Lilian Freeman Clarke, “The Story of an Invisible Institution” (1906)

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ABOUT the middle of the last century a little girl was growing up in North Carolina among slaves and slaveholders. Her mother was a Southerner, but her father came from New England. He had there had a position as master of a high school, and afterward taught a school for young men in North Carolina.

Susan Dimock was accustomed to say in later life, “I am slow to take an idea; I was always slow: I was eight years old before I perceived the sin of slavery.”

At twelve years old she told her father that she wished to study medicine and become a physician. As her family were then in comfortable circumstances, and living in a community where no women ever worked except from necessity, this was regarded as an eccentricity. But she had formed her purpose, and adhered to it. When about thirteen or fourteen, being at a watering-place, she was observed to be absorbed in a book, and continued sitting in the corner of the piazza for an hour or more. “What interesting story has Susie got?” asked one. An old physician, standing by, replied: “It is one of my medical books, which I have lent her, and one of the driest, too.”

In 1861, at the time of the outbreak of the Civil War, she was fourteen years old; a silent, timid, reserved girl. One day she sat by herself reading, while in the same room several persons were discussing the situation and bitterly denouncing the Abolitionists of the North. In a pause of the discussion, a soft, clear voice was heard saying, “I am an Abolitionist.” Some of those present turned angrily upon her, saying, “If that is the truth, you might at least be ashamed to own it!” She made no reply.

When eighteen years old she was living in New England and studying medicine. It proved that she had the peculiar and rare gifts which qualified her to be not

only a physician, but a surgeon. Dr. Samuel Cabot, one of the highest authorities of that time, said that Susan Dimock would without doubt take the highest rank in her profession as a surgeon.

It was at this time that she formed the friendship that brought so much happiness to her short life—a friendship like that of David and Jonathan. Bessie Greene, this nearest and dearest friend, was as rare a character as Susan Dimock, but there was a strong contrast between them. One was timid, silent, and full of reserved force—a deep well full of inexhaustible treasures; the other, all sunshine and brilliancy—a sparkling, flashing fountain, scattering the jewels of her rare mind with generous profusion.

Susan Dimock studied three years in Boston (1865 to 1868), and four in Zurich and Vienna.

Dr. Funk, of Vienna, said of her: “Among those who attended my lectures in the General Hospital of this city she was one of the most talented and industrious; and all of my colleagues have expressed themselves to me as of the same opinion. I still see her before me, this charming figure, as she stepped into the sick-room, full of modesty and propriety, and as though she were treading on holy ground; as she listened with rapt attention to my every word, as she examined the patient tenderly and with merciful hand, and yet thoroughly and completely; how she handled any and all instruments with skill, clearly comprehending all phases of a disease, accurately distinguishing the essential from the incidental (a rare gift in women); and then, after thorough examination, how she gave, though with due care, still a straightforward, unshaken, independent opinion. I may say, as to her classic repose and the beautiful balance of all her being and action, that it was to me a matter of constant, downright surprise.”

In 1872 she returned to Boston and accepted for three years the office of Resident Physician to the New England Hospital for Women.

It was about this time that my own memories of Susan Dimock begin. My father had known her somewhat earlier, as she had come to him for the letter of recommendation which the rules of the University of Zurich required. The letter was to be written by the pastor of the applicant, or some minister in good standing.

The impression I have retailed of her is of a certain grave sweetness combined with reserved force; an earnestness and dignity which commanded respect and even caused an involuntary sense of awe. “She ruled her hospital like a little Napoleon,” said one who knew her.

Her voice was extremely soft and sweet, her articulation clear, but she spoke slowly and in rather a low tone. I do not remember ever to have heard her voice raised or hurried. Perhaps for this reason, any expression of displeasure was very forcible and made a deep impression, although her tones were at such times only lower and slower than usual. Once, having occasion to reprove her students for some neglect or carelessness, she said to a friend after leaving the room: “Do you think I was hard on them? If you think so, I will go back and say so to them.” Then, reflecting, “ But they must learn—they must remember—a doctor has no right ever to forget!” One of her students said of her, “When I receive a reproof from Dr. Dimock, I lose all sense of hurt in admiration for her manner of giving it.”

