CHAPTER XXIX
Question of escort in night practice—Expansion of Hospital by purchase of four houses on Warren (Warrenton) and Pleasant streets—Professional recognition slowly growing—She buys a horse and buggy—For first time in America the name of a woman is listed officially as specializing in surgery, Dr. Anita E. Tyng being appointed assistant surgeon—Resignation of the consulting surgeon (Dr. Samuel Cabot) and the attending surgeon (Dr. Horatio R. Storer), the latter the only man ever appointed on the attending staff—Dr. Cabot continues to act unofficially. (1863-1866.)
Boston had already extended itself in all directions into suburbs which still kept their dependence upon the center, but the means of communication remained primitive, as already described in the out-patient work which Dr. Zakrzewska established at the New England Female Medical College. And the isolation was most complete at night, the hour when the cry of suffering humanity rings most insistent.
So the Doctor was obliged to walk long distances to answer the calls of those patients who could not afford to send a carriage for her. Her familiar itinerary was from Roxbury to South Boston, to Dorchester, to West Roxbury, to Brookline, to Cambridge, and so around the circle. Temperatures of all degrees from below zero to up in the nineties were never allowed to discourage her.
As in New York, she was unmolested in her travels. But she never took unnecessary risks. She always went with the messenger who called her, and who was generally a man. She writes:
If he could not accompany me on my return home in the night, and no accommodation for me was possible in the little apartment, I walked with the policeman, and waited at the end of the different beats for the next one to take me to his limits. I was well known among them, and was not at all surprised when a Franklin Park policeman recently accosted me as a friend well remembered in the night walks of former years.
The second year (1863-1864) of the existence of the New England Hospital, and of this phase of Dr. Zakrzewska’s life, was marked by such increased growth of the institution that it was decided to purchase the former residence of Rev. Charles F. Barnard, No. 14 Warren Street (later Warrenton Street), to add to it three small dwelling houses in its rear (Nos. 13, 15, 17 Pleasant Street), and to connect them by a covered passage. The large house was described as “well built and convenient, airy and sunny, with a pleasant outlook on the Chapel yard and greenhouse” (p. 331). It seemed prudent to continue to lease two of the Pleasant Street houses to tenants but even so the increase in accommodations was marked.
The result of this expansion [says Dr. Zakrzewska] was enabling us not only to enlarge our work, but also to divide it into three distinct departments—Hospital for medical and surgical cases; Lying-in Department and Dispensary.
Had our work not been wanted [she continues], had our help not been needed, here and throughout the country, we should not have found so many patients asking for help and advice; nor have had so long a list of names of students waiting for a vacancy; nor have met with that response from the community which provided the means for carrying on our institution and enabling us to enlarge it.
Professional recognition was slowly growing, but even slight advances helped to lighten the almost overpowering mental strain of isolation. In such conditions, every slight word or act of indorsement, even though with reservations, was like a ray of hope that at last the dawn was breaking.
Referring to this period of professional loneliness, Dr. Zakrzewska writes in a letter to the editor in 1900:
In looking over these reports, there come back to me the many hours of fear and anxiety when I really was the only person who stood before the world responsible for our work in the Hospital.
The few brave men who supported my efforts were advanced in years and had a large practice; they were often not available for consultation when requested to come, or they came too late, when the danger was over or had ended in death.
My co-workers were young and inexperienced, looking up to me for wisdom and instruction, while the public in general watched with scrupulous zeal in order to stand ready for condemnation; this zeal being stimulated by the profession at large who wanted to find fault but did not dare to do so openly so long as the two or three professional men stood as a moral force behind me.
I remember how twice—once in New York and once in Boston—a man colleague told me I was foolish to take to heart the death of a patient which I saw coming as a natural event. Such consolations helped to uphold me.
The New England Hospital for Women and Children
This hospital was first housed in a dwelling house on Pleasant Street further along than the rear houses here seen (1862-1864). This was soon outgrown in favor of the one front and three rear houses here shown or indicated (1864-1872).
This professional loneliness must have been peculiarly poignant to her, since it contrasted so painfully with her recollections of the cordial fellowship which she had enjoyed with Dr. Schmidt and other leading medical men in Berlin.
An appeal issued by the directors in June, 1864, asking for funds for the purchase of the new buildings, contains a letter by Dr. Horatio R. Storer giving cogent reasons for the desirability of a special hospital for women and noting the particular conditions which made the New England Hospital peculiarly suitable for such purpose. This appeal was signed also by Drs. Walter Channing, C. G. Putnam, Henry I. Bowditch, and S. Cabot.
