If Nightingale and Beecher provided the sparkle of celebrity for the new undertaking, Elizabeth’s steadfast ally, the Quaker doctor William Elder, supplied the heart. Elder had traveled from Philadelphia to witness the birth of an institution that would not only promote the progress of women in medicine but also, he predicted, correct the folly of current medical instruction. “All scientific medical works begin at the wrong end,” Elder insisted, condemning the “fogyism and humbug” that infected the profession, and praising the Blackwells’ intention to “educate the medical student in the Infirmary, by the bedside.” He was sure they were standing in what would become not just a hospital but a female college. The Blackwells, he averred, were women of “broad faith,” and the public could trust the virtue of their work. The abolitionist minister Dudley Atkins Tyng, another Philadelphian, arrived late, breathless and dusty from a delayed train, to confirm the spiritual fitness of the lady physicians. And lest anyone fail to mark the significance of the date, he cited Florence Nightingale, yet again, as proof of women’s potential before offering a closing prayer.
The day was an undeniable success, but Elizabeth and Emily left the celebrating to others. Marie Zakrzewska found their restraint exasperating. “Elizabeth Blackwell seemed to feel some sort of gratification at the day of the opening,” she wrote, “though she tried hard to conceal.” Zakrzewska thought she could detect a more obvious flush of pleasure on Emily’s face, though nothing like the triumph she felt was warranted. “It seems to me so strange that some natures always will be in opposition to themselves,” she continued. “These two women for instance, have all right to be satisfied with their work and efforts . . . but still they won’t acknowledge it either to others nor to themselves.” Did they not realize that their supporters needed emotional satisfaction—good fellowship as well as good reform? “In spite of all I love them and feel sad that nothing can cheer them up,” Zakrzewska wrote. “Or do they perhaps show their joy in their bedroom where nobody sees them?”
ANNUAL REPORT OF 1857, THE YEAR OF THE NEW YORK INFIRMARY’S FOUNDING.
COURTESY NEW YORK ACADEMY OF MEDICINE
The infirmary building itself was an apt metaphor for an institution channeling middle-class largesse toward the needs of the poor, “fully respectable on the Bleecker Street side, and full of patients and misery on the other side and at the rear,” as Zakrzewska described it. Around the corner on Crosby Street, the decorative touches of the facade vanished along with the middle-class complacency of the neighborhood. The dispensary was in the dining room on the ground floor—a luxurious space compared to its original incarnation on Seventh Street. There was a desk for the attending physician, an examination table behind a screen, and a workbench for preparing prescriptions. It was attended every morning by the lady physicians or one of their assistants: a series of new graduates from the women’s medical colleges in Philadelphia and Boston who paid for a practical opportunity that was as yet unavailable to them anywhere else.
In the entrance hall, patients waited their turn on donated secondhand settees. The building was chilly in winter and airless in the hot weather, but it was spotless and well staffed, a paradise compared with the hellish conditions awaiting the sick poor at municipal institutions like Bellevue or Blackwell’s Island. The second floor held two inpatient wards, with maternity cases on the third. The slant-ceilinged attic story was a warren of tiny rooms: sleeping quarters for students, nurses, servants, and Marie Zakrzewska, who had moved in as resident physician. Though Blackwell was the name most closely associated with the infirmary, it was Zakrzewska who devoted every waking hour to it during its first two years, tending not just to the patients but also to the building, the larder, the linen closets, the medicine cabinets, and the staff. She was up before dawn to order provisions at the market, and after evening rounds she gathered the students to review the day’s patients while mending sheets. She made sure everyone was in bed by midnight, unless a crisis—or a baby—emerged. People might refer to the infirmary as the Blackwell hospital, but it was Zakrzewska who kept it going.
