As she prepared to repeat her lectures in Birmingham, Manchester, and Liverpool, Elizabeth allowed herself a moment of delighted optimism. “There is an immense charm in this fresh field, where solid English heads receive the highest view of truth, where generosity and largeness of idea meet you at every turn,” she exulted to Emily. “I like working and living in England, immeasurably better than in America, and there is no limit to what we might accomplish here.” Surely the material support she and Emily needed to establish themselves in this far more congenial setting would soon present itself. For the moment, she resolutely ignored a recent warning from Florence Nightingale. “I do not think you know how little your audience represents the public opinion of England,” Nightingale wrote. “I do not draw discouragement from this—but neither should I draw encouragement from them as you do.”
In Elizabeth’s absence, meanwhile, Emily was starting to believe in a future for the institution they had founded in New York. But she had no one to discuss her thoughts with, and visiting her brothers—now decamped to more spacious suburban quarters in New Jersey—was not restorative. “They have got so completely to look upon me as a Dr that I can’t go near them without being pounced upon with regard to the baby’s bowels,” she complained. With the Fifteenth Street house now filled with boarders to cover expenses, Emily spent most evenings alone in her attic room, reading Elizabeth’s rose-colored reports on establishing a new future in the old country, and writing two worried pages back for every one she received.
Emily understood the seductive allure of London, but there were good reasons to resist. The New York Infirmary had one advantage over anything England could offer: it existed. It would not be easy to create a similar institution in England. The graduates of the American women’s medical colleges who arrived at Bleecker Street fed its purpose as a training hospital for female physicians; in England, women were not yet allowed to study medicine at all. And as Emily became more comfortable with leadership, it was hard for her to imagine trotting off in Elizabeth’s wake once again, “a younger, less well known partner, to make my position by extraneous efforts upon the outskirts of yours.” How could they abandon what they had struggled so hard to create in New York? “My liking is for Europe—if circumstances were favourable,” Emily told Elizabeth. But: “My judgment is for America, and for completing our work here.”
Uncertainty complicated the decisions Emily faced in Elizabeth’s absence. Should she search for a building that could serve more efficiently as both hospital and residence in one? What should she tell their patients and donors, now that rumors had begun to fly that Elizabeth wasn’t coming back? Impetuous Bessie Parkes had published a line in the English Woman’s Journal expressing the assumption that Elizabeth would now establish herself in London, “as her sister, Dr. Emily Blackwell, is well fitted to supply her place across the Atlantic.” And then there was the question of Marie Zakrzewska.
Elizabeth had been right in her original estimation of Dr. Zak: she brought enormous energy and skill to her work. Perhaps too much. Her role as the infirmary’s resident physician meant that hers was the face its patients and staff saw most, and her talent as a practitioner, her knack for self-promotion, and her easy openness won her enviable popularity. “In looking over the book I see she has at least twice as many patients every week as I have,” Emily complained to Elizabeth. “She is evidently desirous to get a position which we can not let her occupy—the superintending woman influence in the Hospital.”
Dr. Zak had begun to upstage the Blackwells in their own institution, yet she did not hold herself to Blackwellian standards, whether in terms of her housekeeping (“Z doesn’t even make her bed,” Emily tutted) or her clinical practice. On one occasion, Zakrzewska—herself recovering from illness, probably from overwork—called in reinforcements for a difficult delivery. Emily and her consulting surgeon, Richard Sharpe Kissam, found the mother’s vagina lacerated and the infant’s scalp cut and bruised by Zakrzewska’s clumsy use of forceps—an error she at first denied. Mother and child survived, but Emily was incensed: not only had Zakrzewska shown poor judgment and sloppy technique, she had made an unfavorable impression on their male colleague, something a woman doctor must avoid at all costs. “The whole affair has greatly shaken my confidence in her as an intelligent authority in difficult obstetric cases,” Emily wrote.
