Putting aside for a moment the gendered meanings of a story in which a woman derives her health from nursing a cow, we can see that Zakrzewska was clearly criticizing an image of the modern physician, who would have terminated the clinical encounter after determining that the woman showed no physical signs of sickness. For Zakrzewska, in contrast, that piece of information marked the beginning of their relationship. The ideal physician she depicted took the time to learn about the circumstances surrounding her patient’s experience of ill health; this is what allowed her to tailor her therapeutic advice to the specific situation at hand. Her diagnostic skills stemmed, moreover, not from the possession of a body of specialized knowledge, the command of the latest materia medica, or the handling of new instruments but rather from clear thinking, good judgment, and a ‘‘vivid power of imagination.’’ Indeed, for Zakrzewska these traits allowed her to act rationally, dissecting the situation in order to determine both the true cause of the woman’s ailments and a therapeutic regimen that would restore her to health.
Published in 1893, this article also represented a veiled attack on modern laboratory science. Indeed, two years earlier, Zakrzewska had written to Elizabeth Blackwell, complaining about the ‘‘Scientific Craze’’ that was leading her colleagues to talk about little else than ‘‘vaccination and inoculation.’’ In her eyes, the eagerness with which physicians were embracing Pasteur’s and Koch’s discoveries was decidedly unscientific, ‘‘the same unproven ‘ Science’(?) the same quackery’’ as could be attributed to Hahnemann, the founder of homeopathy.
In contrast, she explained, she was never inclined to rely too heavily on medicines, usually giving them ‘‘as placebos in infinitessimal [ sic] forms’’ and thus earning a reputation among her patients for ‘‘hardly any medicine but teaching people how to keep well without it. . . . I can assure you,’’ she added, ‘‘it is far harder, requiring more thought and more endurance and more patience to practise hygiene than what is called medicine.’’∞π Certainly in Zakrzewska’s mind, the way she brought the farmer’s wife back to health was as clear a proof as she needed.
Therapeutic restraint, hygiene, skepticism toward instrumentation and bacteriology, anecdotal evidence—taken together, they all suggest the sizable gap
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that was growing between Zakrzewska’s understanding of medical science and the focus on laboratory experiments, clinical studies, diagnostic instruments, and surgical acumen that were becoming the mark of modern medicine. Nor was Zakrzewska’s a lone voice. In the late nineteenth century, medical researchers, clinical specialists, and practicing physicians were all engaged in contentious battles over the path modern medicine should pursue, much of their disagreement centering on competing definitions of science.∞∫ One of the
more heated debates was between those who fought to ground medical practice in the knowledge produced at the bedside and those who favored the laboratory.
Zakrzewska may not have chosen this particular language to frame her concerns, but her skepticism toward modern medical techniques cannot be understood apart from the issues that surfaced in this debate.
The debate between the clinic and the laboratory took place to some extent across a generational divide. On the one side were those physicians, older now, who had studied in Paris in the antebellum period and who had returned home lauding empirical studies at the bedside and denigrating the vacuous theories that they claimed were driving medical practices at the time. Whether in the clinic, the consulting room, or the patients’ home, the physician’s task, they insisted, was to collect as much information as possible about the particulars of the case before recommending a specific therapeutic regimen.∞Ω Now, however, they were being challenged by a younger generation of physicians who were more inspired by recent developments in the German laboratories and who sought universal laws that would explain the disease phenomenon. Ultimately, these German-trained physicians believed, such laboratory-based investigations would generate the specialized knowledge that would determine appropriate therapeutic measures. As John Harley Warner’s sensitive study of the Paris-trained generation has illuminated, these battles were only in part about method. Because they marked disagreements over the very nature of the knowledge driving therapeutic practices, at their core were questions of professional authority, professional identity, and moral integrity.≤≠
Zakrzewska, who struggled with many of the same issues, occupied a somewhat anomalous position. As we have seen, she shared with her generational peers a view of disease as embedded in the social environment, and she lauded the clinic as the most important site in the education of young physicians.
