Science Has No Sex
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When he died in 1888, she refused to attend his funeral, fearful that her grief might lead her to make a spectacle of herself.∂∫
In their promotion of radical reform, Sewall and Cheney were joined by Henry Ingersoll Bowditch, consulting physician at the New England from 1865
until his death in 1892. One of the most accomplished medical personalities in Boston, Bowditch earned his medical degree from Harvard in 1832, spent two years refining his medical skills in Paris, was on the faculty of Harvard Medical School from 1859 to 1867, and enjoyed an association with the prestigious Massachusetts General Hospital from 1838 until his death. According to Bowditch’s own account, he became involved in the abolitionist movement the day he encountered an angry mob on the streets of Boston, intent upon attacking William Lloyd Garrison for his antislavery speeches. Already opposed to slavery on principle, Bowditch reacted to this lynch mentality by assuming an active role in the Garrisonian camp of the abolitionist movement.∂Ω
Known for his strong sense of justice and commitment to principles, Bowditch translated his beliefs into practice, ending an a≈liation with the Warren Street Chapel, an institution dedicated to assisting children of the poor, when it closed its doors to black children. He similarly threatened to resign his position as admitting physician at Massachusetts General when the trustees, troubled by the number of ‘‘colored persons’’ Bowditch had been granting admission, passed a law restricting his freedom to admit whomever he considered needy. Disturbed by this turn of events, Bowditch informed them that he had
‘‘always regarded the colored man or woman in the same light that I looked upon other men and women,’’ making it impossible for him ‘‘to remain any longer in a situation where I may be obliged to violate thus my views of justice.’’∑≠
Like Sewall, Bowditch showed an early and sustained interest in promoting women’s rights. He had, along with several other prominent physicians, encour-
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aged Zakrzewska as early as 1860 to take the examination for admission to the Massachusetts Medical Society. (She had not been permitted to do so, the society being steadfastly opposed to the admission of women.)∑∞ Later in the decade, he took on the American Medical Association, actively promoting women’s admission to the national organization. As he wrote his wife at the time, he ‘‘disgusted the Association’’ by speaking out in defense of women doctors, but he was unable to sit still ‘‘and see an honest cause abused and spit upon without at least protesting.’’ Linking this cause rhetorically to that of abolition, he informed his audience that having been born ‘‘under the atmosphere of Northern liberty,’’ he did not believe that anyone, man or woman, should be kept from studying or pursuing a trade.∑≤
Joining Bowditch in his support of the New England Hospital were other members of Boston’s elite medical establishment. Indeed, the list of the institution’s consulting physicians and surgeons reads like a veritable who’s who of the city’s most prestigious physicians. Most of these men had received their medical degrees from Harvard; several subsequently served as faculty members at Harvard Medical School; and most had a≈liations with Massachusetts General Hospital. Their support of the New England Hospital, as other historians have shown, stemmed in large part from their appreciation of Zakrzewska’s commitment to regular medicine. Yet what is often overlooked is that most of these men also traveled in Boston’s liberal and radical circles. In addition to Bowditch, Edward Jarvis left a job in Lexington, Kentucky, because of his opposition to slavery. Walter Channing and John Ware, both members of the faculty at Harvard Medical School, supported the admission of black students in 1850; they were also both actively engaged in poor relief. Channing’s 1843 Address on the Prevention of Pauperism blamed social conditions and politics for the plight of Boston’s poor, not the poor themselves, a perspective, as we have already seen, that Zakrzewska shared.∑≥ The New England Hospital must have appealed to these men not simply because it promoted scientific medicine but because it paired this commitment with a program of social reform. Not all the consulting physicians supported women’s rights directly—we have already mentioned John Ware’s skepticism that women had the fortitude to succeed as physicians—
but the New England Hospital’s role as a ‘‘homelike’’ refuge for poor women and as an emblem of modern scientific medicine made it attractive enough that even male physicians who questioned women’s ability to practice medicine could support its cause.∑∂
An intriguing example of this is Edward H. Clarke, best known for his now
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(in)famous work, Sex in Education; or, A Fair Chance for the Girls, in which he argued that women could not stand the strain of engaging in academic studies on a par with men. The very year he published this study, Clarke joined the consulting sta√ of the New England Hospital, where he remained for five years. Zakrzewska had known him since her days as head midwife at the Charité. He had come to Europe to further his education, and she claims to have helped him out.
