Science Has No Sex

by Arleen Marcia Tuchman

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  to communicate clearly the patient population she wished to serve and the kind of hospital she believed would provide the best care.π

  Zakrzewska recognized that her greatest challenge was to distinguish the New England Hospital from other Boston institutions that were already catering to the poor. Why, in other words, in the midst of the Civil War, should anyone donate funds to yet another hospital when the city already had an almshouse, was about to open a municipal hospital, and could lay claim to Massachusetts General Hospital, a privately endowed voluntary hospital that had been in existence since 1821? Zakrzewska’s strategy was to invoke her audience’s worst fears about large institutions, especially public ones, in order to set the stage for her promotion of a small hospital with the ‘‘character of home.’’

  She conjured up images of patients being treated worse than ‘‘a herd of cows,’’

  left to wallow in their own filth, and housed in buildings so deteriorated that

  ‘‘snow and ice . . . covered the floors.’’ She even invoked the dangers of medical science in the hands of those who felt no compassion for their patients, describing how the deaths of the poor are ‘‘often awaited with impatience in the cold months when, after expelling their last breath, they can be useful again—on the dissection table of the students who naturally long for a rich selection of ‘objects’

  which can still their craving for science.’’ Small wonder, Zakrzewska remarked, that the poor have come to fear the hospital. Ostensibly recounting a case from her past, she described the great anxiety experienced by the family of a young man who had been brought to the Charité with a broken leg, fearful that young physicians, interested in practicing amputations, would remove this young man’s leg without regard for the severity of his case. Although she ridiculed the belief that ‘‘soup for the patients was then cooked from the amputated limbs,’’ she accepted that such fears might be grounded in actual abuses, reflective of the disdain many felt toward the poor. ‘‘Hospitals, like almshouses,’’

  Zakrzewska emphasized, ‘‘are the horror of the poor, for whose well being they were founded.’’∫

  That Zakrzewska chose to highlight the potential abuses of medical science at the beginning of her lecture may seem odd, given her otherwise marked enthusiasm for science. Yet what better way to cultivate her audience than to play o√ their fears of the cruelties that could take place in large institutions lacking in e√ective supervision. In that setting, nothing prevented unscrupulous medical personnel from turning hospitals into sites for ‘‘medical study and experiment.’’ Zakrzewska seems, in other words, to have made a calculated choice, hoping that the vision of such horrors would compel members of her

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  audience to support her hospital. Perhaps she had learned more than she liked to admit from Samuel Gregory, who had used a similar strategy. It is, however, also the case that a closer reading of her lecture suggests that the true vil-lain in her story was the large public institution, with its ‘‘spirit of disdain for the poor that . . . degrades those for whom I register a complaint.’’ One might have had to listen closely to catch this nuance, but the individual who read Zakrzewska’s lecture in Der Pionier may very well have realized that her true contention was that the setting, not medical science per se, hardened the young physician’s heart.Ω

  Having set the stage, Zakrzewska turned to the advantages of small hospitals, including the ease of oversight, which prevented abuse, and the more direct influence donors could have on those they were helping. But far and away what she emphasized most was the ‘‘ Häuslichkeit [homelike nature]’’ of a small hospital, which allowed patients to feel as though they were being cared for in their own homes. This was, in fact, a recurrent theme during the hospital’s first decade of existence. The institution’s directors constantly reminded their subscribers of the role their hospital played in protecting women from ‘‘the publicity of the crowded wards of a public institution.’’ Its small size allowed it, moreover, to ‘‘adapt circumstances to individual cases much more than can be done in public institutions.’’∞≠ Such claims appealed to the hospital’s supporters.

