Science Has No Sex

by Arleen Marcia Tuchman

  Yet to view this conflict as arising from di√erent allegiances—female solidarity, on the one hand, and professionalism, on the other—obscures as much as it clarifies, largely because it makes little sense to cast Zakrzewska as someone who ever explicitly embraced a notion of ‘‘female solidarity.’’ Indeed, it was right around the time of the skirmish with the interns that she petitioned the Boston City Directory to remove the names of the hospital’s sta√ from the heading

  SCIENTIFIC MEDICINE

  ≤ 215

  ‘‘female physicians.’’ In addition, just one year after the initial trouble with the interns, Zakrzewska spoke before the New England Women’s Club, expressing her concern that ‘‘the so hopefully sown good seeds are in danger of being suf-focated by the still more thickly sown weeds.’’∑π Zakrzewska left little doubt that she intended her e√orts to result eventually in the mowing down of these weeds.

  It is, moreover, not at all clear that the interns would have disagreed with Zakrzewska in principle; where they seemed to di√er was over the qualifications that entitled one to claim the honorific ‘‘Dr.’’ Those students who had graduated from medical school believed they had already earned this privilege. Zakrzewska disagreed. That is why she viewed both graduates and undergraduates as receiving identical training during their internship year. It is also why she marked the point when interns were capable of assuming responsibility for their patients as the moment that ‘‘makes them really to be the ‘Dr.’ ’’∑∫

  In making this claim, Zakrzewska was staking out a position in a contemporary debate over the direction of medical education. Indeed, just a few doors down at Harvard University disagreements were surfacing between the university’s president, Charles W. Eliot, who had issued educational reforms in 1871

  that increased the time students spent in the laboratory, and some of the medical faculty. Oliver Wendell Holmes and Henry Jacob Bigelow, for example, both echoed the concerns John Ware had voiced almost twenty years earlier when they cast the curricular changes as a dangerous move toward the production of scientists rather than the education of practitioners.∑Ω Zakrzewska, as we will examine more closely in the next chapter, also viewed the recent move toward the laboratory with considerable ambivalence. It is in this context that one must understand her insistence that the knowledge imparted in medical schools did not translate into the clinical acumen students needed to diagnose and treat the ill. For that, she was telling her interns, they needed instruction at the bedside. Her interns, who may have felt buoyed by the educational reforms that were beginning to take place in medical schools around them, obviously disagreed. Still, this di√erence of opinion, which had more to do with how one evaluated both the nature and the impact of these educational reforms, is hardly indicative of a rift between those who embraced the new professionalism and those who remained critical.

  In one way, though, a sharp division was emerging between the generations, and that was in the evaluation of the hospital’s role in advancing women’s medical education. At least, Zakrzewska reacted most strongly when her interns implied that medical students no longer viewed an internship at the New

  SCIENTIFIC MEDICINE

  216 ≤

  England as desirable. Interpreting this as an indictment of the hospital’s usefulness, she responded by issuing her own threat, declaring her intent ‘‘to dispense with all students’’ if they believed they had ample opportunities for acquiring clinical training elsewhere. ‘‘Then,’’ she elaborated, ‘‘the Hospital will change its character and stand as a charity carried on by women; and in this way, we shall perhaps e√ect as much towards convincing the medical profession of the ability of women physicians, and shall thus force them to open Harvard College to such women as desire entrance there. And after all, that is my object in life, to open the existing colleges to both men and women alike.’’∏≠

  Zakrzewska, whose tone was harsh and patronizing, clearly wanted to call the interns’ blu√ by expressing her readiness to close the teaching hospital. Her implication, of course, was that they were misreading the situation and would realize too late that they needed the hospital far more than it needed them. But Zakrzewska was also communicating her frustration that the interns did not share her vision of the hospital. Its purpose was not to serve their needs but rather to demonstrate the skills of women doctors in order to counter whatever prejudice still existed toward them. That they did not accept the central role of the New England Hospital in the movement to advance women’s medical education rankled her to no end, and she responded by showing nostalgia for the shared sense of mission that had marked the first decade of the hospital’s existence, when the interns were ‘‘earnest and anxious to learn, and worked hard.’’∏∞ Her message was clear, if simplistic: the current crop cared too much about titles and too little about advancing the cause of women.

