This week was the 200th anniversary of the birth of Elizabeth Blackwell, widely celebrated for becoming America’s first licensed woman medical doctor. Given she achieved this in 1849, it is no small achievement. Five years later, her younger sister Emily became the third woman to do so. Their story is told in riveting detail in The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women — and Women to Medicine, by Janice P. Nimura.
We haven’t read the book yet, it’s not available in ebook format (?!?), and it’s too new to be available in libraries. Actually Nimura’s previous book, Daughters of the samurai: a journey from East to West and back, published in 2016, is also not available in ebook format. Maybe it’s a strategy. A bad one from our perspective… By now there would have been a sale.
Anyway, so we haven’t read the book but we have read the reviews of the book, including the most extensive one in The New Yorker by Casey Cep. Don’t meet your heroes comes to mind… And we’re not talking about the reviewers or the author.
In The Doctors Blackwell, Nimura draws from the many letters the Blackwells wrote, contemporaneous news articles about them, and the histories of the institutions that interacted with them — either educating them or refusing to do so — to bring their story to life. She also opens a window into egregious 19th century medical practices, which evidently makes for some horrendous reading, and it might not be the most appropriate time to cope with that at the moment.
Like stories about the metrotome, which sounds like a more pleasant device than it was. A switchblade of sorts, it was once used to treat fertility issues. A doctor would push the metrotome into a woman’s uterus, press the handle, and release the blade; when he pulled it out, it cut through one side of her cervix. After that, the doctor reinserted the tool and repeated the procedure on the other side. Eventually a version of the metrotome was made with a double blade that could cut both sides of the cervix at once—a supposed improvement on the original design. I did say horrendous!
Elizabeth Blackwell did not approve of metrotomes, or much of anything else that male doctors recommended for female patients in the 19th century. When one of her relatives faced the prospect of being treated with one, she argued for less invasive interventions and cautioned that the scarring resulting from the procedure might make pregnancy even less likely. Although neither Elizabeth nor Emily were especially interested in women’s health, the lack of opportunities available to them in the field of medicine meant that they mostly treated female patients and were often limited to obstetric and gynecological care. In order to expand their practice, they opened the New York Infirmary for Indigent Women and Children, the first hospital staffed entirely by women, which went on to treat more than a million patients in its first hundred years.
The Blackwells were medical pioneers, but, except for a few professional awards named in their honor and a plaque commemorating the location of their infirmary, they have largely been forgotten. Possibly the result of the achievement versus character conflict, with character almost wiping out the achievement.
Elizabeth Blackwell was born in Bristol, England in 1821; Emily in 1826. Nine Blackwell children, five girls and four boys, survived past infancy – Anna, Marian, Elizabeth, Samuel Charles, Henry, Emily, Sarah Ellen, Howard, and George Washington. The father, Samuel Blackwell, owned a sugar refinery and was active in the anti-slavery movement, despite his sugar investments profiting from backbreaking slave labor. In 1832, after the sugar refinery burned down, the family moved to America in pursuit of business opportunities and progressive ideas. They spent the next six years in New York City and the suburbs of Long Island and New Jersey. Elizabeth attended school and threw herself into the abolitionist movement, attending anti-slavery meetings and sewing for abolitionist fundraising fairs.
In 1838, with the New York sugar refinery struggling, Blackwell moved his family to Cincinnati where he hoped to plant sugar beets rather than participate in the odious Caribbean sugar trade. But he died a few months later, leaving his family with few resources other than brains and grit. After her husband’s death in 1838, Hannah Blackwell opened a school with her daughters and her sister-in-law Mary Blackwell, in order to support the family and pay for the education of the boys. Her intent was for each child to be self-supporting: the girls by teaching at home or further afield and the boys in business. The school closed after a few years, and Elizabeth went on to teach in several states. It is during this time that she had the meeting with the dying family friend that changed her life.
Neither of the Blackwells sisters showed any early interest in medicine. “I hated everything connected with the body, and could not bear the sight of a medical book,” Elizabeth writes in an autobiography that she published in 1895. “I had been always foolishly ashamed of any form of illness.” She did, however, watch steadfastly as her father died of complications from what was likely malaria, tracking his pulse and breathing as both weakened and noting those measurements in her journal, along with the amount of brandy, broth, and laudanum he was spoon-fed in his final days. Many accounts have suggested that this was formative for her career, but Elizabeth did not cite her father’s death as contributing to her decision to become a doctor. Instead, she describes how a female friend encouraged her to consider medicine: “If I could have been treated by a lady doctor,” Blackwell remembers her saying, “my worst sufferings would have been spared me.” She definitely would have been spared the metrotome.
