Science Has No Sex

by Arleen Marcia Tuchman

  The young interns studying medicine in the early 1890s did not accept Zakrzewska’s assessment either of their own situation or of the importance of the institution. Submitting a statement to the medical sta√ in the fall of 1891, they voiced their anger that the sta√ refused to grant more responsibilities for patient care. ‘‘We have had abundant opportunities during our college years, to see,’’

  they complained; ‘‘we come here to do.’’ But instead, they were ‘‘allowed to do absolutely nothing,’’ forbidden from performing ‘‘even the simplest operations’’

  or from handling any di≈cult maternity cases. They experienced this most significantly as a slight, feeling as though they were being treated ‘‘as mere children’’ who lacked any ‘‘professional standing.’’ What they wanted was recognition of the three or four years of medical school that they all possessed and of ‘‘the fact that we are now women; that many of us have occupied positions of responsibility;—that we have presumably reached the age of discretion.’’ You

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  may think, they argued, that you are doing us a favor by inviting us to spend a year here, but in fact you are reneging on your own promise ‘‘[t]o assist educated women in the practical study of medicine.’’π∫

  This resentment was repeated and embellished two years later by Alice Hamilton, who interned briefly at the hospital. Voicing her complaints in private letters to her cousin Agnes, she did not exhibit any of the restraint the interns may have shown in an o≈cial communication. Hamilton, who eventually became an expert in industrial medicine and was the first woman to join the faculty at Harvard University (1919), did not hesitate in private to brand the New England Hospital a ‘‘narrow, petty, squabbly [ sic], idiotic place.’’ Accusing the sta√ of being narrowly focused on obstetrics and gynecology, she believed them to be ‘‘in a state of self-distrustful antagonism to all men doctors, . . . who escape discovering their own inferiority merely by avoiding their superiors.’’ Adding insult to injury, instead of acknowledging that interns ‘‘could have an opinion of

  [their] own,’’ they were ‘‘treated like a raw school-girl,’’ even being chastised before their patients. All this was di≈cult for Hamilton to stomach. She had arrived in Boston excited about the prospect of spending an entire year developing her clinical skills; instead she found herself either ‘‘sitting around and reading text books’’ or filling her days with boring, menial tasks. Feeling as though she was wasting precious time, Hamilton resented the fact that ‘‘not a man medical graduate in the country . . . would accept so inferior a position as this.’’ Although concerned that to quit would mean reneging on her promise to stay an entire year, Hamilton was so indignant that the sta√ had ‘‘not fulfilled their part of the contract,’’ she ended up resigning her position before the year was out.πΩ

  The combination of the interns’ complaints in 1891 and Hamilton’s scathing remarks served as a devastating indictment of the New England’s pedagogical policies and practices. While not every characterization need be taken seriously—Hamilton’s accusation that the sta√ distrusted all male physicians would not, for example, have applied to Zakrzewska, who maintained close and respectful relations with Boston’s elite male physicians her entire career—there can be little doubt that changes taking place outside the walls of the institution were taking a toll on the practices within. Not only had many schools adopted a four-year graded curriculum, but state legislatures had begun to grant physicians a limited monopoly over the practice of medicine. During the period in question, American society was endowing professions in general with increased power, and the medical profession was among the beneficiaries. Its new prestige had much to do with medicine’s link to modern science, an approach to the

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  acquisition of knowledge that many had come to believe would best allow one to make truth claims. Certainly everything from the germ theory to advance-ments in aseptic techniques was suggesting that scientific investigations were finally resulting in valuable knowledge about the nature of disease, even if therapeutic interventions were still a thing of the future. The resulting ‘‘culture of professionalism,’’ as one historian has called it, placed great value on scientific objectivity and rationality, attributed both authority and honor to those who passed through the educational and licensing hoops, and encouraged individual autonomy, constrained only by the dictates of one’s professional peers.

  Eventually, the medical profession, once a loosely knit conglomeration of highly diverse individual practitioners who frequently fought with one another as they struggled to achieve social standing, was transformed into a self-regulated group whose prestige, power, and autonomy reflected to a considerable extent the practitioners’ possession of an esoteric and highly valued body of knowledge concerning health and disease.∫≠

  In the 1890s, when Zakrzewska was battling with the interns, the medical profession was still far from achieving this goal, but the world Zakrzewska had known seemed to be disappearing. Her own educational experiences had taken place at a time when the model of apprenticeship had still held sway. One need only think of the relationships she had with Joseph Hermann Schmidt in Berlin and John J. Delamater in Cleveland to appreciate the personal nature of her medical studies. This was, moreover, the model she had introduced to the New England Hospital, and for a while it had worked. Zakrzewska had assumed responsibility for her students’ education, and they had accorded her the deference and respect that was her due. Feelings of gratitude to both Zakrzewska and the institution also dominated, given how few alternatives these young women had to acquire this kind of training elsewhere. Many also felt part of a greater mission and were excited by their own role in challenging social prescriptions against women’s entry into the medical profession. The sense one often has when reading of the early years at the New England Hospital was that it did, in fact, resemble a happy family, aided no doubt by the relatively small size of the operation. The year Sophia Jex-Blake wrote her enthusiastic letters home, describing the ice cream socials and strong sense of camaraderie they all felt, only five physicians, three interns, three consultants, and twenty directors were associated with the hospital.∫∞

