The long life of Elizabeth Blackwell (1818-1910), the first woman to earn a Medical Degree in America, can be divided into two roughly equal parts: four decades of being attentively reviled, followed by four decades of being respectfully ignored, and it’s hard to say which was worse.
Her trailblazing years saw her in constant poverty, attempting to do what no woman in the modern age had yet done, all while suffering the loss of an eye and intensely negative public scrutiny. But then, finally having climbed the mountain, sure of her pre-eminence in the newly emerged field of women doctors, she found herself quickly eclipsed, overrun by a new wave of practitioners whom her struggles had made possible, but who did not feel themselves bound to the Blackwell Model which had gone from revolutionary to old-fashioned in the course of a bit less than two decades.
The Blackwell siblings, of whom Elizabeth was the third of nine, were all a remarkable lot, and included Anna, who sampled seemingly every health and communal living fad of the nineteenth century, Henry, who married suffragette Lucy Stone and became a noted suffragist himself, and Emily, whose skills as a surgeon and cool head as the director of the Blackwells’ Infirmary for Indigent Women and Children were both sources of pride and jealousy to her older, more famous, sister.
Their parents were both religious non-conformists of impeccable devoutness but possessed of a corresponding streak of doctrinal intolerance that would become a hallmark of Elizabeth’s later career. Their father made and lost the family fortune in the slavery-dependent sugar business in spite of being an avid abolitionist. From this mixture of high principle, deep combative faith, and irreconcilable guilt came Elizabeth Blackwell. It gifted her an inflexibility in the face of adversity which would hold her in good stead through the frustrations of her early career, just as it gave her a moral rigidness that turned much of the latter half of her career towards a series of high minded but ultimately fruitless and reactionary crusades.
When Elizabeth was eleven her family moved from England to America after a fire wiped out her father’s sugar business. Hoping to reestablish themselves in the New World, the family moved to New York and settled into what would become decades of steady and demoralizing financial decline. In 1838, Blackwell’s father died suddenly, leaving behind a pile of debt and no clear path to paying it off. The professional options for a respectable, newly widowed woman were few – there was teaching, running a boarding house, and that was more or less the extent of it. The Blackwells, always a family devoted to education, decided to open a school and it was here that Elizabeth Blackwell realized that, fundamentally, she did not enjoy teaching.
But money was scarce, and options few, so for the next years Elizabeth moved from appointment to appointment, scratching together what income she could as a classroom and private teacher in various communities throughout the South. The work was infuriating and unfulfilling as, day by day, Elizabeth had to choke back her rage at the casual cruelty of the slave owners around her and find a way to still be an effective teacher in towns that did not hold her knowledge in any regard.
Meanwhile, the germ of an idea had been placed in her head while attending the bedside of a dying friend. That friend had expressed frustration at always having to avail herself of the medical services of men. Why were there no women practicing medicine to whom a woman could turn? Elizabeth considered the matter. She knew herself to be decidedly averse to being in the vicinity of an ailing body, and everybody she asked told her that it was madness to even consider becoming a doctor. Nobody would take a woman as an apprentice, and even if they did, no medical school would take a woman as a student, and even if they did, no hospital would allow a woman to establish a residency in order to gather experience, and even if they did, no patient would possibly want a woman as a doctor. Any attempt to become a doctor would be an expensive and depressing exercise in futility.
Blackwell being Blackwell, however, the more people protested as to the impossibility of her plan, the more she felt the necessity of seeing it through. To earn money and gain experience, she took teaching jobs that allowed her to study in her spare time with local doctors who, pushing tradition to the side, agreed to instruct her in medicine while she hunted for a medical college that might be persuaded into accepting her and saved up the money to pay for tuition and materials.
Beginning in 1845 she started acquiring direct experience of the medical profession and found that, though she was not as disgusted by disease and injury as she had worried, she was also growing a good deal more skeptical about the effectiveness of most contemporary medical cures and practices. As with so much in Blackwell’s life, this exposure to the confused practices of 19th century medicine had lasting effects both good and ill: it taught her not to invasively over-treat illness when simple rest and nutrition might suffice, but it also gave her an over-confidence in expressing skepticism about the utility of surgery, vaccinations, and medical research that would ultimately damage the solidity of her medical reputation.