Nevertheless, she shared none of the Paris-trained physicians’ praise of empiricism. In her opinion, it left the physician without any rational foundation upon which to ground her or his therapeutic practices. This reflected, as I have been
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arguing, her own European training, which took place neither in Paris in the antebellum period nor in the German laboratories and clinics in the postbellum period but rather in Germany in the 1840s and 1850s, when a younger generation of physicians were making loud their demands for the implementation of what they termed ‘‘rational medicine.’’ Conceived of as an antidote to the clinical empiricism that they believed had come to dominate medical theory and practice, they insisted that medicine would become a science only when the laboratory and the clinic joined together to study disease and to derive universal laws that would guide practice. This understanding of medical science, I have been arguing throughout this book, had a profound e√ect on how Zakrzewska shaped her own professional identity.
Thus one of the developments that so disturbed Zakrzewska at the end of the century was the severing of the laboratory’s ties to the clinic, and thus to practice, not laboratory medicine per se.≤∞ This was at the heart of her criticism of bacteriology, and in this regard she may have had the most in common with other Germans of her generation who also viewed with dismay the narrowed focus on bacterial origins and isolated cells and organs that had come to mark German laboratory research. Thus Abraham Jacobi, a leading figure in American pediatrics who studied medicine in Germany before immigrating to the United States in 1853 (the same year Zakrzewska arrived), complained of the
‘‘bacteriomania’’ that had captured the imagination of his colleagues. And Rudolf Virchow, whose views on scientific medicine had so shaped Zakrzewska’s own, criticized his colleagues’ obsession with bacteriology, not so much denying that bacteria were responsible for the transmission of certain infectious diseases as rejecting both the notion that most diseases could be so explained and the idea that nothing else contributed to the diseased state.≤≤ Zakrzewska may have gone one step further and doubted that bacteriologists had actually found the cause of disease, but more important, she considered unscientific the frenzy among her colleagues to vaccinate and inoculate indiscriminately, as though all disease could now be reduced to the havoc caused by a bacterial infection. It was the leap being made from the laboratory to the doctor’s o≈ce that she found troubling, not what was taking place within the laboratory itself.
. . .
Zakrzewska may not have criticized laboratory work, but she also neither practiced nor promoted it. In terms of her own style of practice, and indeed of her professional identity, she positioned herself squarely at the bedside and in the consulting room, helping her patients to understand the link between their
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physical well-being and the social circumstances of their lives. Zakrzewska continued to emphasize the importance of proceeding scientifically—indeed, she never missed an opportunity to lay claim to the mantle of science—but her model was not the physician in the laboratory armed with test tubes and instruments but rather the steward and problem solver, who sought clues in the specifics of his or her patients’ lives,
relying on sound judgment, rational thought, and experience to devise the best therapeutic approach.
How much Zakrzewska had changed since the 1850s and 1860s, when she had promoted microscopy and thermometry, positioned at the vanguard of those arguing for the importance of grounding medical practice in the knowledge produced in both the laboratory and the clinic. Among women physicians she had certainly been one of the loudest and most public advocates of such an approach. Now, however, at the end of the century, her work was a far cry even from that of some of her contemporaries, like Mary Putnam Jacobi and Mary Dixon Jones, who were integrating modern laboratory techniques into their clinical practice, conducting microscopic and pathological investigations of the tumors and exudates they excised from their patients.≤≥ Zakrzewska may not have criticized their work, but she also did not identify with it.