The elder Blackwells were English Dissenters, and their religious ideals manifested not only in their abolitionism but also in domestic thrift and moral zealotry, and all nine of the Blackwell children inherited the reformist energies and moral seriousness. At least in words if not in deed. Elizabeth found slavery abhorrent, but “rescued” an Irish orphan girl in New York City, kept her as a lifelong servant, and declined to grant her any freedoms in adulthood.
“The idea of winning a doctor’s degree gradually assumed the aspect of a great moral struggle,” she wrote in her memoir, “and the moral fight possessed immense attraction to me.”
Her teaching jobs took on new meaning: to earn money to fund her education. Eventually she applied to 29 medical schools and was rejected by them all. Fortunately, she had a mentor, an esteemed physician, who wrote a letter on her behalf to Geneva Medical College, an Episcopal school in upstate New York.
And yet, Elizabeth Blackwell was admitted to Geneva Medical College as a joke. The acceptance letter came from the students of Geneva Medical College. Dated October 20, 1847, it contained the following resolutions: “That one of the radical principles of a Republican Government is the universal education of both sexes; that to every branch of scientific education the door should be open equally to all; that the application of Elizabeth Blackwell to become a member of our class, meets our entire approbation; and in extending our unanimous invitation, we pledge ourselves that no conduct of ours shall cause her to regret her attendance at this institution.”
Although this promising letter purported to reflect the deliberations “of the entire Medical Class of Geneva Medical College,” it failed to explain why Blackwell’s admission had been relegated to the student body. The answer was that the faculty had opposed it but did not wish to offend the esteemed physician who wrote her recommendation letter, and so punted the issue to the students. Nor did the letter explain how those students had come to unanimously support her application: aware of the faculty’s opposition, delighted by the prospect of pranking them, and knowing that their decision had to be unanimous, they menaced the only dissenter until he relented. In the end, the motives of Blackwell’s fellow-students did not matter; she set off right away, starting the fall term a few weeks behind the men in her class.
When Elizabeth started medical school, in 1847, the American Medical Association had only just been founded, in part to standardize education, and an M.D. could be earned in two years. While she was at Geneva, townspeople came to gape at her during classes, fellow-students disparaged her (so much for the pledge about their conduct), and medical journals covered her enrollment as if it were some new disease that needed to be observed and possibly cured. Even the British humor magazine Punch took notice, initially, if facetiously, applauding the first female doctor for “qualifying herself for that very important duty of a good wife—tending a husband in sickness,” later belittling her with a mocking poem called “An M.D. in a Gown,” and eventually publishing a caricature of her sister treating a dog.
Emily started medical school just four years after Elizabeth completed her degree. She was rejected by Geneva, where the faculty had decided not to admit any more female students. Ten other medical schools rejected her application and when she began her studies at Rush Medical College, in Chicago, she was forced to leave after the first term, when the State Medical Association voted to ban the admission of female students and forced the school to expel the one they had already enrolled. She finally finished her degree at Cleveland Medical College, graduating on February 22, 1854, in a ceremony also attended by that school’s only other female graduate, Lydia Folger Fowler.
Nimura details the many obstacles for a woman to study and practice medicine in the 1840s and 50s: gender roles and prejudice against supposed female weakness that would preclude professional usefulness; social disapprobation of women studying the body alongside men; and the jealous gatekeepers of the nascent medical profession at a time when male doctors were pushing female healers to the margins. Male practitioners worried that female patients would wish to see only female doctors. Harriet Beecher Stowe (author of Uncle Tom’s Cabin) actually discouraged Elizabeth from trying to become a doctor because the obstacles were too formidable. Florence Nightingale, a celebrity in Europe, was opposed to female doctors. And even the Blackwell sisters themselves were not supportive of other women seeking medical degrees. And not because of the obstacles they themselves faced.
