A letter in response to D.K. seemed to side with Elizabeth’s cause—up to a point. Surely, wrote “Justus,” D.K. was “decidedly behind the age.” There had always been female midwives, and who could argue against the benefits of a well-educated one? Think of Marie-Louise Lachapelle or Marie Boivin, both renowned authorities on midwifery at the largest public hospitals in Paris fifty years earlier. However: “As to females engaging in the general practice of medicine,” Justus continued, “the idea is absurd.” The letter echoed Charles Lee’s perception of Elizabeth: “From all we have been able to learn respecting Miss B.,” it concluded, “she is emphatically an exception.”
Lee himself added a startling footnote to the published version of his commencement address. He acknowledged the criticism that had appeared in print and even agreed with it in the case of women in general, though having witnessed Elizabeth’s undeniable success, he reasserted his belief that it was appropriate to admit to the medical brotherhood an exceptional woman who possessed the proper “moral, physical, and intellectual qualifications.” But his final sentence revealed just how fragile Elizabeth’s accomplishment was. “While he holds this opinion,” Lee wrote, using the third person to distance himself from hypocrisy, “he at the same time feels bound to say, that the inconveniences attending the admission of females to all the lectures in a medical school, are so great, that he will feel compelled on all future occasions, to oppose such a practice, although by so doing, he may be subjected to the charge of inconsistency.” Charles Lee, whom Elizabeth counted among her strongest allies, was still the equivocating administrator who had left her admission up to the students. He would be happy to celebrate her success, but if the world was not ready for a woman doctor, he did not want the blame.
Elizabeth didn’t linger in Geneva. The day after graduation, she and Henry boarded a train accompanied by Charles Lee, who like many provincial medical professors was in residence only during the sixteen weeks of the term. Soon Elizabeth was back in Philadelphia with her solicitous Quaker friends, the Elders, determined not to slacken the pace of her study while she waited for her plans to become clear.
The men who had blocked her entrance to Philadelphia’s medical schools proved more welcoming now that she had achieved her M.D. somewhere else. “About a week ago I had quite a morning of triumph,” Elizabeth wrote to Henry. Eager to audit the lectures of the most illustrious physicians of the day, she had presented herself at prestigious Jefferson Medical College. She was invited to sit alone in an anteroom off the lecture hall, where she could listen without intruding her presence. “The lectures were good, & I was glad to hear them, but I felt a little mean at hearing a lecture secretly,” she wrote. The next day she returned with an escort of sympathetic professors, including Charles Lee; entering the hall together, they were greeted with warm applause from the five hundred students in attendance.
After that it was easy. One by one, the professors invited her to listen, and the students cheered every time she appeared among them. “Dr Lee was quite in spirits, for he had been blamed in N.Y. for giving me an M.D. & this pleasant recognition from the first college in the country was a support as unexpected as agreeable,” she exulted. “I was delighted that all went so smooth, & felt a little pride too in my triumph,” she continued more soberly, “perhaps this was why I received rather a rude message of refusal from another professor in the afternoon—a providential punishment.” As usual, Elizabeth did not blame her male detractor—pride goeth, after all. Still, it stung: “I am so careful always to avoid intruding, that an ungentlemanly repulse, makes me feel a little bitter,” she confessed. “I have not yet recovered from it sufficiently to visit the Museums to which I was invited.” It was a rare admission of emotional vulnerability.
Days not spent at medical lectures were still busy; Charles Lee was not the only Genevan now in Philadelphia. “My mornings I spend dissecting with George Field—he is a real good hearted little fellow, & I like to be with him,” Elizabeth wrote. Afternoons were for “rubbing up my French” in anticipation of her next goal: practical training in Paris.
