I wish to say farewell to all those who thought of me as a friend, to all those who were kind to me, assuring them all that the deep conviction that there can be no further life is an immense rest and peace to me. I desire no hereafter. I was born; I lived; I used my life to the best of my ability for uplifting my fellow creatures; and I enjoyed it daily in a thousand ways. I had many a pang, many a joy, every day of my life; and I am satisfied now to fall a victim to the laws of nature, never to rise again, never to see and know again what I have seen and known in life.
These were among the words written by Dr. Marie Zakrzewska (1829-1902), to be read aloud on the occasion of her funeral, to assure the mourners there that, though she died with no belief in an eternal reward after death, she did so nonetheless without fear or regret, having lived nothing less than exactly the life she desired. By dint of pure perseverance and will, she rose from the status of a penniless immigrant constructing artificial wigs to earn just enough money to not starve, into one of the Big Four leading the way in fighting for women’s medical education in the United States, to an institution in and of herself, the guiding force behind one of the world’s most important and respected women’s hospitals, which served as a training ground for a new generation of women physicians and surgeons who would know success Zakrzewska had only dreamed of when first she set foot on New York soil.
If ever an individual showed the characteristics in childhood that would come to define them in adulthood, it was young Marie. Her earliest teachers were almost unanimous in their exasperation at her habit of asking the reason behind their edicts, and of refusing to follow those she deemed to be based on flimsy or arbitrary grounds. Attentive to her studies, but neglectful of her outward appearance, she earned few friends until, to punish her for her constant questioning, she was placed in the boys’ class, and found that she fit in rather well with their rough scramble joie de vivre. She would, in fact, only have one real true friend through her elementary school years, a Catholic girl whose parents forbade her to associate with Zakrzewska unless she became a Catholic herself. Marie thereupon made the unspeakably hard decision to give up her only friend rather than submit herself to a religion that was so despotic that it couldn’t even countenance association with individuals of different faiths.
When she was ten years old, her father, a government official by profession, was stripped of his position by his expression of political beliefs deemed too liberal by the Prussian state, and thereupon it fell to her mother to earn enough money to support the family, by seeking and gaining admittance to a two year government-funded training program for prospective midwives. Young Marie enjoyed nothing so much in these years as exploring the hospital with her mother and the obliging figure of one Dr. Mueller who allowed her to accompany him on his rounds, and lent her The History of Midwifery and History of Surgery which she tore through during her vacation. These were the days that fastened in her mind a resolve to do something with her life connected with medicine, even if at the time there did not yet exist in Germany any women physicians.
At school, meanwhile, on the advice of a teacher, she decided to take better care of her appearance in order to make herself more approachable as a possible friend to her classmates, but rather than fitting in, she found herself now criticized for paying too much attention to her appearance, for being vain and coquettish when all she wanted was to not be so alone. Her only solace during this time was an understanding teacher whom she spent her lunch hours with, and who taught her logic. With his sudden death, she lost all will to continue with her formal studies, and at the age of thirteen left school, never to return. Her father then appointed her to the position of housekeeper, a task she was deeply unsuited for, as she spent her days reading the books in her father’s study for as long as possible, until finally she tore herself away long enough to attempt to do the day’s chores in a whirlwind of corner cutting that was always noticed and remarked sharply upon by her parents.
Eventually, however, their resolve to keep her employed exclusively as the household drudge wore down against the persistency of her desire to learn more about the practice of medicine, and her early teen years were filled with a mixture of housework, study, and expeditions at her mother’s side as she visited patients across the social spectrum, from poor prostitutes to ladies of high station, learning from her mother that all were to be treated with equal dignity, honesty, and attention to their needs. It was a virtual certainty by this point that she would attempt to follow in her mother’s footsteps, and indeed at age 19 she applied to the midwife program of Berlin’s Royal Charité Hospital. This was a program begun in 1818, and which accepted only two individuals a year from some hundred or so applicants, the usual wait time being eight to ten years for individuals without useful connections. Zakrzewska’s youth and association with her disgraced father spoke heavily against her, and she was turned down.
She applied again the next year, and was turned down, but caught the attention of a Dr. Schmidt, who was so impressed by her resolve, and the work she did with her mother, that he resolved to do his utmost to ensure her admittance on her third attempt. That attempt also failed, prompting Schmidt to go to none other than the King of Prussia to obtain a royal edict admitting Zakrzewska to the program. This obtained, Marie spent two years in study and practice, and emerged with a first class certification from the eminent panel of medical professionals that Schmidt had assembled to prove once and for all the capabilities of his medical prodigy.
