Paradoxically, our only asset was that we were women doctors. We were almost the only ones established on the west side of New York above Fifty-ninth Street. For many years women came to us because we were women and the competition in that line was small. But we deserved to starve and I do not know why we did not. My first year’s proceeds amounted to exactly $185.00. And, except that I was paid for it, my first case was a sample of the whole year. In those days, Amsterdam Avenue, which has since experienced both a feverish building-boom and a period of gradual decline, was filled with squatters’ shacks made of hammered-out tin cans and waste lumber, inhabited by ne’er-do-wells and swarming with goats. I began my practice by delivering a baby in one of those shacks. Again it was a hurry call and they had sent for me much too late; it was a difficult and abnormal case. Even with Dr. Laighton’s assistance, saving the mother and keeping the baby alive for an hour or two was the best I could do. But the father gave me ten dollars, which considering his economic necessities, was extremely decent of him.
Obstetrics have been a godsend to many a young doctor just starting his career. It is the one sure event in medicine, for babies are always with us. It is an opening wedge of considerable importance to have an obstetric case, stay on as the baby’s doctor and then, when in the natural order of events the father or mother comes down with a cold or some other minor ailment, to find that you are consulted and have other patients. It was in this way that my practice was built up and became a truly family affair. A not too prosperous, but not too poverty-stricken neighborhood with a fairly high birthrate seems to me an ideal place for the struggling young physician to make his start.
A dollar bill should have been saved out of that first ten, to frame and hang in my office. But that was economically impossible. A dollar was such a rare object. On one occasion when I was down to my last two dollars in the world, I defiantly spent it on a grand lunch at the old Waldorf Hotel and a magazine to read on the trolley car going home. Rent day was just around the corner too. But when I reached our apartment, there was a patient waiting who paid me in cash and enabled me to carry on a little longer. Our economic status in those days and our ability to carry on will always remain as a great mystery to me. Somehow, we always did manage and we never got into debt. I suppose that proves something, but just what I frankly do not know.
Being young, we were incapable of worrying. But we did have to use our mother-wit to find ways of supplementing our incomes. For that purpose a call from a much too persistent life-insurance agent proved accidentally helpful. In order to get rid of him, we asked if the company had a woman doctor to examine us if we did take out insurance. He said no, certainly not—he had never heard of such a thing. Our tones were shocked as we said that we would never think of being examined by a man doctor and we showed him to the door with well-simulated indignation. Then, after he was gone, it occurred to us that many women might think as we did and that it would be a sound scheme for the insurance companies to have women-examiners on call.
Having plenty of time in which to pursue the idea, Dr. Laighton and I went down town the next day, she to visit the New York Life Insurance Company while I went to the Equitable. Each of us had the same experience. In both places the Chief Medical Examiner was mildly amused at the idea. But we went on stubbornly pointing out the advantages in the scheme and eventually persuaded the companies to inform their agents that, when a prospective client wanted one, a woman examiner would be available in our persons. We came away enrolled as special medical examiners. That brainstorm of ours brought us a steady stream of profitable fees and opened up that whole field of medical activity for women. I hope that our successors have found it as profitable as we did. One day I was sent up to West End Avenue to examine a client and much to my surprise met Lillian Russell there. She was a truly great and beautiful woman. I was always an inveterate theater-goer, until my public health work made me too busy to take more than a very occasional evening off for the theater, so I stayed chatting with her for most of the afternoon. She was the loveliest, most natural and most charming person I had ever seen and there have been few to match her since. It was one of my first red-letter days.
