In letters home, however, she colored her account of this first patient with bravado. “[Elizabeth] says that some of the students begin to develop apprehension at the idea of the precedent they have set,” Sam reported with amazement and pride, “& fear lest women should usurp the profession!”
Elizabeth and Geneva Medical College grew on each other. The facilities were laughably modest compared to the elite institutions of Philadelphia and New York—and had been considerably exaggerated in the circular Elizabeth had received with her acceptance letter—but the humble scale and remote setting allowed Elizabeth to work closely with her professors. Dr. La Ford, the demonstrator of anatomy, selected a quartet of especially level-headed students to form a separate dissecting class with her in the private room of the surgical professor. Far from bridling at this segregation, Elizabeth remembered her evenings with them fondly—“they treated me like an elder sister”—and to her own surprise began to approach her studies with more pleasure than duty. Geneva’s lectures on anatomy and physiology were good; in her notes, Elizabeth drew intricate diagrams of branching coronary arteries and the graceful curves of the uterus. Sunk deep in concentration, “tracing out the ramification of parts,” she lost track of time, remaining alone in the silent medical building, head bent over a marble-topped laboratory table, until long after the rest of the town had retired for the evening. She would rarely enjoy such unadulterated focus again—outside the sheltering community of the college, few could stomach the idea of a woman with her hands in a corpse.
Elizabeth was now comfortable enough at Geneva to regret the close of her first term in January. After the last lecture, some of her fellow students offered expressions of friendship, which she parried with awkward pride. One asked permission to write to her—a normal request from a young man, but one that solitary Elizabeth found absurd if also gratifying. “It cheered me, funny as it was,” she wrote. Another invited her to sit for a daguerreotype portrait—still a novel technology in 1848—“but I told him it had annoyed me so much to see my name in the papers that I certainly could not give my face too.” There are no extant photographs of Elizabeth as a young woman.
ELIZABETH’S DIAGRAMS OF ARTERIES AND THE UTERUS.
COURTESY LIBRARY OF CONGRESS, MANUSCRIPT DIVISION, BLACKWELL FAMILY PAPERS
Anticipating the graduation requirements of the following year, Elizabeth attended the oral examinations of the second-year students. She was unimpressed. “I suppose they were as thorough as most,” she wrote dismissively, “but they were certainly not much of a test.” Holding her own at this level of difficulty would not be a problem. At the boardinghouse, having warmed to their unusual boarder, they gave her an oyster supper to celebrate the midpoint of her journey through medical school, and Elizabeth packed for her return to Philadelphia, where she would spend the eight months until the next term at Geneva.
After the graduation exercises, she bade her professors farewell. If she expected some gesture of recognition for her impressive success thus far, it was not forthcoming. “They talked over my affairs, but gave me no important advice,” she wrote. “To my great disappointment no letters of introduction were prepared for me, but only a promise that they should be sent on at once.” It was a pattern—enthusiasm without follow-through—with which Elizabeth would become familiar.
The three months of Elizabeth’s first term had been grueling, lonely, and uncomfortable. She was no longer just an ambitious young woman but a public figure. Wherever she went, whatever she did, eyes followed: some shocked, some derisive, some admiring, none indifferent. And that, she began to realize, was how she liked it. She had never made friends easily; she had always been one who would rather impress than endear. She had a mission to fulfill, and a whole town watching. It was exhausting, but it was also exhilarating.
The lawyer and poet William H. C. Hosmer, bard of Avon (a town just a few miles west of Geneva), published a hymn of praise in the Western Literary Messenger just as Elizabeth prepared to depart. “Maiden of earnest thought, heroic heart!” he exhorted her.
God speed thee on thy way to win the prize,
And well reward thy struggle to be wise:
Heed not detraction! for thou hast a part
On the wide, shifting stage of life to play
That will confer renown on thee for aye.
In later writings, Hosmer would clarify his stance: women should study medicine only in order to rescue their suffering sisters from the terrible shame of exposure to men, not to work alongside men as colleagues. But at this fragile moment, Elizabeth was glad for whatever public support she could find. She saved a handwritten copy of the poem—from the poet himself?—among her most important papers.
* Geneva and Trinity Halls are today the oldest buildings on the campus of Hobart and William Smith Colleges. Neither medical building survives. Geneva’s medical department merged with Syracuse University in 1871.
CHAPTER 4
BLOCKLEY ALMSHOUSE
The ferry across the Schuylkill River to Philadelphia’s Blockley Almshouse had much in common with Charon’s across the Styx: for most patients, there was no return trip. Sepsis stalked the wards, which were largely unheated; one winter inspection recorded temperatures between thirteen and eighteen degrees inside, with wet linens and standing water frozen solid. From Blockley’s walls, meadows stretched down to the riverbank. In winter, the sluice gates were opened, and the river flooded and froze. This ice, bearing all the effluent of a bustling city, was cut for the use of the hospital. Cholera and puerperal, or childbed, fever paid recurring visits from which few recovered. Physicians went from patient to patient—from surgery to postmortem to labor and delivery—without washing their hands or changing their aprons.