When she moved to Boston in 1859, Clarke became one of her earliest supporters, sending patients to her in her private practice and o√ering to consult with her should she need his advice. He even joined Cabot and Bowditch in supporting her application to the Massachusetts Medical Society. According to Zakrzewska, Clarke never believed in principle in the medical education of women and viewed her as an ‘‘ ‘exception’ to her sex,’’ but other sources suggest that Clarke had begun his career in favor of women doctors and only gradually changed his mind. It is, of course, possible that Clarke was doing little more than repaying a debt for the help Zakrzewska granted him when they were together in Germany. Whatever may have been the case, Clarke’s willingness to begin consulting at the New England at the very moment he went on record advocating a less intellectually rigorous academic program for women deserves
a closer look.∑∑
What is possible is that Clarke’s interest in Zakrzewska’s cause reflected as well the vision he shared with her of the path medicine should pursue. In 1864, in an article entitled ‘‘Recent Progress in Materia Medica,’’ Clarke came out strongly in support of ‘‘rational therapeutics,’’ which he described as the application of scientific methods in the pursuit of ‘‘an exact knowledge of the physiological action of remedies’’ and ‘‘an equally exact knowledge of the natural history of diseases.’’ Significantly, sprinkled throughout this essay were references to American, British, French, and German sources. Quite evidently, Clarke did not share the skepticism of most his colleagues toward German methods of studying health and disease. Using language that harkened back to the battles fought in Germany in the 1840s and that would have been familiar to Zakrzewska, Clarke warned that unless rational methods are embraced, ‘‘[t]herapeutics in the future will be what they have been in the past—empiricism.’’∑∏ In short,
Clarke’s support of the New England Hospital, and Zakrzewska’s decision to reach out to Clarke despite his criticism of higher education for women, may have resulted from a bond they forged over their shared condemnation of
‘‘empiricism’’ and their positive evaluation of ‘‘rational therapeutics.’’∑π
It bears mentioning that Bowditch also expressed respect for German de-
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velopments in scientific medicine, suggesting that at least a few of Zakrzewska’s consulting physicians may have lent their support because of their positive assessment of European, including German, approaches to health and disease.∑∫ Zakrzewska may have studied only midwifery in Europe, but as we will see, the first generations of women who assumed positions as resident and attending physicians had all studied medicine in one or more of the major European centers of medical training (Zurich, Paris, London). Thus for those physicians committed both to medical and social reform, the New England Hospital would have had a particular appeal.
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Zakrzewska, who was not used to public performances, was exhausted by the hospital lecture. ‘‘I am tired and worn out,’’ she wrote Lucy Sewall, five days after giving the talk. Sewall was in London, training in that city’s hospitals as a way of improving upon the education she had received at the New England Female Medical College. ‘‘I felt miserable all last week,’’ Zakrzewska added, ‘‘so miserable that I had to give up my work and my lessons for the last three days and rest.’’ Her exhaustion stemmed in part from the talk but also from the demands of private practice. In addition to her hospital responsibilities, Zakrzewska held o≈ce hours for her private practice from twelve to two, six days a week. Moreover, for those too sick to make it to her home or to the dispensary, she made house calls, and in 1863, a good two years before she purchased a horse and buggy, this frequently meant long walks. That winter was also a particularly busy time. Not only was her home filled with patients, but her private practice had really taken o√. ‘‘If you could see my o≈ce day after day,’’ she wrote Sewall, ‘‘full of school-teachers, dressmakers, mill operatives and domestics, all too proud to go to the dispensary and yet not rich enough to pay a large fee, you would agree with me that the prescription for good meat, wine or beer would be a farce if I took the money with which they ought to buy these instead of taking the small fee which allows them to keep their self-respect.’’∑Ω
Zakrzewska was succumbing under the strain. Matters were not helped when her sister Anna, who lived in New York and had been caring for their youngest sister, became ill and had to send Rosalia to Boston. But the final straw seems to have been the resignation of Mary E. Breed, the hospital’s first resident physician, which left Zakrzewska with no choice but to assume the position herself, spending nights in the hospital and supervising the day-to-day care. Zakrzewska collapsed under the stress, becoming so ill that she had to suspend her
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practice for a week. When she did not recover, she packed a bag and, along with a friend, ‘‘went to New York on a ‘spree.’ ’’∏≠
Zakrzewska returned refreshed from her trip and immediately tried to make some changes to prevent a relapse. She began by o√ering Sewall the position of resident physician upon her return from Europe, an o√er that Sewall accepted.
Zakrzewska also decided not to take so many patients into her home. ‘‘I would rather live by myself and pay more for the comfort of having a free home,’’ she wrote to Sewall, ‘‘than to make a little profit.’’ Her decision to simplify her life did not last long, however. Soon she was complaining that a year had passed since she had been able to read a newspaper, joking that her dependence on patients for news was giving her some queer opinions on the war and slavery. By November 1865, Elizabeth Blackwell was describing Zakrzewska in a letter to her family as ‘‘looking haggard.’’∏∞ Zakrzewska, who until this time had continued to give public lectures, decided once and for all that she had to end this activity. Thus, when Caroline Dall asked her to lecture at the Lowell Institute the following year, she responded with a remarkably frank letter, explaining that her strength was as ‘‘a logical practising physician,’’ and not as a public speaker.
