Science Has No Sex
Page 27
patients in their homes. Just six years after the New England had opened its doors, the directors were looking once again for a way to expand the hospital in order to accommodate the large numbers of individuals who continued to seek their care.∑
Hospitals all over the country were experiencing similar patterns of growth.
Certainly the exigencies of war propelled this trend; with so many sons and husbands away from home, family members who became ill often had no one to care for them. The end of the war did nothing, however, to stop this trend. On the contrary, a combination of factors, including humanitarian sentiments, a rapidly growing urban population, and concern for the health of industrial workers, led to the founding of ever more and ever larger hospitals that could provide care for the sick and infirm. The pressures the New England Hospital was experiencing were thus typical of hospitals founded in this period. Although many started out small, most soon found that they had to expand in order to meet the needs of the populations they were trying to serve.∏
Much of the New England Hospital’s particular appeal stemmed from the opportunity it provided women to be cared for by physicians of their own sex.
Like the small number of other all-women’s hospitals, it was satisfying a need, Victorian sensibilities having long rendered problematic the physical intimacy that marked the relationship between a male practitioner and his female patients. As resident physician Lucy Sewall wrote in the hospital’s 1867 annual report, women who had evidently been su√ering for some time with ‘‘what are commonly called ‘female diseases,’ ’’ when asked why they had not previously sought care, responded, ‘‘Oh, I could not go to a man.’’ Aside from the obvious power such a story had for soliciting funds from the hospital’s subscribers—what were the annual reports, after all, if not a means of generating and sustaining the interest of their readers in the good work of the institution—there is little reason
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to question the validity of this appeal. The year Sewall wrote this report, almost 63 percent of the women receiving care in the hospital were maternity cases, and another 30 percent among both the hospital and the dispensary populations were diagnosed as su√ering from ‘‘diseases of women.’’ A vague category, it referred to a host of ailments that included everything from prolapsed uteruses to nervous ailments, conditions that many women often found di≈cult to discuss openly with men. Such feelings of propriety contributed at least in part to the popularity of unorthodox medical practices, as a woman would be more likely to find female homeopaths and hydropaths than female practitioners of orthodox medicine. Zakrzewska was, of course, trying to alter these statistics, and although she herself tended to downplay the separatist nature of her institution, for the women seeking care this was certainly one of its greatest draws.π
The experiences at other all-women’s hospitals confirm this. Indeed, the New York Infirmary for Women and Children had moved shortly after Zakrzewska’s departure from its residence on Bleeker Street to Second Avenue because of its need for larger accommodations. The Woman’s Hospital of Philadelphia, which opened in 1861 under the direction of Ann Preston, also found its services much in demand. By 1875 it had grown from twelve to thirty-seven beds and was attending 2,000 patients in their homes annually and seeing another 3,000 through its dispensary. Other women’s hospitals, such as Clemence Lozier’s homeopathic New York Medical College and Hospital for Women, Mary Thompson’s hospital in Chicago, and Charlotte Blake Brown’s in San Fran-cisco, showed similar signs of success. Quickly outgrowing their initial accommodations, they had to expand both their physical space and their sta√ in order to treat the large numbers of women and children who showed up at their doorstep.∫
Unfortunately, too little is known about the specific policies and practices at most of the all-women’s hospitals to assess the reasons, beyond Victorian sensibilities, that may have contributed to their popularity. However, if the New England Hospital is representative, the appeal may have extended beyond gender to class. At least in the New England’s early years, the hospital did not require those who were attending the dispensary to pay anything for either their visits or their prescriptions, although other Boston hospitals, such as Massachusetts General Hospital, charged a nominal fee. In fact, charging the poor a modest amount for their care was a widespread practice, promoted as a way of discouraging dependency and encouraging a work ethic that linked financial independence with self-respect and handouts with humiliation. Zakrzewska
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and her sta√, it should be emphasized, shared these values, but after addressing the possibility of screening their patients to determine who might be able to a√ord a small fee, they decided that ‘‘no test . . . will su≈ce to separate these from others who need all for daily support.’’ Zakrzewska, who was especially concerned about the psychological impact such scrutiny could have on the poor, refused to require dispensary patients to submit proof of their neediness because she did not wish them to receive ‘‘the impression of being considered a pauper.’’ She chose to trust instead that only those individuals who had no other options available to them would seek free medical attention.Ω