At this fraught moment, a providential offer arrived from Boston: would Dr. Zakrzewska consider taking a newly created clinical professorship at the New England Female Medical College? “I felt that a larger field for my efforts might be opened there in connection with a medical school,” Zakrzewska wrote pointedly, “rather than in New York where the two Drs. Blackwell controlled the direction of efforts toward what seemed to them wisest and best.” Emily heartily agreed. “We can not make the hospital what it should be while she is living in it,” she told Elizabeth. Sending Zakrzewska off with their blessings to a prestigious new position in Boston was a happy ending for everyone. “The Lady Doctors in Bleecker Street” were at last winning the approval both of their patients and the male physicians whose respect they craved. As Zakrzewska prepared to leave, Emily laid out her vision for the future.
First they needed to consolidate home and work in a single larger building, one plain enough not to intimidate the patients, elegant enough to make their genteel patrons feel at home, and substantial enough to attract the female medical students who would become the next cohort of women doctors. For that, Emily reminded Elizabeth, was the point: to be not the first female M.D.s but the first of legions. “If ever I come to the conclusion that this is not to be hoped—that our success is only exceptional,” Emily wrote, “then as far as I am concerned the life is an utter & miserable failure even if I made a fortune by it.” This was the best argument for staying in New York: despite England’s charms, Emily had seen little sign there of prospective medical women “as hopeful as these young green independent Americans.”
Once everything was properly arranged in one building—perhaps “one of those old fashioned 2nd Avenue houses,” Emily suggested—they would need to adjust the public perception of their own relationship. “I have had our names put as a firm in the Directory this year,” Emily announced: where the previous city directory had listed “Blackwell Elizabeth, physician” just above “Blackwell Emily, physician,” the new edition had “Blackwell Elizabeth & Emily, physicians”—a small thing, perhaps, but not to Emily. It was inefficient, not to mention demoralizing, when private patients insisted they would see only the elder Dr. Blackwell. If Elizabeth returned, she and Emily must “get people to regard us as medically on the same footing.”
It was increasingly clear that Elizabeth was going to return. The applause in Britain was not translating itself into cash, and “half crazy” Madame de Noailles had proved a difficult patron, insisting on terms that Elizabeth could not grant. “I confess I’ve had a good cry about it,” Elizabeth wrote to Emily. “I find that my feelings were beginning to take strong root in England, and it will be somewhat of a struggle to give all this new life up.” But she would not return empty-handed. She had a thousand pounds, earmarked by Madame de Noailles for the creation of a small sanatorium outside New York City, which could double as a country retreat for herself and Emily. She had new allies in London, who promised to send over young Englishwomen for training at the infirmary—if the English were not ready to educate female medical students, the Blackwells would teach them in New York. And she had realized a historic and symbolic goal.
“I have only one piece of information viz that the Medical Council has registered me as Physician!” Elizabeth scrawled to Emily just before her departure. Britain’s Medical Act of 1858 had required the registration of all medical practitioners, and Elizabeth’s foreign degree, and the fact that she had treated a few private patients while in London, allowed her to slip through. She was now the only woman included in Britain’s first Medical Register. The loopholes that had enabled her admission were swiftly clo
sed, but when the medical profession at last opened to women in Britain, Elizabeth would be ready.
“Your registration is a good thing,” Emily wrote with understated approval in August 1859. “I am glad the old fellows got so far.” But the recognition seemed to her less important than getting on with the work. She closed this last letter before Elizabeth’s return with a pragmatic reminder of her original errand: “Mind you are well provided with eyes.”
* Kitty’s birthdate is obscure. In old age, she remembered celebrating her tenth birthday in the fall of 1859. Other sources place her birthdate in 1847.
† Frances Hodgson Burnett—author of the beloved children’s novels The Secret Garden and A Little Princess—would caricature Madame de Noailles’s notorious excesses in “Piccino” (1894), the story of an English noblewoman abroad who, captivated by a peasant child, decides to buy him for her amusement. De Noailles actually did exchange money for a young Italian girl when she saw a painting of her in a Paris salon; the painting was not for sale, so she bought the original.
