In Her Words
Frances H. Stewart – Oral History Transcription
William R. Massa, Jr. interviewed Frances H. Stewart as part of the Washington University School of Medicine’s Oral History Program. The interview was conducted on May 17, 1977. Dr. Stewart was instrumental in establishing the first Planned Parenthood Center in St. Louis. She was also a clinical instructor in the Department of Obstetrics and Gynecology at the Washington University School of Medicine. This interview was conducted on the occasion of her 50th medical school class reunion.
WILLIAM MASSA: Dr. Stewart, would you tell me about your early childhood and your family life? Did you have any brothers or sisters who were interested in medicine or were there any other relatives who got you interested in medicine?
DR. FRANCES STEWART: Yes, my stepfather was a doctor, here in St. Louis. He was in general practice. When I first started out to go to college I thought I would be interested in bacteriology. One of my father’s friends, I think, got me talking about that. When I went to college, because of the fact that I said I was interested in majoring in bacteriology I was given an advisor in the anatomy department. That has been a while back and I do not remember his name. He had a Ph.D., but it was the great regret of his life that instead of getting a Ph.D., he should have had an M.D. because he had lost out on several things. One of them was that he almost was named dean of the medical school at the University of Wisconsin but somebody with a M.D. got it instead. So whenever he got hold of anybody like me, who was going to do something with the medical field, or at least thought we would, he said, “Register as a pre-medical student, you will never regret it.” He was right. I would rather be a doctor than a bacteriologist. I think one thing you wanted to know is how I happened to go to medical school here. Is that correct?
MASSA: Yes, and why you went to the University of Wisconsin when you were from St. Louis and came back here to medical school.
STEWART: I really don’t remember. My parents had friends who had children there. I don’t really know – I had never been away from home; we all felt it was a good idea. But when it came time to go to medical school, this was my home, this was a good medical school – an excellent one – and there wasn’t any reason for trying to go any place else.
MASSA: During your education here at Washington University Medical School, can you remember any of the professors who had a profound influence on you? There must have been lots of them. But can you single out a few?
STEWART: I will never forget to my dying day Dr. Ernest Sachs, who was a neurosurgeon. Not that I was interested in that field, but he was one of the best teachers that any medical student ever had. Anything he brought to your attention, you never forgot. In our junior year, we had a weekly meeting that we called our Noon Clinic, which was in the old operating room amphitheater. He would bring a patient in, get her down there in the bottom [of the amphitheater], and get a couple of students down and say, “What do you see?” And you’d better tell him what you saw. That sort of thing that was an entirely different approach and I think we all learned a lot from him. He was a firebrand, with an awful temper, but he was a wonderful teacher. He was one of the best teachers I ever had.
MASSA: At the time you were a medical student not many women were going to medical school. Did you feel that you were under any special or unusual pressure because you were female? Did you feel that you were treated equally by the professors as compared with the male students, and did the male students treat you differently?
STEWART: Nobody could have had any better treatment from anybody. I was treated like the rest of my class members were treated by everybody, by the students and the staff. I have no patience with some of these women with whom I have had contact who walk around with chips on their shoulders. I never had any problems.
MASSA: Do you think the fact that you didn’t have any problems might have been because some of the prominent faculty members included women here, like Dr. Helen Graham, or Dr. Mildred Trotter?
STEWART: Well, there’s no question that they were used to women on the faculty. But I don’t know that that part of it had anything to do with it. As far as I was concerned, and the rest of the women in the class, we were treated just as the rest of them were. I never felt that there was any prejudice against me and I also never felt that I had any favors bestowed on me.
MASSA: Do you see any significant differences in the way medicine is taught today as opposed to the approach that was taken when you were a student?
STEWART: Definitely more is demanded of the students. There are so many changes and so much progress has been made over the years, I think it is twice as hard for medical students now as it was when I went to medical school. Of course, we thought we had a pretty hard time. I don’t think we had it the way they have it now. There is so much more, everything is so much more involved than it used to be.
MASSA: So much more reading to do?
STEWART: More of everything.
MASSA: After you graduated from the Medical School where did you take your internship?
STEWART: I spent my first year here at St. Louis Maternity Hospital, and then I went to Detroit. I interned in OB/GYN there and then the following year I had a residency in OB/GYN in Detroit.
MASSA: Could you describe a little bit about those experiences as an intern and also as a resident?
STEWART: In what way do you mean? I can tell you things about my first year as an intern. We thought we never got out of that hospital, ever. They don’t work like that now. They think they do, but they don’t. It was the most rewarding experience. You were expected to work and you did it. The more you worked, the more you learned.
