Science Has No Sex
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clinical techniques.≥ The New England Hospital, as we will see, was among those that did.
The teaching hospital would eventually emerge as the mainstay of medical education. That was not yet the case in the 1860s and 1870s, when hospitals, although frequently allowing medical faculty access to their wards for clinical instruction, severely restricted student contact with patients. In response, some medical schools established their own small clinics and hospitals, but by and large the expense of founding and running a hospital was prohibitive. This was, to be sure, one of the main reasons formal clinical instruction remained so poor in the United States right up to the turn of the century.∂
Zakrzewska’s situation di√ered from that of most other medical educators of her day because she directed an institution created in part to provide clinical instruction. As we have already noted, the New England Hospital was also basically run by the medical sta√, not a board of trustees. Zakrzewska thus had a level of freedom most other medical educators lacked, and she used it to put in place a clinical program grounded in orthodox medical practices that provided her students with knowledge of the latest scientific techniques.
. . .
As soon as Zakrzewska decided to found a new hospital, she sought the support of Boston’s elite physicians. In November 1862, at the hospital’s first annual meeting, she was able to announce that ‘‘[t]wo of the best medical men in the city, Dr. [Samuel] Cabot and Dr. John Ware, are our consulting physicians, and a dozen more are willing to give their assistance whenever it is asked.’’∑ Many of these physicians had withheld their support from Zakrzewska when she had been a≈liated with the New England Female Medical College, convinced that Samuel Gregory was running a second-rate institution. Now, however, Zakrzewska stood at the head of a hospital committed to promoting the highest standards of medical orthodoxy, and they threw their weight behind her.
Zakrzewska’s determination to create an elite medical institution was characteristic of the directors of other all-women’s regular colleges and hospitals, the vast majority of whom had founded their institutions only after trying unsuccessfully to integrate all-male institutions. By and large these women viewed their creations as temporary measures, necessary only until coeducation would become standard policy. Acutely aware that until that time their institutions would be scrutinized closely for any signs that women were unfit for the practice of medicine, they maintained, as we have already mentioned, the highest standards.∏ They also went to great lengths to distance themselves from unorthodox
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practitioners and institutions. Thus the Female Medical College of Pennsylvania, which initially had a few eclectic physicians on its faculty, fired these individuals as early as 1853 and restricted its appointments thereafter to graduates of orthodox medical schools. Similarly, Elizabeth Blackwell refused to have anything to do with Clemence Lozier, who had founded an all-women’s homeopathic medical college in New York City in 1863, despite Susan B. Anthony’s attempts to persuade these two women that they would better advance women’s rights if they would join forces.π All in all, mixing strategy with conviction, the directors of these all-women’s institutions put in place educational models that, they believed, would produce the best practitioners possible and bring women the recognition and prestige that was their due.
In this vein, one of Zakrzewska’s first strategies was to ensure that the qualifications of the women who sta√ed her hospital could not be found wanting by the profession’s elite. Of the ten resident and attending physicians who worked at the New England Hospital during its first twenty-five years, one graduated from the University of Michigan, one from the Woman’s Medical College of Pennsylvania, and four from the University of Zurich. (The other four were graduates of the New England Female Medical College.) All ten, moreover—
not just the four students who attended medical school in Zurich—spent at least one year studying in Europe. Thus Lucy Sewall, who served as resident physician from 1863 to 1869, attending physician from 1869 to 1887, and advisory physician from 1887 until her death three years later, spent a year studying medicine in the Paris, Zurich, and London hospitals. And Helen Morton, who joined Zakrzewska and Sewall in running the hospital for well over two decades, spent four years in Europe, much of that time in Paris at La Maternité. Zakrzewska did not hesitate to draw attention to the European training of her physicians in the hospital’s annual reports.∫ She wanted to be sure that her supporters understood her institution’s embrace of modern scientific methods.
Zakrzewska also set out to distinguish her hospital from irregular institutions.