Wishing no longer ‘‘to increase the number of mediocrity which we have so plentiful to endure on the Platform,’’ she informed Dall of her resolution ‘‘to refuse any such work.’’∏≤
Zakrzewska appears to have kept this resolution. Moreover, in 1869 she redefined her role at the hospital. In 1863, when Sewall had assumed the position of resident physician, Zakrzewska had been the primary attending physician at the hospital, doing her rounds and carrying ultimate responsibility for the care of the patients but no longer playing a part in the actual day-to-day care. Now, six years later, C. Annette Buckel became resident physician, Sewall became a second attending physician at the hospital, and she and Zakrzewska decided to alternate this position every three months.∏≥ Zakrzewska hoped this would allow her increased time for her private practice, which provided a necessary and important source of income, but it also permitted her to focus more of her time and energy on both her administrative and pedagogical responsibilities. Directing a rapidly expanding hospital was proving to be considerably more work than Zakrzewska had anticipated. It was one thing to imagine a hospital that benefited women, whether physicians or patients, and another thing entirely to execute one’s plans, particularly given the changes that took place over time as the hospital outgrew its cozy setting in a small rented home and gradually assumed the trappings of a modern hospital complex.
The Hospital in Transformation
When the doors of the New England Hospital for Women and Children opened in June 1862, it was a small, charitable operation. Located in a rented house in central Boston, it had just ten beds at its disposal, one resident physician, two consulting physicians, and two student interns. The New England admitted an average of about 130 patients a year in the first years of its existence, the vast majority for childbirth or ‘‘diseases of women,’’ and attended to approximately 1,500 patients more through its dispensary practice. The annual reports of the hospital in these early years repeated much the same message Zakrzewska had spelled out in her 1863 lecture, keeping their focus on the necessity of providing a safe haven for the poor and destitute, including unwed mothers. Declaring
‘‘absurd’’ the idea that a lying-in hospital could ever foster immorality, Zakrzewska insisted that every laboring woman, with no exceptions, ‘‘must in the hour of trial be sheltered and cared for.’’ Clearly not having lost any of her radicalism, she urged her supporters to consider the plight of the destitute and respond not only with ‘‘sentiment or sentimental sympathy’’ but also with ‘‘gold.’’∞
By the end of the century, the New England Hospital was a totally di√erent enterprise. With a capacity of roughly ninety beds, it averaged just over 800
patients a year in the first years of the new century and another 17,700 through its dispensary. It had also abandoned the inner city in 1872, moving out to the suburbs of Roxbury close to Zakrzewska’s home. Over the years it expanded to include a new maternity building (1892), a new dispensary (1896), a new surgical building (1899), and a renovated central building, which housed the medical wards. The dispensary, which remained in the inner city, was divided into six separate clinics, one each for gynecology, medicine, surgery, skin, eye, and throat, nose, and ear. The sta√ consisted of one resident physician; twenty-
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four advisory, attending, and assisting physicians at the hospital; another thirty attending and assisting physicians at the dispensary; and thirteen consulting physicians.≤
With this expansion came a change in the rhetoric of the annual reports as well. Gone was any explicit concern with poor unwed mothers, even though they continued to make up roughly 20 percent of the maternity patients. Instead, the hospital proudly announced that the vast majority of its maternity patients were married; indeed, many of them owned their own homes but preferred to deliver in the hospital because they lacked the ‘‘quiet and freedom from responsibility’’ they needed during childbirth. The reports on the medical and surgical wards followed a similar trend; whereas earlier ones emphasized the importance of a dignified setting for ‘‘the wives of clergymen in the country’’
and ‘‘school teachers, worn out by their arduous labors,’’ later ones focused on creating an environment where ‘‘those who have good homes and the command of all that wealth can procure still find their best chance of recovery.’’≥
The New England Hospital had been almost completely transformed.
As the century drew to a close, such changes were taking place throughout the country as hospitals reconsidered their obligations to the poor. As their numbers grew—from 178 hospitals in 1870 with a capacity of 50,000 beds to 4,000 in 1910 and 400,000 beds—hospitals changed from largely charitable institutions,
o√ering both medical and custodial services primarily to the chronically ill poor and infirm, to acute-care institutions, defined increasingly by new technological developments and surgical interventions and catering increasingly to the middle class and wealthy. Abandoning its identity as a home for the
‘‘worthy’’ poor, the hospital became defined instead around its clinics, laboratories, and e≈cient dissemination of care to a paying clientele.∂
Still, few hospitals had started out with as radical an agenda as the New England Hospital, and thus few had been so utterly transformed. As we will see, financial concerns, a growing disillusionment with the changing nature of the patient population, and the realization that poor, chronically ill women did not best serve the needs of a teaching hospital all contributed to a new understanding of the institution’s obligation to the poor. Zakrzewska, whose true passion had always been to open the doors of the medical profession to women, proved unwilling to do anything that would possibly jeopardize that cause.
. . .
‘‘Our beds have been filled and our dispensary thronged with wives, mothers, and children whom want and anxiety have sent hither, for bodily and mental
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relief,’’ wrote Ednah Cheney in the hospital’s first annual report. Only one year in operation and the small house on Pleasant Street was already inadequate to meet the needs of the poor. By 1865 the directors had managed to raise su≈cient funds to triple the size of the hospital’s properties and increase the number of available beds from ten to forty, but the New England Hospital still had di≈-
culty keeping pace with the demand. By the fall of that year, the medical sta√
had seen a total of almost 400 patients since it had opened; it had attended to more than 6,400 people in the dispensary; and it had treated almost 400 patients in their homes. Three years later the numbers had grown to 1,500 hospital patients, more than 18,000 people in the dispensary, and more than 1,000