CHAPTER 15
WAR
The American Civil War broke out in the middle of a letter to Barbara Bodichon. “I wrote the above 10 days ago—very different is the state of things now,” Elizabeth told her friend on April 23, 1861. She had started writing just hours after the Confederate attack on Fort Sumter; now she resumed in a new reality. “Rebellion of the most formidable character threatens the subversion of the government and invasion of our very homes—everyone is up & doing.”
As far back as 1856, Elizabeth had been describing “the overbearing insolence & outrages of the pro-slavery party,” which called forth an equally fiery spirit in the North: “never were evil & good more strongly presented face to face for deadly strife.” Five years later she was more cynical. “I think it is much more of a fight for the tariff, than for principles,” she told Barbara. “I think the great majority of the country are perfectly willing to accept almost any compromise with slavery, if they could ensure safe commercial relations.” Her take betrayed a strengthening bias. There were more obvious causes for the war—the divisive election of Abraham Lincoln, disagreement over states’ rights, the widening cultural gap between the industrialized North and the plantation society of the South—but Elizabeth felt more than ever like an expatriate in America. In writing to her closest London friend, it was easy to slip into an attitude that cast Americans as boors driven by money. “Nevertheless this is a great country and I cannot but feel an interest in it,” she wrote, “although the people are strange to me, and their souls very shallow.”
The national emergency realigned the Blackwell sisters toward a single larger purpose, just as they had begun to diverge. In the year and a half since Elizabeth’s return from England—and despite a move to a new house at 126 Second Avenue spacious enough to hold both the infirmary and the Blackwell residence, exactly as Emily had recommended—Emily had lost her optimism about their joint venture. Elizabeth wanted to teach women the principles of both medicine and hygiene, but she hastened to place those subjects in “their true position, in which I believe the latter stands much higher than the former.” Women physicians, as Elizabeth now defined them, should be teachers armed with science. “I do not look on a good medical training as having power to make men of women,” she wrote, “but as a most valuable educator of their own natures.” Emily, increasingly skilled and confident both in the operating theater and in the labor ward, wanted to train women as surgeons and clinicians on a par with men—and when she considered the callow, untested medical graduates arriving at the infirmary for training, she despaired. “Doubt is disease,” Elizabeth had written, but when it came to the future of women in medicine, Emily had her doubts.
For Emily, the work had become toil rather than triumph. “She has taken an extreme dislike to it,” Elizabeth wrote to Barbara, “and though she performs her duties conscientiously, she only does in medicine what is unavoidable & no longer studies with any future object.” As soon as she saved enough to live on, Emily had announced, she would leave the profession. “Though I was bitterly disappointed,” Elizabeth wrote, “I have now accepted it as inevitable. I used what influence I could at first, but the subject is now never discussed by us.”
The war erased all thoughts of the future—there was only now. Emily’s crisis of confidence would have to wait. “We are compelled to direct the women who in a frantic state of excitement are committing absurdities in nursing talk,” Elizabeth scrawled hastily to Barbara. “I hurry this off, for a thousand engagements press.”
The wave of Union enthusiasm threatened to crash chaotically unless channeled and focused. Americans had only the dimmest understanding of the realities of war—the last large-scale conflicts on American soil had occurred long before most of the population had come of age. Already railcars bursting with poorly packed supplies were heading south. Wilting vegetables and fermenting preserves spilled over bales of unsuitable clothing, including thousands of unwieldy Havelock hats, meant to keep the sun off the neck, but mostly used by the men as coffee filters or cut into pieces to make the oiled patches used in muzzle-loading rifles. Eager, untrained would-be nurses were rushing to Washington to volunteer.
On April 25, Elizabeth and Emily called an informal meeting to discuss how best to help. They were astonished when more than fifty women and several sympathetic men crowded into the infirmary. The result was an appeal that ran in New York newspapers on April 28. “To the Women of New York and especially to those already engaged in preparing against the time of Wounds and Sickness in the Army,” ran the heading. Right-minded women were invited to the Cooper Institute, a short walk from the infirmary, in order to help “organize the benevolent purposes of all into a common movement.”
