The Doctors Blackwell

by Danielle Ofri
The American Scholar

Review of: The Doctors Blackwell: How Two
Pioneering Sisters Brought Medicine to
Women—and Women to Medicine
By Janice P. Nimura

Elizabeth Blackwell, the first woman in America to earn a medical degree, is an icon. But for most of us in medicine, she is only that. Few people today know much about what she actually did, and fewer are even aware of her younger sister Emily, by far the more accomplished clinician. Janice P. Nimura, in her new book, The Doctors Blackwell, aims to give both doctors their proper due.

The Blackwell clan—two parents, nine children, four “starveling aunts”—originated in Bristol, England, and migrated to the United States after the father, Samuel Blackwell, lost his sugar refinery business in a conflagration. The family lived in New York City but later relocated to Cincinnati. Samuel and his wife, Hannah Lane, were active abolitionists but defined themselves more broadly as ideological contrarians, “striving toward a moral high ground,” Nimura writes, “that the placid mainstream ignored, dismissed, or failed to imagine.” Elizabeth spent her entire life in these “isolated and inhospitable heights,” achieving what she thought was right, but often disdainful of others. Inhabiting those inhospitable Blackwell heights required a fierce work ethic, a rejection of material pleasures, political engagement, and most important, an intense focus on education. The Blackwell children had few friends and few clothes but plenty of books, intellectual stimulation, and moral instruction.

Elizabeth’s path to medicine was not preordained. “The very thought of dwelling on the physical structure of the body and its various ailments filled me with disgust,” she later wrote. When she was 18, however, her father died, leaving the family penniless. The Blackwell sisters (the brothers were much younger) were forced to assume the role of breadwinners, and they turned to the profession that had been central to their upbringing: teaching. Within three weeks of Samuel’s death, they opened the Cincinnati English and French Academy for Young Ladies in their living room, and later they began working as itinerant teachers in isolated small towns.

At around this time, a female friend suffering from a terminal illness of a “delicate nature” confided in Elizabeth: “If I could have been treated by a lady doctor, my worst sufferings would have been spared me.” It’s not clear whether Elizabeth experienced the cinematic click of inspiration, as lore would have it. Nimura suggests that Elizabeth was more influenced by transcendentalist writer Margaret Fuller’s insistence that humanity would not reach its full moral heights until women claimed their independence, in particular by doing the same jobs as men. Elizabeth seemed to view becoming a doctor as a “noble ideological quest,” Nimura writes, not to mention a convenient way to avoid the annoying, pedestrian concerns of love and marriage. (None of the five Blackwell sisters ever married.)

Getting into medical school was hard enough—her admission to Geneva Medical College in western New York rested on a lark vote by a crew of male medical students more akin to frat boys than gentleman-scholars. But the real challenge lay in obtaining clinical training. At the time, medical schools offered only two lecture terms, after which students were left to gain practical experience on their own. Offers from American hospitals did not materialize for Elizabeth, so, in 1849, off to Europe she went.

After British hospitals turned her down, she was finally accepted at La Maternité in Paris, where she was the lone doctor trainee in a class of future midwives. Elizabeth relished her practical training in obstetrics but had to quit after six months, when she contracted aggressive gonococcal conjunctivitis  after irrigating the eye of an infected newborn. After losing her eye, she attended medical lectures in London but was unable to participate clinically.

Back in New York City in 1851, Elizabeth struggled to establish herself as a practitioner of medicine. She gained a certain notoriety in the press, but mostly as an oddity; paying customers were scarce.

In 1854, she opened a small dispensary, a free clinic for poor women and children, in what is now known as the East Village, and discovered that poor women had no trouble viewing her as a doctor.

