For a combined total of thirty years, Elizabeth and Emily had immersed themselves in the question of what comprised legitimate, rigorous medical education. They had studied all branches of medicine, not just obstetrics and gynecology. They had experimented with leeches and mercury, blisters and sitz baths, botanical remedies and magnetism and surgery. They had examined specimens under the microscope and lectured on diet and hygiene. They were more eclectic than the Eclectics in their openness to the broadest spectrum of useful approaches to healing, and they could quote from the traditional medical texts by heart. Now they envisioned a program that took all their experience into account—one that would have daunted most of the young men they had once studied with.
Examinations would be held in the laboratory and by the bedside, and students would have to demonstrate their skills, not just parrot back their lessons. They would be expected to speak up in class and work individually with their professors rather than listening and watching in a passive herd. A woman’s traditional caregiving role might endow her with natural instincts as a physician, but instincts were insufficient: “It is knowledge, not sympathy, which can administer the right medicine; it is observation and comprehension, not sympathy, which will discover the kind of disease.” The Blackwells’ college might be for women, but it would command respect from the male establishment.
The speech was a statement not just of intention but of action already underway. The infirmary’s trustees had applied to the New York state legislature, which had duly responded with an act “to enable the corporation entitled ‘The New York Infirmary for Indigent Women and Children,’ to grant and confer the title of Doctor of Medicine.” (In keeping with its new, larger mission, the term Indigent was at this point officially dropped from the infirmary’s name.) As firmly as she had once opposed the founding of a women’s medical college, Elizabeth now embraced it. This, she proclaimed to Barbara Bodichon in the fall of 1864, was now “the San Greal* of my life, the deep unchangeable undying interest.” Emily certainly shared her sister’s views on adding rigor to the medical curriculum. For the moment, they could agree.
Robert E. Lee surrendered on April 9, 1865, and five days later Abraham Lincoln was assassinated. His death inspired Elizabeth in a way his living presence had not. “The great secret of our dead leader’s popularity was the wonderful instinct with which he felt and acted the wishes and judgements of the great mass of the people,” she wrote. Populist instinct was something Elizabeth had always lacked; now, for the first time, she was admiring rather than disparaging it. “I never was thoroughly republican before; there was always a shade of conservative aristocratic tendency,” she mused. “But I am so thoroughly now, heart and soul.” She felt ready to lead again.
On March 5, 1866, Emily turned to her journal for the first time in years. “The circle is broken,” she wrote. “Ah dear Howard! Poor Anna!” After a second sojourn in India, thirty-five-year-old Howard had returned to England in shaky health. In February he died, alone.
Anna was devastated. Howard, fifteen years younger than she, had been not just brother but also son and soulmate, the only sibling to have joined her in leaving America behind. “I had built on that beloved life as on a rock,” she wrote in anguish. “Whether I shall really be able to outlive this loss I have no idea.” Knowing Anna’s histrionic tendencies, no one was seriously worried, but her grief created a compelling reason for another trip to England, which Elizabeth was only too happy to seize. She spent the summer and early fall of 1866 in Paris and London, enjoying a series of encounters that confirmed and intensified her eagerness to complete her work in America.
The first encounter, in London, was with Elizabeth Garrett, the young Englishwoman who had attended Elizabeth’s 1859 lectures and with whom she had been corresponding ever since. Garrett had pursued her medical education doggedly wherever she could, ignoring female peers who saw her as “a kind of ‘social evil’ they don’t wish to know” and a male medical establishment that dismissed her. “Science, at best, seems to sit upon a woman like the helmet on the temples of Minerva,” read a florid editorial in The Lancet, “an incongruous adjunct, conceived by Poetry, not earned by stern experience and actual prowess in war.” But the comparison to the classical goddess of wisdom and strategy was unintentionally apt. Garrett’s determination grew with each obstacle, and she eventually exploited a loophole in the charter of the Society of Apothecaries that enabled her to sit its examinations and receive certification to practice. In July 1866, a month after her thirtieth birthday, she founded her own dispensary for women and children, St. Mary’s, in Marylebone.
Elizabeth arrived in London in time to attend the opening ceremony. “In Miss Garrett we have the first legally qualified female practitioner which England can boast,”† proclaimed Dr. Archibald Billing, a fellow of the Royal Society. “In America, where they move faster than we do, I am assured that women doctors are establishing themselves fairly in the good opinion of the public.” Perhaps he was aware that one of them was listening.
The second encounter lifted Elizabeth into an unfamiliar state that felt suspiciously like happiness. “I have had an unexpected pleasure in the renewal of friendship with an old comrade,” she wrote to Marian. Hippolyte Blot had invited Elizabeth to spend a Sunday with his family at their country retreat while she was in Paris. It had been seventeen years since Blot saved Elizabeth from total blindness at La Maternité. “The intimate friendship of a man of one’s own age, with whom a great deal of chum feeling exists, and of whom you are very fond, has a very great charm,” she wrote with unaccustomed warmth. “[It] is giving to the last part of my stay, an intensity of life, that is very refreshing to a half starved soul.” Within her own family, Elizabeth’s relationships were often fraught; outside the Blackwell clan, they were almost entirely professional. It was a balm to relax with an old friend, a rare example of a man who considered her a peer. Elizabeth had never endorsed Florence Nightingale’s rule that medicine demanded celibacy of its female practitioners, even if in practice she had never broken it. It was satisfying to recall the frisson of personal attraction she had once felt.