Thus she helped found the New England Hospital Medical Society to promote regular women physicians and to distinguish them explicitly from ‘‘charlatans of every description.’’Ω Indeed, almost immediately following its creation, the members of the society petitioned the Boston City Directory to remove their names from the heading ‘‘female physicians,’’ which included everything from homeopathic physicians and Christian Scientists to midwives, nurses, and regular physicians. Successful in their endeavor, the members of this society henceforth appeared under a separate listing for their organization, hoping thereby to
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make their elite standing clear. Zakrzewska’s desire to distinguish her hospital from unorthodox institutions led her, moreover, to support a requirement in 1880 that all interns have the M.D. in hand before beginning their training and that this degree be from a regular medical school.∞≠
In her promotion of medical orthodoxy, Zakrzewska also joined her peers in championing coeducational institutions. Indeed, she wrote optimistically of the day ‘‘when no separate institutions for women will be demanded, and when our Hospital will be only a charity for needy women who prefer women physicians to men, or where men and women may work together.’’∞∞ In fact, she was quite
pleased when Massachusetts General Hospital decided in 1866 to permit her students to walk its wards on the days when Harvard medical students were not in attendance. She saw this as an indication that Harvard might soon follow suit and welcome women as well.
Still, Zakrzewska was not enthusiastic about coeducation at any price.
Rather, like other pioneers of women’s medical education, she wanted assurances that women would be educated in exactly the same way as men. Already in 1874, when the New England Female Medical College closed its doors and the question resurfaced whether Harvard would respond by accepting female students, Zakrzewska’s reaction had been lukewarm. The specific proposal was to have women take the same entrance examinations as men and to have the same professors providing the instruction, but the women were to be educated in their own building, about two miles away from the main campus. ‘‘I did not favor such an arrangement,’’ Zakrzewska explained years later, ‘‘but actually discouraged it, because it seemed to me disastrous to the whole spirit of woman’s work in the profession.’’ She feared in particular that such an arrangement would result in junior professors taking over the education of the female students, thereby perpetuating the notion that women were less qualified than men. Zakrzewska, along with several other women physicians, even o√ered Harvard fifty thousand dollars in 1881 if it would open its doors to women and grant them the same education as men. And in 1890, when a group of Baltimore women joined together to raise funds for the new medical school at the Johns Hopkins University on the condition that the school open its doors to women, Zakrzewska, whose opinion was specifically requested, urged them to police carefully exactly what the trustees meant by coeducation. In short, until the time that elite medical institutions in the United States would agree not to discriminate against their female students, Zakrzewska continued to favor schools, like the University of Zurich, that had proved their ability to treat all students alike. As she aged, she
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may have had increased doubts that that day would arrive any time soon, but she never abandoned her conviction that true coeducation would be superior to separate institutions.∞≤
Zakrzewska’s commitment to the standards of the elite medical profession were all part and parcel of her battle to advance women’s rights. The same could be said of Ann Preston, Mary Putnam Jacobi, and many other regular women physicians.∞≥ An older scholarship lamented the loss of female solidarity that resulted as women became divided between orthodox and unorthodox practitioners.∞∂ Indeed, some contemporaries, such as Susan B. Anthony, regretted this as well. However, from Zakrzewska’s perspective, the best way to advance the cause of women was to hold them up to what she considered to be the highest standards, and those were, in her opinion, the standards set by the best regular medical schools in the country and abroad. The advancement of women, not female solidarity, was the driving force in Zakrzewska’s life.
. . .
