Emily had intended to move on to London and Paris—to St. Bartholomew’s and La Maternité—early in the fall, but although Marie endured her surgery without mishap, her recovery was difficult. Elizabeth encouraged Emily to remain in Edinburgh for Marie’s convalescence, lest she provoke an “ineffaceable hostility” in Kenyon, after all his generosity to his doctor cousins. The repeated delays allowed Emily to accompany Simpson to the university for the graduation of the medical class. She watched the president touch each man’s bowed head with an ancient flat black cap, murmuring te medicinae doctorem creo—“I create thee doctor of medicine”—as he handed him his diploma. Afterward, as Emily passed the platform on her way out, Simpson tapped her on the head with the ceremonial cap and recited the same invocation, “a joke which appeared much relished by his professional brethren,” she wrote, unsure whether to laugh along.
She was coming to understand the limits of Simpson’s esteem. “He rather likes the novelty of a woman Dr—has no objection to my being as far as possible indoctrinated into his view, and as I am sometimes useful does not dislike my being about his house and picking up what I can,” she mused. “But he does not care about the matter—he will not in the least put himself to trouble to aid me.”
The trouble Simpson had taken with Marie did not seem to aid her either—each treatment came with another setback. Inflammation, abscess, and ovaritis were compounded by the mouth sores caused by overuse of calomel, the mercury-based drug that Emily and other progressive practitioners had come to distrust. A frightening bout of peritonitis occurred while Simpson was out of town, and Emily spent a harrowing night at Marie’s side, blistering her abdomen and soothing the pain with laudanum-infused poultices. “The whole case from beginning to end strikes me as a horrid barbarism,” Elizabeth wrote from New York, voicing an opinion Emily refrained from stating explicitly. “I see every day that it is the ‘heroic,’ self reliant & actively self imposing practitioner, that excites a sensation & reputation; the rational and conscientious physician is not the famous one.” Emily could not regret the extra months in Edinburgh—“I believe it has made the difference of life & death to Marie,” she wrote, and acknowledged that taking responsibility for her cousin’s care had “made a Dr of me”—but she was ready to learn from others.
The news that Elizabeth’s friend Florence Nightingale was recruiting women to serve as nurses at Scutari in the Crimean War briefly piqued Emily’s interest—not so much for the sake of clinical experience in the field, as in hopes of accessing new connections and opportunities within the medical establishment. Once she understood that Nightingale would hold the only position of authority, and that only in the sphere of nursing, she dropped the idea, “as I shall not of course accept a subordinate position.” Elizabeth seconded this decision, unable to agree with Nightingale’s conviction that women should be nurses and leave the doctoring to men. She was increasingly dismissive of the efforts that would soon make Florence Nightingale a household name. “She will probably thus sow her wild oats,” Elizabeth wrote, “and come back and marry suitably to the immense comfort of her relations.” An English correspondent of The Una, a new American monthly “devoted to the elevation of women,” drew an explicit comparison between Nightingale’s success and Emily’s struggle. “It seems strange that it should be considered more unfeminine for Miss Blackwell to visit sick women in the Infirmary of Edinburgh,” the article pointed out, “than for Miss Nightingale to go to a foreign land, and live among the horrors of war, for the purpose of attending to sick men.” The Blackwells were contributors to The Una, which was founded by Elizabeth’s friend Paulina Kellogg Wright. The anonymous correspondent might have been Anna.*
The days shortened in Edinburgh, its greens and grays cloaked occasionally in snow but more often in slush, the rotund Simpson swathed always in a fur greatcoat, “in which article he is I verily believe broader than he is long,” Emily wrote. It was January 1855 before Marie was well enough to travel, freeing Emily to leave for London. With her went a letter from Simpson, proof that her extended stay had not been a waste of time. “I do think you have assumed a position for which you are excellently qualified and where you may, as a teacher, do a great amount of good,” Simpson began.
As this movement progresses, it is evidently a matter of the utmost importance that female physicians should be most fully and perfectly educated, and I firmly believe that it would be difficult or impossible to find for that purpose anyone better qualified than yourself.