Both Blackwell sisters struggled to find places where they could practice medicine. Elizabeth worked one summer at Philadelphia’s Blockley Almshouse, with help from Emma Willard (founder of Troy, NY’s Female Seminary and an authority on history and geography), where she cared for the indigent and the mentally ill. After that she went to Europe, working first in obstetrics at La Maternité, in Paris, then studying surgery at St. Bartholomew’s Hospital, in London. Emily managed to find a slot attending lectures and observing operations at Bellevue Hospital, in New York, but, ultimately, she, too, had to go abroad, moving to Scotland, where she trained with the queen’s physician, James Simpson, a professor at the University of Edinburgh whose thriving obstetrics practice included some of the earliest experiments with chloroform and ether.
Among the many women who sought treatment from Simpson during Emily Blackwell’s time in Edinburgh was a cousin’s wife, Marie Blackwell, who had been unable to have children. Simpson, a champion of the metrotome, recommended surgery for Marie right away. Emily spent the rest of the year tending to her cousin, whose procedure was technically a success, since her cervix was widened, at least temporarily, and she did not hemorrhage, but whose convalescence included bouts of inflammation, peritonitis, and ovaritis, along with painful mouth sores from the mercury in the drugs she had been prescribed. “The whole case from beginning to end strikes me as a horrid barbarism,” Elizabeth wrote from New York when she heard about all the complications. Be that as it may, Emily insisted that her close supervision of Marie’s care had “made a Dr of me.”
Marie Blackwell’s experience was like that of many patients before the arrival of antibiotics and antiseptics, and The Doctors Blackwell documents the fascinating and harrowing history of modern medicine. As Nimura explains, the sisters entered the field at a time when it had hardly advanced beyond the four bodily humors. “Thermometers were not yet in use to diagnose fever, and aside from poking, listening, peering, and taking a patient’s pulse, there was no accurate way to divine what might be happening inside the body, and even less certainty about why. Treatment was a matter of better-out-than-in: trying to expel the problem with a toxic arsenal of emetics, laxatives, diuretics, and expectorants, not to mention lancets, leeches, and blisters.”
Neither sister was satisfied with the way medicine was being practiced or taught. “Medicine is always an evil,” Elizabeth once wrote, “though sometimes a necessary evil.” She experienced both realities firsthand after losing her eyesight to gonorrheal conjunctivitis, which she contracted while she was treating a newborn. Her own subsequent treatment included three weeks of cauterizing her eyelids, leeching her temples, painting her forehead with mercury, and applying belladonna and opium ointments. She regained vision in her right eye, but not her left. When the pain and swelling did not subside, she went for hydrotherapy in what is now the Czech Republic. The naturopath who ran the water-cure sanatorium had grown famous for surviving a near-fatal accident as a teen-ager by treating himself with wet bandages and drinking water, and Blackwell hoped to experience his alternative cures for herself. But the sight in the left eye never returned; eventually she had it removed and replaced with a glass prosthesis.
The failures of her own case did not entirely sour Elizabeth on novel treatments, and when she and her sister opened the New York Infirmary for Indigent Women and Children, in 1857, they promoted practices borrowed from hydrotherapy and hygienic cures — basic routines of bathing and sanitation that were so contrary to mainstream methods that they attracted protests for “killing women in childbirth with cold water.” In fact, they were saving women; one of the greatest innovations in health care at the time was hand washing, which doctors had previously failed to do even when moving between morgues and maternity wards. Despite the opposition, the Blackwells and their staff treated nearly a thousand patients in their first year, and performed three dozen surgeries. Both sisters also began giving lectures and teaching classes on public health.
Emily profited from Elizabeth’s fame, but suffered in her long shadow. Yet Emily was the better doctor, an accomplished surgeon with compassionate bedside manner. Marie Zakrzewska — “Dr. Zak” — a Polish immigrant, joined them in the 1850s, having lost an unprecedented appointment as chief of midwifery at the University of Berlin when her mentor died. The Blackwells recognized her strength and accomplishments, insisting that she qualify to practice in America. When Elizabeth moved permanently back to England leaving Emily in charge of the clinic with its accompanying administrative headaches, Emily came into her own and continued to practice medicine until she was seventy-three, retiring only after closing the women’s medical college, in 1899.
Elizabeth wrote and lectured for the rest of her life, a moral crusader against “social evil” since she regarded disease as a moral failing. She advocated for the “good-wife-wise-mother ideal,” for family planning, and for health education.
