This is Archives Oral History interview number 33 with Dr. Frances Stewart, member of the Washington University School of Medicine’s class of 1927.
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 May 17, 1977.
Dr. Stewart, would you tell me a little bit about your early childhood and your family life? Did you have any brothers or sisters who were interested in medicine which got you interested in medicine or were there any other relations of yours that were interested in medicine?
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 as an advisor – as I remember now, he was in the anatomy department. That has been a while back and I’m not sure that I remember what his name is. But he was a Ph.D., and it had been 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 a hold of anybody like me, who was going to have something to do with the medical field, or at least we thought we would, he said, “Register as a pre-medical student, you will never regret it.” He was right. And after I got on in bacteriology beyond that, I [realized] I would rather be a doctor than be a bacteriologist.
You went to the University of Wisconsin as an undergraduate student?
And then I came here. I think one thing you wanted to know is how I happened to go to medical school here. Is that correct?
Yes, and why you went to the University of Wisconsin when you were from St. Louis and then came back here to medical school.
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.
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?
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 – we called it a Noon Clinic meeting, which was in the old operating room theater. 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’d saw. That sort of thing 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.
While you were a medical student, at that time there were that not many women who had gone 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 not treated as equally as the male students by the professors? And also, did the male students treat you differently or thought they should have?
Nobody could have had any better treatment from anybody. There was no prejudice whatsoever. There was no pressure from anyone about anything. In fact I was treated like the rest of the class members were treated by everybody – by the students and the staff. I have no patience with some of these women that I have had contact with who go around with chips on their shoulders. I never had any problems.
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?
Well, of course they were used to women. No question about that. I mean the faculty was 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 have never felt that there was any prejudice against me and I also never felt that I had any favors [bestowed] on me.
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?
Definitely more is demanded of the students. There are so many changes and so much progress [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.
So much more reading to do?
More of everything.
After you graduated from the Medical School where did you take your internship?
I spent my first year here at Maternity [St. Louis Maternity Hospital], and then I went to Detroit. I interned in OB and GYN there and then the following year I had a residency in OB and GYN in Detroit.
Could you describe a little bit about those experiences as an intern and also as a resident?
In what way do you mean? I can give you a lot of things about my first year as an intern. We thought we never got out of that hospital, ever. They don’t work like that these days. They think they do, but they don’t. It was the most rewarding experience – everyplace. You were expected to work and you did it. The more you worked, the more you learned.
Now is that at the St. Louis Maternity Hospital?
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.
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].
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. 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, where its location is now. They had been 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. Because 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. Then I went to Detroit. I hadn’t applied any place else except that hospital.
Why did you leave St. Louis to go to Detroit?
At that time, I didn’t think the opportunity was good enough for me – for another year – to stay here. Things are different now than they were at that time. However, Dr. Schwarz [ed. note: 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.
The after you served your residency in Detroit, did you come back to St. Louis to start your practice?
I understand that you were involved in setting up St. Louis’s first contraceptive clinic. When was that and were there other people involved?
I was involved to a certain extent, but I was not involved the way other people were. This thing started out 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, where they were just starting to talk about it. I went to two or three meetings at his home. He was there and Mrs. [Helen] Buss, 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 and I don’t remember who they were. This thing was talked about and it was a hope that something like this could be started. This was followed up with some more meetings and getting more people interested, and the clinic finally opened the first of August, 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 here at the medical school and that is why they got me involved in that.
When the clinic first opened they had one session a week and Dr. Crossen did that. By February of – that was ’32 – by February of 1933 there were three clinics a week and I worked one of them, Dr. Crossen worked one, and Dr. Leslie 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 started on it in the beginning. Then I did a couple of clinics a week and then they gradually brought in other doctors over a period of time.
What was the name of the clinic when it started out?
When it started out it was the Maternal Health Association of Missouri and it was about 1943 (I think) – somewhere around there – 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.
Was this clinic a neighborhood clinic or was it set up to serve the whole city of St. Louis?
It was set up to serve the whole city of St. Louis and the first clinic that was opened was in a flat on the second floor 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 on, they conferred with the Urban League and some other social agency and decided they would accept – at least it was that time – colored women, now we say “black” women. But 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. And then 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, any unmarried women – [she] didn’t have to have a child – could be accepted.
Could you describe a little bit about these sessions? You said you had three a week or something like that.
That was at the very beginning.
Were they one-on-one, with you talking to the person coming in?
Yes, the doctor saw the patients individually. We had the social worker, at first it was just Mrs. Buss. 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 was being given to her was explained to her by the physician, always. Most of them at that time were using diaphragms.
Was there any opposition?
There was a lot of opposition. At one time— One of the first things that happened was 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 that they were using have 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, they finally got that straightened out and then there was this post office rule – government 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 just automatic, and all of a sudden 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. There had been a lot of outcry at this time. I think that was [the work] of the Knights of Columbus, too. Anyway, they rallied their supporters, and they went down, and they had meetings and all kinds of things. A whole 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. The patients were given – after they were seen by the doctor – this prescription blank was with them and then they took it up to the front [of the clinic] and then the [prescribed] material was given to them. That was usually done by a volunteer worker there. Then all of a sudden there was a problem that came up. 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 the Missouri law said that it must be given to the patient by a doctor or it must be given to the patient by a pharmacist.