  How much of this report Zakrzewska shared with the students is unknown.

  Their reaction to her criticisms and complaints has also not been documented, but Zakrzewska did meet with the students, and a compromise was quickly reached. Admitting that ‘‘there seemed to be fault on both sides,’’ Zakrzewska granted the interns the right to be referred to as ‘‘Dr.’’ when they were working in the dispensary, where they had considerable contact with patients; in the hospital, however, they continued to go by ‘‘Miss’’ or ‘‘Mrs.’’∏≤ With this, the issue was laid to rest.

  The ease with which the disagreement was resolved suggests that Zakrzewska, who had begun to take criticisms of the New England Hospital personally, may very well have been overreacting when she produced such a harsh response to the interns’ concerns. It also suggests that whatever problems may have existed between her and the young interns in 1876 were still relatively minor.

  That was not the case when problems erupted in the early 1880s and again a

  SCIENTIFIC MEDICINE

  ≤ 217

  decade later. Those tensions were never fully resolved and continued to trouble the institution well into the next century. Although some of the issues resembled those that had surfaced previously, the central bone of contention focused on the interns’ demand that they be given greater responsibility for the care of patients. Zakrzewska responded again with lengthy reports, each more conde-scending and insulting than the last. Indeed, in 1883, after chastising the interns for not understanding their obligations, she told a particularly patronizing story about a nine-year-old patient who had severely burned his hand when he held on to a flatiron he had picked up, not dropping it for fear of waking up his sick sibling, whose care his mother had imparted to him. ‘‘My little patient,’’ Zakrzewska wrote heavy-handedly, ‘‘may teach you a lesson on the fulfillment of responsibilities undertaken.’’∏≥

  Zakrzewska had little tolerance for the interns’ request that they be granted primary responsibility for the care of patients. In fact, her evaluation of medical school education had not changed at all since the 1870s. She still contended that it provided poor preparation for the actual treatment of the sick, and she cautioned the interns not to let the self-respect they derived from the possession of a diploma ‘‘deteriorate into self-conceit. . . . The young doctor,’’ she emphasized,

  ‘‘does not yet realise that to know a thing ‘ theoretically’ is far di√erent from applying that thing ‘ practically.’ ’’∏∂

  In making these remarks, Zakrzewska seemed to be ignoring the sweeping reforms that had begun to change the face of medical education, at least among the nation’s elite institutions. Several schools, most important among them the Woman’s Medical College of Pennsylvania and the University of Michigan, where several of the interns had received their degrees, had long since length-ened the course of study, established a graded curriculum, and abandoned didactic teaching in favor of ‘‘practical’’ instruction. The graduates of these institutions had reason to believe that they brought with them more advanced skills than previous generations of intern
s. On the other hand, the reforms had more to do with laboratory instruction and less with clinical training. Indeed, even Harvard, when it decided in 1880 to add a fourth ‘‘clinical’’ year to the curriculum, did not make attendance mandatory. In a similar vein, the University of Michigan did not institute a required fourth-year clinical course until

  1890.∏∑ Zakrzewska may very well have been thinking of this when she accused the interns of hubris.