In her promotion of medical orthodoxy and her embrace of coeducation Zakrzewska was thus far from alone among women physicians. Where she stood out was in her insistence that women did not practice medicine any di√erently than men. As we have seen, in none of her published work did she ever embrace language common among her peers that suggested women physicians had greater ‘‘sympathy’’ for their patients. In fact, in the hospital’s fourth annual report in 1865, she even exhibited a marked concern that her previous emphasis on the homelike nature of the hospital had been misunderstood to mean that the hospital specialized foremost in providing care. Correcting that mistaken view, she now insisted that what mattered most was using science to save lives.∞∑
Zakrzewska brought home this point by relaying two cases in which the medical sta√ had intervened directly in the birthing process. In the first, a woman in her ninth month of pregnancy had been found convulsing and un-conscious in her home. She was transferred to the hospital, where ‘‘artificial delivery was immediately decided upon and commenced.’’ Sixteen hours later
‘‘a living child was born,’’ and thirteen days later mother and child were well enough to go home. In the second case, a woman with a ‘‘deformed pelvis,’’
who had previously lost a child because of complications during delivery, was
‘‘kept under Hospital surveillance,’’ so that when she became pregnant again, she could be helped to deliver the child prematurely, the assumption being that a smaller child would have an easier time passing through the birth canal.
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Marie Zakrzewska, ca. 1870s. (Courtesy Archives and Special Collections on Women in Medicine and Homeopathy, Drexel University College of Medicine)
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When the woman entered the hospital in the thirty-fifth week of her second pregnancy, Zakrzewska proudly wrote, ‘‘I induced labor at once, and three days afterwards a living, healthy child was laid by the side of its happy mother.’’∞∏
Zakrzewska had no doubt that because of these interventions her hospital had saved two lives, that of the woman in the first case and of the child in the second.
The medical sta√ at the New England Hospital, Zakrzewska was announcing, did much more than merely monitor the cases that came to them, o√ering gentle assistance. They were not practicing the kind of medicine Samuel Gregory had prescribed for women. Instead, the physicians intervened, when necessary, to ensure a healthy outcome. The powerful message in Zakrzewska’s second anecdote is that she had been able to create an artificial situation (by inducing premature labor) that circumvented the natural limits of the woman’s body. In other annual reports she repeated this focus on her sta√ ’s ability ‘‘to perform successfully the operative part of obstetrics.’’∞π The New England Hospital may have prided itself on the ‘‘necessary comforts’’ it o√ered women in need, but Zakrzewska wanted to make clear that the medicine they practiced was indistinguishable from that which was practiced at all-male institutions.
In this regard, a study conducted by Regina Morantz-Sanchez and Sue Zschoche comparing obstetrics practices at the New England Hospital and the Boston Lying-In Hospital is particularly telling. They found no significant di√erences between the two hospitals in terms of the frequency of intervention (as measured by the use of anesthetics and forceps), thus challenging historians for whom forceps had come to symbolize the practices of a male medical profession deemed antagonistic toward the needs of their patients.∞∫ The only di√erence they found was in postpartum care: women at the New England received more drugs and remained for a longer period of confinement. Morantz-Sanchez and Zschoche suggest that this may have reflected the persistence of ‘‘traditional holistic orientations,’’ in comparison with the Boston Lying-In, which was moving toward ‘‘a more modern, technocratic approach to their patients.’’ Yet given that the patient population at the New England came from a higher socioeconomic bracket than those who attended the Boston Lying-In (see Chapter 9), it seems more likely that the di√erential treatment reflected the patients’ greater ability to pay for the medicines and extended stay.∞Ω
In short, Zakrzewska, who was determined to prove that women practiced medicine no di√erently than men, appears to have been successful in implementing essentially the same practices one would have found at hospitals sta√ed solely by men. Of course, it would be helpful to know what went on at other all-
