Formal opening of the College term—Professor Zakrzewska delivers the Introductory Lecture—Father disapproves of her removal to Boston—This increases the shock of news of his death. (Thirty years of age: 1859.)
The term of 1859-1860 of the college opened well. A goodly number of students had registered, among them the fine women already mentioned who assisted much in giving a high tone to our work, and I felt greatly supported by their earnestness and zeal. [According to the college announcement, this term opened on November 21, 1859, with the “Introductory Lecture by Professor Zakrzewska.” A few extracts from this formal address will help still further in developing the portrait of the speaker.]
The study of medicine is so great and comprehensive a field that within its horizon we find included the whole moral world. It comprises mankind in all its conditions, in all its changes of opinions and in all its modes of society. It has been subject to the highest wisdom in existence, to the greatest folly and mysticism which superstition could produce and, in our days, to the most profound learning and scientific speculation. And though I am now addressing a miscellaneous audience of which only a few are physicians or students of medicine, every one is in some way connected with the profession, be it only as a patient. Every one receives this liability as an inheritance from nature and, therefore, ought to be interested in a science which occupies itself with mankind.
The only motives that this profession permits to its votaries are the clear and decided conviction of an inborn taste and talent for the practice of medicine and an earnest desire for, and love of, scientific investigations concerning the human being—its construction, its condition of health and disease, and all its relations with the surrounding world.
It is a positive fact, acknowledged among all nations and at all times, that there is in the mass a growth of the human mind from generation to generation similar to that in the different periods of individual existence. And to these varying stages of mental growth we must ascribe the different forms through which the practice of medicine has passed.
Disease is as old as mankind. The first sore finger made the first patient, and the first physician was the one who bound it up or who inquired how it was doing. Pain awakens the instinct to relieve, one following the other, and this must have existed from the creation of mankind.
The practice of medicine dates back, therefore, to the morning of life; the shadows of a hoary antiquity gather around its cradle. The annals of history do not reach back of it, but only open the portals of fable in whose shadowy domain it is supposed to dwell. Æsculapius was the grandson of Zeus, whose father was Time himself.
Gradually we see it emerging from this hazy atmosphere in the form of a mysterious science, assisted and appropriated by the mysticism of the oracles and astrologers, until it found its devotees in the priesthood who pursued the practice upon the body in connection with their duties as priests for the soul.
It is only since medicine has ceased to stand isolated from the other sciences that the erroneous belief that disease was produced by supernatural agency has waned. Nothing has more retarded the progress of medicine in becoming really scientific than its separation from general learning; and nothing could favor empiricism and superstition more than the promotion of this separation.
That this separation produced an apparently inextricable confusion was very natural, just as it was natural that medical sects should have been formed of which the one renounced this, the other that, and the third something else—each individual sect being distinguished by its one-sidedness. The only sect—if we may thus term the regular physicians—which at no time could be accused of one-sidedness in its proclamations was that based upon the principles of Hippocrates and the Alexandrian School—these advising practical, experimenting science, a course of reasoning which Lord Bacon in his works has approved with such justice. And how necessary it was to follow this recommendation continually and in every particular is best illustrated by showing how one branch of medical practice could fall almost into oblivion by neglect to pursue it as an experimental science.
For instance, in the history of Obstetrics, we find that very little was done to promote its elevation from the times of Hippocrates and Celsus until within the last one hundred and twenty years, when Pareus, Mauriceau, De la Motte, Deventer, and Justina Siegesmundin and others began to investigate it and to raise it to its proper place as a science.
Until this time, the obstetric art was so entirely neglected that it was considered beneath the dignity of an honorable man. Low and uneducated persons appropriated this practice to themselves, even in cases of the greatest emergency. The degradation of this branch alone proves the need of the introduction of new ideas formed by constant observation in science at large; it also proves that we cannot abandon speculations and experiments on the natural laws which pervade all organizations; and that it is a matter of great necessity that every student of medicine should be provided with ample opportunities for so doing. And how successful and beneficent, although difficult, such reforms are, I shall illustrate by speaking again of the resurrection of obstetrical science.
New life had to be introduced into it before new light could be thrown upon this field; and this new life was finally introduced when the persons just named entered upon the study. They found that midwifery as it was then practiced must be reorganized. Observations on nature needed to be made and these were to be followed by scientific analysis, and the results introduced into practice.