So somebody conceived the idea of getting a big market basket. They’d fill the prescriptions and put them in the market basket. The patients stood up in the waiting room up in the front. When they had a basket-full, they’d call one of the doctors. And he would go up and he would say, “Mrs. Jones, Mrs. Smith,” and you would hand them that [prescription]. That lasted for a little while and then it got straightened out. There haven’t been any real serious problems.
Was there any opposition from the neighbors in the area?
No. Mostly the neighbors – the clinic sites were usually not in residential neighborhoods. We are in a residential area right now – the clinic recently moved to an apartment building. Don’t ask me what the address is – 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 awfully bad, terrible. This [new site] is in a big apartment building where there had been a doctor’s office on the first floor, on one end of it. There’s a drug store on the other side. Do I say Euclid? I meant to say Taylor. Newstead.
You said Newstead.
Yeah. Newstead. There’s a restaurant and a grocery store and a few things like that. And outside of that it is [a] purely residential neighborhood and we have a clinic on the first floor there 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 would never have been any opposition.
Was there every any attempt or consideration given to – when you limited the clinic just to married women, did you ever bring in the husbands to counsel with them also, or was it strictly female?
Now there is some of it, but not too much of that right now. But at that time the husbands never came.
Today, do the husbands come in of their own free will?
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. Right now, which is 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 in 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. Most of them.
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?
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 these mothers – mostly the colored women (I can’t get used to saying black) – you would be surprised how many of the mothers – they’ve had one girl, older girl in the family, 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.
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?
It is changing all the time. There are more procedures that are being done at the clinic – at what we used to call the old birth control clinic – there’s much more that 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 medications 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, we started doing 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 the solicited basis – the agencies or the schools [ask], we come to them. There has been a problem about that recently – the pro-life people. We had a course set up for teachers – not students – in the Kirkwood schools. Teachers and guidance counselors and that sort of thing – 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. But 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.
Do you have any other community interests that you are involved with?
Oh, not so much any more, no, because I am just going around and getting lazy.
Going back to the clinic, how many hours are you at the clinic now?
Yes. Is that your full-time practice at this point?
Well, I do more of that than I do anything else. I have four clinics a week at Planned Parenthood, I have two clinics a week at the County Hospital, and I have a – not a maternal health clinic (what do we call it?) a prenatal clinic – the City Prenatal Clinic down at 13th and Wyoming. I go there. But I don’t do any deliveries anymore, I quit that five years ago. I’ve cut the private practice down. I’m tired – I’ve worked hard enough. But I keep busy. If I don’t feel obligated, I just don’t do it anymore.
Are you active in any special societies?
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.
I was wondering whether you would be willing to talk on some of the current problems of medical practice. Obviously there are many problems, but this could be narrowed to a few, such as malpractice insurance.
That is a terrible problem. It’s 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, some 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, it’s going to make a lot of 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. But it’s a real problem.
Then we have all this government stuff which I don’t care much for. Somebody asked me, not very long ago, if I would start in medical school – with what’s going on right now – if I were a young person. And I said “No, I wouldn’t.” I don’t want to work for Uncle Sam; of course in part I am doing it. For instance, the clinics that I have out at the County Hospital – that’s funded by the government. 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.
What about the cost of medical care? That is certainly a problem. Recently, President Carter suggested a 9 percent ceiling on increase in hospital costs. This goes even beyond the hospital, and probably affects the operation of neighborhood clinics. Could you discuss that a little bit, please?
I don’t see how he can say to the hospitals or any other group like that, “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 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. The doctors’ fees haven’t gone up that much [compared to what] the hospitals’ have. How anybody who doesn’t have any insurance can be in the hospital for any time, I don’t know. How can they pay for it. What the answer is – who knows? I can’t see where Carter’s plan is going to help things any.
Do you think this will have a negative effect on quality?
It’s bound to. It’s bound to because the hospitals’ expenses are not going to go down. Their income is going to go down but their expenses are going to keep on going up, so what are they going to do?
So it may eliminate medical care for the poverty level people?
No, I wouldn’t say no. I don’t think that. I don’t think it will totally eliminate it but I think the quality of care is going to be damaged, definitely. It can’t help but be.
Now that your class reunion is over, have you given any thought to the past fifty years – what you have done, changes that you would make if you were starting all over again?
No, I would not start over again with the way the things are at the present time. No, I’m sure I wouldn’t. If my daughter wanted to go to medical school right now, I would say, “No, don’t do it.”
Any other reflections on the past fifty years?
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 with 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.
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?
I think I was given a very good education. The education that the 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.
Anything else you would like to add?
I don’t know.
Thank you very much.