The next evening between two and three thousand women thronged the vaulted space of the Cooper Institute’s Great Hall, its fluted columns rising from a sea of bonnets and its floorboards invisible beneath jostling hoopskirts. Just a year earlier, Lincoln himself had stood at the same podium to deliver a speech—rejecting the expansion of slavery into the western territories—that propelled him toward the Republican nomination for president. Now cheers erupted as Lincoln’s vice president, Hannibal Hamlin, made an unexpected appearance: a testament to the well-connectedness of the infirmary’s allies, and also to the current administration’s need for help from any quarter. “God bless the women!” Hamlin finished, to tumultuous applause.
A stream of illustrious speakers, all of them men, followed: ministers and physicians and even a surgeon who had witnessed the attack on Fort Sumter. Among them was Henry Whitney Bellows, the influential Unitarian—and husband of one of Elizabeth’s first patients—who had helped shepherd The Laws of Life into print a decade earlier. He attended the infirmary meeting and emerged from the massive Cooper Institute gathering as one of the leaders of a new organization: the Women’s Central Association for Relief. Led by a board of twelve men and twelve women, it was charged with collecting aid and comfort for the soldiers, managing a central depot of supplies for distribution, and selecting women to serve as nurses.
FIRST MEETING OF THE WOMEN’S CENTRAL ASSOCIATION OF RELIEF, COOPER INSTITUTE, AS REPORTED IN FRANK LESLIE’s ILLUSTRATED NEWSPAPER, MAY 11, 1861.
COURTESY NEW YORK SOCIETY LIBRARY
This last item, of course, was the chief preoccupation of the Blackwells. Elizabeth was named chair of the registration committee—the only female officer in the organization—charged with identifying and training the most promising individuals among the flood of women eager to do more than knit socks and roll bandages at home. Many of them had read Florence Nightingale’s recently published Notes on Nursing, with its thrilling exhortation: “Every woman is a nurse.” “There has been a perfect mania amongst the women, to ‘act Florence Nightingale!’ ” Elizabeth wrote with some exasperation. But the scope of opportunity for women to work as professionals in the field of health had suddenly widened dramatically—it was a powerful moment fo
r the Blackwells to put their ideas into practice. Emily even traveled to Washington to meet with General Winfield Scott, the “Grand Old Man” of the Union Army, who at first opposed the very idea of women nursing the soldiers. He changed his mind.
The sisters quickly drafted a report, “On the Selection and Preparation of Nurses for the Army,” which became the template for the recruiting effort—a template modeled explicitly on “the printed records of Miss Nightingale’s invaluable experience in army-nursing.” Their first priority was to discourage frivolous interest; once the grim challenges of wartime nursing were made clear, they hoped, “much of the noble enthusiasm of women, whose sole desire is to serve their country in this momentous crisis, will be directed into other channels.” Likely candidates would be between thirty and forty-five years of age, possessed of a strong constitution, good references, and restrained manners, and amenable to taking orders. They would dress soberly, as dictated by the committee—no hoopskirts. Once chosen, they would submit to a course of medical training at approved New York hospitals and await the call to the front. Interested parties should come to the registration committee’s offices on the fourth floor of the Cooper Institute between two and four in the afternoon. Kitty liked to come and watch as Elizabeth and Emily interviewed prospective nurses. “Girls of eighteen came and swore themselves black and blue that they were thirty,” she remembered, “in order to get into the service.”
Through the late spring and early summer of 1861, Elizabeth and Emily poured themselves into war work. Women and men, working alongside each other for the collective good: it was a gratifying realization of Elizabeth’s youthful hopes. But in order to fulfill its mission, the Women’s Central needed to open a clearer line of communication with the architects of the war. In May, Henry Whitney Bellows took a delegation of board members to Washington, a city that was unfamiliar to him. In need of a savvy guide, he found his way to Dorothea Dix.
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