And about this time, Dr. Walter Channing writes to Dr. Zakrzewska:
I regret I had not made my visit later as I was too early to have the pleasure of seeing you. I was desirous to do so to express to you my entire satisfaction in regard to the operation you performed the evening before. It was a very difficult operation and was done under circumstances most unpromising of success. I do not think it could have been done better.
I write also to say that if at any time I can do anything to aid you in the performance of your important duties, I shall be always ready and happy to do so.
Very respectfully & truly yrs.,
Walter Channing.
Boston, 39 Mt. Vernon Street,
June 2, 1864.
Remembering the financial difficulties of both Dr. Zakrzewska herself and this young, struggling enterprise of hers, one may well wonder at the second annual report (1863-1864) stating:
Half of our beds are always filled by patients who pay nothing, and the resident physician has the right to receive at half price those whose circumstances require this indulgence.
And realizing how the prices of the necessities of life must have advanced with the continuance of the Civil War, one is not surprised to read elsewhere:
We have been reluctantly forced to double our price of board, placing it at eight dollars per week.
The third year (1864-1865) of Dr. Zakrzewska’s new life of freedom, of the longed-for opportunity for expressing her ideals, and of the attaining of sympathy and support for the forms of such expression, found the Hospital continuing its growth, like a manifestation incarnate of her soaring spirit.
This growth compelled the addition, with alterations, of the remaining two houses on Pleasant Street; and the housewarming which dedicated this further enlargement of its opportunities netted a precious six hundred dollars.
The Legislature of Massachusetts now voted the Hospital five thousand dollars for the purchase of the new site, on condition that a similar amount should be raised by subscription. And the Boston Lying-in Hospital Corporation increased its donation to one thousand dollars.
For the first time Dr. Zakrzewska, as attending physician, presented to the board of directors a formal report which she thus introduces:
Before this year I had never considered that a lengthy report given by me was a necessity. Hitherto our Hospital had been so small and so simple in its management that it was easily understood by the directors and friends.
This is now changed: for after four years of exertion the Hospital has assumed from a simple ward the form of a complicated institution, with its resident and assistant physicians, its consulting, attending and assistant surgeons, and its attending and consulting physicians. Such an institution must necessarily attract the attention of the community; therefore inquiries are constantly being made as to how this institution is carried on. Nothing can answer all these different inquiries better than a minute report.
The most striking feature in its character is that it is designed to give to educated medical women an equal chance with their professional brethren to prove their capacity as hospital physicians, and to admit only female students to its wards—all other hospitals closing their doors to women as physicians and students.
The increase in the number of patients seeking daily advice soon gave a reputation to the institution, and the liberally inclined part of the community as well as of the profession began to look upon it as a test of female capability in professional life.
In this report Dr. Zakrzewska notes that the increase in the number of patients had become so great that Dr. Storer offered to share the dispensary work with her and Dr. Sewall, taking two mornings a week and making an even division of the time.
Referring to the raising of the question as to whether it is not an inconsistency to have a gentleman in attendance, as it has always been stated that the advantage of our Dispensary is that women can be attended by physicians of their own sex, she continues:
In reply to this, I can only say that there is a distinct notice given on the Dispensary cards as well as in the waiting room, when Dr. Sewall or I, or when Dr. Storer is in attendance, so that patients can have their choice.
Interesting features of the annual meeting of the Hospital for this year and of a levee which followed it, were an address by Dr. Elizabeth Blackwell on “The Culture Necessary for a Physician,” and a reading of some charming poems by Mrs. Julia Ward Howe.
Hand in hand with the growth of Dr. Zakrzewska’s Hospital work progressed the growth of her private practice. And the year 1865 was notable in that for the first time she felt able to set up a carriage in proper medical style. She thus describes this felicitous occurrence:
In 1865, I bought a second-hand buggy and a horse for two reasons: one was that I could not accomplish and do justice to my professional work by using public conveyances; the other, that it became a matter of necessity to uphold the professional etiquette and dignity of a woman physician on equality with men. The effect was marvelous. Even the newspapers took notice of the change.
At the Hospital further advance was made by the creation of the staff position of assistant surgeon, Dr. Anita E. Tyng[11] receiving the appointment. Thus for the first time in America the name of a woman is listed officially as specializing in surgery. This year was also notable for the addition of a second consulting physician, Dr. Henry I. Bowditch accepting election.
Dr. Henry I. Bowditch was always an earnest supporter of the education of women as physicians. He befriended Dr. Harriot K. Hunt and Dr. Nancy Clark, and then Dr. Zakrzewska herself when the latter came to Boston in 1856 soliciting money for opening the New York Infirmary. He remained the steadfast champion of medical women and continued as consulting physician to the New England Hospital until his death in 1892.