  By the early 1890s the situation was totally di√erent. For one, the hospital was much larger, with sixteen physicians, six interns, fourteen consultants, and forty

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  directors all involved in the life of the institution.∫≤ But most important, the

  interns made up a vastly di√erent group than their predecessors: they were more highly and thoroughly educated; they had access to a wider variety of schools and hospitals; and they had more recent experiences in integrated settings. In addition, the increased social prestige being accorded physicians gave them a much greater sense of confidence and power. To be sure, women were still excluded from important aspects of this professionalization: medical schools still barred women from entry, and the vast majority of hospitals would not consider placing a woman on their sta√.∫≥ Still, every year opportunities were increasing, and the interns felt inspired and empowered by these changes.

  It was di≈cult for them to arrive at the New England Hospital with the M.D. in hand, feeling as though they had earned a certain level of respect and honor, only to find themselves being treated as children. Undoubtedly they recognized that their training would occur under supervision, but it was an invisible hand, not a heavy hand, that they expected to guide their way. The hospital’s failure to o√er that was the source of their discontent and resentment. Zakrzewska may have viewed them as selfish, but to the interns, the New England was trapped in a model of stewardship that had long outlived its day. Worse yet, it was not providing the same quality of training they believed they could get elsewhere.

  The generational tensions evident at the New England Hospital were by no means peculiar to this
institution. Emily Blackwell also felt compelled to remind the 1899 graduating class of the New York Infirmary and Medical College not simply to work for their own advancement but to recognize ‘‘that the work of every woman physician, her character and influence, her success or failure, tells upon all, and helps or hinders those who work around her or come after her.’’∫∂

  Indeed, historians who have studied late nineteenth-century women’s organizations of all ilks have described the emergence of a ‘‘self-conscious professional culture’’ that seemed to have little in common with the professionalism of its predecessors.∫∑ The older form, referred to by some historians as ‘‘civic professionalism,’’ was grounded in a sense of community. Professional responsibilities and civic duty were woven seamlessly together, one’s place in the community defined by both.∫∏ The newer professionalism, in contrast, replaced the notion of a community with the image of a group of autonomous individuals joining together to protect their own interests. Even the women’s rights movement showed signs of such tensions. Among the older generation (Zakrzewska’s cohort), personal experiences of discrimination fueled a political critique that condemned the unjust concentration of power in the hands of white men. For

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  the newer generation, the battle for women’s rights was a battle for the rights of individuals to pursue their own interests.∫π

  A similar dynamic was at play at the New England Hospital in the last decades of the century. The young interns, having so many more opportunities available to them, did not understand Zakrzewska’s insistence that the time was not yet ripe to close down all-women’s institutions. They certainly did not share her view that the fate of the women’s movement for medical education depended upon the institution’s ability to survive. This did not, however, mean that they were unaware of or indi√erent to the plight of women physicians. Indeed, the interns’ reminder to the medical sta√ that they were in fact ‘‘now women’’

  and that the hospital was failing to fulfill its obligation to ‘‘assist educated women in the practical study of medicine’’ indicates that it was the thought of receiving a mediocre medical education as women that troubled them so much. Hamilton, we must remember, had been disturbed by the thought that she was being asked to tolerate a situation that ‘‘no man medical graduate in the country’’ would ever be expected to endure. Committed su√ragist that she was, she understood only too well that her actions and experiences had consequences for the advancement of women at large.∫∫

  In response to this constant litany of complaints, Zakrzewska turned to the past, trying to convince the interns to see the New England as a ‘‘large family’’

  that required them to place its needs before their own.∫Ω She even spoke passionately about the need for ‘‘a good deal of self-sacrifice’’ to bring to completion ‘‘one of the greatest historical reforms,’’ thus embracing a language of self-sacrifice that she had so adamantly rejected in her youth because of her conviction that it kept women from implementing their own plans and satisfying their own interests.Ω≠ But Zakrzewska’s language, communitarian in spirit, no longer made sense to the younger generation. Thus, where she spoke of sacrifice, family, and stewardship, Hamilton spoke of contractual obligations. Both women were trying to characterize the relationship between two parties, but Zakrzewska assumed the primacy of the group and the existence of a clear hierarchy, where a ‘‘protector’’ assumed moral responsibility for those in her charge. Hamilton, on the other hand, assumed the primacy of the individual; in her view, relationships occurred between equal partners bound together by a written document ensuring that both parties would fulfill their obligations.Ω∞

  There can be no question that the interns’ embrace of the new professional ethos contributed to this clash of visions, but this clash was between di√erent understandings of professionalism.Ω≤ What must be emphasized, however, is