For half a century, Paris had been the best place in the world to study medicine. The Enlightenment and the French Revolution had together created perfect conditions for the rapid advancement of medical knowledge: an embrace of skepticism and empiricism; a clearing away of old ideas and authorities; the reorganization of major hospitals as state-supported educational institutions rather than simply charitable refuges for the incurable; a meritocracy of innovative doctor-professors; and an abundant supply of indigent patients, victims of war and industrial displacement. French medical students learned at the bedside—it was not uncommon for a professor to lead a hundred pupils through the wards—and French hospital patients were routinely seen as offerings on the altar of science, their symptoms considered teaching tools as much as illnesses to be cured. This utility extended after death: the French did not share the Anglo-American horror of dissection. With deceased patients providing a steady stream of specimens, French physicians became leaders in investigating the pathology of disease. American medical students were frequent visitors to the “Paris School” in order to burnish their professional prestige at home.
If training in Paris gave a young doctor an extra gleam of legitimacy, then to Paris Elizabeth would go. Her new allies in Philadelphia would, she hoped, be willing to introduce her to their colleagues in France; indeed, they would be only too glad, she suspected, to make her someone else’s uncomfortable responsibility. And providential help was at hand in the form of cousin Kenyon, who offered to escort her on his homeward trip across the Atlantic.
But first a quick family reunion, something she had not managed since her departure for Asheville in 1845. Elizabeth’s loyalty to the Blackwell tribe burned as true as ever, but Cincinnati lay in the wrong direction, geographically and intellectually. It would be good to renew old ties with the influential Beechers and Stowes in Walnut Hills, though, and fulfilling her filial duty would give her a chance to see—and counsel—the sister she had chosen to follow her. “Is Emily teaching busily, & did she receive my message in relation to certain books I want her to look at, before my return?” she asked. She worried that Emily was spending too much time on German and not enough on anatomy.
Elizabeth stayed in Cincinnati for less than a fortnight. Her impatience was clear. “Obstacles overcome thus far only make her more resolute in her course,” Sam wrote in his journal. “She told me I ‘could not conceive how intensely she desired to be at work.’ Even the 2 weeks at home seemed like lost time.” On April 2, 1849, Elizabeth boarded a river steamer for the journey east. The remaining Cincinnati Blackwells—Hannah on Sam’s arm, with Marian, Emily, and Ellen on one side, and Henry and young George on the other—waved as she receded. “I could not keep down the tears as I caught the last glimpse of those dear, true ones,” she recorded in her journal. As the narrator of her own story, she lingered on the bittersweetness of the moment. But she itched to be gone.
Elizabeth stopped in Philadelphia to bid her friends farewell but also to complete a symbolic errand. On April 13, with Sarah Elder as her witness, Elizabeth Blackwell, M.D., became a naturalized citizen of the United States. For seventeen years, she had thought of herself less as an immigrant than as a semipermanent expatriate. Her attachment to her own Englishness remained strong, but it was in the New World that she had managed to achieve the first step toward her goal. Perhaps this parting gesture was a grateful one—or perhaps it was more strategic. France had long felt more warmly toward America than it did toward England; defining herself as an American might help smooth her path in Paris. For now, having pledged her allegiance to her adopted country, she promptly left it. Within a week she joined Kenyon in Boston and sailed for Europe.
* Different witnesses recorded Elizabeth’s words differently; tellingly, Henry reported her saying “your” diploma, while she remembered it as “my” diploma. Others heard “this” diploma.
† A tre
phine is a circular bone saw used to cut holes in the skull. A gorget is a gutter-shaped instrument used to guide forceps during surgery to remove gallstones or repair fistulas.
CHAPTER 6
PARIS
As the majestic copper dome of the Massachusetts State House receded in the sunset, and the first whiff of bilgewater reached Elizabeth’s nose through the stiffening breeze, all thoughts of her noble mission were replaced by more immediate preoccupations. “I gave myself a little convulsive twist,” she recorded later, “& told Kenyon in a very loud voice, that I had no expectation of being sea-sick.”
When the ship’s bell rang for dinner, she marched resolutely into the saloon, but the flash of mirrors and the clash of dishes; the waiters rushing to pour wine; the chattering diners, like “a herd of pigs come to be fed”—it was all overwhelming. She managed one bite, rose from her seat, and rushed to her tiny stateroom, reaching the washstand just in time.