  However legitimate Zakrzewska’s concerns may have been, her style of confrontation made compromise di≈cult. She had, in fact, painted herself into a

  SCIENTIFIC MEDICINE

  218 ≤

  corner; as a result, she went on the attack, insisting that the interns would be the losers in this battle. Forced to articulate why the interns should care, given that clinical internships at other hospitals were increasing at a slow but steady rate, Zakrzewska abandoned her lifelong defense of coeducational institutions, praising the New England for its exclusionary policies. ‘‘The main object of the Hospital,’’ she impressed upon the interns,

  is to a√ord to young women . . . the opportunity to see women practising both as physicians and surgeons, that thereby they may acquire courage and self-reliance, which can never be so completely gained by seeing men acting as physicians and surgeons. Comparisons are often made between the opportunities o√ered to medical women now, and 25 years ago; but there is still very little opportunity for women to learn from women. The value of seeing women doing skilful medical work, cannot be over-estimated in its inspiring e√ect upon the young woman practitioner, and has a deeper influence than all the assurances of the college-Professor that women can be physicians and surgeons.∏∏

  Zakrzewska could no longer claim that the New England was necessary because most hospitals denied women clinical opportunities. At the time she was chastising the interns, about half a dozen previously all-male hospitals were o√ering internships to women, and more were to do so in the years to come.

  These included New York’s Bellevue Hospital, Mount Sinai Hospital of New York, Cook County in Chicago, Philadelphia’s Blockley Hospital, Boston’s City Hospital, and Chicago’s Wesley Memorial Hospital.∏π Zakrzewska thus shifted ground and presented the critical contribution of the New England Hospital as the chance it o√ered women to learn from other women rather than from men.

  Exactly what they would learn she never spelled out, but there is no evidence that she had come to embrace the popular view that women practiced a di√erent kind of medicine. Instead, Zakrzewska seemed interested in the way female role models could empower younger women, stimulating self-confidence by demonstrating to women their ability to perform not di√erent skills but rather the same skills as men. Notably, Emily Blackwell, director of the New York Infirmary and Medical College for Women, tempered her enthusiasm for coeducation in a similar way. In 1900, the year her institution merged with Cornell University, she drew attention to the advantage that had accrued from the

  ‘‘presence of older and more experienced women in the Faculty,’’ clearly la-

  SCIENTIFIC MEDICINE

  ≤ 219

  menting that coeducational institutions would no longer o√er such role models to their young female students.∏∫

  Zakrzewska’s generation thus viewed with mixed feelings the end of the separate institutions they had founded, although one could argue that their position remained fundamentally pragmatic. After all, claiming that women now needed the New England because few other hospitals provided role models was not a di√erent argument in kind than insisting that the hospital was necessary because women students lacked ample opportunities for clinical training elsewhere. The implication was that when other hospitals began placing women on their medical sta√s, then and only then would an all-women’s institution no longer be necessary. Still, to focus solely on the continuity in Zakrzewska’s rhetoric would be to miss the ambivalence that had come to mark her attitude toward integration. She may not have embraced the notion of a distinct woman’s sphere, but her attitude toward separatism had clearly softened, with the result that she now encountered resistance from the interns.

  There is a definite irony here. The interns were merely questioning whether an all-women’s institution provided the best education possible, something to which Zakrzewska herself (along with many of her peers) had previously answered no. That she now no longer held that view reflected in part her deepening suspicion that coeducational institutions were not always committed to equal education for women. Indeed, Emily Blackwell had watched Cornell refuse to hire the female faculty members who had sta√ed her college, an experience that would certainly lend credence to this view.∏Ω But Zakrzewska’s change of heart also stemmed from her total immersion in the life of her hospital and her inability either to divorce herself from her creation or to articulate an alternative identity for the hospital, other than separatism, as all-women’s institutions struggled to find a new sense of meaning and purpose. It was one thing to imagine that someday the New England Hospital would no longer exist; it was another thing entirely to hear suggestions that it may already have outlived its usefulness. In the end, Zakrzewska’s caution proved prescient—women did not fare as well under coeducation as they had when all-women’s institutions had

  flourished.π≠ But however wise her position may have turned out to be, it was also fueled by a personal identification with the institution that made it di≈-

  cult for her to contemplate a di√erent path or, for that matter, to hear much criticism at all.