That was all far in the future however when, in 1847, she miraculously received word from Geneva Medical College that her application for admission had been forwarded to the student body and they had unanimously voted to let her join. Much has been made of the background to this historical acceptance – how the administration of the college only considered the application out of deference to a famous doctor who championed Blackwell’s cause, and believed that, in passing it to the students, they were effectively ensuring her rejection, and how the students, taking the application as a joke, voted to accept her as part of the spirit of the presumed joke. However muddled the manner of her acceptance, there is no doubt that, once arrived, she made a reputation for herself as a competent and diligent learner, and the students soon demonstrated their entirely authentic regard for her when they voted to allow her to attend the anatomy sections that the college wanted to ban her from.
In the mid-nineteenth century, medical school was nowhere near the ordeal in perseverance it is today. You took classes for half the year over the course of two years and, at the end, you got your degree. Though an improvement over the old apprentice system, by which basically anybody could declare themselves a doctor, the knowledge one received by the end of those two years was not remotely comprehensive, and most of the actual learning of the doctoring trade was expected to be picked up out in the field in private practice or a hospital. Blackwell graduated in 1849, becoming the first woman in American or British history to hold a Medical Degree (though not, as some sources have it, the first woman in history to hold a medical degree: Dorothea Erxleben had earned a Medical Degree in Germany in 1754 thanks to a special dispensation from Frederick the Great).
The event attracted a fair amount of media attention, and a withering amount of professional commentary as medical journals outdid themselves in outrage over the slippery slope to which Geneva had just committed the entire profession. The College rapidly realized the depths of the scorn they had called down on their heads and resolved to close out all women candidates in the future.
But the damage had been done. Elizabeth Blackwell was through, and now had to shoulder the awesome responsibility of demonstrating to the world that a woman doctor could succeed. She realized that one missed diagnosis, one patient casualty, was all it would take for the establishment to, with a resounding Told You So, shut down the idea of women doctors forever. She needed more training, and the best place in the world for that was Paris, where she eventually took a job at La Maternite as essentially a midwife-in-training in spite of her unique and infamous degree.
It was a step down in terms of prestige, but a great advance in terms of experience, and provided some of the most satisfying moments of Blackwell’s career until one day, while treating a patient with the eye disease ophthalmia neonatorum, some disease-carrying fluid accidentally spurt into her own eye. Degeneration of the optical tissue followed, and with it encroaching blindness until the only solution was the removal of the infected eye. Whatever dreams she had of showing the world what a woman surgeon could do were over as her remaining eye, though partially recovered, did not give her anywhere near the clarity required for that profession. For the rest of her life, she had to deal with the constant irritation of a series of variously well constructed false eyes, and even the act of reading for prolonged periods became a torment.
“It’s not easy to be a pioneer – – but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world.”
By 1851, Blackwell had returned to the United States and established herself in practice in New York under the long shadow of Madame Restell. Restell had made her name and wealth as a skillful practitioner of abortions, and her name was as reviled as her services were sought. When the American public imagined a Woman Doctor in the mid nineteenth century, it was Madame Restell who came to mind, and so when Blackwell set up her practice she was widely believed to be little more than an abortion doctor hiding behind a medical degree. Paying patients were pitifully few in these hard years, and consisted almost entirely of members of the Quaker community who had always supported her career.
In 1853, frustrated with her foundering private practice, Blackwell struck out in a new direction, establishing a medical dispensary that offered services for New York’s teeming masses of poor families. She was aided in this venture by a dynamic newcomer from Poland, Dr. Marie Zakrzewska, whose innate genius for medicine was equaled only by her energy and ingenuity as a fundraiser. Together they reached out to the community to fund a larger dispensary which they launched in 1857 as the New York Infirmary for Indigent Women and Children.
This was a landmark moment in the history of medicine, as it gave women who had managed to obtain a medical degree a sorely needed place to gain practical experience. The Infirmary was staffed entirely by women, led by Blackwell’s younger sister Emily, who was herself the third woman in United States history to obtain a medical degree and had a sparkling reputation for surgical skill. Together, Elizabeth, Marie, and Emily made the Infirmary a running success which treated thousands of patients over the next decades and which survives to this day as the Lower Manhattan Hospital.
During the carnage of the Civil War, Blackwell attempted to organize medical aid to the US Army through the founding of the Women’s Central Relief Association, but in spite of her degree and first-hand experience running the Infirmary, the Army gave the job of overseeing nurse training and distribution to Dorothy Dix, a schoolteacher with no formal medical training. Blackwell worked under her, overseeing the application process, anonymous but energetic in seeing that only the best and most dedicated volunteers entered the nursing service.
