. . .
Once Zakrzewska settled into the Blackwell household, she and Elizabeth turned their attention to finalizing their plans for an all-women’s hospital.
Emily, who was at that time in England, did what she could from abroad. One of the first tasks they embarked upon was the writing of a small pamphlet, spelling out in detail the exact nature of the enterprise they sought to establish.
An Appeal in Behalf of the Medical Education of Women built on two central premises: that women physicians had to be ‘‘thoroughly qualified’’ in order to keep the practice of medicine out of ‘‘ignorant or unworthy hands’’ and that a good education meant combining theoretical instruction with practical training.∂
The reference to the ‘‘ignorant’’ and ‘‘unworthy’’ may have been a veiled criticism of unorthodox physicians. All three founders had been educated in regular schools and intended to o√er clinical training in orthodox medical practices. ∑
However, they may also have been attacking female abortionists. Although they do not develop this point in their pamphlet, at other times Zakrzewska described abortionists, like the infamous Madame Restell, as the greatest threat to the reputation of women physicians. Advertising their services, often under the title of ‘‘Doctress,’’ they confused the public, Zakrzewska believed, blurring the boundary between competent female physicians and those who ‘‘disgrace decency and undertake abhorred practice.’’∏ Zakrzewska’s condemnation of abortionists was, it should be emphasized, typical of women’s rights advocates at the time, who argued that such practices allowed men to avoid responsibility for their sexual behavior, assured that any pregnancy that occurred could be terminated for a fee.π
FIRST HOSPITAL
82 ≤
Both Zakrzewska and Blackwell were determined to undo any such confusion. Their hospital, they insisted, would train the best physicians possible, complementing the more theoretical education women received in medical school with an education at the bedside. ‘‘[T]he mere attendances on courses of scientific lectures, even if fully illustrated by cases, &c., is altogether insu≈-
cient,’’ Zakrzewska and Blackwell argued. ‘‘[Students] cannot learn from words the characteristics of disease, which must be appreciated by all the senses. The physician deals with physical symptoms, and those can only be studied by the bedside; and not in a few scattered cases, but by the examination of hundreds and thousands of individuals, before varieties can be distinguished, and delicate but important shades of di√erence thoroughly known.’’∫
Male students, we have already noted, had the opportunity to gain practical experience by attending patients with their preceptors or by walking hospital wards with their professors. Female students, on the contrary, had to rely on the goodwill of a hospital physician who, even if he himself harbored no objections to instructing women, often found it di≈cult to withstand the disapprobation of his colleagues. This, as we have seen, had been Zakrzewska’s experience with Delamater. Blackwell and Zakrzewska thus insisted that women must have their own hospitals; it was the only place where they could become ‘‘really acquainted with disease.’’Ω
In emphasizing the importance of practical training Blackwell and Zakrzewska were by no means alone. Indeed, the desire for clinical training is what sent thousands of American medical students to the European cities of Paris, London, and Edinburgh during the antebellum period.∞≠ Attempts, however, to create similar opportunities in the United States rarely succeeded: poorly endowed medical schools could not a√ord to construct their own hospitals, and hospital trustees generally refused to grant neighboring medical schools the authority they needed to conduct proper clinical classes.∞∞ Aware of this problem, Blackwell and Zakrzewska were seeking to create a teaching hospital, una≈liated with any medical school but one nevertheless whose central purpose would be to train physicians. They saw this as a radically new departure in the American system, for it made the hospital ‘‘the foundation of a medical education.’’ They were, they stated simply but emphatically, promoting ‘‘a very di√erent method of education from anything yet attempted.’’∞≤
Their model was not, however, the European clinics visited by male medical students who went abroad to further their clinical training but, significantly, the
FIRST HOSPITAL
≤ 83
training programs for midwives. In Europe, they proclaimed, even common midwives received an education that was largely practical.
[T]hey reside in a hospital for one or two years, having all the ordinary cases of their specialty in their own hands, under the supervision of superiors; they assist in the medical and surgical treatment of extraordinary cases; their powers of observation are cultivated by detailed records of cases, which they are required to make, day by day, at the bedside; their hand is carefully trained to the delicacy of touch, indispensable in this department of medicine, and through the whole period of instruction they go from the lecture-room to the bedside, receiving at every hour of the day practical illustration of the subject discussed by their professors. If such thorough training is considered necessary for a class of practitioners whose position in medicine, is a limited and subordinate one, how much more is it necessary to the wider duties and higher responsibilities of the physician.∞≥
Historians of medicine who have studied European influences on American medical education have focused on the sites where male physicians trained when they went abroad, that is, on the medical clinics and hospital wards of Paris, London, and Edinburgh (and later in the century on the German labora-
tories).∞∂ But both the New York Infirmary and the New England Hospital for Women and Children, two of the earliest and most successful teaching hospitals in the United States, took their inspiration from schools of midwifery. This is, of course, hardly surprising. Zakrzewska was the product of one of the best midwifery programs in Europe. Elizabeth Blackwell, too, had spent several years following her graduation from Geneva Medical School at the Paris La Maternité, honing her clinical skills and observing a similar training program. Still, it must have rankled many physicians to have the system of medical education in the United States compared unfavorably to the training of midwives, a group most physicians considered beneath them.