Although their degrees and their methods made them pioneers, that word implies a radicalism they rejected. Elizabeth, in particular, disdained the poverty and the alleged promiscuity of some of her patients. Even as germ theory was taking hold, she continued to regard disease as a moral failing. She espoused phrenology, opposed contraception, and campaigned against vaccinations. Neither sister was especially supportive of other women seeking medical degrees, even going so far as to refuse them the honorific of ‘Doctor’. Only begrudgingly and for financial reasons did they finally add a female medical college to their infirmary, after long dismissing women’s schools as inferior.
It gets much worse… “Women are feeble, narrow, frivolous at present: ignorant of their own capacities, and undeveloped in thought and feeling,” she explained in a letter, and then emphasized that this was their own fault: “The exclusion and constraint woman suffers, is not the result of purposed injury or premeditated insult. It has arisen naturally, without violence, simply because woman has desired nothing more.” This is a surprising conclusion from a woman who had desired something more, only to face resistance at every stage of her career from all-male institutions — and who then watched her sister suffer the same systematic exclusion. And yet, Blackwell also held in that letter that “when woman, with matured strength, with steady purpose, presents her lofty claim, all barriers will give way, and man will welcome, with a thrill of joy, the new birth of his sister spirit.” There’s delusion dressed as idealism…
Some of the only men who actually did welcome the sister spirit were Elizabeth’s own brothers, and she excoriated them for it. Two of the brothers, Henry and Samuel Charles, married leading women’s rights activists — Lucy Stone, one of the first American women to earn a college degree and the first one on record to keep her maiden name, and Antoinette Brown, the first female ordained minister in the United States. She disapproved of their marriages to feminists and was appalled when her younger brother Henry wrote to ask for her help in editing a protest statement he planned to read during his wedding ceremony. He and his fiancée wanted to denounce the laws that “refuse to recognize the wife as an independent, rational being” and grant the husband powers “which no honorable man should possess.” Elizabeth called the statement foolish, and she accused him of acting “in bad taste” and performing “vulgar vanity” by politicizing his marriage.
Today, Lucy Stone and Antoinette Brown are better known than the Blackwell sisters. This is hardly surprising: in addition to their own accomplishments, both of those women joined movements that championed the cause of other women, who, down through subsequent generations, had reason to honor and remember them. By contrast, the Blackwells come across in Nimura’s book as careerist, and with an ambition and idealism verging on misogyny. Elizabeth, in particular, envied the popularity and financial success of Florence Nightingale and looked down on nursing. She dismissed Dorothea Dix, who helped to organize medical care for the Union during the Civil War, as “meddler general”. That didn’t stop her from appealing to other women to further her own causes. Elizabeth sought out for years Lady Byron to be her patron. In addition to opposing women’s suffrage, she was condescending and serially alienated both her colleagues and members of her own family, and viewed herself as a “deity”. Delusional and narcissistic…
The author might be on the deferential side toward her subjects, or unwilling to make them totally unsympathetic, not fully confronting the deepest contradictions of the Blackwell sisters: as women who sought their own advancement while opposing women’s rights, as doctors for whom the etiology of disease lay in moral degeneracy, and glossing over some discordances of their public and private lives. Elizabeth adopted an Irish orphan Nimura describes as “a daughter to compensate for her childlessness.” Perhaps; but the girl worked as an unpaid domestic servant, was forced to address her employer as ‘Dr. Elizabeth’, and was prevented from pursuing her own social or professional interests and from marrying. And despite the passage of more than a century, Nimura is as coy as her subject in describing the decades-long relationship between Emily Blackwell and Elizabeth Cushier, offering this anachronistic assessment: “Emily’s partnership with Elizabeth Cushier was warmed by love.” Cushier was professor of medicine at the college and Blackwell’s life-partner for twenty-eight years. About the relationship, Dr. Cushier wrote, “Thus the years happily passed” until in 1910 “a sad blow came in the death of Dr. Blackwell, making an irreparable beak in my life.”
But, Nimura is a close and delightful observer of the Blackwells world. The book brims with hints of richer stories: the whole of the Blackwell clan and their spouses; the cohort of pioneering female doctors to which the Blackwells belonged; the advancement of medicine beyond its days of “horrid barbarism” and the roles that women have played in that progress. However unsympathetic the Blackwells seem, the material good that they and their infirmary accomplished for countless women can’t be denied. The metrotome has long since fallen out of use, but the institution the Blackwells founded has not: the New York Infirmary for Indigent Women and Children, now part of New York Presbyterian Hospital, endures. And the New York Presbyterian presents a totally sanitized version of the sisters history.