  That personal identification appears, moreover, to have intensified over the

  SCIENTIFIC MEDICINE

  220 ≤

  years. Although that should hardly be surprising—one would expect a person’s investment in his or her own creation to increase with time—more may have been going on here. Changes in Zakrzewska’s personal life, foremost the shrinking of her family, may have led her to expect, and to need, a greater sense of allegiance from the individuals with whom she worked. The first member of Zakrzewska’s family to pass away was her sister Minna, who succumbed to tuberculosis in 1877. Although they had not lived together for quite some time, Minna had stayed in Boston, and the two sisters had remained close. Even more devastating for Zakrzewska, however, was Heinzen’s death in 1880. The day he let her know he was dying she described as ‘‘the hardest day of my emotional life.’’π∞ She had been closer to no other man in her adult life and perhaps to no other person, with the possible exception of Sprague. We know too little about the exact nature of their friendship, but it is not di≈cult to imagine that Heinzen had been one of Zakrzewska’s principal confidants as she struggled with the responsibilities and headaches of running a hospital. Despite his own hotheaded-ness, or perhaps because of it, he may have helped her to weather such controversies with more grace. But even if this was not the case, there can be little question that the two individuals had grown extremely close both intellectually and emotionally. Grieving his death, she may very well have thrown herself into her work with an even greater intensity than before.π≤ Certainly it would have been normal for her to expect that the group of women who worked at the hospital would help to fill the void in her life.

  Indeed, as Zakrzewska grappled with her interns’ discontent, directed at least in part, she believed, toward herself, she turned more and more to the past and to a time when everyone in her hospital ‘‘assumed more of the condition of a family circle,’’ united in their pursuit of the same goal.π≥ As she made clear, it was a time when she had felt deeply appreciated. Even as late as 1875, just one year before the first troubles with the interns had manifested themselves, Zakrzewska had spoken proudly of the many graduates of her institution who ‘‘look towards Boston for their strength; strange to say, not so much towards the colleges from which they graduated, as towards the practical workers living and striving here in this Boston Hospital.’’π∂ To some extent, she even viewed some of the interns as her child
ren. This was true, at least, of Lucy Sewall, despite the fact that they were only nine years apart in age. In 1862, when Sewall was studying in Europe, Zakrzewska had written to her: ‘‘It is very strange how you have grown yourself into my heart. I never before have felt such strong attach-

  SCIENTIFIC MEDICINE

  ≤ 221

  ment for a woman, that is, so ‘tenderly’ strong. I have always appreciated and loved women more intellectually. But you are my child.’’π∑ To be sure, Zakrzewska did not develop such intense relationships with all her interns; indeed, the one with Sewall was probably unique. Nevertheless, judging from Sophia Jex-Blake’s description of the early years at the New England, members of the sta√

  did appear to have strong emotional attachments to one another, helping to foster a sense of family and belonging.

  That deep bond seemed, however, to be eroding, and Zakrzewska, rather than engage in constructive ways of strengthening the young interns’ commitment to the institution, widened the gap by chastising them. As she told them in 1891, ‘‘all the ladies present have served as Internes in this Hospital, and all had their grievances, and all had to endure annoyances of one kind or the other, as you have to endure; but just this training, which was borne with dignity and silence, has made them superior women, while everyone of the revolting sisterhood, have either remained on the lowest step of success, or fallen out of the profession entirely.’’π∏ More than likely, Zakrzewska was not aware of the pun she made when referring to the ‘‘revolting sisterhood.’’ Perhaps the interns had a good laugh when they read this phrase, but overall they would not have found her message humorous. Zakrzewska, hurt by their criticisms, had turned a discussion about the nature of clinical training into a statement about the character of the individuals involved. To be a superior physician, she stated in so many words, one must first engage in the arduous task of becoming a ‘‘superior woman.’’ππ