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  that the interns never once mentioned science. Their complaints had nothing to do with the hospital’s lack of laboratory facilities or with the medical ideas and theories of the sta√. Hamilton may once have disparaged the diagnostic skills of one of the head physicians, but even that tirade focused more on the sta√ ’s refusal to let her treat her own patients than on the style of medicine being

  practiced.Ω≥ This is not to say that the meaning and practice of scientific medicine had not changed by this time; they most certainly had. More to the point, as we will discuss in the next chapter, Zakrzewska struggled with some of these changes, criticizing bacteriology and a narrow definition of disease while identifying herself more closely with prevention and hygiene. It is likely that di√erent understandings of medical science were in some subtle way contributing to the tensions that surfaced at the end of the century, but if that was the case, they were never clearly articulated. No, the battles that were fought focused almost solely on di√erent styles of teaching and the distribution of power and responsibilities between interns and the physicians on the sta√.

  Matters did not improve in the following years; if anything, they worsened.

  And to add fuel to the fire, Zakrzewska ended up fighting contentious battles not only with the interns but with the board of directors as well. These kept her awake at night and led her on occasion to threaten to resign from the hospital’s medical board.Ω∂ On the surface, most of the disagreements had to do with the allocation of funds for the construction of new facilities, but beneath the surface another battle was taking place over who had ultimate authority to decide matters. In the first decades, when the directors had numbered twenty and the vast majority had been Zakrzewska’s friends, her authority had rarely, if ever, been challenged.Ω∑ Now, however, the number of directors had doubled, and most lacked any personal ties to her. There was a certain irony in this, given that most other American hospitals at the time were witnessing a handing over of power from the directors (or trustees) to the medical sta√ as medical care became more acute and less custodial.Ω∏ Not so at the New England Hospital, and Zakrzewska, who had held the reins for so long, did not adjust to this shift in power any better than she had with the interns. With an absence of harmony (and a challenge to her authority) confronting her from both ‘‘above’’ and

  ‘‘below,’’ the aging founder slowly withdrew from hospital a√airs.

  Zakrzewska had, in fact, already begun to redefine her relationship to the New England Hospital in 1887, when she was just a few years shy of her sixtieth birthday. On the occasion of the institution’s twenty-fifth anniversary, she, Lucy Sewall, and Helen Morton had all stepped down as attending physicians. Al-

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  though this had marked their withdrawal from the day-to-day management of the hospital, they had stepped immediately into another position created especially for them, that of advisory physician. This had allowed them to remain on the board of physicians, occasionally care for patients, and retain the authority to help run the hospital. Zakrzewska had operated in this capacity for another six years, but in 1893, the year not only of Alice Hamilton’s internship but also of a particularly acrimonious battle with the directors, Zakrzewska ‘‘retired from professional work.’’Ωπ Although she never fully withdrew from the hospital, she severely curtailed her involvement with hospital matters, leaving to others the rewards and the headaches that go along with running an institution. As the years passed, she also found herself growing increasingly estranged from the world she had helped to create but had not anticipated. As she wrote seven months before her death, ‘‘The world becomes young daily, & new to me, into which newness I can hardly find myself.’’Ω∫

  The hospital Zakrzewska left behind never regained its former glory as a teaching institution. The problems that had surfaced in the 1880s and 1890s continued to grow, and by the second decade of the twentieth century, the New
England Hospital was having trouble filling its internships. By this time, moreover, students were complaining not only about the lack of clinical experience and professional standing but also about the hospital’s indi√erence to the growing trends in medicine toward specialization and scientific research. With its focus on general medicine and its lack of laboratory facilities, the institution appeared old-fashioned and behind the times to many observers.ΩΩ As its patient base also began to decline, the hospital struggled to find a niche for itself that would allow it to survive. Two questions, harkening back to its dual identity as a teaching hospital and an institution of charity, formed the core of the debates that ensued: should the New England Hospital abandon its identity as an all-women’s institution and accept both male patients in its wards and male physicians on its sta√ ? And should it forgo any attempt to become a research hospital and embrace instead its earlier heritage by promoting itself as a community hospital? In both cases, the answer ending up being yes. The first male patients entered the hospital in the interwar years; the first male physician (since Horatio Storer) joined the medical sta√ in 1950; and in 1969 the New England Hospital for Women and Children became the Dimock Community Center, catering to the poor and largely African American population that had moved into Roxbury in the postwar years.∞≠≠

  It is an interesting exercise to try to imagine how Zakrzewska would have

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  responded to these changes. My guess is that she would have opposed gender integration, concerned that, despite the strides women had made by the 1960s, only a small percentage of the medical profession was made up of women, with the majority grouped in less prestigious specialties such as obstetrics and pediatrics. This would, I believe, have troubled her deeply, and chances are good that she would have insisted that an all-women’s hospital, where women could develop surgical skills among others, remained an absolute necessity.