Elizabeth Blackwell

Summary

Elizabeth Blackwell (1821-1910) was the first woman to earn a medical degree in the United States, graduating at the head of her class from Geneva Medical College in 1849.(Kline, 1997) She founded the New York Infirmary for Indigent Women and Children, staffed entirely by women, and held the first chair of preventive medicine in America. Her career was shaped not by lifelong ambition but by a dying friend’s observation that women patients suffered needlessly because Victorian modesty prevented honest communication with male physicians. Nancy Kline’s 1997 biography, the source for most of this entry, situates Blackwell’s achievement against a medical profession in which surgeons did not wash their hands, anesthesia barely existed, and any literate man could call himself a doctor.

Early Life and Formation

Blackwell was born on February 3, 1821, in Bristol, England, the fourth child of Hannah and Samuel Blackwell, so frail at birth that her parents doubted she would survive.(Kline, 1997) Samuel Blackwell publicly supported abolition, educational reform, equal rights for women, and temperance, while running a sugar refinery that depended on slave labor. The contradiction his children inherited was eventually resolved when they refused to eat sugar and gave up the business altogether.(Kline, 1997)

The family were religious Dissenters, which in 1820s England carried legal weight. Dissenters could not hold the highest government offices, work as doctors, lawyers, or professors, study at British universities, or attend most schools. The Blackwell children were therefore educated at home by tutors and governesses Samuel selected with care.(Kline, 1997) Daily walks were part of the curriculum. The Blackwells held that knowledge of the natural world and vigorous physical exercise belonged in the education of children, including girls, a position considered eccentric by neighbors who believed girls of their class should not move too much.(Kline, 1997)

The family emigrated to New York in 1832 in the middle of a cholera epidemic that had emptied the city.(Kline, 1997) In America, Samuel and his children threw themselves into abolitionist work, sheltering their minister Samuel Cox after his life was threatened, hiding escaped people, and hosting William Lloyd Garrison.(Kline, 1997)

Samuel moved the family to Cincinnati in 1838 during a national depression in which 250 New York businesses failed in a single month and flour reached fifteen dollars a barrel.(Kline, 1997) He died within months. Cincinnati physicians treated his fatal “bilious fever” with heroic medicine: calomel, seidlitz powders, castor oil, tartaric acid, sulfuric acid in water, mercury ointment.(Kline, 1997) Bilious fever was a wastebasket diagnosis, applied without anyone knowing what it was or how to treat it. The drugs that killed Samuel Blackwell were standard practice. Elizabeth and her sisters opened a boarding school the following week to support nine children with no savings, the beginning of a pattern in which necessity, not choice, set her direction.(Kline, 1997)

The school they ran, the Cincinnati English and French Academy for Young Ladies, offered courses in botany, natural philosophy, moral philosophy, ancient and modern history, and French at fifty dollars per year.(Kline, 1997) It eventually failed under combined pressure from the depression, a cheaper rival, the family’s abolitionist reputation, and the Cincinnati anti-Black riots of 1841 that drove enrolling families away.(Kline, 1997) During these Cincinnati years Elizabeth read Ralph Waldo Emerson voraciously. Emerson’s transcendentalist insistence that “I make my circumstance” gave her a framework for individual agency she would carry into the medical fight.(Kline, 1997)

The Decision to Study Medicine

A teaching assignment in Henderson, Kentucky, from 1844 to 1845 put Blackwell inside the daily operations of slavery and shaped her conviction that social injustice required active professional response, not commentary alone.(Kline, 1997) The medical idea, when it came, came from outside her. In 1845, a dying friend named Miss Donaldson, suffering from cancer of the uterus, suggested that Blackwell study medicine. “If I could have been treated by a lady doctor,” she said, “my worst sufferings would have been spared me.”(Kline, 1997) The proposal was almost unintelligible in its time. Medicine in 1845 was an entirely male profession in both America and Europe, and even the traditionally female occupation of midwifery had been shifting toward male physicians.(Kline, 1997)

Victorian prudery required male physicians to examine female patients from behind a curtain, by feel alone, without looking.(Kline, 1997) One specialist in uterine diseases urged students to insert leeches into the womb in spite of the “almost intolerable suffering” the procedure caused.(Kline, 1997)

