In 1847, the idea that a woman could be a  medical doctor was absurd.

Some thought it couldn’t be done.

Others accepted the premise  that a woman could learn to be a physician, but suggested such a woman would need to  disguise herself as a man and go study far away where no one would recognize her –  Paris, perhaps.

But for Elizabeth Blackwell that defeated the purpose.

Her goal was to prove  that a woman could do anything a man could do.

Hi, I’m Sam welcome to Footnoting History.

Once again, I’m going to introduce you to this episode by sharing a little piece of my own  history with you.

When I was in second grade, my class was instructed to dress up as someone  they admired.

Not being a particularly creative person, I asked my mother for suggestions  and her very first thought was Elizabeth Blackwell – the first female doctor in the  United States.

I readily agreed and dutifully prepared a costume.

But when I got to school,  I discovered to my horror that all but one of the other girls had come as Princess Diana.

To  make matters worse, no one, not even my teacher, knew who I was supposed to be (even though I  had a name tag).

So while Elizabeth Blackwell shouldn’t be a footnote, I fear that she has  sort of become one and that’s too bad because she was a really important and inspirational  person.

I’ll be telling you her story today, and if you enjoy learning about her, I hope you’ll  share her tale widely.

You can also learn more about her by looking at the bibliography on our  website www.footnotinghistory.com, which also includes a link to Dr.

Blackwell’s autobiography.

Elizabeth Blackwell was born in 1821 in Bristol, England – the third daughter of Samuel and Hannah  Blackwell.

The couple would go on to have a grand total of eight children – five girls and three  boys.

Throughout her life Elizabeth would remain emotionally tied to her entire family and  corresponded with them frequently.

Rather unusually for their era, the Blackwells believed  in gender equality and offered their daughters the same education as their sons received.

As a result, the Blackwell sisters were all highly accomplished, though none of them ever  married and I can’t help but wonder if there is a connection between their egalitarian stance  and their decision not to bind themselves in marriage in an era where women were expected to be  subservient to their husbands.

The Blackwells were also dissenters against the Church of England,  believers in temperance, and strongly in favor of abolition in spite of the fact that Samuel  Blackwell operated a sugar refinery.

That meant that his livelihood depended on enslaved labor.

That paradox was a difficult one for the family to process and Samuel Blackwell sometimes tried  to shift his business away from dependency on forced labor.

His experiments with using beets  to replace sugar were ruinously expensive.

Elizabeth spent her early days in Bristol  where she spent most of her time with her two older sisters developing a lifelong love of  nature and of reading.

Her recollections on this period of her life in her autobiography, which she  wrote in 1895, make this period sound downright idyllic.

Then, when Elizabeth was eleven  years old the family – which included not only the parents and their children but also three  aunts and two servants – moved to New York.

They would spend the next six years living in New  York City and New Jersey.

During this period, they became even more engaged in the struggle  against slavery, often hosting William Lloyd Garrison (who apparently had a great fondness for  children and for Russian poetry) in their home.

Unfortunately, while New York was good for the  family socially, Samuel’s business continued to suffer.

He decided, therefore, in 1838 to  move the family to Cincinnati in hopes of finding better business opportunities.

Then, only  months after their move, Samuel got sick and died, leaving his wife and children unprovided for.

Once all his debts were settled, he had only $20 to his name, which was not to even enough  to cover rent.

But the family would not starve because the oldest three daughters were already  capable young women.

They supported their mother and younger siblings by opening a boarding school  for young ladies.

This experience got the sisters more involved in debates surrounding the  education of women and all three of them argued strenuously that women had every bit as  much potential as men.

During this period the sisters also fell under the sway of Rev.

W.

H.

Channing – an eloquent preacher from New England and they would be very involved in moral  and religious reform movements in the future.

By 1842, the oldest of the Blackwell boys was  old enough to start supporting his family, so the sisters closed their boarding school  and Elizabeth accepted an invitation to run a girl’s school in Henderson, Kentucky.

It  would be her first time living away from her family.

It was also Elizabeth’s first experience  witnessing slavery in person.

Previously she held a theoretical abhorrence of slavery, now she  learned to really hate it as she watched the abuse of enslaved people.

One incident that made  a strong impression on her involved the use of a small girl as a human shield between Blackwell and  the fire so that if there were sparks it would be the enslaved girl who got burned rather than the  visitor.

