Science Has No Sex
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13. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1868, 10, 17; see also 12. On Mary Delafield DuBois, see Quiroga, Poor Mothers and Babies, 63–64.
14. This is roughly comparable to the 51.6 percent of the women giving birth at the Boston Lying-In Hospital in the 1870s who were also single. See the Annual Reports of the Boston Lying-In Hospital, 1875–79.
15. On Boston’s racial makeup in these years, see U.S. Bureau of the Census, Eighth Census, 1860, 608; Ninth Census, 1870, 380, 386; Tenth Census, 1880, 419; and Eleventh Census, 1890, 534.
16. According to U.S. Census reports, the foreign-born made up 35.9 percent of Boston’s total population in 1860 and 35.1 percent in 1870. The increased percentage of foreign-born attending the dispensary did not, therefore, reflect an increase in their representation in the population at large. See U.S. Bureau of the Census, Eighth Census, 1860, 608, and Ninth Census, 1870, 380–91.
17. See ‘‘Annual Meeting of the ‘Hospital for Women and Children,’ ’’ 182, and C. K. W.,
‘‘New England Hospital for Women and Children,’’ 35.
18. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1865, 13.
19. Rosenberg, Care of Strangers, 47–68. Physicians did not gain control over hospital a√airs until the end of the century.
20. ‘‘Communication from the Medical Board of the NEHWC,’’ 25 May 1891, NEHWC
Collection, box 6, folder 16, SS, reprinted in WQ, 449–50.
21. On the funds from the Lying-In Hospital Corporation, see Cheney, ‘‘Secretary’s Re-
NOTES TO PAGES 187 – 89
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port,’’ AR, 1863, 8; Cheney, ‘‘Report,’’ AR, 1865, 9; Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1865, 13; and Cheney, ‘‘Report,’’ AR, 1866, 8. In 1868, hoping to bring some stability to its fund-raising strategies, the board of directors informed subscribers that an annual donation of $250 would fund a ‘‘free bed.’’ This remained the hospital’s policy until 1872, when it substituted a one-time donation of $5,000 as a way of permanently funding a free bed that would also bear the donor’s name. See Sewall, ‘‘Report of the Resident Physician,’’ AR, 1867, 13; Cheney, ‘‘Report,’’ AR, 1868, 5; and Cheney, ‘‘Report,’’ AR, 1872, 10.
22. Cheney, ‘‘Report,’’ AR, 1868, 4–5; Zakrzewska to Caroline Dall, 6 March 1869, Dall Papers, box 5, folder 2. The 1866 resolution can be found in Cheney, ‘‘Report,’’ AR, 1866, 9.
The decision to charge for medicines is discussed in Cheney, ‘‘Report,’’ AR, 1868, 4–5. On the hospital’s expansion and the financial pressures that resulted, see Cheney, ‘‘Report,’’ AR, 1865, 8; Cheney, ‘‘Report,’’ AR, 1866, 7–9; and Lucy E. Sewall, ‘‘Report of the Resident Physician,’’ AR, 1866, 14. Statistics on the numbers of people attending the dispensary are drawn from the annual reports for the years 1867–69.
23. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1869, 9. A striking example of Zakrzewska’s willingness to place her hospital before her principles was her recommendation that the application of an intern be refused solely because she was black. Zakrzewska’s fear was that patients would refuse to be treated by this intern and that trouble would arise. The board of directors, however, overturned Zakrzewska’s recommendation, and the intern spent a year at the hospital without any apparent di≈culties. See Records of the Meetings of Physicians, 27 January 1878 and 28 April 1878, in NEHWC Collection, SS.
24. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR 1865, 19; C. A. Buckel, ‘‘Report of the Resident Physician,’’ AR, 1871, 11; Zakrzewska, ‘‘Report of the Attending Physician,’’
AR, 1869, 9–10.
25. See Chapter 6. The greater representation of Irish among the dispensary population was not matched by a proportional increase in Boston’s population at large. Indeed, between 1860 and 1870 the Irish went from 25.9 percent of Boston’s total population to 22.7 percent.
By 1880, they accounted for 17.9 percent. See U.S. Bureau of the Census, Eighth Census, 1860, 608; Ninth Census, 1870, 380–91; Tenth Census, 1880, 450, 536–41.
26. Cheney, ‘‘Report,’’ AR, 1870, 8, 9. The New England was by no means alone in trying to reach out to paying patients. See, for example, Annual Report of the Trustees of the Massachusetts General Hospital, 1866, 5, 39–48, in which the author assesses the hospital’s financial state and concludes that more paying patients must be attracted to the institution. On the changing nature of the hospital, see Rosenberg, Care of Strangers; Starr, Social Transformation of American Medicine; and Stevens, In Sickness and in Wealth.
