Humanitarian commitment in medicine

by Renate Dünki and Elisabeth Nussbaumer

Book review

With the book “Die ersten Zürcher Ärztinnen” (the first female doctors of Zurich), published in 2018, we have come across a publication that is also a stimulus for the present time. With love and great care the author, Heidi Thomann Tewarson, has researched the biography of four women doctors. She has successfully created a vivid picture of these women in their time, a time at the end of the 19th century, when medicine took a dangerous and momentously wrong turn towards racial hygiene. The portrayed young women doctors did not follow this fatal ideology and, each in their own way, unconditionally committed themselves to the well-being of patients in their social working environment – far beyond what is generally expected of a doctor. All four of them decided at the age of 16 or 17 to embank upon a path through life which was at that time unusual and required a lot of courage. They became female doctors with the aim of serving people in need.

Ida Hilfiker-Schmid – energetic in the service of health of mothers and children

Ida Hilfiker-Schmid (1867–1951) opened her own medical practice in 1894. She was an excellent diagnostician and soon a well-known and sought-after doctor. In her work, she expressed a special understanding for social circumstances, which can be a heavy burden on a woman. Her social commitment is reflected, among other things, in her medical work at the Swiss Nursing School, especially in the gynaecological and obstetrical departments. (Historically, the Swiss Nursing School is regarded as a milestone in the modern care of the sick and needy). Ida Hilfiker-Schmid worked for many years in non-profit associations and institutions which set themselves the task of improving the situation of women, mothers and children.
There she worked as a much sought-after speaker on socio-medical topics and was co-founder of the “Verein für Mutter- und Säuglingsschutz” (Association for mother and infant protection). In 1911 she founded the first “Home for Mothers”, (now “Inselhof Triemli”) for pregnant single women, with the aim of creating a refuge for mothers with illegitimate children. At that time, this institution was life-saving for mother and child, because single mothers were very often cast out by their family and by society, and illegitimate children had little chance of survival. Young mothers also received free advice and help on hygienic care and proper nutrition for their infants at a mother’s advice centre specially set up for this purpose. As Ida Hilfiker-Schmid often emphasised, the best protection for a woman is her love for her child. Therefore, everything must be done to strengthen this bond. She valued the appreciation of human life much higher than any interest in a so-called “healthy genetic make-up”.

Pauline Gottschall – first female doctor descending from the peasantry and called the “Sun of Aussersihl”.

Pauline Gottschall (1867–1932) began her professional career as an assistant doctor at the psychiatric clinics of Rheinau and Burghölzli. Under demanding working conditions she was yet very successful in caring for disturbed women and men. After a few months however, she gave up this activity and opened a general practice in Aussersihl, a former Zurich working-class district, as she desired to be able to help more effectively and widely. Pauline Gottschall combined great skills and efficiency in her profession with unlimited dedication and heartfelt sympathy for all her patients. Therefore many patients from far and wide visited her in her large practice, which she ran for 38 years. Her simple and unstudied manner and her cheerful and humourous way worked as an additional healing factor. This earned her the name “Sun of Aussersihl”.

Jenny Thomann-Koller – a solid researcher

Jenny Thomann-Koller (1866-1949) came from an intellectually and politically interested family and assumed responsibility for her four younger siblings at an early age. Her mother advised her to study medicine and introduced her to the first ever Swiss woman doctor, Dr Marie Heim-Vögtlin (1845-1916). Jenny Thomann-Koller completed her studies in 1892. After working as an assistant doctor at the Charité in Paris for seven months, she filled in for colleagues at the Psychiatric Special-Care Home Rheinau. Almost 700 (!) patients were entrusted to her there. In 1895 she was awarded her doctorate. She proved the effect of a “regenerative factor” in her strictly empirical dissertation “Beitrag zur Erblichkeitsstatistik der Geisteskranken im Canton Zürich. Vergleichung derselben mit der erblichen Belastung gesunder Menschen durch Geistesstörungen u. dgl.” – (Contribution to the heredity statistics of the mentally ill in the Canton of Zurich. Comparison of the same with the hereditary burden through mental disorders etc. of healthy people). With this evaluation she distanced herself from the ideological theory of degeneration and the associated readiness to take eugenic measures. Although she revered the psychiatrist August Forel as her teacher, she adopted her own independent, differentiated and critical attitude towards eugenics. In the 1890s, she opened her own practice for gynaecology and paediatrics and administered not only to the medical needs of her patients but also to their need of human warmth, regardless of their status. Jenny Thomann-Koller was also one of the leading physicians of the Nursing School, where she worked free of charge, according to her social convictions.