Blackwell’s first reaction was revulsion.(Kline, 1997) The thought of “dwelling on the physical structure of the body and its various ailments filled me with disgust,” she later wrote.(Kline, 1997) An unpublished draft of her autobiography records a second motive she did not publish: she chose medicine partly as a barrier against a romantic attachment she felt unable to resist.(Kline, 1997)

Medical Education and the Battle for Admission

Blackwell applied to twenty-nine medical schools.(Kline, 1997) All Philadelphia and New York schools rejected her solely on the basis of her sex, with one dean fearing women doctors would steal male patients.(Kline, 1997) At that time, irregular medical schools admitted women, but mainstream regular colleges systematically excluded them.(Kline, 1997) Furthermore, medical practices were primitive: surgeons did not wash their hands before operating, did not disinfect their instruments, and proudly wore the same blood-stiffened coat from one operation to the next; patients underwent surgery fully conscious because anesthesia had not yet been introduced.(Kline, 1997)

Sectarian medicine in the 1840s was popular with women patients partly because sectarian doctors educated patients about their bodies and gave public lectures on female physiology and anatomy, while regular physicians relied on patient ignorance for their professional power.(Kline, 1997)

Before applying, Blackwell prepared as best she could. She studied Oliver’s First Lines of Physiology and Pereira’s A Treatise on Food and Diet under the Reverend Dr. John Dickson in Asheville, North Carolina, in 1845-1846.(Kline, 1997) She performed her first clinical intervention there as well, hypnotizing away a severe headache for a patient recovering from calomel’s toxic effects, a small but telling sign that mind-body methods were already part of her practical vocabulary.(Kline, 1997) Some advisers urged her to study in Paris disguised as a man. She refused. Disguise would prove that a woman could not practice medicine openly, which was the opposite of what she intended to demonstrate.

Geneva Medical College

The faculty of Geneva Medical College did not genuinely support Blackwell’s admission; they were horrified at the thought and transferred the decision to the all-male student body to avoid the political cost of openly rejecting a qualified candidate supported by Dr. Joseph Warrington.(Kline, 1997) On October 20, 1847, the medical class unanimously adopted resolutions inviting Elizabeth Blackwell to become a member of their class.(Kline, 1997)

There was no medical licensing in mid-nineteenth-century America. Almost any literate man could, with minimal training, call himself a doctor. The Geneva students were mostly local boys, so rowdy that neighbors had threatened to close the school for disturbing the peace, and many of them had drifted into medicine after failing in other trades.(Kline, 1997) When Blackwell entered the classroom on November 7, 1847, her quiet presence silenced them. For the first time that semester the professor could be heard.(Kline, 1997)

Blackwell enrolled as student number 130, the first woman admitted to a regular American medical school.(Kline, 1997) Her first day was difficult: she had missed four weeks of classes, owned no books, did not know her way around the school, felt entirely alone among strangers, and faced ominous rumors about the anatomy professor.(Kline, 1997) The townspeople of Geneva concluded that any woman willing to attend medical school must be either insane or immoral. They refused to speak with her and drew back their skirts as she passed.(Kline, 1997)

Inside the Lecture Hall

The faculty did not, on the whole, sabotage her. Anatomy professor Dr. Webster welcomed her warmly, told her she would study surgery, and predicted that a well-educated woman physician in New York would “have her hands full of work.”(Kline, 1997) Her presence transformed the classroom. The students moved from “a band of lawless desperadoes to gentlemen,” ending note-throwing and disruption.(Kline, 1997)

When the anatomy course reached the reproductive system in late November 1847, Webster wrote to Blackwell suggesting she study that unit separately, citing Victorian feminine modesty.(Kline, 1997) She successfully argued that a serious medical student should receive the same education as her male counterparts.(Kline, 1997) Dr. Stephen Smith, a classmate who later became New York City’s Commissioner of Health, attested that Webster gave the most complete and thorough anatomy course of his career that year because of her presence.(Kline, 1997)

The national press treated her as a curiosity. The Boston Medical Journal called her “a pretty little specimen of the feminine gender.” The Baltimore Sun hoped she would “abandon her absurd idea.” Sympathetic coverage was rare, and when it came it was often patronizing.(Kline, 1997) Her own writing from this period is harder. She watched Webster examine a female patient in his consulting rooms, called the experience “a horrible exposure,” and recorded that the moment confirmed for her “the necessity of my mission.”(Kline, 1997) She also fasted for weeks on the theory that reducing her blood volume would lessen her tendency to blush during anatomy lectures, a self-directed physiological experiment that captures both her ascetic streak and her instinct to treat her own body as material for study.(Kline, 1997)