27. The dispensary operated at first out of a house on the corner of Tremont and Pleasant streets. It eventually moved to 33 Warrenton and then to 29 Fayette Street. See Circular. The New England Hospital for Women and Children (published together with the AR for 1873); Lucy E.
Sewall, ‘‘Report of the Dispensary,’’ AR, 1875, 27; ‘‘Dispensary Report,’’ AR, 1880, 10; and Fiftieth Anniversary of the New England Hospital.
28. See, for example, Kraut, Silent Travelers, and Rosenberg, Cholera Years. See also Douglas, Purity and Danger, and Baldwin, Contagion and the State.
NOTES TO PAGES 190 – 98
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29. Kisacky, ‘‘Architecture of Light and Air.’’
30. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1869, 10.
31. For an explicit link between class and cure rate, see Lucy Sewall, ‘‘Report of the Resident Physician,’’ AR, 1866, 14.
32. The intern was Alice Hamilton; cited in Sicherman, Alice Hamilton, 73.
33. History and Description of the New England Hospital, 12; Cheney, ‘‘Report,’’ AR, 1872, 6–7; Cheney, ‘‘Report,’’ AR, 1873, 8; Call, ‘‘Evolution of Modern Maternity Technic,’’ 395; Cheney, ‘‘Annual Report,’’ AR, 1877, 5. The distribution of the beds is from Zakrzewska et al.,
‘‘Report of the Furnishing Committee,’’ AR, 1873, 16–17.
34. Beginning in 1897 they reported both on the number of free days and on the numbers who paid board.
35. For example, whereas the percentage of free days in 1897 was 57.7, the percentage of charity cases was 43.7. See AR for the years 1897–1901.
36. See Crumpacker, ‘‘Female Patients in Four Boston Hospitals’’; Drachman, Hospital with a Heart, 88, 219 n. 45; and Morantz and Zschoche, ‘‘Professionalism, Feminism, and Gender Roles.’’
37. The first quotation is from Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1865, 17. The second is from an address she gave on the occasion of the opening of the new dispensary building, cited in Cheney, ‘‘Report of the Secretary,’’ AR, 1897, 9. On the ‘‘Diet Kitchen,’’ see Lucy Sewall, ‘‘Report of the Dispensary,’’ AR, 1876, 29.
38. Emma L. Call, ‘‘Report of the Dispensary,’’ AR, 1881, 21; E. B. Culbertson, ‘‘Dispensary Report,’’ AR, 1886, 10–11; Adaline S. Whitney, ‘‘Report of the Dispensary,’’ AR, 1887, 7.
On the Associated Charities of Boston, see Watson, Charity Organization Movement, 197–201.
On the general move on the part of hospitals to pay organizations to check the financial status of those applying for charity, see Rosenberg, ‘‘Inward Vision and Outward Glance,’’ 375.
Statistics on the dispensary populations are from the Annual Reports, 1886, 1893.
39. The first reference I found to this ruling was in History and Description of the New England Hospital, 26. However, in this report nothing was said about extenuating circumstances. Not until 1879 did the board add that an exception could be made if the medical sta√ determined that there were extenuating circumstances. See Reference Book of Standing Rules. Rules for the Hospital, 12 May 1879, 7, Countway.
40. Bertha van Hoosen, ‘‘Report of the Resident Physician,’’ AR, 1891, 11–12; Zakrzewska,
‘‘Report of the Attending Physician,’’ AR, 1865, 13; Zakrzewska to George A. Go
ddard, 6
June 1893, NEHWC Collection, box 8, folder 40, SS.
41. Cheney, ‘‘Secretary’s Report,’’ AR, 1880, 8. On the new payment scheme, see Reference Book of Standing Rules, 17. On the relationship between wealth and care in the modern hospital, see Stevens, In Sickness and in Wealth.
42. Cheney, ‘‘Report,’’ AR, 1870, 5–8; Circular. The New England Hospital for Women and Children (published together with the AR for 1873).
43. Zakrzewska, ‘‘Ueber Hospitäler’’ (4 March 1863). Cheney confirmed this in 1876, when she wrote that ‘‘the plea that the soldier’s wife and child were here sheltered and cared for, was then more powerful with the public than any claim for education.’’ See History and Description of the New England Hospital, 25.
NOTES TO PAGES 199 – 203
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c h a p t e r t e n
1. Zakrzewska’s commitment to the standards of the elite medical community has been the subject of both Drachman, Hospital with a Heart, and Walsh, ‘‘Doctors Wanted,’’ 76–105. I build on both these studies, although I often diverge from the authors’ evaluations of Zakrzewska’s motivations.