Elizabeth and Emily remained at Fifteenth Street, making the twenty-minute walk to staff the dispensary in the mornings and, in Emily’s case, to treat surgical patients. At this early stage, the infirmary didn’t actually provide full-time employment for three physicians. Two-thirds of the beds remained empty. This was not for lack of patients but lack of funds; Elizabeth refused to spend money she didn’t have. “It is a principle distinctly laid down, that no debt shall be contracted by the Institution,” read the annual report. Although the hospital’s mission was to provide free care to the indigent, once it reached the limits of its meager resources, it accepted only those inpatients who could afford to pay four dollars per week. There weren’t many of them. The Blackwells and Zakrzewska spent a substantial amount of time away from Bleecker Street, attending to private patients. It was their only source of medical income; the infirmary paid them nothing.
The New-York Times ran an enthusiastic notice of their efforts—“What the Lady Doctors Are Doing”—two months after the infirmary opened. The item cheered the infirmary’s modest beginning, noting the founders’ “ambitious plans for the future” and highlighting their “mortal horror of debt, quite unusual in similar enterprises.” The “homelike” establishment was “as fresh and clean as if just swept by the proverbial new broom,” and the nursing care was unusually good, “if one may judge from the physiognomy of the motherly-looking dames who have charge of that department.” Surely the infirmary would prove to be the kernel of women’s medical education in New York: “The plan is well laid, and only needs a refreshing shower of endowments and donations to hasten its growth materially.”
All this was excellent publicity, but the article mentioned the Blackwell sisters only briefly before devoting a full paragraph to the credentials and merits of Dr. Marie Zakrzewska. “She is an enthusiast in her profession, and is of the timber from which good artists are made,” the reporter enthused. “She is aided by the Drs. Blackwell.” It is likely the reporter was Mary Louise Booth, a frequent visitor to Zakrzewska’s attic quarters at the infirmary, and later the first editor of Harper’s Bazaar. Dr. Zak had recognized the young reporter as a sister across disciplines: “I found that she also was a beginner in her career and had obstacles to overcome; as, for instance, hiding her sex by signing only her initials to whatever she wrote, or not signing at all.” Their friendship had yielded exactly the kind of warm support Elizabeth and Emily found so hard to attract.
Policemen walking the night shift became accustomed to seeing the women of the infirmary coming and going at all hours. The doctors and their students spent significant time in “out-door practice,” visiting patients and laboring mothers in the slums. Given the infirmary’s limited finances, it was a good way to expand its reach and reputation without the extra expense of feeding and housing inpatients. Some nocturnal calls surely rattled the composure of even the bravest visitor, but those moments had their own value in plucking at the heartstrings of potential donors. “Night after night is spent by the young physician in these dens of misery,” read one early annual report, “when the only bed is a heap of rags on the floor, and that heap is shared, perhaps, by a drunken husband, and here the newborn child is ushered into a world of woe.” There is no record of either doctors or students coming to any harm beyond “unpleasant annoyances from unprincipled men.” Though uptown ladies might draw in their breath and their skirts at the sight of a female with a doctor’s bag, women of the tenements welcomed the unusual physicians into their private spaces. Women had always helped each other in sickness.
Their menfolk were not as sure. Who knew what really went on upstairs at Bleecker Street? When one woman died on the maternity ward, gossip flew: Weren’t those lady doctors known to promote hygiene over calomel and leeches? What kind of doctoring was that? Though relatives had been present at the woman’s bedside throughout her ordeal, by early afternoon members of her extended famil
y—including men armed with axes and shovels—were pounding on the Bleecker Street door, condemning the infirmary for “killing women in childbirth with cold water.” Their shouts drew a crowd that expanded to fill the sidewalk as far as Broadway; a few ran around and battered at the back door as well. The infirmary staff were trapped, their calls for help inaudible over the noise of the mob. At this point two policemen arrived, and the doctors had reason to be grateful for the reputation they had built in the neighborhood. Bellowing for silence, the officers ordered the rioters to disperse. Didn’t they know the lady doctors did the best they could for their patients? After all, they scolded, “no doctor could keep everybody from dying some time.”