Municipal hospitals, evolving from their origins as poorhouses, remained refuges for the destitute, who entered—or were deposited—as a last resort. Four massive yellowish-gray buildings, four stories each, had risen in 1834 as a new home for America’s first public hospital, but new construction could not change old attitudes. Fifteen years on, roughly two thousand people lived and suffered within, a grim rebuke to Philadelphia’s prosperity.
Outside Blockley’s lunatic wards, patients allowed fresh air were chained to iron rings bolted to the courtyard walls; inside, the doors bore the teeth marks and bloodstains of those who remained confined. Wealthy visitors crossed the river to gawk at the insane as a form of entertainment, and persisted in the complacent belief that ill health was the wages of sin rather than the consequence of poverty. “Blockley is the microcosm of the city,” wrote one observer. “Here is drunkenness; here is pauperism; here is illegitimacy; here is madness; here are the eternal priestesses of prostitution, who sacrifice for the sins of man; here is crime in all its protean aspects; and here is vice in all its monstrous forms.”
Elizabeth’s notebooks were full of theory; now she needed practice. Between the two terms of medical school, students were expected to study independently, observing at hospitals or assisting private physicians—but most hospitals would not allow a woman to walk the wards, and Elizabeth wanted to see more than her friends Dr. Warriner and Dr. Elder could show her. In Philadelphia, there was no better place than Blockley to observe illness, if not, perhaps, healing. Young physicians regularly sought experience there, regarding the steady stream of patients more as teaching aids than as people. Its crowded wards were always short-staffed, and its impoverished patients were in no position to take issue with the gender of their doctor. During the empty months before her return to Geneva College, Blockley would be both Elizabeth’s home and an intensive course in the social context of disease.
Learning that the hospital’s board was riven by political infighting, she plotted a careful strategy. She introduced herself to each party leader in turn—Whig, Democrat, Native American (later known as Know-Nothing)—and impressed them with her modesty and determination. When her petition to enter Blockley reached the trustees, “all were prepared to fight in my behalf,
but there was no one to fight!” Her admission was unanimous. “Resolved that permission be granted to Miss Elizabeth Blackwell to enter this Institution, enjoy such accommodations as can be conveniently afforded her and occupy such a position as may be assigned her by the Chief Resident Physician,” read the official document, leaving plenty of room for interpretation with each ambiguous “such.” By the beginning of March, Elizabeth had moved in as a student, the first woman ever to do so. Official histories of Blockley fail to mention her at all.
Elizabeth reported home with determined cheer, delighting in her airy room with its snow-white walls and large windows, open to the spring breeze and a view of the meadows and the city beyond. “I feel disposed to shut out all business remembrances, listen to the little birds warbling outside, & pay you a spiritual visit,” she wrote. “No infection I fancy will travel with the paper.”
Her room was located off the female syphilis ward. Today penicillin is effective at the first sign of genital sores, but in 1848, eight decades before its discovery, most women ill enough to end up at Blockley were deep into the debilitating and disfiguring tertiary stage of the disease: seizures, incontinence, blindness, dementia, and necrotic lesions that ate away the bones of jaw and face and skull. The collapsed profile characteristic of advanced cases was known as “saddle nose.” Blockley’s patients were likely also suffering the effects of earlier attempts to cure them. “One night with Venus, a lifetime with Mercury,” went the adage. Mercury—in the form of calomel ointment or pills—was used to burn away syphilitic sores and purge infection, but the intense excretion and salivation it caused led to kidney damage and eroded gums, and then there were the cognitive effects of mercury poisoning. The righteous uninfected saw these afflictions as appropriate punishment for promiscuity. Blockley’s syphilis ward was a gallery of misery.
Its inmates had no idea what to make of the studious newcomer in their midst, and Elizabeth, at least initially, was at first equally innocent of the circumstances that might have led to their hospitalization. “Most of the women are unmarried, a large proportion having lived at service and been seduced by their masters,” she noted. “I found no instance of a married woman living with her husband entering.” She could hear them lurking outside her door; in response, she moved her desk to a position in line with the keyhole, in full view of the curious. “It was thought that my residence there might act as a check on these very disorderly inmates,” she wrote, but their impact on her was more profound. Her awareness of their plight, once she came to understand its origins in prostitution and “the hideousness of modern fornication,” would resonate later in her career.
Nothing in her peripatetic past had prepared her for the agony she beheld at Blockley. “Within one week,” she wrote to her teenaged brother George, “a lunatic scalded himself to death, one woman cut her throat, another fell down a cellar opening and broke both legs, they died the following day, another jumped over the banisters, breaking both ancles [sic].” Just the night before, she had been roused from sleep by screams and running footsteps; throwing open her window, she looked down. “There in the moat that surrounds the building, a depth that made me dizzy, lay a white heap, covered with blood, uttering a terrible sound, half groan, half snort.” Elizabeth recognized the crumpled form: a young patient who had been locked in the room next door as punishment for fighting. She had tried to escape down a rope made of bedsheets. Elizabeth’s account of the scene—the moonlight, the jangling of keys and creaking of hinges as the great gates of the hospital opened and the shrieking woman was borne inside, the voices raised in wonder or pity or scorn—is both clinical and fascinated, the doctor writing with the relish of a gothic novelist.
