having been ‘‘so ludicrously inadequate for the purpose, as to constitute a gross usurpation of the name.’’∂≥ By and large, the emerging medical elite among women physicians—Elizabeth Blackwell, Emily Blackwell, Mary Putnam Jacobi, Ann Preston, Mary Thompson, Eveline Cleveland, and others—all feared that a substandard school would produce graduates whose skill level would reinforce the accusation that women physicians could never be more than second-rate practitioners. Few among this elite (with the clear exception of Jacobi) may have o√ered as unabashed a defense of science as did Zakrzewska,
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but they all insisted that scientific instruction be part of any medical school curriculum. Indeed, the all-women’s medical colleges founded in the 1850s and 1860s frequently stood at the forefront of curricular improvements. Thus the Female Medical College of Pennsylvania o√ered clinical training to its students at the newly founded Woman’s Hospital as early as 1861; eight years later it instituted a curriculum that surpassed the requirements at many all-male institutions, including a three-year graded curriculum and mandatory clinical instruction. In 1867, the Woman’s Medical College of the New York Infirmary had done the same, years before similar changes were adopted at Harvard and the University of Pennsylvania.∂∂ Clearly Zakrzewska was trying to make an early move in this direction when she fought for curricular changes at the New England Female Medical College.
Significantly, Gregory closed the clinical department as soon as Zakrzewska left. From his perspective, the experiment had also not worked out well. The constant battles were detracting from the school’s central mission, which remained, in his eyes, the training of female practitioners who could wrest midwifery out of the hands of male physicians and thereby protect the women and children entrusted to their care. The college continued on under Gregory’s directorship until his death in 1872. One year later, it merged with Boston University to form a coeducational homeopathic institution, a move Gregory would probably never have made. Ironically, he would have found common ground with Zakrzewska on this issue, but once again for vastly di√erent reasons. Where Gregory would have objected to educating men and women together, Zakrzewska opposed the merger because of its association with homeopathy. In her estimation Boston University Medical School was ‘‘an inferior school and a homeopathic one, which has no other merit than that it admits men and women on equal terms to all its advantages; therefore, it does not in-jure the movement for women any more than it does the profession at large.’’∂∑
By the time of the merger, Zakrzewska had been directing the New England Hospital for Women and Children for eleven years. She had founded the hospital immediately upon leaving the New England Female Medical College in 1862, when she was just thirty-six years old. Zakrzewska had finally achieved what she had been working toward since her arrival in the United States: the establishment of an institution committed to training female physicians at the bedside in modern medical techniques and, most important, one that was almost completely under her control.
On Hospitals
On 22 June 1862, Zakrzewska founded the New England Hospital for Women and Children, one of only a few institutions in the United States at which women could receive clinical training. Not much had changed in the nine years since Zakrzewska had begun her medical studies. Women continued to be denied admission at most medical schools, and those fortunate enough to receive an education often had di≈culty acquiring clinical training. Zakrzewska and Blackwell had set out to redress this when they founded the New York Infirmary for Women and Children. Four years later, in 1861, the Woman’s Hospital of Philadelphia opened its doors. Now, in 1862, Zakrzewska followed suit, creating only the third institution of its kind.∞
There can be no question that Zakrzewska most wanted to create a teaching institution. Indeed, when she first contemplated leaving the New England Female Medical College, she had explored the possibility of establishing her own medical school rather than a hospital. She had envisioned a coeducational institution, although one run by women that catered primarily to female students. She had also imagined male professors on the faculty and dreamed of luring Jacob Moleschott, one of the premier German scientific materialists, to the faculty of her school. However, the lean years of the Civil War turned out to be a bad time to start experimental projects, and Zakrzewska had di≈culty attracting donors. She thus redirected her focus and succeeded in generating support for a hospital run by and for women. As she informed an audience that came to hear her speak about her hospital seven months after she had opened its doors, the plans for a school having fallen by the wayside, she had founded a hospital that would ‘‘set an example that women understand how to run a hospital, and that they can practice medicine just as well in such institutes as
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they do in private practice. In this way we cultivate public opinion through facts and bring the public, through examples, to the realization that women are just as well cut out for the medical profession as men.’’≤
Zakrzewska recognized that the tepid response she had received from donors to the idea of a medical school required that she shift her focus away from the pedagogical aims of her institution and toward the benefits the hospital would provide poor women in need of quality care. For the first ten years of the hospital’s existence, this is exactly what she did. Her first love may have been pedagogy, but her experiences at the Charité and the New York Infirmary for Women and Children had had a great impact on her, and with the political education she had acquired from both the women’s rights movement and her contact with the radical German community, she approached the founding of her hospital with the zeal of a social reformer, intent on and committed to improving the lot of the poor.