2. Warner, Against the Spirit of System, 330–64.
3. Ludmerer, Learning to Heal, chaps. 2 and 3; Reiser, Medicine and the Reign of Technology; Rosenberg, Care of Strangers, 190–211; Warner, Therapeutic Perspective, 266–71.
4. Atwater, ‘‘Touching the Patient’’; Ludmerer, Learning to Heal, 155–65.
5. ‘‘Annual Meeting of the ‘Hospital for Women and Children,’ ’’ 182.
6. Morantz-Sanchez, Sympathy and Science, 64–89; Peitzman, New and Untried Course, 38–
44. I discussed this briefly in Chapter 7 of this book.
7. On Philadelphia, see Peitzman, New and Untried Course, 14–15, and Wells, Out of the Dead House, 126–27. On Elizabeth Blackwell and Clemence Lozier, see Kirschmann, Vital Force, 58–61, and Morantz-Sanchez, Sympathy and Science, 73–74.
8. See Zakrzewska, ‘‘Report of the Resident Physician,’’ AR, 1875, 12–13. On Sewall, see Ingebritsen, ‘‘Lucy Ellen Sewall’’; Hurd-Mead, Medical Women of America, 32; and Todd, Life of Sophia Jex-Blake. On Morton, see Lovejoy, Women Doctors of the World, 86; Jacobi, ‘‘Woman in Medicine,’’ 166; and Hurd-Mead, Medical Women of America, 33. The women, other than Sewall and Morton, were C. Annette Buckel, Emma Louise Call, Emma Culbertson, Susan Dimock, Augusta C. Pope, Emily F. Pope, Mary Almira Smith, and Adeline Whitney.
9. Cited in WQ, 393. On the foundation of this society, see Walsh, ‘‘Doctors Wanted,’’ 104, and Drachman, Hospital with a Heart, 125–27. The all-female Practitioners’ Society of Rochester, New York, also excluded anyone who did not have regular training. See More, Restoring the Balance, 46.
10. WQ, 411. The requirement in 1880 was in many ways a formality. By 1876, students were almost always graduates of medical colleges. See History and Description of the New England Hospital, 19. Massachusetts General Hospital had already in 1873 restricted its appointment of house pupils to Harvard students who had completed a three-year course of study. See Ludmerer, Learning to Heal, 113. For other actions on the part of Zakrzewska and her sta√ to distinguish the New England Hospital from unorthodox institutions, see Drachman, Hospital with a Heart, 127–28.
11. Zakrzewska, ‘‘Report of Resident Physician,’’ AR, 1875, 18. Zakrzewska might, however, have gone further than most when she advised women against seeking admission to the Female Medical College of Pennsylvania, arguing that to ‘‘have fully educated female physicians, they must study like men, and with men.’’ See Zakrzewska to Sewall, 20 February 1863, reprinted in WQ, 310.
12. WQ, 381. On the o√er in 1881 to Harvard, see ibid., 401–3, and Mosher, ‘‘Woman Doctor Who ‘Stuck It Out.’ ’’ On Hopkins, see Harvey et al., Model of Its Kind, 137–56; WQ, 436; and ‘‘Open Letters.’’ On Zurich, see WQ, 383.
13. Bittel, ‘‘Science of Women’s Rights’’; Morantz-Sanchez, Sympathy and Science, 184–202; Peitzman, New and Untried Course, 45–55; Wells, Out of the Dead House, 57–79.
NOTES TO PAGES 203 – 8
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14. See Drachman, Hospital with a Heart, 127.
15. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1865, 13–15.
16. Ibid. Of course, one must wonder how happy any woman could have been who had spent three days in labor. Relieved and exhausted would probably have been more apt a description.
17. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1868, 14. See also Zakrzewska to Dall, 27 February 1869, Dall Papers, box 5, folder 1.
18. Morantz and Zschoche, ‘‘Professionalism, Feminism, and Gender Roles.’’ Specifically, they found that at the New England Hospital, either anesthetics or forceps or both were used 18 percent of the time, whereas at Boston Lying-In it was 20 percent of the time. (Forceps were used alone in 9.5 percent of the cases and with anesthetics in 13.5 percent of the cases). In support of their work, see Moscucci, Science of Woman, 128. For a challenge to their work (which I consider weak), see Drachman, Hospital with a Heart, 88–89.
19. Morantz and Zschoche, ‘‘Professionalism, Feminism, and Gender Roles,’’ 583. The authors entertained the possibility that class di√erences played a role in the di√erential treatment, but they did not pursue it.
20. Peitzman, New and Untried Course, 24–44.
21. On Jacobi’s advocacy of vivisection, see Bittel, ‘‘Science, Su√rage, and Experimentation.’’
22. Call, ‘‘Evolution of Modern Maternity Technic.’’ The quotation is on 393, the statistics on 400. See also Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1868, 15.