The New England’s policies regarding admissions were similarly lenient. To be sure, as at other hospitals, medical, surgical, and maternity patients were expected to pay for their care: four dollars a week for full board (which was increased to eight dollars in 1864 and to ten dollars in 1869). Those with little or no means of meeting this expense had the options of reduced board or no charge at all. However, unlike other hospitals where a lay board of trustees handled admissions and evaluated an applicant’s ‘‘worthiness’’ for care, the New England Hospital placed admissions squarely in the hands of the resident physician. In fact, Zakrzewska had made it a condition of her directorship that the medical sta√ retain the right to determine care based on an individual’s need. To be sure, this did not mean that resident physicians ignored nonmedical issues when determining whether to admit a patient; an applicant’s presumed morality was part of their calculus of admission as well. Nevertheless, investing the resident physician with the power to weigh medical and pedagogical needs over moral concerns meant that the level of scrutiny would vary depending on the judgments of the person who occupied this position.∞≠
This may help to explain why the New England Hospital was able to reach out to unwed mothers when so many other hospitals turned them away. As already mentioned, most other hospitals with maternity wards refused admission to anyone without a marriage certificate. Tellingly, one member of the medical sta√ at the Woman’s Hospital of Philadelphia tried to alter her institution’s policy in order to o√er refuge to unwed mothers; her request, however, was not heeded, presumably overruled by the lay board of trustees, who did not believe that helping these women would serve the best interests of the hospital.∞∞
This is not to suggest that medical personnel were necessarily more sympathetic to the plight of unwed mothers than were lay trustees. We simply know too little to make such a claim. What is clear, though, is that Zakrzewska’s insistence that admissions remain ultimately with the medical sta√ created a
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situation in which it was easier for those who were so inclined to show openness to a class of women whom others turned away. Thus both Zakrzewska, as attending physician, and Lucy Sewall, as resident physician, came repeatedly to the defense of pregnant women, regardless of their marital status. In the 1867
annual report, for example, Sewall announced proudly that the New England had saved ‘‘many a poor girl, at the very crisis of her fate’’ from the almshouse, being ‘‘the only institution, in the great city of Boston, for the reception of indigent women in the pangs of labor.’’ Zakrzewska, moreover, repeating much the same message she had communicated in her hospital lecture, issued a lengthy report t
he following year, insisting that women in labor be treated with respect and chastising those who recommended sending unmarried mothers to the almshouse for subjecting them to a ‘‘greater debasement than an illegitimate pregnancy entails.’’ To those who continued to condemn maternity hospitals for encouraging illegitimacy, she responded curtly that no woman, ‘‘(to her honor be it said), however degraded, thinks, in the beginning of her love-a√air, of the consequences and of the probably existing charities of which to make use in case a child is born.’’ After all, she explained, we are talking about roughly twenty dollars’ worth of charity, which cannot possibly compensate for the
‘‘long months of deprivation and anxiety’’ that mark illegitimate pregnancies.
But what also troubled Zakrzewska was the unfairness of meting out punishment based solely on one’s financial status. ‘‘A woman in labor must be taken care of,’’ she insisted as she had in 1863. ‘‘Whether this is done by means of her own money, by private charity, or by public institutions, has no e√ect upon her morality.’’∞≤
This should not be taken to mean that the New England Hospital set no limits on the women it was willing to help. As in her hospital lecture, Zakrzewska once again coupled her impassioned defense of unwed mothers with a promise that her hospital did not welcome just anyone who showed up at its doorstep, turning away those who had been ‘‘recognized as absolutely perverted.’’ Similarly, her insistence that a homeless mother deserved shelter after being discharged from the hospital did not apply to the ‘‘very few really bad women, bad in every way,’’ who were granted temporary refuge only because they had arrived at the hospital in an advanced stage of labor. Thus, Zakrzewska flouted social conventions only to a certain degree, but she still went further than most. She seemed, in fact, to care less about the specific actions a woman had taken and more about whether the woman was capable of feeling shame for what she had done and, conversely, whether she understood the honorable
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table 1. Unwed Mothers at the New England Who Had Previous Pregnancies 1872
1873
1878
1883
1888
1893
Number
1
11
1
4
1
2
Percentage
6.2
27.5
3.6
7.8
3.6
5.7
Source: Calculated from New England Hospital for Women and Children, Maternity Case Records [b ms b19.3], Boston Medical Library in the Francis A. Countway Library of Medicine, Boston, Mass.
thing to do. In one of her more radical statements in the 1868 annual report, Zakrzewska defended unwed mothers of multiple births by insisting that they knew the di√erence between honor and shame and that frequently these women chose, on their own, not to return to the hospital during their confinements because of the shame they felt. While others, such as Mary Delafield DuBois of the Nursery and Child’s Hospital in New York, also reached out to single mothers during their first pregnancies, few went as far as Zakrzewska when she spoke kind words in public about mothers who had had more than one child out of wedlock.∞≥
Unfortunately, the absence of any maternity records prior to the New England Hospital’s move to Roxbury makes it impossible to assess the relationship between rhetoric and practice. We simply do not know how many unmarried women gave birth in the hospital while it was still located in central Boston and, of these women, how many had had a previous pregnancy. In 1872, however, the first year following the move, sixteen out of twenty-nine maternity patients were listed as single (55.2 percent), with one having had a previous pregnancy. The number of unmarried mothers may, of course, have been higher, given the likelihood that some unwed mothers may have lied about their marital status.