I was in general practice for a number of years. But as events turned out, private practice was not to be my whole career and after fifteen years of dividing my interests, it was inevitable that it should be discarded. I was hardly well started when another accident, the mere catching sight of an item in the morning paper, diverted me into taking the first step toward my real career. The paper said that civil service examinations for the position of medical inspector of the Department of Health would be held at such a time and place; the salary to be thirty dollars a month. A dollar a day: about double my first year’s rate of income. It was tempting enough to make me take the examination and I came out high enough on the passed list for a possible appointment. Ordinarily I would have supposed that this would guarantee me the job. But by this time I was vaguely aware that there was corruption in city politics and that people sometimes had to use pull to get city appointments. That really was the innocent extent of my knowledge of what I was getting into. So I asked a lawyer patient of mine to give me a letter of recommendation to a justice of the New York Supreme Court who was, of course, right in the middle of politics and the justice passed me on with another letter to one of the, then, three Commissioners of Health. R. A. Van Wyck was then the Mayor and not until the succeeding administration of Mayor Seth Low did the Department function under its present plan of one commissioner.
The Department headquarters were at that time in a forlorn old building at the corner of Sixth Avenue and Fifty-fifth Street which had formerly housed the New York Athletic Club and had obviously been neither cleaned nor painted since the athletes had vacated it. As the central focus of the sanitary and medical services of a great city, it was a shock; the Commissioner was another. I do not remember his name, but he could have sat as a cartoon for the public idea of a typical Tammany henchman. He was paunchy with a fat blue-jowled face and sat with his feet on the desk, his hat on the back of his head and the last two inches of a disorganized cigar in the corner of his mouth. I had supposed he would ask me some questions but he did not deign to do that. He did not even look at me twice. He just opened my letter, glanced through it, rang a bell and, when a clerk appeared, he jerked his thumb at me over his shoulder and said: “Give the lady her appointment.” That was my first lesson in the ways of the world of I’ll-do-you-a-favor-sometime. It was also my launching in public health work.
Inspecting school children was my first assignment and it seemed to me to be a pathetic farce. We inspectors went around to certain assigned schools and asked the teachers if any pupils showed any signs of illness. If, by chance, a teacher had noticed that a child did not seem well, we looked him over, more or less perfunctorily, and sent him home if we suspected some form of contagious disease. There was not, and could not be, any serious attempt at diagnosis. Our appointment was for one hour’s work a day and in that time we had to visit three or four schools. Another inspector was sent to visit the child at home and decide whether or not he was to be excluded from school. But, in view of some later discoveries of mine, there is fairly good reason to doubt that this follow-up proved much. The only thing to recommend the whole dismal business was that it did, in a futilely primitive fashion, recognize that something might conceivably be done about controlling contagious diseases in school children.
I stayed away from the Department office except on pay-day. I could not stand the atmosphere of the place, either literally or figuratively. It reeked of negligence and stale tobacco smoke and slacking. It was inconceivable that any such organization could accomplish more than merely keeping a certain number of political hangers-on firmly attached to the public payroll. Many inspectors, as I learned later, never bothered to go to their schools at all, merely making the concession of telephoning each school each morning. Yet no one bothered to call them to account. In honest moments, I could not h
elp feeling that my own job was a minor racket too, for, even if I did work at it, I knew that I was accomplishing no good whatever. But that dollar a day came in very handily and I decided to stay until summer when, with the closing of the schools, I felt that this temporary adventure into the political field would be over.
In the end I was glad that I had stayed. When Mayor Seth Low came into office in 1902 and Dr. Ernst J. Lederle was appointed Commissioner of Health, the whole department shuddered at the shake-up and house-cleaning that occurred. At the beginning, I knew little or nothing of that for I had no interest in the administrative side of my job. But I did know that in the shaking-up process I was sent for by a new assistant sanitary superintendent and offered a summer position in hunting out and looking after sick babies. This new appointee, Dr. Walter Bensel, my chief for years afterwards, was about the only reason I had yet seen for changing my opinion of the Health Department and its works. He had every appearance of being energetic, clean-cut and honest; all of which proved true and all of which was a novelty. I liked him, and his attitude, so much that I changed my mind and took the offered job at an increase in salary to one hundred dollars a month.