Josefine Fallscheer-Zürcher - Doctor and benefactor in the Orient

Josefine Fallscheer-Zürcher (1866–1932) described her parents as “highly gifted people, full of character, who led an ample, beautiful and free life in narrow, small circumstances”. Under the loving care of her parents she grew up to be an imaginative and energetic girl. Due to the early death of her father, she spent her youth in an orphanage. Despite the resistance of the head, or “father” of the orphanage, she entered a teachers’ seminar at the age of not yet 16 years, in order to be later admitted to medical studies. During her residency with Charcot in Paris, she developed an independent, critical attitude towards the new method of treatment with hypnosis. For she did not want to exercise power over other people, but to have an effect by means of encouragement and understanding. In her dissertation on “Jeanne Darc. Vom psychologischen und psychopathologischen Standpunkte aus“ (Jeanne d’Arc. From psychological and psychopathological points of view) she dealt with the individual social and political circumstances of this visionary and pursued a cultural-anthropological and socio-psychological approach. After unsuccessful efforts to, as a woman, find a job in psychiatry, and after filling in for colleagues at various places, Fallscheer-Zürcher courageously applied for a medical position in a distant part of the world. When the “German Aid Association for Armenia” was looking for a Christian surgeon, she volunteered for service to this unfortunate, persecuted people. This marked the beginning of her medical exertions in the Orient, which she pursued for more than 30 years, at her husband’s side, thereby relinquishing preferment. During her life in the Orient she had to brave many dangers, diseases and challenges. It was only in her old age that Fallscheer-Zürcher was at leisure to report the case of a young Armenian woman who fell ill with psychosis as a result of horrendous experiences. Only through continuous care in Fallscheer-Zürcher‘s house could this patient and her son be brought to lead a normal and meaningful life. Just as impressive as the mother‘s medical history is the description of the help provided to her son, who initially appeared to be an idiot. Initially, the child was not able to speak, laugh or cry. Very empathetically, Fallscheer-Zürcher describes the development of this child from a traumatised, „autistic“ child displaying great behavioural problems to a healthy pupil who finally became a British state surveyor-engineer with officer’s rank, a man, husband and father fit for life and well-proven in all situations. With this case history, the psychiatrically educated doctor turned against the tendencies towards categorisations prevailing in psychiatry.
In their time, the „first female doctors of Zurich“ faced the challenge of developing an independent ethical stance against the spreading social Darwinism combined with the ideology of the eugenic eradication of “unworthy” life.  Our society today faces a comparable task. Neoliberal thought with its primacy on money and power affects all areas of life. This becomes visible, for example, in our present school policy or in our profit-oriented health policy. Today doctors find themselves confronted with the imposition of being expected to kill people by suicide. This was still unthinkable a few years ago, and it is only just the tip of the iceberg. So they, too, are called on to develop, represent and practice their own independent, ethically responsible attitude, despite the ever-present influence of mainstream media. This also applies to all of us. The four female doctors described in the book, who courageously took a humane path, can serve as role models.    •

Thomann Tewarson, Heidi. Die ersten Zürcher Ärztinnen. Humanitäres Engagement und wissenschaftliche Arbeit zur Zeit der Eugenik. (The first female doctors in Zurich. Humanitarian commitment and scientific work at the time of eugenics.) Schwabe Verlag. Basel 2018

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