I have had the fairest and best opportunity of testing the extent of your medical acquirements during the period of eight months when you studied with me, and I can have no hesitation in stating to you—what I have often stated to others—that I have rarely met with a young physician who was better acquainted with the ancient and modern languages, or more learned in the literature, science, and practical details of his profession.
Emily was pleased with this encomium, though its last line suggested that Simpson, for all his ringing approbation, still found the idea of a female physician uncomfortable. “Permit me to add that in your relation to patients, and in your kindly care and treatment of them,” he closed reassuringly, “I have ever found you a most womanly woman.”
* In the next issue of The Una, Elizabeth was quick to correct the aspersions the anonymous correspondent cast, not on Nightingale, but on the leading physicians of Edinburgh. “Our English correspondent alluded to the injustice which Dr. Emily Blackwell met with in Edinburgh,” she wrote in an unsigned piece. After pointing out that Emily had gone there to study not at the Royal Infirmary but with James Young Simpson personally, she concluded, “It is therefore with feelings of sincere gratitude that Dr. Emily Blackwell leaves the capital of true-hearted Scotland, and with the earnest hope that she may find elsewhere the same admirable facilities in the pursuit of her chosen profession.” Elizabeth was more interested in elevating women than in criticizing men. And even with the Atlantic between them, she could not resist quibbling with Anna.
CHAPTER 12
NEW FACES
“This medical solitude is really awful at times,” Elizabeth confided to Emily in Edinburgh, in the spring of 1854. “I should thankfully turn to any decent woman to relieve it, if I could find one.” Three days later she received a visit from a young woman with an austere severity about her dark hair and shadowed eyes, her strong jaw and wide mouth. By the end of the afternoon, Elizabeth knew she had found an ally.
Marie Zakrzewska was as ambitious and undaunted as Elizabeth herself. “With few talents and very moderate means for developing them,” Zakrzewska would write in her memoir, “I have accomplished more than many women of genius and education would have done in my place, for the reason that confidence and faith in their own powers were wanting.” Two years earlier she had achieved the impossible: appointment to the position of chief of midwifery at the University of Berlin. But her bad luck was as spectacular as her achievement, and on the day of her confirmation, her mentor and predecessor in the position died. Finding the politics and chauvinism of the medical community in Berlin untenable without his support, she emigrated.
She had spent the past year in New York trying and failing to continue her medical career. She spoke little English, but she would not consider nursing despite an invitation from a German doctor to serve as one. “I thanked him for his candor and kindness, but refused his offer,” she wrote. “I could not condescend to be patronized in this way.” After all, her mother had been a respected midwife, and her grandmother a veterinary surgeon. Her father was a scion of Polish nobility. Zakrzewska supported herself and the siblings who had followed her to America with a shrewdly managed business in knitted goods, and refused to concede her plans for a medical future. Doubt was not something she suffered from.
MARIE ZAKRZEWSKA.
COURTESY SCHLESINGER LIBRARY, RADCLIFFE INSTITUTE, HARVARD UNIVERSITY
Straining the limits of her German, Elizabeth listened to her visitor’s astonishing tal
e. Both as a physician and as an instructor, Marie Zakrzewska (pronounced Zak-SHEFF-ska and soon shortened, among the Blackwells, to “Dr. Zak”) was better qualified than Elizabeth. “She knows far more about syphilis than I do,” Elizabeth noted, “and has performed version 4 times”—this last referring to the tricky process of turning a breech baby in the womb before delivery. But penury and the language barrier rendered Zakrzewska’s credentials useless in America. Both her need for Elizabeth’s help and the depth of her experience ensured that she would reflect well on her benefactor. Here, surely, was the perfect deputy. “There is true stuff in her,” Elizabeth wrote immediately to Emily, “and I am going to do my best to bring it out.” Perhaps Zakrzewska could obtain her M.D. at Cleveland Medical College, as Emily had. “My sister has just gone to Europe to finish what she began here,” Elizabeth told her new protégée, “and you have come here to finish what you began in Europe.”