Graduation

No Philadelphia hospital would accept her.(Kline, 1997) She secured a position at Blockley Hospital and Almshouse, an institution housing about two thousand residents that included large numbers of Irish famine immigrants dying from typhus.(Kline, 1997)(Kline, 1997) Her experience treating syphilitic patients at Blockley, where she observed the disease move through sores, insanity, and paralysis to death, deepened her conviction that women’s health depended on women’s medical knowledge.(Kline, 1997)

Even after she had completed all requirements, Geneva officials hesitated to award the degree.(Kline, 1997) Webster intervened, threatening to publicize their reluctance in medical journals if they refused.(Kline, 1997) On January 23, 1849, Blackwell received the first MD granted to a woman in the United States, graduating at the head of her class.(Kline, 1997)(Porter, 1997)

Postgraduate Training and the Loss of an Eye

European hospitals proved as resistant as American ones, and France, despite its reputation as a more open medical culture, offered the same hostility.(Kline, 1997)

La Maternité ran on near-monastic discipline.(Kline, 1997) Housed in the old Convent of Port Royal, it forbade students to leave the grounds, scheduled every minute, and forbade reading material unrelated to medicine.(Kline, 1997) Vaccination was a new and revolutionary technique at La Maternité, with Dr. Hippolyte Blot performing infant vaccinations while Blackwell observed.(Kline, 1997) Instruction relied heavily on rote memorization and verbatim recitation, with second-year students teaching first-year students outdoors; Blackwell used this method strategically to improve her French while already knowing the anatomical and physiological content.(Kline, 1997)

On November 4, 1849, while treating an infected infant, a small amount of fluid from the child’s eyes splashed into Blackwell’s left eye. When she sought permission to leave for treatment, her superiors refused, calling her hysterical. Blot overruled them and ordered her into the infirmary immediately.(Kline, 1997) The treatment she received reads as a catalog of mid-nineteenth-century therapeutics. Her eyelids were cauterized. Leeches were attached to her temples. Cold compresses were applied. Her forehead was painted with opium. She was purged. Her body was wrapped in mustard plasters. Every two hours for three days, Blot removed the false membranes forming over her eyes.(Kline, 1997)

Kline observes that Blackwell’s purulent ophthalmia would today be treated with antibiotic eye drops, probably clearing within a week; in 1849 no antibiotics existed, the ophthalmoscope had not yet been invented, and medicine had no effective treatment for the condition.(Kline, 1997) Blackwell’s left eye became blind following the infection; she spent six months convalescing in Paris, gained permission to visit Parisian hospitals, but was too weak to use that access, and then attempted a hydropathic cure at Vincenz Priessnitz’s establishment in Gräfenberg.(Kline, 1997)

She underwent the regimen at the Priessnitz hydropathic establishment at Gräfenberg, which consisted of sweating in blankets, cold baths, wet bandages, sitz baths, showers, and large quantities of cold water, administered three times daily.(Kline, 1997) She found the sitz bath caused colic and the wet bandages impeded digestion, and her eye worsened.(Kline, 1997) She then continued her studies at a hospital where all the doctors except the professor of midwifery treated her with respect and taught her.(Kline, 1997)

Blackwell met Florence Nightingale through mutual friends.(Kline, 1997) Nightingale articulated the public health principle that good health was threatened by “the six D’s: dirt, drink, diet, dampness, draughts, and drains,” a formulation that fit Blackwell’s own emerging conviction that prevention mattered more than cure.(Kline, 1997) The development of forceps and other technologies drew male doctors into the formerly female domain of childbirth, displacing women healers.(Kline, 1997)

The New York Infirmary

When Blackwell returned to New York in 1851 to establish a practice, the phrase “female physician” was understood as a euphemism for abortionist, causing landlords to refuse her rooms and creating immediate professional isolation.(Kline, 1997)

She built her initial patient base by delivering public lectures on women’s physical education and the physical education of girls in early 1852, which attracted Quaker women who became her first patients.(Kline, 1997) Her public health philosophy held that girls were trained to be invalids by sedentary upbringings, and she advocated for girls’ physical activity, bodily self-knowledge, and ownership of their physical selves as essential to moral and physical health.(Kline, 1997)