Outsiders were admitted to her lectures to nurses. I attended those; and a sentence which closed one lecture made a strong impression upon me. With earnestness which came from deep and strong feeling, she said: “Think that every patient is your sister. Imagine that you see your own sister in that bed before you; and treat her in every respect as you would like your own sister to be treated.”

How to express that which is in truth inexpressible—the depth of her tenderness for the suffering, the weak, the sinful? What is most repelling to the ordinary mind, disease, mental weakness, moral degradation, seemed to win from her only love, pity, and sympathy. I recall her saying of a poor, half-insane patient who was found difficult to manage but was amenable to the influence of Dr. Dimock and of one other friend, “She knows that we love her!” But the tone and manner in which this was said cannot be transferred to paper.

“One department of the Hospital was devoted to maternity patients, and the young physician became deeply interested in these patients; more especially in the young, unmarried mothers, who at this perilous crisis were in especial need of a friendly hand. There was no provision made for caring for them after their discharge, and she suffered much from her unsuccessful efforts to meet and provide for this want by interesting those who, she hoped, would share her feelings on this subject. But help was at hand.

During the winter of 1872–3 Miss Greene (the friend of Susan Dimock) spent some months at the New England Hospital receiving treatment for an accident to her knee which caused a temporary lameness. She soon became interested in the patients in the Maternity Department, and, instead of being afraid to attack a difficult problem and feeling excused by youth and inexperience from handling it, she determined courageously that something should be done.

Her earnestness and hopefulness drew to her side one or two friends (of whom I was one), and our work may be said to have really begun in the autumn of 1873, though planned the previous winter.

Susan Dimock’s laborious and engrossing cares and duties as Resident Physician of the Hospital made it impossible for her to engage in this outside work for the patients, which needed, practically, the whole time, thought, and strength of those who made themselves the responsible workers. She assisted us, however, by her sympathy, her warm personal interest in every patient, and the degree of co-operation which was necessary in making our arrangements for each one before entering the Hospital and after leaving it.

We called this charity “The Invisible Institution,” because, although doing in fact the work of an institution, it was found better to aid each patient as a personal friend; not founding a “Home,” and so avoiding the heavy expenses and cumbrous methods of institutional charity. All the work was done by two or three individuals; and each patient was assisted according to her especial needs.

A saying of Miss Greene’s has stayed with me ever since those early days. In speaking of one or two of those who were hardest to help, she said, “Now, we must not set our hearts upon reforming them. We must be satisfied if we can pour a little oil into their wounds.”

Before we had fixed upon some settled plan, we were once very much puzzled in regard to the destiny of a poor infant whose mother seemed unable to take care of him. “What can we do?” I asked Dr. Dimock; “no institution for infants will accept him; all are full; but when there is a vacancy, no one wants a boy, because boys are hard to have adopted; and, moreover, this child is so ugly, and has some peculiarity of the eyes that makes him very unattractive. No one wants the care of an ugly, sickly, cross baby!” “No,” said she, and then her eyes filled with tears. “I should,” she added.

It was true. Disease, insanity, even vice and sin, drew only love and pity from that deep, tender heart. She believed that the worst people could be reclaimed by love. “It is love,” she said, “that gives a soul.”

For two short, happy years we worked together. Then, in the spring of 1875, these two dear and noble women were called to higher work elsewhere, at the age of twenty-eight. And their work—this part of it—was left to us.

They were lost in the steamer Schiller, off the coast of the Scilly Isles, in May, 1875.

The body of Bessie Greene was never recovered. Susan Dimock’s was found, floating on the water, with an expression of such peace and power on her face that it made a wonderful impression on all who saw it. Even the rough men who carried her to the shore were strongly influenced by it. .

A letter from her friend Dr. Hoggan, who went at once to the spot, is worth quoting. He says:

“One officer, who stood by me while we gazed at the face of the dead, said: ‘Look there! that woman died like a hero! I warrant ye she neither showed nor felt any fear of death! I would willingly meet death to-morrow if I could wear the same expression on my face afterwards.’

“The men who had showed so much feeling begged to lay flowers at her side.

“One officer declared to me that he had never in his life before experienced the power that the look on her face after death had upon him; he told me that had he met her in life he would have been ready, had she ordered it, to leave everything and obey her as a slave. Another told me that even in old age he would retain the vivid impress of her face and recognize her by it, even after death, should he meet her.”