As she collapsed into her berth, the door burst open to admit her assigned cabin mate: an elderly woman, staggering with each lurch of the ship, too overwhelmed by nausea to locate the necessary basin. “After a few minutes violent exertion,” Elizabeth recounted, “she tumbled upon a box, declared she had never been so ill in her life, & believed she was going to die.” The newly credentialed doctor clung mutely to her lower bunk, leaving the unfortunate old lady to call for the overworked stewardess’s help in boosting her up into bed. It was nearly a week before Elizabeth felt well enough to venture out on deck. Throughout the ordeal she maintained a stoic silence, though the poor soul in the upper bunk moaned loudly enough for two.
Too queasy to study, but well enough to feel the weight of idle hours, Elizabeth contemplated the uninspiring society on board. The gentlemen smoked and discussed horse racing and money, their voices rising with each glass of brandy. The ladies “gathered themselves into groups, & turned their backs on all solitary individuals,” talking of titles and dresses and the opera. “I listened in vain for one thought, one noble sentiment, or one mark of true refinement,” Elizabeth complained. “Oh I grew very very weary of those uncongenial people, who never spoke to me, but were all the time with me.” Kenyon, himself bedridden with an attack of rheumatism, was little help.
At last Elizabeth woke to see the banks of the Mersey on either side with Liverpool ahead, the ships at anchor in the harbor seemingly right up among the houses. At the customs house, Elizabeth held her breath anxiously for a moment—partly because she didn’t have the money to spare for duties, and partly because she had stashed her two largest and most expensive medical textbooks under her clothes to avoid paying tax on them. But the officials took little notice of the plainly dressed young woman and her ailing cousin. She exhaled, and on they went.
There wasn’t much time before the train that would take them to Birmingham, where Howard and Anna were now settled near Kenyon’s branch of the Blackwell family. Elizabeth could hardly bear to blink, there was so much to take in. The last time she stood on English soil, she had been a girl of eleven. She might have come of age among Americans, but despite her new citizenship, she still wasn’t sure she wanted to be one. She was ready to fall in love with England again. Liverpool was built on a noble scale; the buildings seemed so substantial, defying the march of centuries. But as her gaze descended from Liverpool’s elegant architecture to its consumptive-looking residents, ambivalence crept in. “Many of the people looked watery to me,” she wrote. “I wanted to expose them to a bright American sun & dry them.”
Still, as they rattled toward Birmingham, the countryside—neat hawthorn hedges and ancient stone churches, gardens full of cowslips and primroses—seemed verdant and perfect compared to the raw American towns Elizabeth had known. A chaise carried them the last few miles west from Birmingham to Portway Hall, home of Kenyon’s brother Sam Blackwell, an iron refiner, and his father, Uncle John Blackwell. Even here in the “Black Country,” Britain’s coal-fueled industrial heart—where the very leaves on the trees were darkened with soot, and the sun through the smoke “gave a pale light that resembled an eclipse”—Elizabeth found plenty to admire. Portway Hall, built in 1674, was like a castle from a fairy tale: entered through an arched door in a central tower ornamented with a sundial, festooned with ivy, and crowned with battlements. Three stories of mullioned windows commanded a view of lawns sloping down to gravel paths and a fishpond. There were greenhouses, galleries hung with paintings, and a sweeping stone staircase. For Elizabeth, veteran of drafty boardinghouses, daughter of a family eternally on the edge of penury, Portway Hall felt like the beginning of a better story.
It was joyful to see her little brother and eldest sister again. Howard seemed to be flourishing, though Anna was her usual valetudinarian self. “This morning she stood for 10 minutes, rubbing a magnetized dollar over the back of her neck, to cure nervousness, & drank a tablespoon of magnetized water, which has a special tendency to the heart,” Elizabeth wrote, bemused but open-minded.