While Blackwell’s writing is infused with the casual racism of her era, when she wrote to  sisters, she reflected that it was intolerable be “utterly unable to help [the slaves].”  Almost as bad as the treatment of the slaves, in Elizabeth’s view, were their mistresses  who “think [their slaves] very well off, and triumphantly compare their position with  that of the poor in England and other countries.” When her contracted year in Henderson expired,  Blackwell returned to her family, who were by then situated in a suburb of Cincinnati.

While she  was there figuring out her next steps, the idea of studying medicine was first presented to her.

According to her own narrative, the thought was implanted when Blackwell was visiting one of her  lady friends who was dying of a terminal illness.

The friend, it seems, suggested that Elizabeth  was intelligent and could become a doctor.

She also remarked that “If [she] could have been  treated by a lady doctor, [her] worst sufferings would have been spared.” At first Blackwell  recoiled at the idea, protesting that she “hated everything connected with the body,” preferring  instead to study history and metaphysics.

Once the idea had been suggested, however, she  had trouble putting it out of her mind, especially when it dawned on her that becoming a  physician could be a good alternative to marriage.

But Elizabeth did not know how to go about  becoming a physician so she began writing to all of the doctors in her acquaintance.

She received  scant encouragement.

While there were some men who acknowledged that the idea of a lady becoming a  doctor was good, they also noted that it would be impossible for a woman to actually get a medical  degree because the process was long and expensive.

It was, perhaps, this prognosis that it would be  impossible for her (or for any lady) to become a doctor that drove Blackwell to seek out the  profession.

Incidentally, Blackwell also discussed the idea with Harriet Beecher Stowe, the author  of Uncle Tom’s Cabin, who apparently also believed that the idea of a lady doctor was impracticable.

Stowe also warned Blackwell that she would face strong prejudice if she pursued this path.

Blackwell later observed that the “the idea of winning a doctor’s degree gradually assumed the  aspect of a great moral struggle, and the moral fight possessed immense attraction for [her].”  Indeed, in her later reflections, her quest to become a doctor does take on the character of  a religious crusade.

According to Blackwell’s autobiography, shortly after she committed herself  to becoming a physician she had, and here I quote “the most direct personal communication [with] the  Unseen that [she had] ever consciously had” when, in a moment of despair, she had prayed and her  prayers were answered by a glorious light in which “all doubts as to the future, all hesitation as  to the rightfulness of [her] purpose, left [her], and never in after-life returned.” She would  always present her life journey as a necessary step for the “future of society.” I am reminded  here that while Blackwell’s claim to fame was that she became America’s first female doctor,  she was also a deeply religious person and her faith informed her professional choices.

While  it’s hard to know what Elizabeth’s motivations really were as opposed to what she wanted  people to think they were, the truth is that she pursued the medical profession with grit  and determination.

She persevered in the face of rejection after rejection.

It’s hard not to  believe she didn’t have some powerful motivation.

Before she could really start  pursuing a medical education, however, Elizabeth would need to save some money.

So she  accepted a position at a school in Asheville, North Carolina that was presided over by Rev.

John Dickson, who had previously been a doctor, and who could allow her to test the waters of  medical study.

Rev.

Dickson supported Elizabeth’s ambitions and granted her full access to his  medical library.

As a result, Blackwell would reflect on this move as “the first step in [her]  future medical career.” She liked Asheville better than Henderson, even though there was slavery  there too.

Part of the difference, perhaps, was her new role and the active support she got  from Rev.

Dickson.

She may also have enjoyed the tendency of the students in Asheville to call her  Dr.

Blackwell, though she had not yet formally earned that title.

She also began to try to use  medical techniques.

In a letter to her mother, she rejoiced that she had performed her “first  professional cure” by mesmerizing away a headache.

The other major difference from Elizabeth’s  experience in Kentucky was that in Ashville she could do something that she perceived to help  the enslaved population.

While she was prohibited by law from teaching enslaved children to read,  Blackwell could instruct them in religion and so she opened a Sunday school explicitly for that  purpose.

It was that effort that allowed her to reconcile living in a slave society when she  believed that slavery was inherently a violation of the first principles of Christianity.

When the Asheville school closed in 1846, Blackwell moved to Charleston where she got a job  teaching music at a fashionable boarding school.

She also informally continued her studies under  the guidance of Dr.

Samuel Dickson (the brother of the first Rev.

Dickson).

She was, it seems,  happy in Charleston even as many of those around her (though noticeably not the Dickson brothers)  actively redirected towards the field of nursing.

By the summer of 1847, Elizabeth had saved enough  money to embark on her medical education.

So made her way to Philadelphia which was, at that time,  the premier place for the study of medicine.

She applied to conventional medical schools, where she  was met with derision – at least one member of an admissions committee literally laughed aloud  at her application.

At least two admissions committees reached out to Elizabeth to suggest  that she should disguise herself as a man and go to study in Paris (where medical school was  free).

Reflecting back on this advice, Elizabeth would later write that “the suggestion of disguise  [did not tempt her] for a moment.

It was to [her] mind a moral crusade on which [she] had entered,  a course of justice and common sense, and it must be pursued in the light of day, and with public  sanction, in order to accomplish its end.” She had a point there too, if Blackwell had not received  her medical degree publicly, the example she set would not have opened a path for other women to  follow in her shoes.

For Blackwell, that really seems to have been the point.

It wasn’t so much  that she desperately wanted to be a doctor, it was more that she desperately wanted it to be possible  for women to be doctors.

This point is driven home the fact Blackwell apparently found the study of  anatomy abhorrent.

Even as she was applying to formal medical schools, she was studying privately  with Dr.

Allen to help get over her revulsion.

In spite of the support of Dr.

Dickson, who had  lots of connections in Philadelphia, Blackwell was rejected by all of the medical schools in  Philadelphia and in New York City.

Unwilling to give up, she began to submit applications to  smaller schools.

When the medical department at Geneva University got her application, they  decided to put the matter to a vote by the student body.

All the young men who were enrolled  were gathered together and presented Blackwell’s case.

They were then left alone to debate the  matter and were informed that if even one man voted against the scheme, she would be turned  away.

It appears that the 113 men in attendance thought it would be quite a joke to admit a woman  and so they voted to let her in, even threatening the lone would-be dissenter into silence.

So  it was that Elizabeth Blackwell, a diminutive 26-year-old woman, was admitted to medical school.

By the time she received her acceptance letter, which promised that she would be well treated,  the term was already underway.

So, making all possible haste, Blackwell left for upstate New  York where she secured lodging.

When she arrived in November 1847, she was student number 130 –  dead last.

Almost as soon as Blackwell arrived, Geneva University began getting publicity for  having taken on a female pupil and according to her autobiography some of the doctors at the  college already predicted that Elizabeth’s precedent would allow other women to study too.

While she received a warm reception from her fellow medical students (who treated her like an  older sister) and from most of the instructors, Blackwell soon found that the women in the  community were hostile towards her and had decided that she must be either amoral or insane.

As a result of this broadly negative opinion, she would spend much of her time in Geneva  fairly isolated (though that suited her well enough since it gave her ample time to study).

It took some time, however, for Blackwell to get her footing.

At first there were a few  instructional demonstrations from which she was barred because the instructors worried that as  a lady she was too delicate.

Blackwell, however, would have none of that.

She politely  complained to the faculty that if she was going to become a doctor, she would need  to do everything the men could do.

After she presented her case to the student body, all  restrictions on her education were lifted.

The summer after her first year of medical school,  Blackwell decided to continue her studies by working at Blockley Almshouse in Philadelphia  where she was given rooms in the women’s ward and got to see the medical care afforded to  the poor up-close and personal.

On the whole, she was not pleased by what she saw.

Moreover, while the head doctor was kind, the young physicians shunned her and offered  her no support.

This experience encouraged her to write about typhus when she returned to Geneva  for the winter term.

Her resulting thesis was the most highly applauded of her graduating class  and was soon published.

Elizabeth studied hard, passed her exams at the top of her class,  and finally earned her medical degree.

The graduation ceremony, the best attended that Geneva  University had ever had, took place on January 23, 1849.

Elizabeth Blackwell, having decided it was  unladylike to march in the procession with her male classmates, entered the ceremony discretely  with her brother, and was called up separately from her peers to receive her medical degree.

In her journal that evening, she described the experience as being one of “heavenly communion.” Dr.

Blackwell had already made history by successfully getting her medical degree and  the effects were immediate.

That very year, eight women were admitted to study medicine at Central  Medical College of Syracuse and Rochester and in June 1850 Lydia Folger Fowler became the second  woman in the United States to earn a medical degree.

Dr.

Fowler would later become the first  female professor at an American medical college.

For Dr.

Blackwell, her journey was  still beginning.

After graduation, she returned to Philadelphia to continue her  studies.

Now that she had her MD, she found that she was welcome at many lectures from which  she had previously been excluded.

Nevertheless, she felt she needed more opportunities to  study and so she made her way to Europe with her cousin.

Dr.

Blackwell received a warm welcome  at Queen’s Hospital and at the General Hospital in Birmingham.

Then she visited London where  she gained tours of several hospitals.