She did wonders in her life, and after her death her body prophesied.

When we left the island, with the case containing the body in our care, those who followed it insisted on putting it on board with their own hands; and one remarked to me, “There I we have placed her on board as gently as ever her mother laid her to her breast as a baby.”

It would be impossible to describe the sense of loss that fell upon her patients and friends.

“Why, Miss C——,” said one of them, “I can’t imagine that woman any different in heaven from what she was here!”

After the death of Susan Dimock and Bessie Greene the work was carried on by a few friends of theirs; the chief responsibility resting on two—Miss Mary Parkman and the writer of this article.

If asked, How has this enterprise succeeded? we answer that, in the most important point of all, it has succeeded beyond our fondest hopes—that is, that a large number of those whom we assist turn out well, and but few disappoint us.

There are a Scylla and Charybdis in all charitable work, and especially in such work as ours.

On the one hand, if a woman receives sympathy and help in money, or money’s equivalent, because she has done wrong, there is a certain justification in the charge sometimes brought against us, of “encouraging vice.” On the other hand, if a young woman receives no aid at this time from those who would assist her to lead an upright life, she is in great danger of falling into the hands of those who for their own purposes would lead her further astray. When, therefore, we are asked, “Are you not encouraging vice? Is it not better to let a woman who has done wrong suffer the consequences of her fault?” we answer, “Much suffering is inevitable, but it is encouraging vice not to assist her.” After some reflection, we decided on the following plan.

The primary object of our work should be:

To assist a mother to retain her infant in her personal charge, when for want of such temporary aid she might be forced to place it in an institution or to give it up for adoption.

Our aim should be, in all cases, to render such a mother able to support herself and her infant as soon as possible.

We did not include the depraved, since other methods and appliances are needed to assist them.

But we did include the young unmarried mothers; for in them we felt a special interest.

Here, then, are the three points which differentiate our work from other charities which have objects akin to ours:

  1. The aiding a mother (temporarily disabled and in danger of being obliged to part from her infant) to keep the child in her own personal care, instead of placing it in an infant asylum, or giving it up for adoption.
  2. The including both married and unmarried in our charity.
  3. The working without an institution. The experience of more than thirty years has confirmed us in the belief that these methods are wise, efficient, and practical.

By including an unmarried mother in our charity we avoid stigmatizing a well-meaning girl, anxious to retrieve her fault, as a member of a degraded class. She is assisted as a mother, not as a “fallen woman” or an “unfortunate” girl. Her fault is neither ignored nor condoned; but the emphasis is laid on something good; on her love for her child. As by our method there is no concealment, the wounded spirit has a chance to heal “by the first intention.” No doubt institutions are necessary for some charities; but we feel that this work, our work, is better done by coming into personal relations, as individual friends, with those assisted.

If a woman is so weak that she must have constant watching, she is like a patient who requires hospital treatment and may need institutional care; but, just as some invalids are cared for by sunshine, fresh air, and exercise, so our patients need work, hope, a sense of responsibility, something to love and live for. It has a bad effect on some natures to shut them up in an institution. They learn self-control and steadiness by not receiving too much support.

The kernel of our work, the fundamental, central idea, is to keep mother and child together.

We have to fight quite a hard battle here. I am glad to say that there are now other charities which take approximately the same position. When we began, there were none; and there are still none which cover exactly the same ground that we do.

We cannot speak too strongly on this all-important point. As we have said, our charity does not include the depraved. But many of our young mothers are weak, childish, and shallow; the conscience and intellect are in embryo, and cannot be appealed to as a guiding force. There remains the one saving, purifying influence, the love of the mother for her child, which draws out and educates her whole higher nature. It is a wonderful thing to watch the effect of this, as we have done for more than thirty years and in hundreds of cases; and we cannot help feeling that we are working in harmony with a wise Providence by encouraging this instinct—in some mothers very strong from the first, in others either crushed or developed according to surroundings.

It is a dangerous thing to take an infant away from a mother of this type. It is saving her reputation at the expense of her character. If deprived of this powerful motive and influence toward an upright life, a daily safeguard from temptation, the empty, craving heart is like the house swept and garnished, ready for the evil spirits to come in and take possession.

Lilian Freeman Clarke, “The Story of an Invisible Institution,” The Outlook 84 (December 15, 1906): 932–936


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