Kenyon, still ailing, had meanwhile become a lesson in the limitations of heroic medicine. The doctor from the neighboring town of Dudley arrived daily with “all manner of drugs & absurd directions” that only weakened the patient. In the doctor’s absence, Elizabeth and Anna took matters into their own hands: “For a few days the medicines were regularly thrown away, & bread pills & flavored water substituted, & with judicious diet, cleanliness, & kind cheerful nursing he improved rapidly.” But then, disaster: “Uncle Blackwell discovered the plot & all was over, with the unfortunate effect of making Kenyon suspicious of his kind nurses—he gives himself up with the strangest blindness to the Doctor.” It didn’t occur to anyone that the Dudley physician was unnecessary. There was already a doctor in the house—still green but possessed of good instincts.
A visit to Dudley Castle was an opportunity for Elizabeth to express the pent-up energy that drove her. The ruined keep stood at the top of a hill, its thick curving walls pierced by arrow slits. “I began to imagine how grandly an army would approach, & how noble a defence the Castle would make,” she wrote, “till I longed to revive one of the antient conflicts, & almost frightened my companion by my martial demonstrations.” The excursion inspired her to resume her own crusade. Touring Birmingham’s hospitals, she found a familiar mixture of shock and gratifying courtesy. “Mr. Parker, Surgeon to the Queen’s Hospital, had some difficulty in believing that it was not an ideal being that was spoken of,” Elizabeth wrote dryly, “but when he found I was really & truly a living woman, he sent me an invitation to witness an amputation.” She borrowed Anna’s velvet and sables for the occasion—modern crusaders’ armor—and was pleased to see young male faces “peeping through doors & windows” to catch a glimpse of the fabled lady doctor.
Impatience for the work ahead soon overwhelmed Elizabeth’s limited appetite for family reunions. By the middle of May she had moved on to London, accompanied by her cousin Sam’s friend, the amiable Charles Plevins. “I parted from Portway friends with great regret,” she wrote home. “We are getting used to one another, a home feeling was growing up there to me, & so—it was time to be off.” Domestic contentment was the enemy of progress.
London was wonderful. Charles Plevins took Elizabeth to Sunday luncheon at the home of his formidable aunt near Regent’s Park, where they were announced by a footman in velvet breeches, white stockings, and a burgundy vest with gold buttons—Elizabeth wasn’t sure whether to curtsy or laugh. Museums and hospitals, paintings and pathology; one day she was admiring a Rembrandt at the National Gallery, the next attending a dinner party thrown by a doctor with an exquisite collection of microscopes, through which Elizabeth beheld “the lung of a frog most minutely injected” and the innumerable tiny teeth of a piece of sharkskin. The attention was intoxicating, though Elizabeth, dressed in serviceable black, felt uncomfortably outshined by the begowned beauties she met at soirées. “The English ladies have very beautiful busts,” she wrote, with mingled irony and awe, “as round & white & full as gelati
nous marble.” If this was more human interaction than she had ever sustained in her life, the former teetotaler had luckily discovered a helpful social solvent. “Iced champagne,” she told her family, “is really good.”
She felt more at home at the Royal College of Surgeons, among the jars of preserved limbs and organs at the Hunterian Museum, where she was unintimidated by the towering forehead and protuberant stare of its notoriously difficult curator, Richard Owen: “Mr. Owen is a man of genius, & the hour passed away like a minute.” Racing through the galleries of the British Museum at top speed, she had time only to regret that “a certain Emily B” couldn’t be there to enjoy the cultural riches on display. Elizabeth walked the wards with a senior physician at St. Thomas’s, one of London’s most illustrious hospitals, and proudly heeded his insistence that she sign her name followed by the hard-won “M.D.” in the hospital ledger. She received more medical invitations than she could possibly accept during her week’s visit. “I thought such excitement would have bothered me intensely—it did at first bewilder, but now I’ve roused to meet it,” Elizabeth exulted. “The more I have to do, the more I can—I believe I’ve never yet even begun to call out my power of working.”
The Doctors Blackwell Page 10