A new era for the studious was opened, and many young and brilliant minds now found their attention directed towards this branch of learning which before they had considered as a subject beneath their dignity. Very soon after the first attempt for improvement, an ardent enthusiasm was created in the subject, since in it a field for new investigations, and consequently for new honors, became apparent to the eyes of the ambitious or the learned. In a very short time, the practice of obstetrics was regulated in such a manner that not only had the horror towards the persons engaged in it entirely disappeared, but the terrible operations often practiced had also become lessened to an insignificant number, these latter belonging to the class of unavoidables.
Every country produced authorities. England boasted her John Burns and Hunter, while France raised up her Baudeloque, her Madame Lachapelle, Madame Boivin and many others. But no country gave to the profession such thoroughly scientific investigators as did Germany, and of these a woman took the lead. Justina Siegesmundin was the pioneer of this great reform, and her work, written upon the subject in 1741, came upon Europe like a thunderbolt. In every country, minds which had been preoccupied with a thousand other things, forgetting the most important, were awakened to an activity which would but a short time before have been deemed impossible. In Germany, therefore, the subject of obstetrics is still considered as of momentous importance, the foundation almost of all other practice ... and the statistics prove that in this branch of practice less loss of life occurs there than in any other country, though its proportion of difficult cases is the greatest of any.
Reformations similar to this will be constantly demanded in all the different branches of medical science.... Every day brings results of new researches which are throwing fresh light upon subjects not yet understood.
And this is the position which a physician must assume to-day, and for which those who are entering upon this field of study should fit themselves. To be an honorable acquisition to the profession, a consoler to those who require assistance in overcoming disease, a public instructor in the art of preserving health, a reformer from the artificial to the natural—these are the aspirations which must animate every one who dares attempt to step forward to the platform of the benefactors of mankind.
This is the aim which the beginner must have in her mind, and if she falls short of attaining it, she must be able to say that it was neither through indolence nor indifference, but through absolute powerlessness. If you doubt this to be the position which the student should take, then look around and ask yourself what you want of your physician.
If you are educated, you want your physician to be still more so; if you possess perception of conditions and circumstances, you demand this of your physician still more. You want of him that he shall not only perceive and penetrate into the secret relations and conditions of the body physically and psychically, but that he shall also explain to you those phenomena which are incomprehensible to you in spite of your great perceptive faculties.
You further demand of your physician that he shall know everything belonging to medical science. If you understand physiology well, you demand that your physician shall explain in a moment every fact that is dark to you, while a lifetime may not be sufficient to prove a hypothesis. If you are at home in chemistry, you will certainly be greatly surprised if your physician makes a mistake in some combinations, and you will be ready to say that he is stupid. If you have great skill in nursing, you will expect your physician to teach you how to improve; if you are kind and agreeable and amiable, you demand the same qualities in him; if you are irritable, fretful and capricious so that you have been designated by your neighborhood as a fury, you want at least that your physician should comprehend your subtle nature. And in addition to all this, your physician must be sociable, entertaining, wise in every word, overflowing with great thoughts, and uttering new truths whenever you invite him to your table.
All this is really demanded of the physician, but how far it may be justifiable, I leave it to the thinking ones to decide. But of this we may be sure—the physician of the present day occupies a higher station than ever before and greater qualifications for the study of medicine are increasingly demanded.
I mentioned in the beginning that the motives for the study of medicine must be the right ones; now I have to add that these alone will not suffice to make a good physician such as we want to-day. These motives must be accompanied by certain qualifications. The latter are twofold, and may be divided into those belonging to the intellect, and those belonging to our personal and affectional nature.
It is of infinite importance that the intellect should have been previously developed by a course of study which shall train the student in logic and reasoning and familiarize him with natural as well as with moral and mental philosophy. Observation and experiment are the two great auxiliaries to medical study. Those who possess the first as a natural gift and who have judgment enough to apply it whenever they have an opportunity will take the lead, but those in whom both must be developed will always limp behind unless they study most industriously and perseveringly.
Foremost among the second group of qualifications stands the matter of age. The student ought to be mature enough to think and to reason, but not advanced beyond the time when the mind is naturally predisposed to acquiring knowledge. Physical health and prepossessing appearance are of the next importance; while cultivated manners and agreeable behavior, as well as talent in adapting himself or herself to all conditions, all circumstances and all persons, are by no means the last to be considered.