Having established her abilities so singly, Zakrzewska was then promoted, again supported by zealous campaigning from Schmidt, to the position of professor at the School for Midwives. The triumph of that appointment was blunted by the sudden death of Schmidt the day after her acceptance was announced. Only twenty-two years old, Marie had already had and lost two important mentors in her life, and was entering a hornet’s nest of intrigue and politicking which she, with her forthright nature and relative inexperience, was in no way equipped to navigate. She was undermined from the start by the machinations of a Sister Catherine, who took every opportunity to spread false rumors about Zakrzewska’s performance of her work. Marie pushed herself to the limit of her endurance to prove the earnestness of her dedication to the job at hand, but of course honest hard work rarely wins the day against persistent and deliberate campaigns of misinformation, and by 1852 the swirl of toxic rumor had grown too much to bear and Marie announced her intention to surrender her post at the hospital, and leave the field to those who had spent the better part of a year intriguing against her.
Fortunately, across the ocean, the cause of women’s medical education was proceeding apace, with Elizabeth Blackwell historically becoming the first woman to attend medical college in the United States in 1847, the Boston Female Medical School opening in Boston in 1848, and the Female Medical College of Pennsylvania following in 1850. When word of these new opportunities for women to not only act as midwives and administrators of midwives, but actual physicians, reached Germany, it fired Zakrzewska with a desire to stake her future on a career in the New World, a scheme which her father only relented to if she would take her younger sister to the United States with her. Thus it was that in 1853, with only a hundred dollars in cash to split between the two of them for all their foreseeable needs, Marie and her sister set sail for New York, neither speaking any English, nor possessing any definite connections who might help them on their way to a career in medicine.
This might seem to modern ears like a daring-unto-foolhardy plan - heading to a country whose primary language you don’t speak, to take up a career that doesn’t properly exist yet, with only enough financing to see you through perhaps two months. However, at the time New York was brimming with German immigrants, who formed such a tight web of connections that one could navigate daily life decently well without speaking a word of English, and as to the prospect of studying medicine in a language not her own, well, that was gutsy, but she was perhaps buoyed by the knowledge that many of the greatest medical authorities of that era were French and German, and published their work in those languages, and that therefore her knowledge of European languages could see her through the more modern and advanced material.
Of course, everything went sideways from the virtual start. Her sister was propositioned by a strange man at the pier intent on sucking her into the life of prostitution that many young German women got tricked into pursuing (he was not successful). Nobody was interested in her services as a medical expert, and in fact she found that the term “woman physician” was regarded with intense scorn in her new country, associated as it was primarily with illicit abortionists, and that no woman of decent society would deign to speak with, let alone allow into her house, a person who considered themselves one such. Down to their last dimes, Marie’s sharp mind noticed an economic opportunity, observing that demand for finished tassels in the German shops she frequented far exceeded the supply. So, she took the very last scraps of coin that she and her sister possessed, bought some raw materials, and set to work producing as many tassels as she could, gradually building up a small business that employed other girls, which produced a respectable if fragile income. From tassels she moved to synthetic wigs, and later to embroidered caps, trying gamely to keep one step ahead of the shifting demand of the German shops, and ever wondering if this was to be the rest of her life, just scraping by making frivolities while a real career in medicine slipped ever further from her grasp.
Fortunately, in May of 1854, her path crossed with that of Elizabeth Blackwell, who knew enough German to understand and sympathize with Zakrzewska’s story. Using her connections, she was able to arrange for Marie to study at Western Reserve University in Cleveland, on the understanding that she would learn English while pursuing her medical degree there. These were to be difficult years, her success hindered by her lack of deep understanding of the language, and her mood darkened by the further realization of just what low esteem women medical practitioners were held in, both within the college, and by the world outside. Her time was however lightened by association with a small group of progressive thinkers, espousers of everything from women’s suffrage to free love to socialism, and who included such eminent figures as Ralph Waldo Emerson and William Lloyd Garrison, who encouraged her to stay true to her life’s path.
She remained on course, took her degree in 1856, and returned to New York, where she and Elizabeth Blackwell set up a practice together which could make no headway in the face of the prejudices against women who chose to leave their “sphere” and sully themselves with the medical profession. Unable to thrive in private practice, they hit upon the notion of expanding the dispensary that Blackwell had successfully founded in 1853 into the New York Infirmary for Women and Children, which opened in May of 1857, some three years after Blackwell and Zakrzewska first met. As she had in Berlin, Zakrzewska worked tirelessly at the Infirmary, as administrator, doctor, and mentor, guiding new women students as they gained their first practical exposure to medical work, and organizing programs that brought care to the doors of poor homes that needed it.
