#55 Following in Her Footsteps
Although women have been midwives and healers for centuries, our status as physicians was slow and difficult to navigate. The rights of women to study medicine and become licensed as physicians was taken up by several intrepid 19th Century immigrants to our country. When I lecture at medical schools and hospitals, the attentive faces of female students fill half or more of the seats. Knowing how they were able to get there will help keep this accomplishment in perspective. This review appears in the Book Club column of the October 2022 edition of The DO magazine.
Janice Nimura’s The Doctors Blackwell (WW Norton and Company) presents so much more to her audience than the history of these two pioneers in medicine. The story of Elizabeth and Emily Blackwell casts the spotlight on a tumultuous time in American history. The sisters’ prodigious correspondence reflected on the great causes of their day: slavery and the Abolitionist movement, the Women’s rights movement, North versus South and rich versus poor. The improbable fact that the sisters obtained medical degrees during this era reflects makes their achievement even more remarkable.
The Blackwells immigrated to the United States from England as children in a large family of active abolitionists and religious dissenters. The loss of their father during a cholera epidemic drove them to their mission to become the first female doctors educated in the United States. But first, Elizabeth had to undertake the nearly impossible task of gaining admission to medical school.
Elizabeth was firmly rejected from every medical school she approached for admissions. The faculty of Geneva Medical College in upstate New York turned the big decision over to its student body, and those men voted unanimously to allow her in. their intention was to enjoy in the humor of the spectacle. Elizabeth was determined not to become the butt of their jokes. She graduated at the top of the class.
After her classroom studies, she turned to obtaining clinical experience as options for further training were severely limited. She became the first female resident worked at a public hospital in Philadelphia. Taking an entry level position in the great city obstetric hospital in Paris, gave her unparalleled clinical experience in medicine, obstetrics, and surgery. While delivering a baby in Paris, her eye was splashed with gonorrhea-infected fluid. Medicated soaks and leeches applied to the temples did not work. Nearly 100 years before the development of antibiotics, she lost her eye. With her procedural capabilities restricted, she turned towards medical care and raising funds for her clinic.
Elizabeth Blackwell was not gloved or masked during a delivery and an infection caused the loss of an eye.
Elizabeth’s success did not open the doors of other medical schools to female applicants. Her alma mater in Geneva declined to admit her sister Emily when she applied three years after Elizabeth graduated. Emily talked herself into Rush Medical College in Chicago, but when she suddenly found herself expelled from Rush after a year when her mentor exited, she had to persuade a dean in Cleveland to let her finish and graduate. Elizabeth and Emily viewed the women’s medical college that opened during this era as inferior in faculty and lacking in the standard curricula.
Elizabeth Blackwell emerges as a prickly and eccentric character through her written correspondence and journals. “Caring for suffering individuals had never been the engine that drove her. In becoming a doctor, she meant to heal humanity.” (page 69) Along with a Polish emigree, Marie Zakrzewska and her sister Emily, the three founded and staffed a clinic for women, then a women’s hospital, and, finally, the uniquely rigorous Women’s Medical College in New York City. Elizabeth eventually turned away from the clinical practice of medicine and more towards matters of public health and hygiene.
Elizabeth did not view other women as intellectual equals who were ready for the vote and equal rights. Even as one of her sisters-in-law was notable women’s rights leader Lucy Stone, she disdained any connection to the suffragist movement. The networking and fund-raising necessary to keep the project afloat financially took tremendous effort when the role of a woman outside of domestic life was not recognized or accepted.
Emily comes across as a more accessible person who was very much interested in direct patient care and surgery. She was a perfectionist who found it difficult to accept other women in the profession who she deemed to have had inferior training. She carried on as the dean at the New York Infirmary for Indigent Women and Children after Elizabeth went back England in 1869.
The men running the medical schools reflected the generally held opinion that women simply could not handle the intellectual rigor and gore of medicine. Women were expected to stay home, have children, and do the household chores. The expectation for any woman entering the medical profession as a physician was that they would also forego marriage and traditional family life.
Both Elizabeth and Emily, who never married, adopted daughters from the local orphanage in New York City. Readers today may judge the ladies harshly for adopting children for the purpose of companionship and service. People of the 19th Century viewed (even their biologic) children as helpers and companions. Elizabeth’s child, Kitty, called her Aunt Elizabeth, and was bequeathed half of Elizabeth’s fortune. Emily’s daughter called her “Mama” and by all accounts, was treated as a much-loved daughter. Emily lived in her latter decades with Elizabeth Cushier, who trained as a gynecologic surgeon at the Blackwell’s school. As with the custom of their era, the ladies were devoted companions and not forthcoming with the details of their personal life.
The author, Janice Nimura, does her best to weave a readable story out of the lives of two remarkable and rather eccentric ladies. Even more interesting, is the light shone on the primitive state of medicine in the early 19th century. “The first half of the nineteenth century was the high-water mark of what came to be known as “heroic medicine.” Doctoring had become an established profession, but the state of medical knowledge had not evolved much beyond the Hippocratic doctrine of the four humors (black bile, yellow bile, phlegm, and blood), the four elements (earth, air, fire, and water), and the four qualities (hot and cold, wet and dry) whose imbalance was thought to be the root of all illness. (Page 51)
By 1899, the Women’s Medical College was closed as the older and well-established institutions such as Johns Hopkins and Cornell finally accepted women students and faculty. Emily stated at the final commencement, that the Women’s Medical College “had held open the door for women until broader gates had swung wide for their admission.” (p. 265)
Emily Blackwell also spoke these words to the last class of lady physicians graduating from her college.
“You will be brought in contact with the working ways of men. Get from this new companionship all that is good, but do not lose in it a particle of what is truly and desirably your own…It is for us to do our part, that hereafter the old and time-honored profession may be proud of her daughters as of her sons.” (p. 265) Today, more than half of all medical students are women who symbolically enter through those gates once opened by Elizabeth and Emily Blackwell.