This was not an isolated incident. On another occasion, a similar mob responded to the news that appendicitis had claimed a victim, though the patient had been attended repeatedly by Richard Sharpe Kissam, an eminent Bellevue surgeon who was one of the infirmary’s consultants. This time Zakrzewska was able to send a note summoning Kissam, who told the angry gathering to fetch the coroner and have him examine the body in the presence of a “jury” of a dozen of them. “It was a sight to behold,” Zakrzewska remembered. “These poor distraught men in overalls, with dirty hands, disheveled hair and grim faces, standing by during the autopsy, and at its close, declaring their satisfaction that death had been an unavoidable consequence of the disease.” It was good to have champions like Kissam in a crisis, but the women he had just rescued must have wished they could do without his help.
By midsummer things were running smoothly enough that Elizabeth took a vacation, a solo weeklong ramble along the Connecticut shore near Lyme. Charmed by the blue and green and gold landscape, she filled her lungs with sea breezes, sometimes walking twenty miles in a single day. One afternoon an elderly gentleman driving a wagon in her direction offered her a ride, assuring her that he was a married man and she should feel no anxiety, despite the remote spot in which they found themselves. “I informed him that I had great faith in humanity,” Elizabeth wrote, “& believed in men, not in tigers.”
The infirmary’s annual report for 1857 announced that nearly a thousand women and children had received care, though only forty-eight as inpatients. There had been thirty-six surgical cases, with Emily performing admirably as attending surgeon. “I have been delighted with the sound judgment and ability she showed, at every step,” Elizabeth wrote after Emily’s first successful operation. “I think a reputation in surgery will be sure to make her fortune in time, for it will be the very thing that will overcome the distrust women still feel in employing women Doctors.” While a skeptic might insist that a feverish patient’s recovery would have happened more rapidly under a male doctor’s care, no one could question the skill of a woman who safely removed a tumor or corrected a clubfoot.
Word was spreading among the communities the infirmary served, and the trustees were happy to report that “the kindly, home-like way in which this charity is conducted, attaches the poor people to it, and they gladly return there.” In fact, too many returned, and lack of funds forced the painful necessity of turning many of those patients away. But Elizabeth’s adamant refusal to borrow money was prudent. The political turmoil that followed the Supreme Court’s Dred Scott decision—which unexpectedly opened western territories to slavery—and the subsequent collapse of the market in western railroad securities led to a financial panic in the fall of 1857 that convulsed the country, closing New York banks for two months. Even as commercial credit evaporated, the infirmary proceeded with its work, unaffected. “Its funds have been managed with great economy,” the Times wrote approvingly, “and, notwithstanding the commercial embarrassments of the past year, it is free from all debt, and has even increased the number of its beds.”
Despite such proofs of success, Elizabeth, at least, remained unsatisfied. Though the Blackwells could claim staunch allies, most of New York’s elite still looked at them askance. Remembering her enthralling encounter years earlier with Fanny Kemble in Lady Byron’s parlor, Elizabeth brought Zakrzewska to pay a call when the actress visited New York, hoping she might offer her talent in support of the infirmary. Kemble listened attentively, but when she realized the attending physicians of this hospital for the poor were women, her reaction was immediate and thunderous. “She sprang up to her full height,” Elizabeth wrote, “turned her flashing eyes upon us, and with the deepest tragic tones of her magnificent voice exclaimed: ‘Trust a woman—as a doctor!—NEVER!’ ” Elizabeth and Zakrzewska left the hotel bemused and disappointed.
Elizabeth was increasingly unafraid to declare that America wronged its accomplished women. “When a woman has won herself an honorable position in any unusual line of life,” she wrote in the Philadelphia Press, “she is still excluded from the companionship and privileges of the class to which she should belong, because her course is unusual.” Her hard work had won her admirers, but she was still mostly unwelcome in the drawing rooms of the prominent people who could help her the most—people whose approval she craved more than she would admit. “Stop the sneer at any effort because it is unusual,” she wrote with unguarded frustration. “Let us learn to regard women as human beings as well as women.” She was weary of the gossips who wondered whether female doctors dressed like ordinary women, or cut their hair short like men.
It was good to have allies like Lady Byron, who had remained a flatteringly faithful correspondent in the years since Elizabeth had returned from Europe. “Your kind thought for our Hospital cheers me,” Elizabeth wrote to her at Christmas 1857. To a woman as sophisticated and well respected as Lady Byron, Elizabeth felt no need to soften her sense of her own value.