  Garrison, for example, who promoted the New England in the Liberator, focused less on the medical interventions available at the hospital than on the existence of a unique environment absent ‘‘of all disturbing causes . . . of a large general hospital.’’∞∞ Significantly, in the early years of Massachusetts General’s existence, it too used the language of the home. However, by the mid-1860s, when it had 180 beds and provided in-house care to more than 1,500 individuals a year (compared with 10 beds and about 130 individuals at the New England), the hospital’s trustees focused more on ‘‘improved forms of hospital economy’’

  than on the virtues of the home.∞≤

  It bears emphasis that Zakrzewska was by no means alone in her attack on large public institutions or her praise of the home. By midcentury, reformers from across the political spectrum engaged in a similar rhetoric as they grew concerned that traditional forms of poor relief, high among them almshouses, were proving ine√ective in either caring for or controlling the rapidly increasing population of urban poor. Motivated by a combination of fear, arrogance, and benevolent stewardship, reformers tried to ensure that those capable of working did not live o√ the public dole, while digging deeper into their pockets to help

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  those they considered truly needy. In their eyes, almshouses only fostered long-term dependency and sheltered those too lazy to work. Many of the reforms thus sought to distinguish between those deserving and undeserving of assistance, to deny access to anyone capable of work, and to steer children, single mothers considered capable of redemption, and the sick poor into the newly founded orphanages, maternity homes, and voluntary hospitals. These alternative institutions were frequently promoted as respectable environments, promising to replicate the virtues and values of the middle-class home.∞≥

  The valorization of the ‘‘home,’’ touted almost universally by the founders of social welfare institutions, built on the tradition of female benevolence we have already mentioned.∞∂ Lauding domesticity, piety, and purity as particularly feminine traits, female reformers had justified their transgression of traditional gender boundaries by recasting the solution to many social problems within a language of domesticity. To these women, the home promised refuge from the hardships of the street, encouraging an intimacy that cemented bonds between those providing care and those receiving it, while permitting increased surveillance. Among nineteenth-century reformers, no site could compare to the middle-class home as a symbol of virtue in and of itself.∞∑

  When Zakrzewska had delivered her introductory lecture at the New England Female Medical College, she had chosen to distance herself from this tradition. Now, however, her needs had changed, and in an attempt to generate enthusiasm and financial support for her hospital, she emphasized the Häuslichkeit of her institution, even at one point challenging her audience to consider whether a hospital is ‘‘anything other than a representative home for the sick.’’∞∏

  She also promoted the idea that such a home should be reserved for the worthy poor, denying entry to ‘‘paupers in the true sense of the word.’’ Indeed, despite her attack on large state institutions, Zakrzewska insisted that some individuals deserved nothing better than the almshouse. Reflecting the same prejudices she had revealed in her autobiographical sketch, when she had written so disparagingly of the Irish and the French, she defined paupers as ‘‘those whose feelings are dulled, whose mental capacity for understanding is not much above that of animal life.’’∞π In contrast, she assured her listeners, the individuals to whom she intended to provide a homelike environment during times of need consisted of the ‘‘true poor.’’ They marked, she explained, a di√erent class of needy, who become ill either through all k
inds of misfor-tune (no matter whether they are responsible or not) or by the e√ort to earn

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  their livelihood. . . . There is, moreover, among these individuals a class for whom the opportunity to secure their own existence is either curtailed or totally denied, and who, neither through upbringing nor through birth[,]

  belong to the class of paupers. However, by their e√orts to escape from this fate, either through bad luck or through the fault of others, they nevertheless fail—I am speaking of women.∞∫

  Zakrzewska’s confidence that she could distinguish between deserving and undeserving women situates her among middle-class reformers who frequently spoke disparagingly of the very people for whom they claimed to be advocates.

  This attitude was certainly typical of nineteenth-century hospital trustees.∞Ω Yet despite her limits, she belonged without doubt to what Michael Katz has labeled

  ‘‘the left wing of respectable reform,’’≤≠ and it was to those on this end of the

  political spectrum that she directed her talk. This is evident in the trenchant critique she o√ered of a social system that denied women the means of supporting themselves financially, and then held them solely responsible for their situation.

  ‘‘Shame upon those who deny them their help,’’ she preached to her audience.≤∞

  It is also evident in the analysis she provided of the relationship between labor and poverty. Unlike, for example, many evangelical Christian reformers, who viewed poverty as necessary in order to encourage individuals to rise above it, or even to provide the wealthy an opportunity to act magnanimously, Zakrzewska argued that the true reason the wealthy needed the poor was for the labor they provided. For this reason the wealthy had an obligation to care for those ‘‘who work for us and to whom we owe so much.’’ Indeed, part of her critique of large public institutions was that rather than acknowledging this obligation, which, in her view, should translate into creating institutions that served the needs of the poor, state hospitals and almshouses served the wealthy by basically removing those individuals who had become a burden because of ‘‘their poverty, their dirt and their sickness.’’≤≤

  Even Zakrzewska’s embrace of the rhetoric of home represented an interesting twist because, unlike evangelical reformers, who adopted a sentimental vocabulary when they spoke of the ‘‘spiritual’’ and ‘‘redemptive’’ power of the home, Zakrzewska emphasized the feelings a home conveyed of ‘‘authority, independence, and security.’’ Thinking perhaps of her own role as a home owner, she established a link not between domesticity and morality but rather between home ownership and power or status. This is a country, she elaborated,

  ‘‘where even the middle classes are not considered ‘respectable’ if they do not

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  possess their own homes, where they can find refuge in old age and sickness; [a country] where the ability and respect of a person are determined by his independence from his friends. In such a country knowing one is homeless must necessarily create a feeling of degradation.’’≤≥ Zakrzewska’s choice of words suggests that she did not fully approve of the association made between the ownership of private property, social independence, and respectability, but she believed strongly that in a culture that attached so much meaning to the home, to o√er the poor anything less than at least the feeling of home was to treat them as though they were less than human.

  Finally, the way Zakrzewska spoke of the patient populations she intended to care for places her among the more radical nineteenth-century reformers. She may have joined her contemporaries in deciding for herself who was worthy of care, but she definitely drew her lines more loosely than most. Indeed, the last section of her lecture focused specifically on the patient populations she deemed most vulnerable and thus most in need of a caring hand. After defending the needs of foreigners, especially the wives, mothers, and daughters whose men were fighting in the Civil War, she turned to a much more controversial group: unwed mothers, whom she declared ‘‘most needy, but also most cast o√.’’ To the frequently heard charge that such women deserved to be punished, Zakrzewska cautioned her audience, ‘‘Let he who is without sin throw the first stone.’’≤∂ She

  also insisted that poverty and the feelings of abandonment and helplessness that accompany bringing a child into the world alone were punishment enough; the claim that coddling such women would lead to repeat o√enses she considered simply erroneous. But her radicalism truly showed itself when she condemned making admission to a hospital dependent upon possession of a marriage license. Not only did she deem the practice ine√ective—married women were known to loan their marriage licenses to unmarried friends—but she balked at the notion that a marriage license should determine whether a woman was treated humanely. ‘‘[T]rue charity and humanity,’’ she told her audience, ‘‘consists of examining each person individually and either rejecting their admission because it is unnecessary, or permitting it and giving the admitted every kindness, so that she either gets better or is prevented from sinking even further down.’’≤∑

  The lecture of 1863 was not the only time Zakrzewska addressed the particular dilemma faced by unmarried mothers. As we will see later, it was a constant theme in the hospital’s early annual reports. Indignant that a di√erent set of standards often applied to women of means, Zakrzewska saw the New England

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  as leveling the playing field, providing women the opportunity to live their lives with respect, regardless of their financial situation. One should note, however, that there was nothing unusual in Zakrzewska’s decision to draw attention to the problem of unwed mothers; they had been a focus of Christian moral reform societies for decades. But such reformers frequently advocated punitive measures, standing behind the decision on the part of most lying-in institutions to deny access to anyone who could not produce a marriage certificate. It may be that unwed mothers did occasionally find refuge in these institutions, thus suggesting that practices did not always follow policy statements. Nevertheless, at a time when Massachusetts General Hospital refused to take any maternity patients at all for fear of attracting ‘‘women of notoriously bad habits . . . whose inheritance has been sin’’ and the Philadelphia Woman’s Hospital’s stated policy was to admit only married women to its maternity wards, Zakrzewska’s public defense of the rights of unwed mothers stands out. ≤∏

  Punishment was not, however, the only approach to illegitimacy proposed by antebellum moral reformers. Many, inspired by sentimental and melodramatic tales of seduction and abandonment, cast unwed mothers as innocent victims of unscrupulous men and thus capable of repentance and redemption. As a result, they occasionally reached out to single mothers, at least during the first pregnancy (a second pregnancy implied culpability).≤π Still, Zakrzewska’s approach di√ered from theirs in two important respects. She did not speak out against single women who had had previous pregnancies. (As we will see in the next chapter, the New England Hospital also did not necessarily turn them away when they sought care during childbirth.) And, picking up a theme she had developed in her address at the New England Female Medical College, she eschewed most forms of sentimentalism. Although at other times in her life she did not hesitate to portray poor women as objects worthy of pity, the unwed mothers she wrote of in this lecture did not seem capable of being duped. On the contrary, they knew how to work the system, producing marriage certificates, for example, with ease. Zakrzewska’s message was not, however, beware of sly women. Instead, she seemed determined to portray them as equal to anyone sitting in the audience and therefore entitled to the same care as those who had money. As she once explained, her goal was to dispense justice, not charity. ‘‘Charity,’’ she elaborated, ‘‘is what an opiate is to a patient: it soothes for the time but the same bad consequences result as follow the drug. We must teach ourselves that the Golden Rule must be
actually practiced in order to reach and raise those who need to be helped.’’≤∫

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  In significant ways, then, Zakrzewska’s vision of the population the New England Hospital would serve di√ered little from that of other founders of voluntary hospitals and social welfare institutions. Her harsh comments about paupers, even her emphasis on domesticity, all signal the way middle-class values shaped not only the rhetoric she used but also her image of the institution she was creating and the population she hoped it would serve. In other ways, though, Zakrzewska’s vision was far more radical than that of many nineteenth-century moral and social reformers. Importantly, in the age-old debate about the extent to which the poor are responsible for their own living conditions, she tended to blame poverty and disease on social and political inequalities rather than on an individual’s behavior.≤Ω As a result, she reached out to many women whom others would have condemned to the almshouse. For these women, receiving medical, surgical, or obstetric care at the New England Hospital rather than at a large public institution may very well have made all the di√erence in the world.

  . . .

  Zakrzewska realized that for strategic purposes she needed to keep her lecture focused on her institution as a site of care, but she still dedicated an entire section to the question of how the hospital should be sta√ed.≥≠ Founding a hospital at which female physicians could receive clinical training had, after all, been her primary intent. In her lecture she expanded her discussion to include the need for female administrators and nurses as well. As she had done in her autobiographical sketch, Zakrzewska charged right into an attack on standard definitions of what it meant to be a woman. ‘‘The great error,’’ she told her audience, ‘‘is the expectation that women should play the sacrificing role everywhere. Wherever they take part, whether in charities or other enterprises, their participation is always considered as a duty toward others.’’ Zakrzewska insisted instead that women should work ‘‘directly for their own goals and their own satisfaction.’’ Doing charitable work was all well and good, but true satisfaction came only when actions marked ‘‘the execution of our own ideas.’’ For this reason she encouraged women’s employment as hospital directors and administrators, insisting, in fact, that women be allowed to direct Civil War hospitals. To those who raised the question of decorum, she replied that women ‘‘of upbringing and purity of the senses [Reinheit des Sinnes]’’ would never have problems and that such an argument was simply a ruse to keep women away. Drawing once again on the domestic ideology of female reformers, she insisted that since the hospital was just like a home and no one