By 1859, Zakrzewska had completed the two years of service to the Infirmary that she had pledged herself to, and was being head-hunted to bring her sense of organization and medical professionalism to the cause of women’s medicine in Boston, a city which she had always experienced as far more open to the idea of women physicians than New York. That, plus the opportunity to be the leader of an institution instead of subordinate to the Blackwell Sisters who ran the New York Infirmary, convinced her to relocate to the city that would be associated with her name for the next four decades.
Her first post was with the New England Female Medical College (formerly the Boston Female Medical School which we met above, and which changed its name in 1856 to reflect its new goal of graduating more women physicians), where she was a professor and supervisor of the department of obstetrics. Here, however, she ran against a problem that would bother her for the rest of her career, namely what she perceived as women’s colleges’ willingness to accept women with insufficient study to qualify as good candidates simply to fill out their numbers, and to grant them degrees without their having sufficiently proven their knowledge or skill. Granted, this was a problem of all medical colleges of the era - as a man you could still get a high quality medical degree with two years of middling coursework, and a shockingly brief time picking up practical skills at the side of a preceptor. But Zakrzewska saw laxity in standards as doubly dangerous for women, whose position was still so tenuous that a few individuals, granted a degree too easily, could wreck the reputation of those who had worked so hard to establish themselves in the profession, and provide ammunition for those who had doubted women’s ability to practice medicine.
Understandably, this opinion, that standards should be set and adhered to, did not win her many friends at the college, and it being unlikely that any of her suggestions would be attended to and addressed, she decided, once again, to set out on her own and create an institution from the ground up which represented her full vision of what women in medical practice could be and achieve. This was to be her masterpiece, the New England Hospital for Women and Children, which she founded in 1862, and would act as the driving force behind until her retirement a quarter century later in 1887, seeing its expansion from a couple of rooms in a rented house into a collection of dedicated buildings including a dispensary, in-patient building, hospital where newly graduated medical professionals could gain crucial experience while other American hospitals systematically refused them entrance, and in 1872 the creation of the nation’s first proper nursing school, founded on grounds of complete racial equality, which resulted in 1879 in the graduation of America’s first African American certified nurse, Mary Eliza Mahoney. The Hospital from the first was dedicated to providing its services for free or at minimal charge to the economically disadvantaged, was the first to have a woman in the role of surgical specialist (Dr. Anita Tyng), and soon became a model institution of its type under Zakrzewska’s careful and astute management.
From its opening in 1862 to her death in 1902, the New England Hospital for Women and Children grew from an institution consisting of two physicians and two interns to one boasting a resident physician, 54 attending and advisory physicians, and 13 consulting physicians, with forty years behind it of producing and sustaining some of the greatest medical practitioners of the coming century, including Mary Putnam Jacobi, Lucy Sewall, Anita Tyng, Fanny Berlin, and Hannah Myrick.
For her part, Zakrzewska was happy to step down in 1887 to make room for the rising generation whose path to the profession had been made decidedly less fraught by the work she had done and institutions she had established along the way. Over the next decade and a half, she remained in an advisory capacity to the Hospital, gave popular speeches on the state of women’s medicine, and grappled with the steady decline of her body and mind which she approached with a level-headed resignation made all the more heroic by her complete denial of any belief in an after-life. She lived long enough to see the main building of the Hospital she had founded renamed the Zakrzewska Building (1899), and to see the first major American medical college, Johns Hopkins, open its door to women applicants (1893). From a twenty-four year old young woman stepping off a boat onto the shores of a land whose language she did not understand and which had no occupation to offer her, she ended her life a universally beloved and admired pioneer of the women’s medical community, who gave two generations of women an example to follow, and a place to begin.
FURTHER READING:
Zakrzewska wrote an extended autobiographical note that takes the reader up into the 1860s, which Agnes Vietor published, along with a selection of her letters and speeches in later years, in the volume A Woman’s Quest: The Life of Marie E. Zakrzewska, M.D., which is an invaluable source for the details of Zakrzewska’s hard scrabble early years in America. For secondary sources, you’ll probably want Arleen Tuchman’s 2006 volume, Science Has No Sex: The Life of Marie Zakrzewska, M.D.