Very few understand the soul of this work, or the absolute necessity which lies upon me, to live out the ideal life to the utmost extent of my power. My work is undoubtedly for the few, it is labor in the interlinkings of humanity, and is necessarily difficult of appreciation to the mass, very slow in gaining their esteem. It has been my most toilsome lesson, to translate my thought into the common language of life, and I labour at this translation perpetually, and too often remain still incomprehensible.
At least, she told her friend, she now had a loyal companion on her difficult path. “My sister is a noble helper, and we shall stand, I trust, shoulder to shoulder, through many years of active service.” But even in her gratitude, Elizabeth saw her younger sister as an aide, not a partner: someone to hold the ground they had won, even if she herself was too restless, and too ambitious, to settle there.
CHAPTER 14
RECOGNITION
“I am going to tell you my plans, which I have not yet mentioned to the family generally,” Elizabeth wrote to her brother George in June 1858, “so keep it to yourself for a while.”
The infirmary had been open for a year. Emily had attracted new interest with her own series of lectures for women, enlivened with anatomical illustrations borrowed from the city’s medical schools. In Albany, she had successfully lobbied the New York state legislature for a grant that would place the infirmary on sounder footing. And she had overseen the care of one particularly important patient: Lucy Stone, who was expecting her first child at thirty-nine. “I should not object to its being a boy,” Emily wrote, “but as the Blackwell family has always been distinguished by its women, I should be very well satisfied either way, and it may turn out a little Stone and no Blackwell after all.” Lucy and Henry’s only child, Alice Stone Blackwell, was born September 14, 1857, looking almost comically like her father. She would grow up to become a leader in the suffrage movement.
Emily’s capable management allowed Elizabeth to look ahead—and to recognize the itch of her own dissatisfaction, despite the slow, steady growth of their practice. “Life in New York is monotonous,” she wrote, “and it will continue so, for it arises partly from our position which is without money or connexions, partly from our nature which with the best endeavor, cannot enter into close relations with the society we meet.” The wider approbation that Elizabeth
craved remained elusive. Antoinette Brown Blackwell reported that few people on her lecture-tour travels had heard of the New York Infirmary for Indigent Women and Children—though mention of her own married name frequently elicited the question, “Whatever happened to that Elizabeth Blackwell, you know, the one with the medical degree?” Elizabeth might think of herself as a beacon of enlightenment, but her light was not shining as brightly as she had expected.
Barbara Leigh Smith had recently visited New York with her new French husband, Eugène Bodichon, an eccentric doctor sixteen years her senior, who spent most of his time in Algiers and affected a flowing white burnoose over his street clothes. Though the reform-minded Bodichons had planned their American wedding tour as an educative opportunity to observe southern slavery and northern liberalism at first hand, they paused for a pleasure trip to Niagara Falls, and Elizabeth brought Kitty along for the treat. Her friends urged Elizabeth to consider bringing her work “home” to England. Surely London was ready for women doctors, now that Florence Nightingale had become a household name?
Upon her return to England, Barbara Bodichon and Bessie Parkes founded a monthly magazine, the English Woman’s Journal. The second issue, published in April 1858, included an extensive profile of Elizabeth and Emily, written with sororal pride by the Blackwell family journalist, Anna. Citing Queen Elizabeth I and the Huntress Diana as Elizabeth’s models, Anna filled her account with the kind of hyperbole usually accorded a folk hero: how teenaged Elizabeth had proved her prodigious physical strength by hoisting a skeptical (and protesting) male visitor in her arms for three laps around the parlor; or how she had severely restricted her diet while at medical school, so as to remain pale of countenance no matter how trying the anatomy lesson. Anna mentioned neither the farcical circumstances of Elizabeth’s acceptance at Geneva nor the tragic loss of her eye in Paris, and she was careful to correct the “very general misapprehension” that her sisters were American. As true daughters of Bristol, Anglophile Anna averred, Elizabeth and Emily had been “incapable of resorting to the system of puffing and self-vaunting so much in vogue among our transatlantic cousins.” Their success, earned the hard way, Anna suggested, would be all the more lasting.
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