Dr. Zakrzewska realized the necessity of having on the consulting staff of the Hospital men physicians of the highest standing in the profession, such men serving as vouchers to the community for the medical women and their hospital.
But aside from this vital consideration she also believed that the best results follow when men and women work together. In this conviction she was ably supported by Dr. Henry I. Bowditch, who wrote to her at one time:
In regard to having a full corps of well-known experts, male and female, connected with the hospital, I still have no doubt. As I think there should be women physicians and surgeons in the other hospitals, so I think it important for the fullest success to have a joint corps at the women’s hospital. Also, I cannot but think it would be beneficial pecuniarily to all the hospitals if such arrangements were made.
Indeed, Dr. Bowditch was prepared to go even further, for in another letter he expresses the opinion that all three hospitals—the New England, the Massachusetts General and the City, should throw open their clinical instruction to both men and women. Though he was still conservative enough to advise that the clinics should be held at different hours for the two sexes.
In spite of the increasing support given the Hospital, its financial situation continued to cause anxiety. This was due to the need for paying for the four buildings purchased, to the increased expenses of the expanded institution, and to the disproportionately large amount of service given free or at only nominal rates.
The acuteness of the problem continued to increase and in the following year (1865-1866), although the mortgages had been paid off and the general debt reduced, the institution was unable to pay its current expenses.
To meet this situation a more conservative course was felt to be imperative, and it was decided, except in Maternity cases, temporarily to discontinue receiving any patients at a reduced rate except in the free beds, those which were endowed or definitely subscribed for.
Dr. Tyng continued as assistant surgeon, and her progress was so satisfactory that Dr. Storer writes:
During July and August, I shall be able to visit the Hospital only on Saturdays. During my absence, I wish Dr. Tyng, in accordance with her duties as assistant surgeon, to take my place as concerns both the Dispensary and the Surgical Wards. Of course, operations of any magnitude will be reserved until the days of my attendance.
In the midst of this peaceful development and orderly progress, clouds suddenly gathered and a tempest broke forth, with much lightning though with little thunder. This was followed by the clearing of the air characteristic of the passing of tempests in this latitude but, as sometimes happens, a marked change in the local landscape was the result.
The storm center seems to have been Dr. Storer. It is often difficult to explain misunderstandings and disagreements. Frequently, no one person seems to be definitely responsible. Electric conditions develop from many causes; minor frictions occur; an accident produces a spark; and an explosion follows.
Dr. Storer was connected with the Boston Lying-in Hospital before that institution suspended operation. He later became connected with the New England Hospital as already related, beginning then to specialize in the diseases of women. He worked assiduously in his department, and he accepted the letter of his obligations to the Hospital.
Subsequent history shows that this acceptance did not include the convictions of the spirit. Perhaps a psychoanalyst of to-day would trace the ultimate explosion to the “complex” resulting from conflict between this letter and spirit.
Or, perhaps (as suggested by the primary resignation of Dr. Cabot) it was a technical disagreement as to the limits of the respective domains of attending and consulting staffs—always a subject filled with delicate potentialities.
Or, perhaps, as claimed by Dr. Mary Putnam-Jacobi (Woman’s Work in America, published in 1891), a most careful and conscientious observer with the true scientific spirit, it was because the successful outcome of Dr. Storer’s operations fell too often below the boldness of his conceptions of them. (Dr. Sewall in this year says in her report as resident physician, “Only three deaths have occurred among our patients, and all these took place in the surgical wards after hazardous operations.”)
Be the explanations—one or all—as they may, the first outward manifestation of the storm was the receipt by the board of directors of the following letter from Dr. Samuel Cabot, the early and long-tried friend of the Hospital who had from the beginning served as consulting surgeon:
Boston, June 2, 1866.
To the Board of Directors of the New England Hospital For Women and Children.
Ladies and Gentlemen:
Feeling as I do the very warmest interest in the cause of female education and advancement, and believing as I do that the path of medicine and surgery, as well as every other path to honor and profit, should be open to women as well as to men—still, I feel constrained to send you my resignation of the office of Consulting Surgeon to the New England Hospital for Women and Children with which you have honored me, and to request you at your earliest convenience to accept it and to appoint my successor.
I cannot enter into any explanation of my reasons for this step, and can only ask you to believe that it is from no loss of interest in the cause you represent nor from any dissatisfaction with the ladies connected with the Hospital.