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women’s hospitals. Certainly the emphasis the Woman’s Hospital of Philadelphia placed on surgery, coupled with the Woman’s Medical College’s construction in 1875 of laboratories for microscopy, pharmacy, and chemistry, suggests that the style of medicine taught there would also have di√ered little from what one found at elite all-male institutions.≤≠ If that was the case, it would suggest that actual practices had little to do with whether women emphasized their unique contribution to medicine (as Ann Preston, Elizabeth Blackwell, and the majority of women physicians contended) or denied that they practiced medicine any di√erently than men (as Zakrzewska and Mary Putnam Jacobi insisted). It would also suggest that Zakrzewska’s criticism of sympathy and her lauding of science distinguished her from her peers more rhetorically than in practice. Unlike Mary Putnam Jacobi, who engaged in laboratory investigations and fought to be permitted to teach and practice vivisection, Zakrzewska di√ered little from others of her generation, male or female, in her actual approach to the practice of medicine.≤∞
Nevertheless, in one area, the fact that the New England was sta√ed solely by women may very well have made a di√erence, and that was in the hospital’s ability to control puerperal fever. This disease was, in the words of one of the hospital’s physicians, ‘‘the constant dread of all the physicians of maternity hospitals. At times all the cases would do well, and then without discoverable cause, fever would begin and spread among the patients with appalling rapidity and fatal results.’’ The New England had, however, comparatively little trouble with this infection. Between 1862 and 1872, its reported death rate from puerperal fever was 2 percent; the following decade the rate dropped to 0.5 per-
cent.≤≤ This stands in comparison with the Boston Lying-In Hospital, which may have had some years with similarly low rates (in 1879, for example, its mortality rate from puerperal fever was only 0.9 percent) but which had considerable di≈culty sustaining sanitary conditions. Thus in 1880, its rate jumped up to 3.9 percent, in 1881 to 4.8 percent, and in 1883 to 5.2 percent. The comparable numbers for the New England Hospital during those same years were 0.9, 0.9, and 0 percent.≤≥
One historian has suggested that the New England’s success in controlling puerperal fever may have resulted from female physicians’ greater commitment to eradicating a life-threatening condition that a∆icted women alone.≤∂ Such claims, however, are extremely di≈cult to prove
. Nevertheless, gender may have mattered in a di√erent way: the low rates may have reflected the unexpected consequences of the discrimination women faced in this country. Denied clini-
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cal opportunities at home, female medical students often studied abroad, where they received a far better introduction to the scientific management of infection than they would have received had they remained in the United States. This was certainly true, as we have seen, of the women who sta√ed the New England.
Susan Dimock, resident physician from 1872 to 1875, even submitted a thesis on puerperal fever to the faculty at the University of Zurich as part of the requirements for the M.D. ≤∑ It is reasonable to assume, therefore, that the sta√ carried this greater awareness with them as they managed their cases at the hospital.
In addition, the New England had a director who had begun her career as a midwife, when she had been taught to manage childbirth with the minimum of intervention and certainly without the use of instruments. Zakrzewska’s mentor, Joseph Hermann Schmidt, had also, as we have already mentioned, probably introduced her to the ideas of Ignaz Semmelweis, who had argued that puerperal fever was spread by the infected hands and instruments of physicians and medical students. She thus learned about the utmost importance of maintaining sanitary conditions in the maternity wards. But she was also convinced that hygienic measures alone would not always prevent the spread of infection. For that, one needed small hospitals divided into even smaller wards, thus allowing one both to isolate the infected patient and occasionally to close an entire ward for thorough cleansing.≤∏
Armed with this knowledge, Zakrzewska instituted a variety of practices all of which must have contributed to the New England’s low mortality rate from puerperal fever. When the hospital was still in the inner city and occupying a single building, she separated the maternity and surgical cases, making sure that no infections spread from one room to another. Recognizing, moreover, that crowded conditions created the perfect environment for the spread of the disease, she broke up the maternity ward into several smaller rooms, separating the women according to their stages of delivery. Zakrzewska also at times ordered the closing of almost the entire hospital for a few months for ‘‘the purpose of purifying and repairing’’; she instructed her sta√ to wash their hands after examining a woman in labor and to dip their fingers in oil; and she did what she could to isolate any suspicious cases.≤π