Next, she was off to Paris, which, Dr.

Blackwell  had been told, was “the one place where [she] should be able to find unlimited opportunities  for study.” Her first impression of France, was not a positive one and she later observed that  the “Parisians [were] at the same time the most brilliant and the most conceited people in the  world.” While Blackwell hoped to study surgery in Paris, she was instead directed to work at  La Maternité, a state-run institution designed to train women as midwives.

In her letters,  she sometimes referred to her time learning obstetrics as La Maternité as imprisonment, but on  the whole, she was content and she learned a lot.

Then, On November 5, 1849, while she was still  working at La Maternité, Dr.

Blackwell contracted an eye severe infection.

Although she was given  the best care that was available at the time, she completely lost her sight in one eye  and her eyesight in the other eye was left considerably weakened.

This disability did  not prevent her from practicing medicine, but it did mean that she could never be a  surgeon.

Disappointed at this turn of events, Dr.

Blackwell returned to London, where she  received permission to study at St.

Bartholomew’s Hospital where she found herself welcome in every  department but one.

The one that did not welcome her was the department devoted to the study of  female diseases and the reason that they didn’t welcome her was that the department head did  not like the idea of women practicing medicine.

Dr.

Blackwell remained in London to  study for a year.

While she was there, she learned much and she made valuable  connections even forging a friendship with Florence Nightingale.

Like Nightingale,  Blackwell developed a strong interest in sanitation and hygiene.

It was also in  London where Elizabeth first developed a lifelong a passion for providing women  and families with education on how best to raise healthy families.

Even from London,  Elizabeth also encouraged her younger sister, Emily, to become a physician referring to  her in letters as her “future partner.” In July 1851, Blackwell left England to return to  New York and set up her practice there.

According to her biography, the first seven years in New  York were “very difficult” because “the profession stood aloof, and society was distrustful.”  She was also receiving sporadic hate mail.

She also received kind letters from her  friends in England, which, she later asserted, would be part of the reason she eventually moved  back.

During this period, most of Dr.

Blackwell’s clients were Quakers who had become acquainted  with her because of a lecture she gave about physical education for girls (she later published  these lectures, and received accolades for them).

In 1852, Blackwell, who had been excluded from  participating in New York’s existing dispensaries, opened her own dispensary in a poor part of town.

By1854, she had recruited doners to transform her little dispensary into “an institution  where women physicians could be available [to] the poor.” Eventually this institution  would expand and become its own hospital: the New York Infirmary for Women and Children.

At  first, Blackwell worked out of rented consultation rooms until, finding that too expensive, she  got a loan from a friend and bought a house.

In spite of the good work she was doing providing  medical care to the poor (or perhaps because of it), Blackwell was plagued by “ill-natured gossip,  [and by] insolent anonymous letters.” She also struggled with the heat of the New York summer and  with sporadic harassment as a single woman in the city.

Blackwell found life in New York difficult  and lonely so in October 1854, she adopted a seven-year-old orphan girl named Kitty.

Kitty  brought Elizabeth great joy, and would remain her steadfast companion for the rest of her life.

The situation improved when Elizabeth’s sister, Emily, who had followed in her footsteps and  earned a medical degree at the Medical College of Cleveland, joined Elizabeth in New York  after completing a year of additional study in Edinburgh.

The pair would also be joined by  Dr.

Marie Zackrzewska, an immigrant from Germany who had been a talented midwife before Elizabeth  encouraged her to get a medical degree.

By 1856, the three of them were the core medical team at  the New York Infirmary for Women and Children, which settled into its new location at 64 Bleeker  Street the following year.

The infirmary was the first hospital that was run for and operated  by women.

It was also later accredited as a medical college so women could also go there  for training in medicine.

The sisters were not content to provide a bare bones medical education.

Therefore, when they put together the curriculum for the Medical College, they added material and  transformed the program from the then standard 3-year course of study to a four-year medical  program.

As such, the Women’s Medical College of the New York Infirmary became one of the  first four-year medical schools in the country.

The establishment of the New York Infirmary  and the associated medical school was the real fruit of Elizabeth Blackwell’s legacy even  if it would primarily be her sister, Emily, who provided the vast majority of the medical  supervision for the hospital.

It was also Emily, who kept it in operation even when her older  sister moved away.

The hospital was entirely staffed by women (at its height employing  45 of the most prominent female physicians in the country).

It ran on donations so that it  could provide free medical care for women and by women.

While the work being done by the New York  Infirmary for Women and Children was essential, it was controversial and there were many who  distrusted the endeavor or who feared “that without men as resident physicians they would not  be able to control the patients.” These fears, it turned out, were unfounded.