The New England Hospital was, in fact, founded at a time of steady growth in the number of social welfare institutions. In Boston alone, Boston City Hospital, the Children’s Aid Society, and the Children’s Hospital were all founded in the 1860s, followed in the next decade by the reopening of the Boston Lying-In Hospital and the founding of the Dispensary for Diseases of Women and the Dispensary for Children, the Boston Society for the Relief of Destitute Mothers and Infants, the Free Hospital for Women, the Cooperative Society of Volunteer Visitors among the Poor, and the Associated Charities of Boston.≥ These institutions and associations marked a concerted e√ort on the part of both public and private organizations to gain control over the rapidly increasing population of urban poor. Historians of social welfare have long argued that nineteenth-century reformers frequently drew their inspiration from a mixture of Christian stewardship and Victorian moralism, combining a sense of obligation toward the poor and needy with a reformist impulse that sought to discipline them. Whether establishing a female asylum, an orphanage, or a hospital, reformers sought to o√er a respectable alternative to the almshouse for the
‘‘worthy’’ poor: those individuals who did not abuse alcohol, who were engaged in or sought honest work, and who seemed to have fallen on hard times through no fault of their own. Such compassion for the poor did not, as historians have illustrated, usually translate into an acceptance of di√erent lifestyles, values, and habits. Administrators set out to educate, rehabilitate, and reinforce middle-class values and a Protestant work ethic every bit as much as, and sometimes more than, they concentrated on providing adequate financial support or medi-
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cal care. Those deemed ‘‘unworthy’’ of such charity were still destined for the poorhouse.∂ The New England Hospital was no exception. Zakrzewska understood her responsibilities as director of a new charitable institution to be a blend of medical care and moral education. She also shared with other reformers the conviction that she could distinguish between the ‘‘unworthy’’ and the
‘‘worthy’’ poor.
Still, among nineteenth-century reformers important di√erences existed in where one drew the line between these two groups and in how one evaluated the roots of poverty. At one extreme were those who linked urban poverty to an individual’s character. As a result, they focused their reform e√orts on moral education. At the other extreme stood individuals who believed that socioeconomic conditions limited one’s choices more than individual character, and they thus paid greater attention to improving the material conditions of the
poor.∑ In the early 1860s, Zakrzewska clearly stood among the latter. Convinced that one’s ‘‘vices’’ were often a reaction to unjust social and political conditions rather than a matter of choice, she viewed herself as an advocate for the poor, especially for poor women. Women, she insisted, were caught in a particular bind, trapped in a political system that discouraged and sometimes prevented them from achieving financial independence and then abandoned them when they became ill or pregnant. The hospital Zakrzewska imagined would mark a significant step toward remedying this injustice, for one of its central goals was to provide poor, needy women with medical assistance and a ‘‘respectable’’
environment that would guarantee them the honor and dignity she claimed they deserved. Nowhere did she lay out her vision more clearly than in a public lecture she delivered almost seven months to the day after the New England Hospital for Women and Children opened its doors.
. . .
Entitled ‘‘On Hospitals,’’ the lecture gave Zakrzewska an opportunity to showcase her hospital and to generate much needed financial support. Radical Boston newspapers, including William Lloyd Garrison’s Liberator, provided lengthy descriptions of the event in subsequent days, praising ‘‘the good thoughts and wise suggestions of the accomplished lecturer.’’∏ Heinzen’s newspaper, Der Pionier, went one step further, translating the lecture into German and reprinting it almost verbatim in a five-part series, extending to twelve long newspaper columns. If Der Pionier ’s account reflected the actual structure of her talk, Zakrzewska was not the most disciplined public speaker. Still, although disorganized, she filled her lecture with powerful anecdotes and images, all of which allowed her
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