23. Calculated from the Annual Report of the Boston Lying-In Hospital and the Annual Report of the New England Hospital for the years 1879–81, 1883.
24. Walsh, ‘‘Doctors Wanted,’’ 94–95. See also Crumpacker, ‘‘Female Patients in Four Boston Hospitals.’’
25. Cheney, Memoir of Susan Dimock. My analysis of the role gender played in the New England Hospital’s control of puerperal fever builds on Morantz and Zschoche, ‘‘Professionalism, Feminism, and Gender Roles,’’ 581.
26. Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1868, 12. Zakrzewska also discussed many of these measures in an article she published toward the end of her career. See
‘‘Report of One Hundred and Eighty-Seven Cases.’’
27. Zakrzewska instituted the same policy when dealing with serious surgical patients, isolating them as well. See Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1865, 16, and ‘‘Report of the Attending Physician,’’ AR, 1869, 9. According to Emma Call, the hand washing and use of oil were for the protection of the physician, not the patient. See Call,
‘‘Evolution of Modern Maternity Technic,’’ 394.
28. Susan Dimock, ‘‘Report of Resident Physician,’’ AR, 1873, 11. On hygienic measures at the hospital, see Zakrzewska, ‘‘Report of the Attending Physician,’’ AR, 1869, 10; ‘‘Report of the Furnishing Committee,’’ AR, 1873, 16–17; History and Description of the New England Hospital, 13–14; and Mary Smith, ‘‘Annual Report of Resident Physician,’’ AR, 1881, 12.
29. Kisacky, ‘‘Architecture of Light and Air.’’
30. WQ, 304.
31. I discuss this notion of disease in greater detail in Tuchman, Science, Medicine, and the
NOTES TO PAGES 209 – 12
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State, 60–63. Max von Pettenko√er’s views, developed later in the century, were quite similar.
See Evans, Death in Hamburg, 257–84.
32. Call, ‘‘Evolution of Modern Maternity Technic,’’ 396.
33. Cited in ibid., 393. On the history of reactions to the germ theory, see Rosenberg, Care of Strangers, chap. 5, and Tomes, Gospel of Germs.
34. The first two were the New York Infirmary for Women and Children (1857) and the Woman’s Hospital of Pennsylvania (1861).
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35. In contrast, the Woman’s Hospital of Philadelphia had thirty-seven beds in 1875. See Peitzman, New and Untried Course, 26.
36. Numbers are gathered from the annual reports. Interns at the Woman’s Hospital of Philadelphia saw a similar number of dispensary patients in 1875 (more than three thousand); the New York Infirmary saw a much larger number (about eight thousand new patients). See Peitzman, New and Untried Course, 25–26, and McNutt, ‘‘Medical Women,’’ 136.
37. History and Description of the New England Hospital, 18–19; Fiftieth Anniversary of the New England Hospital, 29.
38. Susan Dimock, ‘‘Report of the Resident Physician,’’ AR, 1874, 15.
39. Cited in Morantz-Sanchez, Sympathy and Science, 169. See also Mosher, ‘‘Woman Doctor Who ‘Stuck It Out.’ ’’ I derived the information on the interns’ activities from several sources. See Zakrzewska to Sewall, 25 January 1863, cited in WQ, 308; Jex-Blake to her mother, 24 November 1865 and 27 November 1865, reprinted in Todd, Life of Sophia Jex-Blake, 173–74; Cheney, ‘‘Report,’’ AR, 1874, 6; Cheney, Memoir of Susan Dimock, 11; ‘‘Rules for Internes, September 1886,’’ in NEHWC, Rules for the Hospital. February 1874–February 1889, 39, Countway; Drachman, Hospital with a Heart, 77–78. The experiences of the New England’s interns seem to mirror those of house pupils in other hospitals. See Ludmerer, Learning to Heal, 17.
40. McNutt, ‘‘Medical Women,’’ 137.
41. For a discussion of the sti√ competition that men who sought hospital internships experienced, see Rosenberg, Care of Strangers, 179.
42. Helen Morton, ‘‘Report of the Dispensary,’’ AR, 1874, 20. See also Cheney, ‘‘Report,’’
AR, 1865, 6–7.
43. Jex-Blake to her mother, 27 November 1865, reprinted in Todd, Life of Sophia Jex-Blake, 174. On Jex-Blake, see also Roberts, Sophia Jex-Blake.
44. Lucy Sewall, ‘‘Report of the Dispensary,’’ AR, 1875, 28; Emma Call, ‘‘Report of the Dispensary,’’ AR, 1881, 20; C. Augusta Pope, ‘‘Dispensary Report,’’ AR, 1885, 10.