MASSA: Now is that at the St. Louis Maternity Hospital?
STEWART: That was every place, but particularly here at Maternity. I worked harder there than I did when I was in the hospital in Detroit, but everybody else did, too. You will never get any place if you don’t work hard.
MASSA: Did you encounter any difficulty in having a hospital accept you because you were a woman? I guess not so much, since you were going into OB/GYN.
STEWART: Yes and no. I’ll tell you what I mean by that. I knew before the internships were passed out that I was going to be an intern at Maternity because I was told by Dr. (William J.) Dieckmann, “If you want to come here, you’ve got it.” I applied also at Jewish Hospital for an internship; I didn’t want it, but a friend of my father’s was a surgeon on the staff there and he wanted me to apply. They had their new hospital then, in its present location. They were formerly on Delmar, west of Union, and they had moved into their new hospital not too long before that. He didn’t see any reason why they didn’t have any women interns, and they didn’t have any. So he asked me, as a favor to him, to apply. He said, “You are not going to get it. I know the people on the intern committee and they are not going to let any women in there, but please do it.” So I did and my answer was, “We have no facilities or quarters for women interns.” Well, I didn’t apply any place else; I went to Detroit. I hadn’t applied any place else except that hospital.
MASSA: Why did you leave St. Louis to go to Detroit?
STEWART: At that time, I didn’t think the opportunity was good enough for me to stay here. Things are different now than they were then. However, Dr. Schwarz [ed. note: this could be either Henry Schwarz or his son, Otto Schwarz] told me that I could stay if I wanted to, but I decided I could further myself a little better if I left.
MASSA: After you served your residency in Detroit, did you come back to St. Louis to start your practice?
STEWART: No.
MASSA: I understand that you were involved in setting up St. Louis’s first contraceptive clinic. When was that and were other people involved?
STEWART: I was involved to a certain extent, but I was not involved the way other people were. This thing started with Dr. Fred Taussig and Dr. Robert Crossen. I don’t remember the exact date, but it was very early in 1932, and I remember that I was called by Dr. Taussig and asked to come to this meeting. They were just starting to talk about it. I went to two or three meetings at his home. He was there and Mrs. Butts [?], who was the social worker and later to be the executive director of the clinic when it opened was there, and Dr. Crossen. There were a couple of other people whose names I don’t remember. This thing was talked about and it was a hope that something like this could be started. It was followed up with more meetings and getting more people interested, and the clinic finally opened August 1, 1933. They had their first board meeting, which I was not a member of, in 1932, but at that time I was doing what we called our Maternal Health Clinic at the medical school and that is why they got me involved.
When the clinic first opened they had one session a week and Dr. Crossen did that. By February 1933 there were three clinics a week and I worked one of them, Dr. Crossen worked one of them, and Dr. Lesley Patton, who has been gone many a day, worked that, too. Then they finally stopped it. They thought it was best for them to get it started in the beginning. Then I did a couple of clinics a week and they gradually brought in other doctors over a period of time.
MASSA: What was the name of the clinic when it started out?
STEWART: When it started it was the Maternal Health Association of Missouri and it was about 1943 that it was changed to the Planned Parenthood Clinic of Missouri. Shortly after that, the name was changed to the Planned Parenthood Clinic of St. Louis. That is the current name. It is affiliated with the national Planned Parenthood Association.
MASSA: Was this clinic a neighborhood clinic or was it set up to serve the whole city of St. Louis?
STEWART: It was set up to serve the whole city of St. Louis and the first clinic that was opened was in a second floor flat on Euclid Avenue, right near McPherson. They had three rooms. The patients were accepted only on a referral basis from the social agency or a physician and they must be white, married women. Later, they conferred with the Urban League and some other social agency and decided they would accept colored women, now we say “black” women, and everybody had to be married. It was some years before they began to accept unmarried women. If they had had a child, if they were a mother, they would accept an unmarried woman. Finally, any woman who had a child whether she was married or unmarried, it didn’t make any difference. Then they changed it so that anybody, even unmarried women who didn’t have a child, could be accepted.
MASSA: Could you describe a little bit about these sessions? You said you had three a week or something like that. Were they one-on-one, with you talking to the person coming in?
STEWART: Yes, the doctor saw the patients individually. We had the social worker, at first it was just Mrs. Butts. Over the years, of course, they added more staff. The patient was interviewed and the history taken by the social worker and she was talked to for some time. The purpose of her visit there was [discussed.] “Why did you come?, What do you expect out of this?”, and she had quite a counseling session. Then the patient was seen by the doctor for her examination and whatever birth control method being given to her was explained to her by the physician, always. Most of them at that time were using diaphragms.