The difficulty she faced in seeking a quality medical education—and perhaps her less-than-vigorous interest in actual patients—solidified Elizabeth’s lifetime focus on the educational side of medicine. Her younger sister Emily, however, faced the same obstacles yet emerged as a talented surgeon and dedicated clinician. When Emily completed her clinical training (also in Europe), she joined Elizabeth in New York along with Marie Zakrzewska, a Polish midwife who eventually obtained her MD. While Emily and Zakrzewska were responsible for the daily medical care at the dispensary, Elizabeth harbored grander aspirations. Besides spending her time giving public lectures about the importance of hygiene, she wanted to create a new hospital, one that would be a training ground for the doctors graduating from the newly founded women’s medical colleges in Philadelphia and Boston.

Elizabeth raised enough money to purchase a house on Bleecker Street and founded the New York Infirmary for Indigent Woman and Children in 1857.  Luminaries such as Florence Nightingale and Henry Ward Beecher were there for the opening.

The infirmary absorbed all the energies of the Blackwell sisters, albeit in different ways: Emily served as the attending surgeon, while Elizabeth was the infirmary’s spokesperson, administrator, and resident idealist. Their relationship wasn’t always smooth. Although the Blackwell siblings remained steadfastly loyal to each other, Elizabeth seemed to view Emily more as an aide than a partner.

The infirmary offered a venue for newly graduated female doctors to obtain clinical training, but as Elizabeth quickly discovered, many of them had received mediocre educations at the existing women’s medical colleges. So in 1868, the sisters created their own medical school—the Woman’s Medical College of the New York Infirmary, which promised a rigorous education on par with men’s medical schools.

Restless, Elizabeth departed for England within the year. There she focused on moral reform, which included hygiene, sexual propriety, and antivivisectionism, in addition to women’s medical education. She was active in the Social Purity Alliance, the Moral Reform Union, and the National Vigilance Association. (Nimura observes that her “faith in her own righteousness could be breathtaking.”) Elizabeth was not as well received in her homeland as she’d hoped, and spent the rest of her life in England consigned to more ceremonial roles than positions of power.

Instead, it was Emily who invested the next three decades in running the infirmary and the college, solidifying the Blackwell legacies. By 1899, the college, now a full-fledged, four-year institution, had graduated 364 physicians. The year before, Cornell Medical School had begun accepting women, and Emily decided to transfer her students there. The infirmary, however, continued for nearly a century, until it merged with Beekman Downtown Hospital in 1981.

Surprisingly—to modern eyes, at least—Elizabeth openly disdained the suffragists and the emerging women’s rights movement. What good would voting rights be if women hadn’t fully actualized their intellectual capabilities? “Women are feeble, narrow,” she wrote, “ignorant of their own capacities, and undeveloped in thought and feeling.” In her opinion, the problem wasn’t men holding them down; it was women not raising themselves up. For Elizabeth, medicine was merely a way to achieve that.

Like many others, I had always assumed that Elizabeth Blackwell had been drawn to medicine out of a desire to relieve suffering. But that seems not to be the case. “The study and practice of medicine,” she wrote, “is but one means to a great end”—that end being humanity’s full moral awakening. Everyone is entitled to her own reasons for becoming a doctor, of course, and Elizabeth’s motivations do not detract from her accomplishments. After all, how many people have pursued medicine merely for prestige and financial stability, or to satisfy family expectations? Nevertheless, it was Emily who came closer to realizing the image of the pioneering woman physician. She was the third woman in America to receive a medical degree (Lydia Folger Fowler slipped in just between the two Blackwell sisters), and she devoted herself to patient care—taking an in-the-trenches approach to her clinical work and combining it with the administrative grit of running two medical institutions. The Blackwell sisters died in 1910, within months of each other and, in more ways than one, an ocean apart.

Nimura writes fluidly, and her book is an engaging and meticulously documented guide not only to the sisters’ lives but also to the medical practices of their time. We hear about obsolete medical treatments (intravaginal leeches), student ingenuity (stuffing medical textbooks under clothes to avoid paying taxes), and New York trivia (the Blackwells’ infirmary on Bleecker Street was a former Roosevelt residence). But the greater part of Nimura’s achievement lies in how she brings new life to the story of two extraordinary and idiosyncratic physicians who forever changed the medical profession.