Rochester, Minnesota, United States
The Doctors Blackwell. Janice P. Nimura.
Edith Lutzker celebrated the centennial anniversary of the struggle of five British heroines in her 1969 groundbreaking book Woman Gain A Place in Medicine. Much less has been written on women physicians in Europe and Asia, but the Italian universities admitted women to study and teach medicine beginning in the fourteenth century. Elizabeth Blackwell (1821-1910), however, has been recognized by many historians as the one who blazed the trail.
Before achieving the degree of medical doctor in the US, Elizabeth Blackwell lamented: “I wish I could devise some good way of maintaining myself but the restrictions which confine my dear sex render all my aspirations useless.” Blackwell, a small, young, shy, “simply dressed” lady with a “gentle manner,” persistently pursued her aspirations. Janice P. Nimura’s book, based on deep archival research, follows Elizabeth Blackwell’s medical career and collaboration with her sister, Emily Blackwell (1828-1910). They co-founded the New York Infirmary for Indigent Women and Children and Woman’s Medical College of the New York Infirmary, a medical school for women. While recounting this groundbreaking career, Nimura portrays the dissonance that Elizabeth surely felt as a pioneering woman in medicine by relying extensively on the sisters’ written correspondence to their close-knit family and connections in America and Europe.
Elizabeth’s medical school applications were rejected at all but one school, Geneva Medical College. Nimura recounts that Blackwell’s 1847 admission was intended as a hoax. (One account is that she signed her application with initials only so her gender was unknown.) While in medical school, Elizabeth’s impeccable demeanor earned her the respect of her colleagues, even though she was viewed as a spectacle in the classroom and community. Her training piqued international interest and she was elevated on a feminist pedestal, though her early writings to feminists express harsh views: “Women are feeble, narrow, frivolous at present, ignorant of their own capacities, and undeveloped in thought and feeling.” Elizabeth considered herself an exception: “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.” In her medical training that foreshadowed clinical practice, she was largely confined to caring for women. During training, her views shifted as she confided to Emily that “women will have to save women after all, they have the truer love & understanding for their own sex.” In Nimura’s words, “Elizabeth regarded women with the calm superiority of a benevolent deity.”
Following graduation, Elizabeth pursued training in London and reveled in London society, establishing longstanding correspondences with Florence Nightingale, Lady Byron, and others. While she was accepted academically, opportunities to practice were scarce. She moved to Paris, where despite her insistence on studying on the same terms as men, her only option was to study obstetrics and gynecology at La Maternité.
Elizabeth combated her isolation by coaxing her younger sister Emily to join her. Five years younger, Emily benefited from the experiences of Elizabeth and a few women who subsequently obtained medical degrees after Elizabeth’s seminal achievement. Emily also faced resistance to medical training; after receiving excellent marks in her first year, she was denied entry to finish her second year and had to finish her degree abroad. In Edinburgh, she specialized in midwifery and diseases of women and children. Returning to New York, Emily became the cornerstone of the Blackwells’ medical practice. While Elizabeth was the visionary, Emily was the resolute clinician and surgeon. Together, the Blackwells trained female interns in their infirmary, cared for patients in homes, and taught preventative hygiene. Emily also influenced Elizabeth’s ideals, reminding Elizabeth of a common goal and shared vision of opening the field of medicine to other women.
A notable trainee of the Blackwells was Rebecca J. Cole, the first Black graduate of the Female Medical College of Pennsylvania. Returning to practice in Philadelphia, Cole became an early voice against racial bias in public health. The Blackwells’ writings focus on the success of their pupil as a clinician with minimal mention of her race.
The world of medicine, to which the Blackwells had aspired so single-mindedly, often saw them as an exception. For instance, Britain’s Medical Act of 1858 required registration of all medical practitioners. With her degree and history of treating private patients in London, Elizabeth was the first woman included in Britain’s Medical Registrar. This loophole was found and quickly rewritten to exclude women. Yet Elizabeth’s influence emboldened Elizabeth Garrett Anderson, the first British woman to qualify as a physician and surgeon.
As a pioneer, Elizabeth foresaw changes in the roles and perspectives of women. When told by Paget to expect resistance from women as well as men, Elizabeth replied: “I am prepared for this . . . A hundred years hence women will not be what they are now.” While certainly true, barriers that the Doctors Blackwell faced over 150 years ago continue to plague medicine. Despite near gender parity of medical school matriculants, the number of women in certain medical specialties is strikingly disproportionate. There are few women in academic medicine and leadership positions. There are still gaps in physician compensation between men and women. Women in medicine, and particularly BIPOC women in medicine, still face harassment and bias. The TIME’S UP Healthcare Movement predicts that 50% of female medical students will experience harassment before finishing medical school. More than a few female physicians still wear badges with DOCTOR to clarify their position for patients. While the Doctors Blackwell faced explicit misogyny in training and practice, much of today’s work involves dispelling the ongoing bias that women in medicine face. While discrimination and bias against women may perhaps have somewhat gradually diminished in the formal structures of medicine, it may not be true of society in general.
The Doctors Blackwell
Janice P. Nimura, 2021
WW Norton and Co, New York ISBN-10: 0393635546
For further reading on Elizabeth Blackwell, please consider “Elizabeth Blackwell, MD” by JMS Pearce in the Physicians of Note section of this journal.
ELIZABETH A. COON, MD, is a Consultant and Assistant Professor of Neurology at the Mayo Clinic with a subspecialty interest in Autonomic Disorders as well as personal interests in English literature and the history of Neurology.
EELCO F. M. WIJDICKS, MD, PHD, is a Consultant in Neurocritical Care and a Professor of Neurology and History of Medicine, Mayo Clinic. He is author of Cinema, MD: A History of Medicine on Screen (Oxford University Press, 2020).