MASSA: Was there any opposition?
STEWART: There was a lot of opposition. One of the first things that happened: patients were allowed to get their supplies after they had been to the clinic, of course. If they were using a diaphragm they were allowed to get the jellies or creams they were using sent to them by mail. The Knights of Columbus or somebody tried to stop that delivery by mail. That wasn’t working out too well. Anyway, we finally got that straightened out and then there was a government post office regulation that they could be mailed.
One of the next things, the clinic had to get a city permit every year. This had always been automatic, and suddenly the clinic was informed by a newspaper reporter that they were not going to get the permit, that the Board of Aldermen was going to deny it. I think that was the work of the Knights of Columbus, too. They rallied their supporters, went down, had meetings and all kinds of things. A group of people decided they were going to go down and practically picket the place, but that got straightened out and the permit was given.
We had another thing one time that was rather amusing. After they were seen by the doctor, patients were given a written prescription which was taken to the front of the clinic and the prescribed material was given to them. Usually that was done by a volunteer worker. Suddenly a problem developed. I don’t remember who started it, but it was a problem. They wanted to know who was handing these materials to the patients, that according to Missouri law it must be given to the patient by a doctor or a pharmacist.
Somebody conceived the idea of getting a big market basket. They would fill the prescriptions and put them in the market basket. The patients stood in the waiting room in the front. When they had a basket full they would call one of the doctors. [The doctor] would go up and say, “Mrs. Jones . . . Mrs. Smith . . . ” and would hand them this and that. That lasted a little while and then it got straightened out. There haven’t been any real serious problems.
MASSA: Was there any opposition from the neighbors?
STEWART: No. Usually the clinic sites were not in residential areas. We are in a residential area right now – the clinic recently moved to an apartment building, I don’t know the address. It’s an apartment building on the corner of Newstead and West Pine. We were on Delmar, a block east of Kingshighway, and the neighborhood [there] got too bad. This [new site] is in a big apartment building where a doctor’s office had been on the first floor, on one end of it. There’s a drug store on the other side. A restaurant, a grocery store and a few things like that are close by. Outside of that it is a purely residential neighborhood and we have a clinic on the first floor where the doctor’s office was. There is no opposition there. The rest of [the sites] had been more commercial than anything else, so there wouldn’t have been any opposition.
MASSA: When you limited the clinic to just married women, did you ever attempt to bring in the husbands to counsel them also, or was it strictly female?
STEWART: Now there is some of it, but not too much. But at that time the husbands never came.
MASSA: Today, do the husbands come in of their own free will?
STEWART: Once in a while, we have a husband who comes in and wants to talk to the doctor, too. But more of that goes on with the social workers – and there’s not an awful lot of that. An interesting point, for the last couple of years now there is a vasectomy clinic in connection with it and they have that once a week, Thursday night. A couple of urologists take care of that, but that is run by the Planned Parenthood Association. We don’t get many husbands coming with their wives. They may bring them there but they sit in the waiting room and for most of them that is as far as they go.
MASSA: Right. I guess they feel that is their responsibility. Do you find that there is a trend that your clientele, your patients, are becoming younger all the time?
STEWART: Oh yes, there is no question about it. Definitely. An awful lot – I don’t mean just college, I mean high school now. We haven’t had any sixth graders yet. I shouldn’t really say that, because we do get them. Some of the mothers – most of them are colored women, I can’t get used to saying black – you would be surprised how many of them have one girl, one older girl, that has an illegitimate child and they [also] have some younger daughters. So they don’t trust [the younger girls] because of the older ones and they will bring them in.
MASSA: Is there anything else you would like to say about the work of the clinic; where you think it will be going, the future of it?
STEWART: It is changing all the time. There are more procedures that are being done at the clinic – what we used to call the old birth control clinic – much more is being done now. At first we did absolutely nothing except give the patient contraceptive advice and if we found any minor medical conditions we said, “We can’t treat you. You have to go to your doctor.” Now, for minor things we do have medication for them and we do give information about that. But anything of any serious nature, of course we don’t try to do anything about; we refer them. But we are doing more and more all the time.