Very respectfully
Your obedient servant,S. Cabot.
This resignation was accepted with great regret when after consultation it was found to be irrevocable.
This letter having brought the subject of consulting physicians to the attention of the directors, after much thought and inquiry the following preamble and resolutions were unanimously passed at their regular meeting on August 13:
Whereas, the confidence of the public in the management of the Hospital rests not only on the character of the medical attendants having its immediate charge but also on the high reputation of its Consulting Physicians and Surgeons, and
Whereas, we cannot allow them to be responsible for cases over which they have no control, therefore,
Resolved, that in all unusual or difficult cases in medicine, or where a capital operation in surgery is proposed, the Attending and Resident Physicians and Surgeons shall hold mutual consultation, and if any one of them shall have doubt as to the propriety of the proposed treatment or operation, one or more of the Consulting Physicians or Surgeons shall be invited to examine and decide upon the case.
Voted, that a copy of this resolve be sent to all medical officers connected with this Hospital
On September 10, the board of directors received from Dr. Storer a letter containing his resignation as attending surgeon, and on this letter the report comments, “Its tenor left the Board no alternative but its acceptance, which was unanimously voted.”
The report then continues,
The Directors would, however, take this first public occasion to express their sense of the value of Dr. Storer’s professional services and of the aid which he has rendered to the Treasury of the Hospital. Cheerfully bearing witness to his talent and active zeal in his profession, they offer him their best wishes for his future success.
Dr. Storer’s letter containing his resignation was remarkable for its expressions of misunderstanding of the resolutions quoted above and for its misrepresentation of the general charitable policy of the Hospital. But it was chiefly remarkable for the needlessly offensive manner in which the writer revealed his personal disapproval of the study of medicine by women. Yet he condescended on second thought to qualify the latter statement, by adding:
For certain of the professional ladies whom I have met, I have personally the highest respect and esteem. Miss Zakrzewska, the beauty and purity of whose life as already published to the world I have long seen verified, may well challenge comparison in practice with a certain percentage of my own sex. Miss Tyng, now for two years my assistant in private practice, has such natural tastes and inclinations as fit her, more than I should have supposed any woman could have become fitted, for the anxieties, the nervous strain and the shocks of the practice of surgery. And there are others not now officially connected with the Hospital whose names I would mention in terms of similar commendation.
Such are, however, at the best, but very exceptional cases, and I am driven back to my old belief, the same that is entertained by the mass of mankind, that in claiming this especial work of medicine women have mistaken their calling.
An interesting by-action of the writer was his concurrent sending of this extraordinary letter of resignation to the Boston Medical and Surgical Journal for publication. This journal has already been quoted as being opposed to the entrance of women into the medical profession, and at this time and for many subsequent years, it still continued its attitude of opposition.
It is of a certain interest to note here that Dr. Storer once more emerged in public to express his sex-peculiar views regarding women physicians. This was in San Francisco in 1871, when, at the annual meeting of the American Medical Association, the question of women as delegates and members was brought into the debate upon a related subject. In the discussion, Dr. Storer spoke in opposition, saying:
... We will grant that some exceptional women are as interested in our science as ourselves; that some of them have those peculiar qualities, that especial temperament, that gives them not merely a taste for anatomy and surgery but courage to face the greatest dangers and anxiety in surgery; and that there are some women who are able to go out in inclement weather and brave the storm. We may grant that women, some of them, may have had peculiar means or favorable opportunities which allow them to get this same education that men have. We may grant, and grant it freely, that in some matters, women intellectually, are as completely mistresses of their subject as we are masters of ours.
But, beyond this there is a point that is fundamental to the whole matter ... and that is, this inherent quality in their sex, that uncertain equilibrium, that varying from month to month according to the time of the month in each woman that unfits her for taking these responsibilities of judgment which are to control the question often of life and death ... women from month to month and week to week vary up and down; they are not the same one time that they are another.
To this, Dr. Gibbons of San Francisco replied:
If we are to judge of this proposition by the arguments of my friend from Boston, I think it would prove conclusively the weakness of his side of the question.... Is it not a fact that a large majority of male practitioners fluctuate in their judgment, not once a month with the moon, but every day with the movement of the sun....
Thus are some of the humorous pages of history made.
However, this seems to have been the last time that the subject of women as members was discussed in that Association. In 1876, the first woman delegate (Dr. Sarah Hackett Stevenson, from the Illinois State Medical Society) was seated amid cheers. And in 1877, Dr. Henry I. Bowditch of Boston, in his presidential address, congratulated the Association that women physicians had been invited to assist in the deliberations.