This time I had let myself in for a really gruelling ordeal. Summer anywhere in New York City is pretty bad. In my district, the heart of old Hell’s Kitchen on the west side, the heat, the smells, the squalor made it something not to be believed. Its residents were largely Irish, incredibly shiftless, altogether charming in their abject helplessness, wholly lacking in any ambition and dirty to an unbelievable degree. At the upper edge of Hell’s Kitchen, just above Fifty-ninth Street, was the then largest colored district in town. Both races lived well below any decent level of subsistence. My job was to start in this district every morning at seven o’clock, work until eleven, then return for two hours more—from four to six. I climbed stair after stair, knocked on door after door, met drunk after drunk, filthy mother after filthy mother and dying baby after dying baby. It was the hardest physical labor I ever did in my life: just backache and perspiration and disgust and discouragement and aching feet day in and day out.
I worked out one minor way to save myself by going up the long flights of stairs to the roof of one tenement and then climbing the dividing wall to go down the stairs of the next. Trailing street-sweeping skirts were not much of a help. There was no dodging the hopelessness of it all. It was an appalling summer too, with an average of fifteen hundred babies dying each week in the city; lean, miserable, wailing little souls carried off wholesale by dysentery. Even New York’s worst slums have now forgotten what dysentery epidemics were like. But we knew thirty years ago. The babies’ mothers could not afford doctors and seemed too lackadaisical to carry their babies to the nearby clinics and too lazy or too indifferent to carry out the instructions you might give them. I do not mean that they were callous when their babies died. Then they cried like mothers, for a change. They were just horribly fatalistic about it while it was going on. Babies always died in summer and there was no point in trying to do anything about it. It depressed me so that I branched out and went looking for healthy babies too and tried to tell their mothers how to care for them. But they were not interested. I might as well have been trying to tell them how to keep it from raining.
One fantastic incident will illustrate their shiftlessness. A dead baby always meant a neat little white funeral because, no matter how poor the family were, they always insured their babies and usually received twenty-five dollars when the baby died—enough to pay for a cheap white coffin and a few wilted flowers. One afternoon, when I found a despairing family sitting around a baby’s coffin in a stifling, cockroach-ridden room without a single cent to buy food, I let my feelings get the better of me and handed them a five dollar bill. A week later one of that family’s numerous children showed up at my office and presented me with a cheap little photograph of one of the dead baby’s survivors. “Mama always wanted a picture of one of us,” she said gleefully, “but until you gave her that five dollars she had never had enough money to have one taken.” Well, I suppose there must be hyacinths to feed one’s soul.
Why I stayed on that job is another mystery. But I actually refused my regular summer laboratory work at the Dansville Sanitarium in order to stay with this brutal punishment. Perhaps the sight of such sluggish, crawling misery fascinated me. You could not say that I was sentimental about these people. I had a sincere conviction that they would all be better off dead than so degradingly alive. But they apparently had an instinct for life and I had to go through the motions of helping them. It did seem pretty futile. One could hardly walk a block in any tenement district in the city without meeting a “Little White Funeral.” Dead horses (there were horses then) were a common sight in almost every street. Pasteurization of the milk supply was just beginning to be urged by that great philanthropist, Nathan Straus, but the bulk of the milk supply that these babies were fed on was drawn from rusty cans and the milk was dotted with flies as well as full of bacteria. One could do so little at best. In my mind was a vague idea that something could and must be done; what it might be I did not yet know, but I did know that it was infamous to let these things go on. I have heard out-of-towners ask the reason for Hell’s Kitchen having that picturesque name. I could give them a good reason and it would not have anything to do with gangsters either.
Presently I was in such a frame of mind that no horror could be really disturbing. That was the summer of the General Slocum disaster, when an excursion boat filled with women and children on a picnic party burned in the East River and hundreds were drowned or burned. All of the Health Department inspectors were summoned by telephone to rush to North Brother Island, where bodies were being washed ashore from the burning vessel. There was precious little to do by the time we got there; it was just a question of getting the bodies out of the water and ranging them in long rows on the shore, dead woman after dead woman, dead child after dead child, all huddled and wet and still. It was fearful, I suppose, but you cannot realize things wholesale that way, any more than you could psychologically afford to realize the mass of misery in my Hell’s Kitchen slum.
In fact one of my brother-inspectors was so little affected by the spectacle that while we were talking together on the ferry boat bringing us back from the island he chose to let me know that he, and a number of other inspectors, were finding my behavior thoroughly unethical.
“Do you realize,” he asked me, “how tough you are making this job for the rest of us?”
I hope I looked as puzzled as I felt.
“I mean,” he said, “you are spoiling things. You are actually inspecting tenements and reporting sick babies, aren’t you?”
I admitted it.
“Well,” he said, “I guess you just don’t know any better. The boys asked me to tip you off. You don’t need to go to all of that trouble. All we do is to ask the janitor how many families are in the building and note down that many families visited and let it go at that.” He looked at my face whose expression must have been sufficiently queer, and went on, “Ordinarily that would be just your business. But if we don’t report any sick babies and you go ahead and report shoals of them, it makes our reports look pretty bad. I thought you ought to know.”
That was a problem. I had never aspired to be an Elsie Dinsmore; in fact I have never disliked anyone more than I do her. But I did know that there were at least a few other inspectors in the Department who really did work, honestly. The more I thought of it, the more I could see that this was a matter between me and the babies. I was truly puzzled. Did the Department really expect you to do your work, or didn’t it? Was it all the same old racket?
And then things began to happen; I had been right about Dr. Bensel. He had been following the same line of reasoning as my fellow-inspector. It did not seem reasonable to him that dysentery should be confined to a few small slum districts surrounded by exactly similar districts which had not reported a single case. The storm broke and dozens of inspectors were dism
issed. At last we were going to be honest and decent. At the end of the summer Dr. Bensel appointed me as his office assistant. Little as I liked getting my preferment that way, it was hardly a valid reason for refusing it. The cards had been dealt so and I could not have behaved otherwise.
I had long since acquired a burning sense of the injustice in the world, which was intensified by the conditions among these people with whom I had worked. My encounter with cynical dishonesty and resulting neglect of duty did not tend to reassure me. Without my knowing it, there was already shaping up in me the foundation of my whole active career—a career of struggling to force, persuade or cajole the social consciousness of the people to meet this challenge of the underworld.
This spectacle of official negligence, or worse, was the last straw I think. It was already horrible enough injustice that human machinery should always be in need of repair. The problems of food, clothing, shelter and children were in themselves almost too difficult to be solved. It did not seem fair that these people should have to cope with the results of official negligence and dishonesty. It was going to take a world of change to better all this; I knew that many people of many minds might ponder and work for generations before any change could be made in the social organism. I was only a raw beginner in the field of public health and all I had time or energy to realize was that the waste of life, at the beginning, might be prevented if only one knew how. For the moment, I could merely take bewilderedly to heart the one-sentence sermon preached to me by another drunken mother during my interne days in Boston.
This lady arrived late at night in a cab. An orderly rushed in to tell me that there was a “case” outside. Somewhere along the way, however, it had ceased to be a case. The baby was already born and lying on the cold cab floor, hidden under his mother’s long skirts. The mother was so completely drunk that, so far as I could make out, she had experienced no discomfort at all during the baby’s birth. With the nurse’s help, we got her out, carried her into the hospital and placed her on a bed. She made no sound, just lay propped against a pillow with her hat over one eye, apparently quite oblivious of the fact that she had just brought another life into the world for good or ill. But, when I lifted the baby by the heels and spanked him in order to start him breathing, she did open her one visible eye. Its expression was the essence of that sad quizzicalness which seems to me to belong to the Irish more than to any other race:
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