Zakrzewska had come to embrace a style of practice that was, as several scholars have argued, becoming increasingly feminized.≤∂ This association did not, however, trouble her. On the contrary, she now seemed intrigued by the overlap between her own approach and those of her friends, like Elizabeth Blackwell, who had long insisted that women practiced medicine dif-ferently than men. ‘‘I sympathize with you on so many points, if not on all,’’
Zakrzewska wrote Blackwell in 1891 after reading her friend’s paper on hygiene,
‘‘but I feel grateful whenever I see your writings and try to spread its truths.’’ It is not unreasonable to assume that Zakrzewska was rejecting Blackwell’s explicit embrace of gender di√erences; at the same time, however, she shared her friend’s insistence that medical practice and medical ideology be understood in moral terms. ‘‘You have the advantage over me that you talk and write in a strain of religious belief which will be understood by the many, while I can simply set forth the moral questions of moral righteousness as is expressed in the ‘golden rule,’ ’’ Zakrzewska continued.≤∑ Ever skeptical of religious doctrine, Zakrzewska nevertheless shared with Blackwell—and, indeed, many others of their generation—a conviction that questions of justice were part and parcel of any discussion about health and disease. Indeed, her growing disillusionment with modern medicine may have reflected, more than anything
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else, her sense that questions of ‘‘moral righteousness’’ were no longer as prominent as they had once been.
. . .
As Zakrzewska’s thoughts on medical practice changed, so too did her perception of the female body. There was already a hint of this in the 1889 obstetrics article when she coupled her emphasis on childbirth as a natural process with a reference to a woman’s ‘‘first babe’’ as the ‘‘great event of her life.’’ Even the story she told in the Woman’s Journal suggests a view of women’s bodies as intimately connected to nature. This is evident in the bizarre way she blurred the line separating the wife and the cow, describing their blossoming friendship as they helped each other grow fat (pregnant in the case of the cow), healthy, and happy. The strongest indication, however, of Zakrzewska’s altered view of women’s bodies came in the 1891 letter she wrote to Blackwell, in which she followed her criticism of bacteriology with an attack on gynecologic surgery. Zakrzewska knew well Blackwell’s own opinion of ovariotomies as ‘‘permanent mutilation.’’
Without mincing words, she let her friend know that she shared this position, lamenting the ‘‘lack of sanctity for their own body growing up in girls and women’’ that was sending women to the hospital ‘‘on the slightest cause’’ in order to ‘‘urge upon us operations.’’≤∏
At the time Zakrzewska wrote this letter, a spirited debate was under way in the medical literature over the use of surgical solutions to cure women’s health problems. Women physicians were no strangers to this debate. Thus Blackwell, with her total rejection of any kind of gynecologic surgery, represented one position. In contrast, Mary Dixon Jones, one year older than Zakrzewska and an 1875 graduate of the Woman’s Medical College of Pennsylvania, made a career for herself specializing in ovariotomies. Regina Morantz-Sanchez’s rivet-ing account of two late nineteenth-century trials against Dixon Jones—one for manslaughter and the other for libel—reveals the di≈culties encountered by women who demonstrated too great an eagerness to cut and too much enthusiasm for their own self-promotion.≤π Although Dixon Jones’s detractors were many, she had her supporters as well, among whom Mary Putnam Jacobi could be found. Less controversial than Dixon Jones but no less committed to using the knife, Jacobi directly accused Blackwell of refusing to consider the lifesaving nature of such operations. Besides, she fumed, ‘‘there is not such special sanctity about the ovary!’’≤∫
Zakrzewska had once shared Dixon Jones’s and Jacobi’s views of women’s
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bodies, but that was no longer the case. She may never have gone so far as to embrace Blackwell’s notion of the ‘‘spiritual power of maternity,’’ which supposedly taught ‘‘the subordination of self to the welfare of others,’’ but she was clearly moving away from her highly mechanistic view of women’s bodies and her absolute denial of di√erence.≤Ω Why she made this move is unclear, although the parallel between her embrace of a style of medical practice that was becoming gendered female and the sacredness with which she now viewed the female body would indicate a sharp turn toward the language of di√erence that had long characterized Blackwell’s views.≥≠ Zakrzewska continued to reject any idea that her practices or her views represented a peculiarly female style, but there is no denying that in the last decade or so of her life the values and practices that were becoming feminized held far more appeal for her than those that were assuming the mantle of masculinity.