Some years back we started doing Pap tests and gonorrhea cultures besides our regular examinations. We run a pregnancy-testing clinic and there’s a big educational department. We do a lot of work all over town, mostly on a solicited basis, if agencies or schools come. There has been a problem with that recently. A course was set up for teachers and guidance counselors, not students, in the Kirkwood Schools to give them an insight into what the sex education business would be. The pro-life people made such an awful fuss that Kirkwood dropped it. They are still doing a good bit.
We do not do abortions, but we do refer the patients who come to us who are pregnant and want an abortion. We refer them mostly to the Reproductive Health Service. We have a lot of those.
MASSA: Do you have any other community interests that you are involved with?
STEWART: Oh, not so much any more, no, because I am just getting lazy.
MASSA: How many hours are you at the clinic now?
STEWART: Right now, I have four clinics a week at Planned Parenthood, I have two clinics a week at the County Hospital and the City Prenatal Clinic down at 13th and Wyoming. I go there. But I don’t do deliveries anymore. I quit that five years ago. I’ve cut the private practice down. I have worked hard enough, but I keep busy.
MASSA: Are you active in any special societies?
STEWART: I am a member of County Medical Society, and the State Medical Society. I’m a founding fellow of the American College of Obstetrics and Gynecology. I did belong to the AMA, but I quit a few years back.
MASSA: I was wondering whether you would be willing to talk on any of the current problems of medical practice. Obviously there are many problems, but this could be narrowed to a few, such as malpractice insurance.
STEWART: That is a terrible problem. I don’t know what is going to happen about it. I don’t think anybody really does. It hasn’t been too long ago, a doctor sued a patient for suing him for malpractice and he won the case. I think that sort of thing, if it goes on very much, will make a difference in the number of malpractice suits that are brought. I think a lot of the malpractice suits are instigated by shyster lawyers. Maybe I shouldn’t say “shyster,” but some of them are. I don’t think anybody knows what is going to happen.
Then we have all this government stuff that I don’t care much for. Somebody asked me not very long ago if I would start medical school if I were a young person, with what is going on right now, and I said, “No, I wouldn’t.” I don’t want to work for Uncle Sam; of course in part I am doing it. The clinics I have out at County Hospital are funded by the government, but I think we are getting entirely too much poking into our medical business by people who don’t know anything about it and that is why I resent it.
MASSA: What about the cost of medical care? That is certainly a problem. Recently, President Carter suggested a 9% ceiling on increase of hospital costs. This goes beyond the hospital, and probably affects the operation of neighborhood clinics. Could you discuss that a little bit, please?
STEWART: I don’t see how he can say to the hospitals or any other group, “You have to cut this down, your fees have to be lowered.” Because what the hospitals are paying their employees, and for their supplies and everything, is not going to go down. That is going to go up all the time. One of the things that a lot of the people resent is that they say it costs too much to be sick. It does, it costs an awful lot. The doctors aren’t getting what the hospitals are getting in proportion. Doctors’ fees haven’t gone up that much [compared to what] the hospitals’ have. I don’t know how anybody who doesn’t have any insurance can be in the hospital. I don’t see how they can pay for it. Who knows what the answer is? I can’t see where Carter’s plan is going to help things any.
MASSA: Do you think this will have a negative effect on quality?
STEWART: It’s bound to, because the hospital’s expenses are not going to go down. Their income is going to go down but their expenses are going to keep going up, so what are they going to do?
MASSA: So it may eliminate medical care for the poverty level people?
STEWART: No, I wouldn’t say so. I don’t think they will be totally eliminated but I think the quality of care definitely will be damaged. It can’t help but be.
MASSA: Now that your class reunion is over, have you given any thought to the past 50 years: what you have done, changes that you would make if you were starting all over again?
STEWART: No, I would not start over again. Not the way the things are at the present time. I am sure I wouldn’t. If my daughter wanted to go to medical school right now, I would say, “No, don’t do it.”
MASSA: Do you have any other reflections on the past 50 years?
STEWART: It has been very worthwhile. I have enjoyed it. I have enjoyed every moment of it. I don’t know what I would have liked to have done if I hadn’t done that. I don’t regret it by any means, but the way things are now I am sure I wouldn’t start out if I were a young person now. Somebody’s got to do it though.
MASSA: Those are all the questions I have. Do you have anything else that you would like to add, in regard to your practice, your medical education, anything?
STEWART: I think I was given a very good education. The education present-day medical students are getting is different than we got because there is more to learn. There is more that we know about things now that we didn’t know years ago, but I still think we got a very good medical education and I am glad I got it.
MASSA: Anything else you would like to add?
STEWART: I don’t think so.
MASSA: Thank you very much.
STEWART: Thank you.
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