The following year forty out of eighty-eight maternity patients were listed as single (45.5 percent), with eleven having had a previous pregnancy. Such a high number of multiparae was, however, unusual and probably reflected the unwarranted poverty and devastation that resulted in 1873 from a national economic depression combined with a citywide fire. As Table 1 demonstrates, in no other year did the number of unwed mothers who had had previous pregnancies exceed more than a few a year.
One must, of course, be cautious about extrapolating backward to the 1860s from data collected in the 1870s. Still, given that the patients who came to the
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table 2. ‘‘Colored’’ Patients at the New England (All Wards) 1873
1878
1883
1888
1893/94
Number
3
0
2
1
0
Percentage
1.2
0
0.6
0.3
0
Sources: Calculated from New England Hospital for Women and Children, Maternity Case Records [b ms b19.3], Surgical Case Records [b ms b19.1], and Medical Case Records [b ms b19.2], Boston Medical Library in the Francis A. Countway Library of Medicine, Boston, Mass.
Note: Because records for 1893 are missing for the medical ward, the data under 1893/94 are drawn from 1894 for the medical ward and from 1893 for the maternity and surgical wards.
New England Hospital once it was located in Roxbury tended to be somewhat better o√ financially than their predecessors (more on this later), chances are that the percentage of single mothers had, if anything, been higher than 50 percent while the hospital was still in the inner city.∞∂ As far as the multiparae are concerned, there is simply too little evidence to speculate whether a higher percentage may have found refuge in the 1860s than after the move. The most one can say is that the rhetoric of the early years suggests that it was at least Zakrzewska’s intent to create an environment that would be welcoming to second-time single mothers as well.
Similar problems arise when trying to determine whether the New England Hospital’s rhetoric of color blindness led to the admission of patients of color.
Again, since we lack any patient records for the years prior to the move out to Roxbury, we are limited in what we can conclude. The data we have for the years after 1872, as Table 2 shows, demonstrates that the New England Hospital never had more than a few patients of color at any given time, although given the small size of Boston’s African American population throughout this period (1.3 percent of the total population in 1860; 1.2 percent in 1870; 1.6 percent in 1880; and 1.8 percent in 1890) this may also have reflected a lack of demand for services.∞∑
We know, in fact, hardly anything at all about the patient population prior to the hospital’s move to Roxbury. Although records exist from the medical and surgical wards, they never mention whether, or how much, an individual paid, so we do not know the percentage of patients who received charity. The records also did not start including the individual’s occupation until 1873. We are thus dependent upon the annual reports to paint a picture of the patient population,
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table 3. Percentage of Foreign-Born at the New England’s
Dispensary and Hospital Compared with Massachusetts General 1863
1864
1865
1866
1867
1868
1869
1870
1871
1872
neh-d
54.1
52.9
55.1
55.1
58.0
61.5
57.6
60.7
60.7
58.4
neh-h
59.3
n.d.
n.d.
n.d.
59.6
54.2
42.4
58.2<
br />
55.4
49.4
mgh
60.7
59.1
52.4
52.0
53.7
52.3
51.0
55.1
54.5
57.0
Sources: Calculated from the annual reports of the New England Hospital and Massachusetts General Hospital and from New England Hospital for Women and Children, Records of Patients Who Received Prescriptions [b ms b19.5], Boston Medical Library in the Francis A. Countway Library of Medicine, Boston, Mass. Records of Patients Who Received Prescriptions were used for 1864, 1865, and 1866, the only years for which the annual reports of the New England Hospital contained no information on the nationality of the dispensary patients.
Notes: The data for Massachusetts General Hospital are for its female patients alone.
neh-d = New England Hospital, Dispensary; neh-h = New England Hospital, Hospital; mgh = Massachusetts General Hospital; n.d. = no data.
and the only reliable information they provide concerns the patients’ nationality. Our picture is thus highly sketchy, but we learn, as Table 3 shows, that for most of the decade the populations in both the dispensary and the hospital consisted predominantly of the foreign-born. This remained the case at the dispensary, where the percentage increased over time. At the hospital, in contrast, despite some fluctuations, the percentage of foreign-born gradually declined, until the year of the hospital’s move to Roxbury, when it dipped below 50 percent for the second time. As will see later in the chapter, this dip marked the beginning of a trend toward ever greater Americanization of the hospital population that eventually distinguished it not only from the dispensary population but also from other hospitals in the city that catered to the poor. Until the move, however, as row 3 of the table demonstrates, there was basically no di√erence between the hospital populations at the New England and Massachusetts General when it came to the percentage of the foreign-born receiving care. If nationality was any indication of socioeconomic status during that time, then as long as the hospital remained in the inner city, its patients were every bit as poor as those who sought care at Massachusetts General.∞∏