Zakrzewska’s altered view of women’s bodies had, however, personal roots as well and was tied to a number of changes right around her sixtieth birthday. As we have already noted, she had significantly reduced her involvement in the day-to-day a√airs of her hospital in 1887 when she had resigned her position as attending physician. Pulling back from an institution that had been both her creation and a home away from home had already brought some sadness; the loss of two very dear friends just a few years later made things even more di≈cult. The first to pass away was her close friend Mary Booth, who was only fifty-eight when she died on 5 March 1889. They had remained close through the years and had shared, in Zakrzewska’s words, an ‘‘intimacy [that] was only broken by death.’’ Then, less than a year later, Lucy Sewall passed away at the age of fifty-two. The year, she wrote to Severance on the day of Sewall’s death, had been a ‘‘sad’’ and ‘‘a cruel one,’’ and she ‘‘felt almost tired of life’’ herself.≥∞
These changes in Zakrzewska’s life led her to think more about both her own mortality and the meaning of her life’s work. There can be no doubt that she derived considerable satisfaction from the hospital she had founded and the work she had done to further the cause of women physicians, but on several occasions she implied that this was not enough. Indeed, in a particularly moving letter she wrote to Caroline Severance in 1889, she spoke of her regret that she had not brought any children into her life. Commenting on Severance’s son’s decision to remain a bachelor, she wrote: ‘‘I am sorry for him, because I know he will feel the penalty for doing so, just as keenly as I do, now that I completed my 60th year and have no young life, which belongs to me. . . . Now with mature
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thought, I see that life is selfish when the dread of sorrow prevents us to fulfil our natural mission, and whatever this sorrow may be, it is never as great, as not to be tentimes balanced by the joy, which precedes such grief & anxiety.’’≥≤
In the midst of this contemplation and sadness, Zakrzewska found herself drawn to the German biologist and philosopher Ernst Haeckel, who had recently written of his view of the material world as both fundamentally mechanical and capable of generating soul-like properti
es.≥≥ Haeckel, who set out both to deny the existence of ‘‘immaterial forces’’ and to avoid a ‘‘soulless materialism,’’ was arguing at the time that the first life forms, or Monera, had generated spontaneously from inorganic matter, emerging from that process endowed with the property of irritability. This property eventually evolved, moreover, into consciousness and the human soul. ‘‘I am a monist,’’ Zakrzewska wrote Severance. ‘‘The whole universe is one great power or material & evolves the spirit.’’≥∂
Zakrzewska appears to have found some comfort in Haeckel’s ideas about the material world. She knew she could not, nor did she wish to, believe in an afterlife. She had no desire, she once explained, to join her friends once again
‘‘in a form, which is either by virtue of surroundings or an advanced development, so altered for the better or the worse, that they have become estranged to my comprehension or feeling.’’≥∑ But perhaps Haeckel’s belief that matter could give rise to emergent properties, thus leaving room for something akin to a spiritual element, satisfied a need she had for something to persist after she died.
That such thoughts were on Zakrzewska’s mind is suggested by a comment she made to Elizabeth Blackwell a few years before her death: ‘‘I fully agree with you,’’ she wrote, ‘‘and beleive [ sic] that the spirit cannot die, is indestructible and lives forever, altho individual consciousness is lost in Nirvana.’’≥∏
I am suggesting that Haeckel’s blurring of the boundary between the natural and the spiritual not only o√ered Zakrzewska comfort but also contributed to her vision of the body as material but nevertheless sacred. At the very least, it o√ered her a language and a philosophical foundation, distinct from the religious doctrines she continued to hold suspect, in which to ground her increased reverence toward the human form. Still, this picture is too neat because, among the many emotions Zakrzewska expressed at this time of her life, she also showed considerable anger toward the younger generation. As we have seen, she did not hesitate to accuse the interns in her hospital of extreme selfishness, putting their own needs before the interests of women physicians as a whole.
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