The DO Book Club, Oct. 2022: The Doctors Blackwell

The Doctors Blackwell, Janice Nimura’s history of the famous sisters, Elizabeth Blackwell, MD, and Emily Blackwell, MD, presents so much more to her audience than the history of these two pioneers in medicine. Their story casts a spotlight on a tumultuous time in American history.

The sisters’ prodigious correspondence reflected on the great causes of their day; slavery and the abolitionist movement, the women’s rights movement, North versus South and rich versus poor. The improbable fact that the sisters obtained medical degrees during this era makes their achievement even more remarkable. Elizabeth was the first woman to earn an MD in the U.S. and Emily followed close behind her.

The Blackwells immigrated to the United States from England in 1832 as children in a large family of active abolitionists and religious dissenters. The loss of their father during a cholera epidemic drove them to their mission to become doctors. But first, Dr. Elizabeth Blackwell had to undertake the nearly impossible task of gaining admission to medical school.

Elizabeth’s journey

Elizabeth was firmly rejected from every medical school she approached for admissions. The faculty of Geneva Medical College in upstate New York turned the big decision over to its student body, and those men voted unanimously to allow her in. Their intention was to enjoy in the humor of the spectacle. Elizabeth was determined not to become the butt of their jokes. She graduated at the top of the class in 1849.

After her classroom studies, she turned to obtaining clinical experience as options for further training were severely limited. She became the first female resident at a public hospital in Philadelphia. Taking an entry-level position in a city obstetric hospital in Paris gave her unparalleled clinical experience in medicine, obstetrics and surgery.

While delivering a baby in Paris, her eye was splashed with gonorrhea-infected fluid. Medicated soaks and leeches applied to the temples did not work. Nearly 100 years before the development of antibiotics, she lost her eye. With her procedural capabilities restricted, she turned toward medical care and raising funds for her clinic.

Emily’s medical path

Elizabeth’s success did not open the doors of other medical schools to female applicants. Her alma mater in New York declined to admit her sister, Dr. Emily Blackwell, when she applied three years after Elizabeth graduated. Emily talked herself into Rush Medical College in Chicago, but when she suddenly found herself expelled from Rush after a year when her mentor exited, she had to persuade a dean in Cleveland to let her finish and graduate.

Meanwhile, a women’s medical college opened in Boston in 1848; however, Elizabeth and Emily viewed it as inferior in faculty and lacking in the standard curricula.

The sisters’ different personalities

Dr. Elizabeth Blackwell emerges as a prickly and eccentric character through her written correspondence and journals.

The author notes, “Caring for suffering individuals had never been the engine that drove her. In becoming a doctor, she meant to heal humanity.” (pp. 69)

Along with a Polish emigree, Marie Zakrzewska, and her sister Emily, the three founded and staffed a clinic for women, then a women’s hospital, and, finally, the uniquely rigorous Women’s Medical College in New York City. Elizabeth eventually turned away from the clinical practice of medicine and more toward matters of public health and hygiene.

Elizabeth did not view other women as intellectual equals who were ready for the vote and equal rights. Although one of her sisters-in-law was notable women’s rights leader Lucy Stone, she disdained any connection to the suffragist movement. The networking and fundraising necessary to keep the project afloat financially took tremendous effort when the role of a woman outside of domestic life was not recognized or accepted.

Emily comes across as a more accessible person who was very much interested in direct patient care and surgery. She was a perfectionist who found it difficult to accept other women in the profession whom she deemed to have had inferior training. She carried on as the dean at the New York Infirmary for Indigent Women and Children after Elizabeth went back to England in 1869.

The men running the medical schools had the opinion that women simply could not handle the intellectual rigor and gore of medicine. This view was generally accepted by most in society at the time. Women were expected to stay home, have children and do the household chores. The expectation for any woman entering the medical profession as a physician was that they would also forego marriage and traditional family life.

Both Elizabeth and Emily, who never married, adopted daughters from the local orphanage in New York City. Readers today may judge the ladies harshly for adopting children for the purpose of companionship and service; whereas, people of the 19^th century viewed even their biological children as helpers and companions.

Elizabeth’s child, Kitty, called her Aunt Elizabeth, and was bequeathed half of Elizabeth’s fortune.  Emily’s daughter, Anna, called her “Mama” and by all accounts was treated as a much-loved daughter. Emily lived in her latter decades with Elizabeth Cushier, MD, who trained as a gynecologic surgeon at the Blackwells’ school. As was the custom of their era, the ladies were devoted companions and not forthcoming with the details of their personal life.

Medicine in the early 19th century

The author, Janice Nimura, does her best to weave a readable story out of the lives of two remarkable and rather eccentric ladies. Even more interesting is the light shone on the primitive state of medicine in the early 19^th century.

She writes: “The first half of the nineteenth century was the high-water mark of what came to be known as ‘heroic medicine.’ Doctoring had become an established profession, but the state of medical knowledge had not evolved much beyond the Hippocratic doctrine of the four humors (black bile, yellow bile, phlegm and blood), the four elements (earth, air, fire and water), and the four qualities (hot and cold, wet and dry) whose imbalance was thought to be the root of all illness.” (pp. 51)

Sea change

By 1899, the Women’s Medical College was closed as the older and well-established institutions such as Johns Hopkins and Cornell finally accepted women students and faculty. Emily stated at the final commencement that the Women’s Medical College “had held open the door for women until broader gates had swung wide for their admission.” (pp. 265)

Emily Blackwell also spoke these words to the last class of lady physicians graduating from her college:

“You will be brought in contact with the working ways of men. Get from this new companionship all that is good, but do not lose in it a particle of what is truly and desirably your own … It is for us to do our part, that hereafter the old and time-honored profession may be proud of her daughters as of her sons.” (pp. 265)

Today, more than half of all medical students are women who symbolically enter through those gates once opened by Elizabeth and Emily Blackwell.

November’s books

For November, Daniel J. Waters, DO, MA, will review What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri, The Rise and Fall of Modern Medicine by James Le Fanu and A Christmas Carol by Charles Dickens. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

If you read The Doctors Blackwell or any previous Book Club selection and want to share your reflections, please leave a comment below or email [email protected].

Related reading:

The DO Book Club, Sept. 2022: Letter to a Young Female Physician, Ask Me About My Uterus, Practical Management of Pain

The DO Book Club, Aug. 2022: Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU