The Doctors Blackwell

by The Doctors Blackwell (retail) (epub)

  The precise mechanism of infection was equally mysterious—it would be more than a decade before Louis Pasteur proposed the germ theory of disease. The prevailing wisdom held that “miasma” was responsible for contagion: poisonous air, arising from swamps or other rot-filled places, like the malarial neighborhood of the short-lived Blackwell residence in Flushing. Elizabeth, never one to accept convention without scrutiny, was not afraid to question this, eloquently, in the first draft of her thesis:

  In truth we know so little of disease that we are not prepared to state the manner of its production; we see a certain set of symptoms, grouped together, and we give a particular name to the state of the patient, but these symptoms do not constitute the disease, they are simply indications of a hidden power, whose connexion with the symptoms, we are unable to trace—of the disease itself we are in complete ignorance.

  Given the general tendency of medical men not to admit what they did not know, this was bold; coming from a woman attempting to win herself a place among them, it was ill advised. In the manuscript, the passage is crossed out with heavy strokes.

  Elizabeth laid out a methodical explication of the symptoms of ship fever, its progression, possible treatments, and onward, whether to convalescence or autopsy. “The following sketch which I made by the bedside of a woman dying,” she wrote, “will serve as an illustration of the general termination of the fever.”

  The eyes were bloodshot filmy & nearly closed; the mouth half open, drawn on one side, the saliva trickling down; the teeth & gums were covered with hard sordes§; the tongue dry, with black crusts, & incapable of protrusion; the breath of a peculiar and offensive smell; respiration labored, the chest heaving violently; the movement of the heart extremely feeble, the pulse almost extinct; the patient lay in a comatose state, with entire loss of voluntary power, medicine could no longer be swallowed, the head slipped down on the chest; there were now involuntary passages of a dark green colour; the neck & other parts of the body were swollen & of a livid hue; sometimes a furious delirium occurred in the last stage; and occasionally the vomiting of black sooty fluid, continued until death.

  It was all dispassionately recorded by a woman who, not three years earlier, could hardly bring herself to touch a dead beetle.

  Elizabeth’s dissertation made it clear that no one really knew how to treat typhus. She describes the use of virtually every preparation in the apothecary’s cabinet, up to and including a heavy reliance on brandy and, as a last resort, the rubbing of cayenne pepper on the inner thighs. Indeed, it seemed more useful to resort to her sister Anna’s recent preoccupation: the water cure. In her manuscript, she addressed at some length the findings of the Scottish doctor James Currie, who at the turn of the century had doused fever patients with cold water and won fame for his remarkable success rate: “well worthy of careful consideration,” Elizabeth insisted. But no self-respecting medical school—founded, after all, to defend the profession against quacks—would accept a thesis that endorsed an alternative therapy. Between the first and final drafts, this passage also disappeared. Elizabeth did, however, slip in the suggestion that a patient fortunate enough to survive typhus might benefit from “the practise of washing the body in cold water,” though she attributed the idea to a male physician, carefully protecting herself from any critic ready to dismiss a woman’s laughable attraction to fads.

  It was becoming obvious to Elizabeth that a hospital was not a healthy place, and doctors were as likely to do harm as to help. Just a year earlier, in 1847, a physician in Vienna named Ignaz Semmelweis had noticed a connection between contact with corpses and puerperal fever, and he insisted that his students wash their hands when moving between the morgue and the labor ward. The mortality rate among new mothers immediately plummeted. But the universal acceptance of germ theory was decades in the future, and his colleagues jeered, offended by the suggestion that their own habits were to blame. Semmelweis was eventually committed to an insane asylum, still insisting upon his insight, and died there in obscurity—from an infection, no less. Elizabeth remained ignorant of his discovery, though given her growing conviction that simple hygiene was at least as effective as anything she saw prescribed at Blockley, she would not have laughed.

  “I am not afraid myself of sickness,” she wrote to Marian, “but it is very certain, if I should be ill, none of their nostrums would go down my uncontaminated throat. I should trust to fresh air, cold water, & nature, & live or die as the Almighty pleases.” Classing herself neither with patients nor with physicians, she saw no contradiction in her attitude. The work was larger than that.

  Six months at Blockley taught Elizabeth formative lessons about the limitations both of her chosen profession and of women, in whose name she had pledged her determination to practice. About doctors, she was skeptical; about women, she was scathing. She was bluntest in her letters to Emily. “Oh Milly, what is to be done with the women,” she wrote.

  Alas for woman she seems to me inexpressibly mean—it is not her intellectual inferiority I lament—I believe as a rule, an intellectual difference will always be—but if she were only grand in those qualities attributed to her, all might be well, but the petty, trifling, priest-ridden, gossiping, stupid, inane, women of our day—what can we do with them!

  Surrounded by wretched female patients crushed by the weight of ignorance, poverty, and disease; ill-trained nurses who performed their duties mechanically, when not helping themselves to the medicinal brandy; and doctors who dismissed them all as a lesser order of beings, Elizabeth grew ever more convinced of her own strength and the responsibility it placed upon her. “There are a few strong ones—a sort of exceptional eighth† perhaps,” she allowed. “If they could be united, it would be a good beginning—you are one Milly, and sometime or other, we must work together, though the way does not seem clear yet.”

  If Elizabeth did not admire most women, neither did she blame them. Living with the syphilitic inmates of Blockley—and discussing Fourier’s communal phalanxes at Associationist meetings across the river in Philadelphia on her days off—had opened her eyes. “As I learnt to realize slavery & hate it, deeply eternally, while living amongst slaves—so I am learning to curse from the bottom of my soul this heathenish society of the nineteenth century, surrounded here by its miserable victims,” she wrote. The conundrum of woman’s lot had never seemed clearer: women could not rise until the attitudes of their society shifted, but social mores would never change without women’s leadership, “so there seems to me, no opening in the circle.” Even among the educated women of her acquaintance, few seemed formed for noble causes—“there is a great deal of the sweet flower, & bright butterfly about them.” How to undergird these “bright loving qualities” with “a foundation of truth & earnestness”?

  Her answer, as confided to Emily, was breathtaking in its conviction. “[W]omen will have to save women after all, they have the truer love & understanding for their own sex,” she began, reasonably enough. Then her tone intensified:

  I do strongly admire & deeply love, the beautiful weak women, who now occupy so unworthy a place in society, I see into them & feel their lovely qualities but I know they need my eye to guide them & my arm to keep them in a true position, a friendly insight to correct their faults & make them as good as beautiful—what a blessed thing it would [be] to act Providence for the helpless, all unseen but omnipotent to shape their destinies, & create their highest happiness . . . truly to be co-worker with God, to catch a glimpse of his design . . . is reward enough for a life of toil & gloomy effort.

  Elizabeth regarded women with the calm superiority of a benevolent deity. Unattributed, her words could pass as the musings of a profoundly paternalistic man. Women were not her peers or her equals, and she had little desire to work alongside them. Empowered by her own divine gifts, she meant to guide them toward better versions of themselves.

  This attitude went for all women, including those crusading openly for the newborn cause of women’s rights. Th
at summer of 1848, the first formal meeting of these reformers had convened at the squat brick Wesleyan chapel in Seneca Falls, not far from Geneva, where in July the attendees adopted a “Declaration of Sentiments,” written mostly by Elizabeth Cady Stanton and modeled on the familiar Declaration of 1776, with certain key edits: “We hold these truths to be self-evident: that all men and women are created equal . . .” Laying out “a history of repeated injuries and usurpations on the part of man toward women,” the declaration asserted women’s moral and intellectual equality, demanded greater opportunity in education and employment, and—though some delegates thought it shockingly radical—called for woman suffrage. A second Woman’s Rights Convention followed on August 2 in Rochester, where the Declaration of Sentiments was approved and further resolutions proposed, including one that praised Elizabeth’s “persevering and independent course” through medical school as “a harbinger of the day when woman shall stand forth ‘redeemed and disenthralled,’ and perform those important duties which are so truly within her sphere.”

  A different sort of woman might have responded to such unsolicited applause with grateful pride, but Elizabeth did not consider herself in thrall to anyone, nor in any particular need of redemption. It was flattering that they had heard of her, but she had no interest in becoming their emblem or their mascot, let alone in joining their ranks. “I don’t sympathize with these reforming ladies,” she wrote. “I’m very sorry my name was mixed up with the Rochester absurdity. I understand all the good that’s in them & esteem it for as much as it’s worth, but they mistake the matter & make themselves very foolish.” Though Elizabeth was undoubtedly a reformer and a lady, she placed herself in a separate category. She sympathized with the general goals of the women’s movement, but she chuckled dismissively at its tactics.

  One of the reforming ladies, she reported incredulously, had written her an admiring letter “full of enthusiastic sympathy, at my ‘bold resistance of man’s outrageous tyranny.’ ” Responding to the woman with appropriate courtesy, Elizabeth nevertheless proceeded to set her straight. The problem was not the tyranny of men, she wrote, but the disappointing weakness of women. “Women are feeble, narrow, frivolous at present, ignorant of their own capacities, and undeveloped in thought and feeling,” she lectured her well-wisher. “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.” Once women awoke to their untapped powers, Elizabeth believed—encouraged by the growing respect of her medical school classmates—men would welcome them as equals. The full development of women would then enable “the consequent redemption of the whole human race.”

  Quoting Margaret Fuller, Elizabeth invoked an idea at the heart of Associationism: “Earth waits for her queen.” The limited goal of woman suffrage—winning the vote for women who were still enslaved by their own ignorance—was, she believed, woefully premature. What good was a vote if one didn’t know how to think independently? It was more important to prove the capacities of women and show them the way forward into the light, out of the shadow of their menfolk. For women, just as for the enslaved, the first step must be freedom. “The study and practice of medicine is in my thought but one means to a great end,” Elizabeth wrote. Caring for suffering individuals had never been the engine that drove her. In becoming a doctor, she meant to heal humanity.

  Elizabeth had no interest in joining her strength to the emerging women’s movement. “I have curious glimpses into the American female world just now,” she wrote:

  There are several little eddies of women, in various places, that whirl & froth so furiously that . . . one would think the whole of womankind, was about to rise in general rebellion, & trample down all the common rules of society. Standing on the bank however, these little eddies assume their relative value, & that I fancy is a very small one.

  The metaphor places Elizabeth, godlike, on high, gazing down at the women’s rights movement as something directionless and frivolous, bubbly and easily popped, laughably “little.” She watched the chaotic eddies whirl away, and kept her feet dry. The only true sisterhood she felt, at this stage of her journey, was with her actual sisters: Anna, Marian, Ellen, and especially Emily.

  As the heat of summer waned and her months at Blockley drew to a close, Elizabeth took a break from her studies to welcome her cousin Kenyon Blackwell, visiting from England. With him was her second-youngest brother, Howard, now seventeen and planning to return with Kenyon to Birmingham and join him in the iron trade. After more than four years without seeing her brother—four years of unremitting intellectual intensity for Elizabeth—she thought Howy disconcertingly “dreamy & indifferent.” She was unsure whether to admire his gentle, poetic apathy or give him a good shake.

  Kenyon she found well read and sympathetic. He had brought her two expensive medical textbooks, gratifying proof of his confidence in her success. “They form a substantial foundation for my future library, & will cut quite a dash in the little office (that is to be),” she reported to Henry. “I consider them a good omen.” A decade older than Elizabeth, Kenyon stepped naturally into the role of the solicitous older brother she lacked, and he made it clear that he would be proud to lend her money in support of her admirable goal. With her usual horror of debt, she neither accepted nor declined, but felt “all the safer for the offer”—“it is a very different matter to receive willing aid from friends, for the promotion of a noble object.”

  The moment was full of promise. On the first night cool enough for a fire in Philadelphia, she drew her chair close to the hearth to write in her journal. “As I watched the beautiful sunset from my great window,” she wrote, “I almost regretted that I was going to leave.”

  * Encrustations on the mouths of fever patients.

  † Her words carry a prophetic resonance. Half a century later, in his essay “The Talented Tenth,” W. E. B. Du Bois would call for college education for Black students, writing, “The Negro race, like all races, is going to be saved by its exceptional men.”

  CHAPTER 5

  DIPLOMA

  The dissecting room at Geneva College was in an attic, exposed beams crisscrossing the space. The subject was stretched on a narrow wooden table, head and feet exposed, the rest draped with a sheet. Dr. Corydon La Ford, the demonstrator of anatomy, stood at the head, wrapped in a black apron, scalpel in one hand and forceps in the other. He had drawn a chair next to him for Elizabeth’s use, “while all around,” Elizabeth wrote to Emily, “sitting, standing, leaning on each other’s shoulders, on tops of benches, holding onto the rafters, were piled the students.”

  After the nightmares at Blockley, Elizabeth’s return to Geneva for her second term in the fall of 1848—even when confronted, as she was now, with a human brain lying exposed in the bowl of a sawed-open skull—was a relief. The professors were comfortable enough to allow her greater access, and for the first time she joined the rest of the class at a dissection.

  Some of Elizabeth’s classmates wore aprons, and others protected their clothes with dressing gowns; many were smoking or chewing tobacco in an attempt to hold the stench of a decomposing body at bay. None of them had washed their hands, nor would they when the demonstration was over. Jostling and jockeying for vantage, they somehow preserved a circle of calm around Elizabeth’s chair: “if a hand or a shoulder came in the slightest contact, it was instantly withdrawn, & perfect attention & good order prevailed.”

  The scene was typical of Elizabeth’s student days: hours of intense study surrounded by raucous human interaction that never quite touched her. Within the college, among men who had come to recognize her competence, the distance was a respectful one; outside, Genevans continued to regard her with horror. “People still gossip freely,” Elizabeth wrote to Sam, “report my intended marriage, if an unlucky student happen to walk home with me, & still consider me a sort of eccentric monster.”

  She did have one frie
nd, George White Field, one of the steady fellows from her tutorial group. Five years her junior, Field would go on to become a demonstrator of anatomy at the college. “I’ve never met with a young friend who lets my life flow out so freely,” she wrote. “Most people have a styptic effect on me.” The fact that Field had an older sister named Elizabeth, and Elizabeth a younger brother named George, can only have reinforced the familial comfort. But even this sustaining friendship fell victim to scandalized scrutiny. “Of course,” she continued, “all manner of stories have gone abroad about us, which oblige me now, to see scarcely anything of him.”

  She proclaimed herself grateful for the isolation, as it relieved her of the burden of feigning affection. To Marian, she described a classmate given to gazing at her during lectures, ambushing her on the walk home from church, and blushing when she caught his eye. “He is to me utterly repulsive,” she wrote. “Though a handsome fellow, I should be very sorry to let him touch my hand.” Chemistry as an academic subject was straightforward, but chemistry between individuals was mystifying: “it is strange that love cannot always excite love.” She preferred the noble goal of harmony between Man and Woman to the messy reality of men and women.

  As her friendship with Field suggested, what Elizabeth craved most was the unconditional support of a younger sibling: a fellow Blackwell, superior to others but subordinate to her. Her hopes veered again toward Emily, who remained at home in Cincinnati, teaching where she could. “Your life interests me particularly, as it seems more nearly related to my own, than that of any other member of our family,” Elizabeth wrote to her. “Emily I claim you, to work in my reform—will you answer to the call, & let us sketch our future together?” She had forced open the door to a new field of study for women; now she invited—or instructed?—Emily to walk through it. The mixture of commendation and command, superiority and supplication, would mark Elizabeth’s demeanor toward Emily throughout their entwined careers. “I’ve taken it into my head that you will lecture on anatomy someday in our college,” she told Emily. And Emily, who shared Elizabeth’s voracious intellect but not her polestar certainty, began to orient herself toward the future Elizabeth described.