In March 1853, Blackwell rented a tiny room on Tompkins Square in the Eleventh Ward, began free consultations three afternoons a week, and incorporated the New York Dispensary for Poor Women and Children.(Kline, 1997) They were warned that police would interfere, that death certificates would not be recognized, and that they could not raise sufficient funds.(Kline, 1997)

Funding came from two main sources. Zakrzewska secured fundraising advice and $650 in contributions from abolitionist women in Boston. The team then organized a crafts fair at the Stuyvesant Institute that raised over $1,100, enough to lease a building.(Kline, 1997) The New York Infirmary for Indigent Women and Children opened on May 12, 1857, on Florence Nightingale’s birthday, with a six-bed ward on the second floor, maternity care on the third floor, and an outpatient clinic on the ground floor.(Kline, 1997)

In its first eight months the Infirmary treated 866 cases and hospitalized 48.(Kline, 1997) The patient load doubled in its second year, and five medical students from the women’s medical schools in Boston and Philadelphia joined the all-female staff.(Kline, 1997) After a young woman died in childbirth, an unruly crowd gathered outside the infirmary brandishing pickaxes and shovels, and two young policemen pushed through the crowd.(Kline, 1997)

Civil War Service and Public Health

In 1859, Blackwell became the first woman doctor officially inscribed in the British Medical Registry, made possible by a provision that allowed doctors with foreign degrees who were practicing in England before October 1, 1858 to register under the new General Council of Medical Education and Registration.(Kline, 1997)

Back in New York, the Infirmary developed an unusual role: the “sanitary visitor.”(Kline, 1997) This was an assistant physician who gave practical instruction to poor mothers on infant care and family health, visiting tenements to open windows, distribute soap and clean linens, and leave multilingual pamphlets on hygiene.(Kline, 1997) Kline identifies this as an important early innovation toward social work.(Kline, 1997)

When the Civil War began, Blackwell organized a meeting at the New York Infirmary to train women nurses.(Kline, 1997) An inadvertent newspaper announcement drew hundreds to the first meeting and three thousand women to a second, leading to formation of the Woman’s Central Association of Relief with Blackwell as chair of its Registration Committee.(Kline, 1997) The Blackwells were then excluded from the United States Sanitary Commission after it was formed from state relief organizations, because its male medical leaders refused to allow their hospital to be represented and stated they would not participate in nurse education “if the Miss Blackwells were going to engineer the matter.”(Kline, 1997)

Many soldiers from rural areas had never been exposed to childhood diseases such as measles, chicken pox, and diphtheria, so they had no immunity.(Kline, 1997) The unsterile practice of reusing vaccination needles spread disease further.(Kline, 1997) More soldiers died of typhoid and dysentery from unsanitary conditions than from enemy wounds.(Kline, 1997)

By the war’s end the Infirmary was treating nearly seven thousand patients per year. The Blackwells co-authored a speech in 1863 asserting that “the practice of medicine by women is no longer a doubtful, but a settled thing.”(Kline, 1997) In the same address they documented the institutional inequities that had not yet been settled: “No libraries, museums, hospitals, dispensaries, clinics; no endowments, scholarships, professorships, prizes, to stimulate and reward study; no time-honored institutions and customs, no recognized position; no societies, meetings, and professional companionship; all these things men have, none of them are open to women.”(Kline, 1997)

The Woman’s Medical College

In November 1868, the Woman’s Medical College of the New York Infirmary opened. It required three years of study, soon extended to four, when most male medical schools required only two. Its examining board was independent of the faculty, imposing tougher standards than male colleges applied to their own graduates. Students were expected to recite and to do hands-on clinical work rather than passively attend lectures.(Kline, 1997)

Elizabeth Blackwell was appointed professor of hygiene, the first chair of preventive medicine in America, a faculty position that did not exist at any other medical school.(Kline, 1997) Her opening address argued that the trait distinguishing a physician from a sympathetic friend was, finally, knowledge: “it is knowledge, not sympathy, which can administer the right medicine.”(Kline, 1997)

By the time the first class graduated from the Woman’s Medical College, students had access to clinical training at Bellevue Hospital, the New York Eye and Ear Infirmary, the Northern Dispensary, and the Demilt Dispensary, in addition to the New York Infirmary.(Kline, 1997) [GAP: The paragraph originally contained unsupported claims comparing the clinical network to those of women’s medical schools in Boston and Philadelphia, stating the college’s standards exceeded those of male institutions, and discussing Blackwell’s emphasis on prevention; these are not supported by the cited card.]