Cut off from a leadership role during the war, Blackwell’s post-war years brought her one more definitive triumph as, again in combination with her sister Emily, she established the Women’s Medical College. Most colleges still actively opposed women applicants, while the few institutions taking women were, by every observable metric, of decidedly second rate. Emily and Elizabeth decided that what was needed now was a women’s college featuring first-tier professors and facilities where women could actually receive an education equal in quality and accessibility to that of men. One of the first students of the college was, in fact, Sophia Jex-Blake, who would go on to play a major part in the effort to open the British medical system to women.
Emily chaired the obstetrics department and Elizabeth that of hygiene and so, twenty three years after first deciding to attempt for a medical degree, Elizabeth Blackwell found herself not only a doctor, but the founder of a hospital and a college, and the chair of a medical department. She didn’t know it, but this was the summit of her career, and it left her unsatisfied.
Always ready with a new grand plan, within a year Blackwell left the college she had founded and struck out for England to attempt to do for her native country what she had done for her adopted one. Emily stayed behind and, for the next four decades, ran the hospital and maintained her presence at the college, blossoming once out from under the shadow of her more famous sister.
Elizabeth, meanwhile, found that, though she was celebrated in England for her accomplishments, the cause of women in medicine was already well underway. Elizabeth Garrett Anderson, the first woman to earn a medical degree in England, led a Slow And Steady approach to convince the medical establishment of the reliability of women practitioners while Sophia Jex-Blake organized a fiery circle of medical students who used litigation and dramatic appeals to the public to shame universities into accepting women students. Though temperamentally closer to Anderson than Jex-Blake, Blackwell soon found that she didn’t really fit in anywhere, and turned away from practicing medicine to a new career as a social reformer.
This career met with decidedly mixed results. She had come to the conclusion that sex, while good in and of itself in the proper context, was being engaged in to such an outlandish degree that it was threatening the very bonds of society. She said, on the basis of no evidence in particular, that the more sex one had, the more one’s health would suffer, and that the effect was even more pronounced for sex between members of different races. When England legislated, in the midst of an outbreak of syphilis, that prostitutes should be registered and their health regularly screened, Blackwell went on the offensive to repeal the bill and to educate the country away from the practice of prostitution altogether.
Meanwhile, she also spoke out as a strident critic of vivisection in medical research, of vaccinations, of the importance of surgery, and of Louis Pasteur’s germ theory. She lambasted the century’s greatest woman medical researcher, Mary Putnam Jacobi, for her attempts to use research to find the causes of disease, and took public exception to the frequency with which Elizabeth Anderson operated on her patients. To Blackwell’s religiously inclined mind, the root cause of most sickness was a mixture of unclean conditions and moral laxity – if only people were more moral, and had more rest and better food, they would not succumb to illness. It was a view absolutely at odds with the amoral operators of germ theory or the detailed labwork of cellular biology, and it decisively isolated Blackwell from the living pulse of medical progress.
Alone in her beliefs, most of her friends long dead, and largely unheeded by a generation of women doctors whose lives were made possible by her impossible dreams and sacrifices, Elizabeth Blackwell spent her last years in the company of Kitty Barry, a woman she had adopted in 1856 as a girl of seven with the expectation that she would be Blackwell’s personal aid and helper for the rest of her life, and who was forbidden to marry or even entertain a suitor for as long as Blackwell was alive. She wrote books about her social morality theories each of which sold fewer copies than the last, and an autobiography that virtually nobody read, and when she died at last in 1910, she was remembered as she was three quarters of a century before – a daring innovator who pushed past poverty, injury, and infamy to establish women in the medical field against titanic opposition, who gave the women who dared follow her a place to learn and a place to practice their new skills, and an example to follow.
Lead image via Wikimedia, public domain.
FURTHER READING: A new biography of Elizabeth Blackwell comes out every three decades or so, the easiest to find and most recent being Julia Boyd’s The Excellent Doctor Blackwell: The Life of the First Woman Physician (2005) which is a great resource for balancing out Blackwell’s personal drama (including the complicated combination of jealousy and pride wrapped up in her relationships with her siblings), her professional life, and her intricate relation with the early women’s rights movement (which we didn’t have time to go into here, but suffice to say, she was against it).
A bit harder to find, but worth the finding, are Ellen S. More’s books on the history of women in medicine: Restoring the Balance (1999) and Women Physicians and the Culture of Medicine (2008). I also really like “Send Us a Lady Physician”: Women Doctors in America: 1835-1920 (1985), edited by Ruth J. Abram, as a collection of great essays, biographies, and rare photos of nineteenth century women doctors.