In addition there are some qualifications yet to be mentioned which form a part of our affectional nature and without which no practitioner can succeed. Of these, the most essential is sympathy—not sentimentalizing sympathy, but the sympathy which never betrays weakness or timidity and which is firm and persevering, controlling every action that it may not become rashness. Modesty and reticence, sobriety and unselfishness are other virtues much desired in the practitioner. And I add here a word of warning against temptations into which physicians are constantly led because I know how often pecuniary gain or social position can be obtained by being untrue to one’s best self. I have also had occasion to see the consequences in those who have yielded to the temptation to abandon their principles.
No greater misery can perhaps be imagined than contempt for one’s self; no greater punishment can be endured than the consciousness of having acted meanly and despicably. A man who when alone in his chamber is forced to blush for himself carries hell within him—the loss of a clear conscience is the source of much despair. Conscientiousness, so important for every man of whatever station in life, is still more important in a physician. To be scrupulously honest, to satisfy his own conscience even at the cost of material profit, is absolutely essential for him.
It is human life—that most divine element in creation and irreplaceable when once lost, for which the practitioner is responsible; and no regrets, no penitence, no despair will be accepted by those who mourn or will reconcile them to their bereavement. The loss of a beloved wife and mother perhaps brings another life to the grave, or it may fix the unhappy fate of a dozen human beings of whom she was the guardian angel, and who now are left alone.
Pause and think for a moment, and try to appreciate the weight of misery which in lonely hours such a picture reveals to the mind of one who in a critical moment was made responsible for life and death, and who must confess that such victims fell a sacrifice to the ambition which prevented him from owning his inability for the work intrusted to his hands.
I must leave the subject here and allow you to decide if I have pictured clearly enough what we want in a physician of to-day. If I have succeeded, you will certainly join with me in giving voice to your convictions that not only the very best method for instruction should be provided, but that every facility should be offered to the student to make him or her acquainted with the past history of medicine. Only those who are familiar with all that occurred before they stepped on the platform as public instructors or practitioners will thoroughly comprehend their duty. Great deeds stimulate to greater ones, and so much has already been done in the profession that in order to understand his or her own position the newcomer needs to have knowledge not only of to-day and yesterday but of all times.
[The foregoing definition of the medical profession paints a picture far removed from that of Dr. Johnson, as quoted in one place by the speaker—“The profession of physic is a melancholy attendance on misery, a mean submission to peevishness and a continued interruption of pleasure.”]
The men professors, of whom there were four, and the other woman professor (teaching physiology) were in apparent harmony with my plans. These were to devote my teaching—which was threefold, namely, obstetrics, diseases of women and diseases of children—to only one of these subjects at a time instead of giving two lessons a week on each.
This seemed to work very well; but as it left only four weeks for treating the diseases of children, while obstetrical teaching ran through the winter, the students of less intelligence began to be dissatisfied and my college troubles had already begun before the winter session had ended.
Meanwhile, I was not happy in my relations with my father, whose letters disapproved of my having left New York, where he felt that I was under the supervision of the Drs. Blackwell with whom all responsibilities for the hospital enterprise rested. He now became really distressing to me because his conviction was that whether I succeeded or not I was disgracing the family, and German womanhood in general, by accepting a position which caused my name to come prominently before the public.
I finally felt that I must write a strong and decided letter to him, requesting him either to stop writing to me altogether or else to preserve silence as to his judgment of me and my actions. This letter arrived in Berlin at a time when he was ill in bed and he died a few days later.
I received the news of his death in November from his wife, he having married again. But I never knew whether he read my letter or not. The shock was very great and it upset my nerves, not only as the loss of so near a relative naturally would but also from the fact that I had written a letter which I had for several years hesitated to write, not wishing to place myself in a hostile position to a father who, after all, had been kind and had done the best he knew how to do for his children.
This news also added another care and responsibility, as my father left two younger sisters unprovided for. Being a salaried civil officer in the government, he had no opportunity to accumulate money, and both these sisters were above the age when government pensions are allowed to children. Although my sisters who were married and lived in New York and Washington gladly joined in this financial care yet their own family interests could not be sacrificed.