Elizabeth’s instant confidence in Zakrzewska stood in sharp contrast to her usual attitude toward women with medical ambitions, most notably Nancy Clark, currently the only female graduate of a regular medical college who wasn’t a Blackwell. “Yesterday little Mrs. Clark called on me,” she wrote to Emily. (“Little” Mrs. Clark was a year older than Emily. Neither Blackwell sister ever addressed her as “Dr.”) “Hers is a good little nature, with some shrewdness too, but she wants independent strength.” Elizabeth was unimpressed with Clark’s narrow focus on obstetrics rather than the broader science of women’s diseases and surgery. “This is evidently the natural tendency of present women,” she tsked, “instinct and habit, not intelligent thought.”
When Clark expressed her hope of joining Emily in Europe, both Blackwells were wary. “Would her companionship be unpleasant in any way?” Elizabeth asked her sister. “I don’t want her to depend too entirely on me,” Emily wrote back. “If she come and do at all well I will do all I can to help her.” It was fine for Clark to pursue her vocation, in other words, as long as she did it somewhere else. “I find it as much as I can do to maintain a respectable standing medically among the physicians I meet at the Hospital & in Queen St,” Emily told Elizabeth. “A more ignorant companion would certainly be no aid.” The Blackwell sisters had no time or patience for any woman who might hinder their progress. And though neither mentioned it explicitly, it was not to Nancy Clark’s advantage that, with her blue eyes and cupid’s-bow mouth, she was undeniably attractive. She was also financially secure and had a doctor brother who planned to accompany her to Europe, further smoothing her path. In the Blackwells’ opinion, Clark’s seriousness—despite her diploma—was suspect. “I fancy she’s a pretty little thing,” Elizabeth wrote, “& that’s about all.”*
Yet since Clark’s visit, Elizabeth had begun to question her own natural tendency toward solo superiority. In May she had attended a public lecture delivered by J. Marion Sims, a self-promoting surgeon known in his home state of Alabama for his experimental work repairing catastrophic vaginal and rectal fistula, the debilitating internal damage caused by prolonged obstructed labor. That he had practiced on enslaved women, without anesthesia, was something he downplayed to his contemporaries; later generations have condemned his ethics and questioned his legacy. Elizabeth knew him only as an ambitious outsider like herself, one who was rapidly drawing the attention of the New York medical establishment for a technique that could rescue afflicted women—prisoners in their homes, constantly leaking urine and feces—from a living death. (Sims’s surgical technique is today of vital importance in restoring women to independence in the developing nations of East Asia and sub-Saharan Africa.)
Elizabeth was intrigued by Sims’s stated goal of founding a hospital for the treatment of women—“much grander than anything I can hope to establish for many many years,” she noted—and paid him a call, offering her support. “He is thoroughly in favor of women studying, and will treat them justly, which is all we want,” she wrote to Emily, unaware of any irony. “He is a most fiery man, but with much sweetness nevertheless, honorable and a gentleman.” His hospital, she hoped, would be an ideal place for female medical graduates to train.
Sims’s apparent faith in medical women inspired Elizabeth to reexamine her own scornful attitudes toward her female peers. If exceptional women seemed scarce, it was Elizabeth’s responsibility to find and cultivate more of them. “You must settle this matter, Miss Blackwell, for yourselves,” Sims had told her: Women must elevate women and help each other “contribute to journals, get practice, show their force.” His advice was dismissive—but also very much in line with Elizabeth’s own thinking. She had never believed that the progress of women was the responsibility of men.
Connecting Zakrzewska to Emily’s allies in Cleveland, Elizabeth smoothed her path to admission at Cleveland Medical College in the fall. Meanwhile the newcomer from Berlin was the ideal assistant at the dispensary in Little Germany, where her native language was an asset. Not to mention her company. Elizabeth felt the imperative of maintaining her tiny institution as at once credential, laboratory, and rallying point for women pursuing medicine, but the daily reality was a trial. “My Dispensary business is rather wearisome,” she confided to Emily. “As it stands it seems to be of no special use except to give me a long hot walk.” That summer indoor temperatures reached ninety degrees. From cooler Edinburgh, Emily sent encouragement: “I look on the little dispensary with interest as affording us the means of practice among the poor and then testing new methods and making improvements.” The daily, steady effort of medical practice left Elizabeth unsatisfied and impatient. It attracted Emily profoundly.