The Infirmary and  Medical College operated for more than a century, during which time it cared for more than a  million patients.

Eventually it evolved into New York-Presbyterian Lower Manhattan Hospital,  which is still open and seeing patients today.

But like I said, while Elizabeth was the founder  of the Infirmary, Emily was the real driving force behind it.

That’s partially because Elizabeth  was still on the move.

During a trip to England in 1859, Dr.

Blackwell had herself enrolled in  the official authorized Medical Register of the United Kingdom.

This register had been created in  the wake of concerns raised by the 1841 Census, which revealed that there were many unqualified  doctors practicing in England (as many as a third of the people who called themselves doctors were  not trained).

So, a list was created to enforce basic standards of training and care.

The list  would make it possible to verify the credentials of medical practitioners no matter where they had  been trained.

The register of 1859 was the first one created by the Medical Council and Elizabeth  Blackwell was the only woman included on it.

She would remain the only woman on the register until  Elizabeth Garrett Anderson qualified in 1865.

Dr.

Garrett Anderson, incidentally, had also been in  touch with and mentored by the elder Dr.

Blackwell since before her own inclusion in the registry.

Blackwell was back in the United States for most of the 1860s.

She got involved with providing  medical care for union troops during the Civil War and she served as the Chair of Hygiene for  the Medical College at the New York Infirmary.

She particularly relished this position because  Blackwell believed that doctors should not only understand medicine but they should also  be able to use their sanitary knowledge to instruct their patients in such a way as  to enable parents to raise healthy children.

In 1869, Elizabeth Blackwell moved permanently  back to England where she accepted a position as Chair of Gynecology at the newly established  London School of Medicine for Women, which had been inspired, in part, by Blackwell’s  hospital in New York.

After her return to Britain, however, Blackwell’s time was mostly devoted to  advocating for social reform and to writing rather than practicing medicine.

During this period, she  worked to promote sanitary and hygiene instruction in schools and helped to establish the National  Health Society in Britain.

She also spoke out strongly against experimentation on animals, not  because she was any kind of animal rights activist but because she feared that doctors might become  desensitized to their patients’ pain and may come to perceive their patients as test subjects rather  than people with feelings.

Her fears proved to be well founded.

There have been moments in which  minority groups and the poor have not been given the care they deserve and have been treated  as test subjects by the medical establishment.

Elizabeth Blackwell died at her home in Hastings  on May 31, 1910.

She was 89 years old.

During her career, Dr.

Elizabeth Blackwell’s work  involved a lot of public outreach both in the form of writing and in delivering public lectures  (most of which were intended to teach women how to maintain healthy lifestyles).

In her view it  was the responsibility of doctors to and here I quote “watch over the cradle of the race; to see  that human beings are well born, well nourished, and well educated” end quote.

She did not,  therefore, withhold her religious and moral opinions for she saw them as very much a part of  medical practice.

She often left the practice of medicine to the women who followed her – in New  York, for example, it was Emily Blackwell and Marie Zakrzewska who saw the vast majority of  patients and provided medical care.

While these limitations in Elizabeth Blackwell’s practice were  due in part to her poor eyesight, they were also a product of her idealism and of the fact that her  goal was not so much to provide medical care as to empower women to provide medical care and to  convince the world that they were right to do so.

Elizabeth Blackwell was simultaneously forward  thinking and backward looking.

She championed women’s education and professional opportunities.

And yet, part of the reason she perceived women to be particularly well suited to medicine was their  “natural” state as mothers and caregivers.

Dr.

Blackwell studied with some of the most important  medical minds of her day but she was extremely resistant to accept the prevailing theory of  bacteriology and she consistently eschewed some of the most popular medical wisdom of her era.

She desperately did not want to see medicine become impersonal and believed that doctors  should know their patients well in order to diagnose them correctly.

And to her credit  her instinct has been somewhat vindicated.

Diagnoses can be more accurate if physicians  understand a person’s medical history and lifestyle.

In helping to establish the New York  Infirmary for Women and Children, Dr.

Blackwell ensured that poor women could access medical  care.

And even when she retired from medicine, Blackwell never gave up the fight.

She continued  advocate on behalf of women.

She also took a personal interest in individual women often  encouraging them to pursue medicine.

So while some of her ideas (and her self-aggrandizing  tone in her autobiographical works) might be sort of distasteful in retrospect, I think we  can all be grateful for the model that Elizabeth Blackwell provided for generations of women.

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