Blockley was vast, and at first Elizabeth was lost. Like a language student who has only conversed in a classroom, she found her studies of little use, and no one at Blockley volunteered to guide her. “I see a great deal without understanding it, pass over what is important, & dwell upon circumstances of trifling moment,” she wrote to Emily with uncharacteristic candor. “Sometimes I feel certain that I see just so & so, & find out afterwards, I was entirely wrong.” There was so much she had never witnessed: “Today, for the first time, I saw a person bled—only think of it—& that is a fair specimen of my practical knowledge in general.”
The resident physicians watched her with a volatile mixture of scorn and insecurity. Elizabeth was clearly “stepping out of woman’s sphere”; at the same time, they feared she might catch them in a moment of ignorance or even malpractice. None of them had any interest in teaching her: “When I walked into the wards they walked out.” They evaded her efforts to watch them, listen to them, or even read their decisions regarding their patients; though it was routine to write notes on diagnosis and treatment at the head of each bed, after her arrival this practice was quietly suspended. The physician-in-chief, Nathan Dow Benedict, was an exception—Elizabeth gratefully thought him “the very loveliest man the Almighty ever created”—but she saw him so rarely there was never time to ask all her questions. “I glean a little from him,” she told Emily, “but oh how different it would be, with intelligent, interested instructors, & companions to share study”—in other words, with the benefit of what any male medical student of her caliber could expect to find. “You would laugh to see me wandering eagerly about those great wards, timidly enquiring into symptoms, & peering about for useful knowledge,” Elizabeth wrote.
She found it easier to avoid the doctors entirely, reading in her room until midmorning, when their rounds were over, and only then venturing onto the wards, feeling like an intruder. “I find that some of the patients like to detail their symptoms,” she remarked with surprise. She watched the nurses apply poultices and perform injections, and she sometimes dared to auscultate, listening for a heartbeat with the monaural stethoscope of the time, a straight wooden tube with trumpet-shaped ends, one pressed to the patient’s chest, the other to the doctor’s ear. She was unable to deduce much from what she heard. Talking to patients, even if she didn’t understand their symptoms, did have one benefit. “I believe the practice will be of great service to me morally as well as intellectually,” she wrote, “& teach me to go about with that authority & manner essential to the physician.”
Elizabeth often sought the company of the matron, the woman with the most intimate understanding of the institution. “Ensconced in her armchair, with feet propped on a velvet footstool, she dispenses orders from morning to night, gives out clothing, raves at the paupers, and dooms the refractory ones to a shower-bath,” she wrote. “I like to talk with her occasionally, for she is shrewd and has seen much of life through dark spectacles.” Separated from Elizabeth by a gulf of class and education—and thus posing no threat—the Blockley matron was a bulwark against discouragement. Here was a woman of authority, surrounded by men, unafraid to raise her voice, and accustomed to being obeyed. Most important, she liked Elizabeth. “I drank tea with her lately & had a very pleasant evening,” Elizabeth wrote. “She is a remarkably strong independent woman, full of energy & quick decision—she braces me up, excites me, I never talk so well as in her company.” It was a relief, away from the hostile stares of the physicians, to discuss patients with this capable woman—so different, in Elizabeth’s opinion, from the lowly nurses, whom she dismissed as “mere hands” who “never think.”
Blockley was Elizabeth’s first deep dive into doctoring. Unlike the empathetic Dr. Benedict, with his “voice as gentle, his touch as kind to each patient as if she were his sister,” she walked the wards as if they were the pages of a textbook, and the patients illustrations for intensive study. Waves of refugees from Ireland’s Great Famine were arriving in American ports, many of them ill with typhus, known as “ship fever.” They filled the beds at Blockley and overflowed onto pallets on the floor, often still infested with the body lice no one yet recognized as the carrier of the disease. Choosing epidemic typhus as her graduation thesis topic—avoiding obstetrics and gynecology in favor of a ge
nder-neutral focus—Elizabeth took meticulous notes on patients’ dying agonies. Her letters home contain no reference to them, only an urgent request to send books—“one, ‘Letters from Ireland at the Time of the Famine in ’47,’ the other, on the health of large cities.”
At Geneva College, Dr. Lee’s materia medica lectures had offered little on why epidemics killed some and left others unscathed. His best guess suggested that “fear predisposes to disease”—a theory Elizabeth used to explain the infection rates of the Irish arrivals, as she imagined their flight, packed into stinking steerage quarters. “Without employment or exercise, their minds had time to brood over the fearful scenes they had left,” she wrote. “Fear, sorrow, anxiety joined with the physical evils of their condition to depress the vital energy, & the seeds of disease sown in their constitutions were thus nourished into life.”
The Doctors Blackwell Page 7