Blackwell’s and Zakrzewska’s focus on the ‘‘Hospital’’ (which they capital-ized) did not preclude an appreciation of laboratory exercises. On the contrary, they asserted that ‘‘[a]s soon as possible a laboratory and good anatomical rooms will be added to the hospital, which shall a√ord thorough practical facilities to students.’’∞∑ Thus under ‘‘practical,’’ which they believed to be the
‘‘most important part of medicine,’’ they placed both clinical training and exercises in the laboratory and dissection rooms (although there can be no
FIRST HOSPITAL
84 ≤
question that they placed greater importance on the former). In doing so they were parroting the demands of German physicians, who had been pressuring their governments for almost a decade to make such ‘‘practical’’ exercises a required part of the medical curriculum. We have already noted that Zakrzewska was still in Berlin when Prussia and several other German states began to reform their medical schools in accordance with these demands. In the United States such requests for reform could be heard as well, although in contrast to Germany they appealed only to a small elite until much later in the century.∞∏
Blackwell and Zakrzewska counted themselves among this elite.
Armed with this message, the two women began to try to raise money for their hospital. Most of their financial backing ended up coming from the community of social reformers who saw this as an opportunity to provide quality care to poor women while also advancing the cause of women physicians. The Quakers, to whom Blackwell had particularly strong connections, provided critical support. Zakrzewska also reached out to more radical groups, although she claimed Blackwell was ‘‘often repelled by the theor
ies advanced by them.’’
Exactly which groups troubled Blackwell is unclear, but Zakrzewska described attending the salon of the literary sisters Alice and Phoebe Cary; joining Alpha, an association for the advancement of women; and meeting with Free Lovers,
‘‘the admirers of the socialist Fourier,’’ and Spiritualists. She became, she explained, ‘‘acquainted with the leading minds who agitated the public, and who helped to advance our plans for the establishment of a hospital.’’∞π
‘‘We were the happiest,’’ she once reminisced, thinking of the women who gave their support to the hospital, ‘‘even if materially the poorest, of a group of women which included friends engaged in di√erent lines of work, such as journalism, art and music. Of these, none identified herself so closely with us as Mary L. Booth . . . who spent every Sunday with us.’’∞∫ Booth (1831–89), who was a reporter at the New York Times, covered issues related to women and education. Upon request, she received her editor’s permission to run announcements for the hospital in the newspaper, soliciting funds for the cause and helping to raise considerable sums. An active member of the Anti-Slavery Society of New York and a founding member of Alpha, she shared many of Zakrzewska’s political passions, and the two women gradually became extremely close.
Booth went on to earn a national reputation as both the editor of Harper’s Bazaar, a literary-fashion magazine founded in 1867, and a translator of French works, being responsible for the translation of roughly forty volumes in her lifetime. In addition to producing English editions of literary works, she trans-
FIRST HOSPITAL
≤ 85
lated the writings of European sympathizers with the Union’s cause. As we will see shortly, she and Zakrzewska also pursued a number of political projects together, including an aborted attempt to found a women’s journal during the early years of the Civil War. Their friendship lasted until Booth’s untimely death in 1889 at the age of fifty-eight.∞Ω
In her fund-raising attempts, Zakrzewska also received substantial backing from the Boston community of social reformers. Walter Channing, a Boston physician with a deep and abiding interest in the promotion of women physicians, had convinced her to visit his city to seek funds. She made her first trip in early July 1856. Although she traveled to other cities over the next few months, she returned to no city as often as to Boston; nor did she find anywhere else the same level of enthusiasm for a women’s hospital. Zakrzewska was able to take advantage of her connections to Harriot Hunt and Caroline Severance, but it was primarily through Channing that she met Lucy Goddard, Mary Jane Parkman, Abby May, and Ednah D. Cheney, all of whom would become her most ardent supporters when she decided to found her own hospital in Boston several years later. Her circle of friends also soon extended to William Lloyd Garrison II, with whom she stayed during one of her Boston trips. As he wrote his brother, Wendell Phillips Garrison, he found her ‘‘a charming woman, and a splendid scholar. She is the easiest person in conversation that I ever saw, & interests everyone whom she converses with.’’≤≠
Zakrzewska returned from Boston with the promise of half the rent for three years. This, in addition to the other funds she and Blackwell raised, allowed them to open the first all-female teaching hospital in the country in 1857. The New York Infirmary for Women and Children was located at 64 Bleeker Street, right on the outskirts of the neighborhood known as Five Points. Zakrzewska and Blackwell had scheduled the o≈cial opening for 12 May, which coincided with the twenty-fourth meeting of the American Anti-Slavery Society. Whether this was intentional is unclear; it may be that they hoped to draw a larger crowd to their opening. Unfortunately, in some cases it backfired. Zakrzewska, who had hoped that William Lloyd Garrison II would attend, learned with disappointment that he had other obligations to fulfill. Nevertheless, they did manage to get together during his stay.≤∞
Garrison’s absence could not, however, quell Zakrzewska’s excitement for long. Two days after the opening, she wrote Harriot Hunt, who had by this time become a close friend. ‘‘Will you not come to New York this spring? I am homesick for you, I wish to see you & also Mrs. Severance. I feel the first time
FIRST HOSPITAL
86 ≤
myself since my life in New York, I wish to embrace the whole world for gratitude of this feeling, as if they had bestowed it upon me, & all this together makes me thanking God, that I live, lived & will live to be useful to my contemporaries
& perhaps even to posterity.’’≤≤
This is one of the few letters I have come across that captures the combination of youthful enthusiasm, verve, and sense of purpose that seems to have made Zakrzewska attractive to so many individuals when they first met her. It allows us to understand more easily Elizabeth Blackwell’s comment to her sister, shortly after meeting Zakrzewska, that ‘‘[t]here is the true stu√ in her’’ or Hunt’s remark that ‘‘when I met her, an electric communication was instantly established between us.’’≤≥ Zakrzewska seems to have made friends easily, quickly, and intensely. This was certainly true of her friendships with Mary Booth and Karl Heinzen in New York. It would also characterize her first encounters with Lucy Sewall, Caroline Healey Dall, and Julia Sprague once she moved to Boston. Zakrzewska’s spiritedness may, moreover, have inspired many of her donors, both in New York and later in Boston, who sensed in Zakrzewska a young woman of conviction and passion.