Everything that Emily learned from James Young Simpson she reported faithfully in her letters to New York, filling the margins with sketches of instruments and techniques. She even sent a small pessary, which Elizabeth immediately tried out on a patient, unguided by anything other than Emily’s description. It took a few attempts and a little improvisation. “She cried oh just as I judge it entered the cervix, & oh again as it passed the cervix—she said it was not pain, but like a little electric shock each time,” Elizabeth reported. “It has been an immense satisfaction to have something rational that I could do.” Rejoicing in Emily’s famous mentor, she exhorted her sister to embrace her fortunate circumstances. “I do increasingly think that your position with the popular Dr Simpson, is a most rare chance for becoming known, both in America & Europe,” she wrote. “I very much wish you could stay there a year, thoroughly recognized as his pupil.”
But Elizabeth’s insistence that Emily remain abroad meant her own isolation in New York would continue. Marie Zakrzewska left for Cleveland Medical College in the fall of 1854; in her absence, Elizabeth closed the dispensary. Its limited hours had made it difficult to connect with the women of the neighborhood; on some afternoons, Elizabeth waited alone and in vain. Rather than spend her modest resources on rent for both residential and underused professional space, she decided, with the help of a generous loan from sympathetic friends, to buy a house at 79 East Fifteenth Street, at that time located between Irving Place and Third Avenue. Without a disapproving landlord, she would be free to see private patients and carry on her dispensary work on her own terms. It surely did not escape Dr. Blackwell’s notice that her new house backed onto the Fourteenth Street building that housed University Medical College, founded by New York University in 1841. For six years she would live within sight of its rear windows, even renting rooms to its students for extra cash. It would be another six and a half decades before New York University admitted a woman as a medical student.
Elizabeth was relieved to own a permanent home, and grateful for Marian’s housekeeping in the three years since her arrival in New York. But whether as helpmeet or intellectual companion, mild Marian could not satisfy Elizabeth’s craving for connection. Having eschewed marriage and motherhood for a career that existed more on paper than in practice, Elizabeth felt herself sliding toward depression. “I found my mind morbidly dwelling upon ideas in a way nei
ther good for soul or body,” she wrote.
Passive resignation, however, had never been her style. One day in late September, Elizabeth boarded a ferry bound for Randall’s Island, northeast of Manhattan. Her destination was the juvenile department of the New York Almshouse, known as the Nurseries. She was going to pick out a child.
A five-minute walk from the ferry landing brought Elizabeth to a group of buildings built half a dozen years earlier, facing eastward into the salty breeze off Flushing Bay. Here lived more than a thousand children, ranging in age from three to fifteen. Some had been scooped from the streets, others deposited by desperate parents. Many were the children of recent immigrants: an “Infant Congress of many nations,” as one observer recorded, noting—in the unsettling cultural shorthand of the day—the round faces of the Germans, the “dogged look” of the English, the “pleasure-loving lips” of the French, the “whimsically grinning” Irish. It was a “great depot of small humanities,” Elizabeth wrote, “such forlorn children, assembled under harsh taskmasters, fast becoming idiots or criminals.” Inmates of the Nurseries went to school, but their training in the sewing workshops and the vegetable gardens was more important. The best way off the island was through indentured labor.
“I must tell you of a little item that I’ve introduced into my own domestic economy in the shape of a small girl,” Elizabeth announced to Emily, “whom I mean to train up into a valuable domestic, if she prove on sufficient trial to have the qualities I give her credit for.” The transactional tone is startling, especially when juxtaposed with the rosy sentimentality of some of Elizabeth’s writings on motherhood. But Elizabeth was less in search of a daughter than a useful companion. The small girl she chose—after several visits to look over the options—was Katharine Barry, a dark-haired, dark-eyed orphan of Irish parentage, thought to be about six years old. “She was a plain, and they said stupid child though good, and they all wondered at my choice,” Elizabeth continued. “I gave a receipt for her, and the poor little thing trotted after me like a dog.”
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