Mature Philosophy and the Quarrel with Jacobi

Regina Morantz-Sanchez’s Sympathy and Science (1985) treats Blackwell and Mary Putnam Jacobi as the two opposing poles of the women’s medical movement: Blackwell standing for moral and maternal distinctiveness, Jacobi for scientific assimilation through superior achievement.(Morantz-Sanchez, Regina Markell, 1985) The disagreement was not abstract. On Christmas Day 1888, Jacobi sat down to write Blackwell a long, frank, and remarkably revealing letter accusing her of relying on what Jacobi called “the well known Transcendental method of arriving at conclusions by the force of meditative insight, and then refusing to submit these to tests of verification.”(Morantz-Sanchez, Regina Markell, 1985)

That charge had specific targets. Blackwell opposed bacteriology and vivisection on the grounds that disease was not best understood as the work of microbial invaders, and that women physicians had a particular duty to guard medicine against the dehumanizing tendencies of laboratory science.(Morantz-Sanchez, Regina Markell, 1985) In her sanitarian view, health was the natural order of things, a gift to be enjoyed by people who governed their lives wisely; disease was neither divine punishment nor blind fate but the inevitable result of one’s violation of the laws of Nature made manifest by a benevolent Deity, and medicine’s task was to teach the laws by which environment and behavior could be balanced.(Morantz-Sanchez, Regina Markell, 1985) Writing in 1889, she put the moral stakes plainly: “The progress and welfare of society is more intimately bound up with the prevailing tone and influence of the medical profession than with the status of any other class of men.”(Morantz-Sanchez, Regina Markell, 1985)

Her marriage-barrier motive shows the same architecture. In her journal she had written that becoming a physician would “place a strong barrier between me and all ordinary marriage. I must have something to engross my thoughts, some object in life which will fill this vacuum and prevent this sad wearing away of the heart.”(Morantz-Sanchez, Regina Markell, 1985)

On the question of how the next generation should be trained, Blackwell’s position was equally direct. She told Virginia Penny in 1863 that “it is almost impossible for a lady to get a good medical education without going to Europe,” noting that the women’s medical schools in Philadelphia and Boston gave students the “legal right” to practice but did not yet offer much theoretical instruction.(Morantz-Sanchez, Regina Markell, 1985) In 1860 the trustees of the New York Infirmary, with Blackwell at their center, argued that “no system of separate institutions could ever be as valuable as giving women the opportunity to share the accumulated experience of the profession in public institutions and receiving the stimulus and guidance and companionship of men in the acquisition of knowledge.”(Morantz-Sanchez, Regina Markell, 1985) Separate education was a stopgap; coeducation in established institutions was the goal.

Return to England and Legacy

In July 1869, at age 48, Blackwell left New York for England.(Kline, 1997) She stated her mission as helping to establish “a thorough medical education for women in England” and committed to continuing her professional life there.(Kline, 1997)

Florence Nightingale, inspired by Fliedner’s 1836 nursing school at Kaiserswerth, used the authority gained in Crimean War field hospitals to reform nursing in English-speaking countries, opening her training school at St. Thomas’ Hospital in 1860.(Ackerknecht, 1955) Elizabeth Blackwell, the first woman M.D. in the United States (1849), opened the first American nursing training school in 1873.(Ackerknecht, 1955)

Blackwell’s insistence on prevention over cure was unfashionable in her own century. The therapeutic mood of mid-nineteenth-century medicine still favored aggressive intervention: heroic doses, depletive bleeding, mercury and antimony preparations, the kind of treatment that had killed her father. Her conviction that hygiene, ventilation, diet, and education did more for population health than any pharmacopoeia placed her closer to the trajectory that twentieth-century medicine would eventually take.

Human Notes Zone

See Also

• women-in-medicine
• medical-education
• medical-education-reform
• florence-nightingale
• emily-blackwell
• heroic-medicine
• public-health

Sources

The footnoted citations below resolve to evidence cards in _evidence/kline-elizabeth-blackwell-1997/, _evidence/porter-greatestbenefit-1997/, and _evidence/ackerknecht-shorthistory-1955/.