Zakrzewska now applied this energy to her work at the New York Infirmary.
She was, she later claimed without any sign of modesty, ‘‘really the soul of that establishment.’’≤∂ She and the Blackwell sisters (Emily had since returned from England) agreed that Zakrzewska would assume the role of resident physician, living in the hospital while managing its day-to-day a√airs. The infirmary had a total of twenty-four beds: two general wards each with six beds; a maternity ward; and sleeping quarters that could accommodate four students, three servants, and the resident physician. Zakrzewska shared with Elizabeth and Emily the care of the patients and the instruction of the students; they also all took turns running the dispensary, which they kept open six days a week from nine until noon. In addition, Emily handled most of the surgical cases while Zakrzewska mixed medicines in the apothecary, a skill she had acquired while studying medicine in Cleveland. In no time at all they had filled all the beds in the hospital and were often seeing thirty people a day through the dispensary.
Emily later estimated that by the end of their first year, thirty-seven hundred women and children had benefited from the New York Infirmary’s outpatient practice.≤∑
The novelty of the New York Infirmary was not, it should be emphasized, in providing care for women and children. Other hospitals in America already o√ered that service. What was new was that the hospital was run by an entirely
FIRST HOSPITAL
≤ 87
female sta√; in addition, this sta√ provided clinical training to women interested in pursuing a medical career. In its first year, four medical students lived in the hospital, paying three dollars a week for board and receiving in exchange instruction ‘‘at the bedside,’’ both in the wards and at the dispensary. The level of supervision they received may very well have been higher than at most other hospitals that permitted clinical instruction, a reflection of the high standards Zakrzewska and the Blackwells set out to impose. With three physicians and four students, the New York Infirmary avoided what had become a central criticism of many other hospital arrangements both at home and abroad: that with so many students following their instructors on their rounds, only the most aggressive ever got to see anything, let alone practice their own skills.≤∏ Indeed,
Zakrzewska and Blackwell had made it a goal to avoid ‘‘the rush of students . . . , crowding and elbowing one another for the best place, peering over each other’s shoulders in the e√ort to see as well as hear what is going on.’’ They did this by keeping the classes small; in fact, at any given time, only two students were in the di
spensary and two in the wards. As they explained, this was done ‘‘so as to keep them completely under the supervision of the professor, to enable him to acquire a full acquaintance with the ability and needs of each individual student, and to allow the latter to obtain that special aid of which the want is so much felt by those who have been members of a large hospital class.’’≤π
The arrangement Zakrzewska had made with the Blackwells was that she would work for two years in exchange for room and board. Whatever earnings she made had to come from her private practice, which she continued to pursue in the late afternoons and early evenings. ‘‘In truth,’’ she later remembered,
‘‘often I had to earn by outside practice, the money to buy a holiday or Sunday dinner, as the Institution was too poor to a√ord a decent table.’’≤∫
During the first year of the infirmary’s existence, all three women worked together, but in the second year Elizabeth went to England to help advance women’s entry into the medical profession in her native land. The work, Zakrzewska later remembered, grew more di≈cult—she and Emily often saw sixty patients a day in the dispensary—but she continued to find it extremely rewarding. What she also deeply appreciated was the constant support they received from some of the city’s more established physicians, such as Richard Kissam, a well-known obstetrician; Willard Parker, professor of surgery in the College of Physicians and Surgeons; and Valentine Mott, another well-respected surgeon.
Some of these physicians came to the hospital to consult on a case or provide clinical instruction; others invited the female students to visit their dispensaries;
FIRST HOSPITAL
88 ≤
yet others joined the hospital’s board of consulting physicians. Thus what the female students must have learned, in addition to the medical knowledge they acquired, was something that Zakrzewska had long ago appreciated, and that was the value and importance of the support that prominent men could o√er their cause.≤Ω
Science Has No Sex Page 13