Also in Paris, Elizabeth caught up with a woman whose history had been entwined with the Blackwells’ since the beginning of their medical presence in New York. Mary Putnam had been a girl of ten when her father, George P. Putnam, published Elizabeth’s first book, The Laws of Life. At seventeen, just as the Blackwells moved the infirmary to Second Avenue, she had joined them as a student: “a very talented girl,” Elizabeth had noted approvingly. Later, Putnam became the first woman accredited by the New York College of Pharmacy, and in 1864 she received her diploma from the Female Medical College of Pennsylvania. She continued her education in Boston at the New England Hospital for Women and Children, with Marie Zakrzewska. But Putnam’s unusual ambition remained unsatisfied, so she pursued it across the Atlantic.
“Little Miss Putnam, who is gaining her first experience of Europe, is quite intoxicated with Paris,” Elizabeth reported. It was gratifying, a generation after her own studies in Paris, to mentor a stellar student whose medical education she had initiated. Elizabeth helped Putnam find lodgings in the Latin Quarter and even unbent enough to complain to her about Anna: “a great Spiritualist much to the Dr.’s distress,” Putnam noted, who “thinks she is continually receiving communications from the brother who has recently died.” Venting to Putnam apparently did Elizabeth good. “When she went away,” Putnam wrote, “she actually kissed me for the first time during the period of our long and friendly acquaintance!” Putnam was the first woman admitted to the medical school of the Sorbonne; her success drew Elizabeth Garrett away from her dispensary in England to join her in pursuit of more advanced medical education. Garrett would be the first woman to receive a degree in Paris. And Putnam, once she had hers, would become one of the Blackwells’ most important allies in New York.
The ranks of accomplished women doctors were growing, and the Blackwells could take much of the credit
for showing them the way. They were not, however, ready to be overtaken. Even sharing the path remained difficult for them. Clemence Lozier and Sarah Dolley, who had earned a degree from the Eclectic college in Syracuse in 1851, invited the Blackwells to join them in an effort to establish a much-needed national association of medical women. The sisters swatted away this gesture of solidarity. “They will, as always, parody a good idea,” Emily fumed to Elizabeth, “pretend falsely to meet a real want, and lay hold of the work in so shallow & vulgar a way as to make it impossible for us to work with them, and yet cut ground from under our feet, and place us at the disadvantage of standing aside & in the background, while they noisily assume the centre of public notice & action.”
Elizabeth and Emily preferred a quieter kind of progress. In 1866 they created the position of “sanitary visitor,” sending their interns to attend patients in their homes not only when they were ill or in labor, but also to teach preventive hygiene. One resident assistant who filled this innovative role was Rebecca J. Cole, the daughter of free Black laborers in Philadelphia. Born in 1848, Cole received a classical education at the Institute for Colored Youth, the oldest African-American secondary school in the country, and went on to become the first Black graduate of the Female Medical College of Pennsylvania. After finishing her thesis on “The Eye and its Appendages” in 1867—with a thorough explanation of purulent ophthalmia—Cole had arrived at the infirmary, where she “carried on this work with tact and care,” Elizabeth wrote approvingly.
Cole would return to Philadelphia and become an early voice against racial bias in public health, asserting that “the respectability of a household ought to be measured by the condition of the cellar,” not by the complexion of its members. There is little surviving material related to her time at the infirmary, but her position—and the lack of comment upon it in the Blackwells’ correspondence—is evidence of their unusual open-mindedness regarding race. Some of the infirmary’s more conservative supporters—and plenty of its white patients—must have reacted to Cole’s presence with less equanimity. Rebecca Lee Crumpler, in 1864 the first Black woman to earn a medical degree, from the New England Female Medical College, immediately moved to Virginia to work among the newly emancipated. Susan McKinney Steward, who received her degree in 1869 from Clemence Lozier’s New York Medical College for Women, practiced in Brooklyn’s Black community. The number of Black women doctors would slowly grow in the decades following the Civil War, but most of them studied in the South at schools founded to educate the formerly enslaved, and practiced exclusively among Black women. Cole’s presence at the New York Infirmary was a noteworthy exception.
The opening of their own college would mark the end of the Blackwells’ shared journey toward the moral high ground. Though her own name remained permanently associated with the New York Infirmary, Elizabeth knew that her sister was outgrowing the role of deputy. “Emily . . . does grandly at the centre of this movement,” she confided to Barbara, “and exercises a certain imperiousness as head of the establishment which is not unbecoming.” Emily was ready to lead, and Elizabeth was ready to leave. They could see the point ahead where their paths diverged, and both looked forward to it with some relief. (A postscript in a letter to George, who had begun to prosper in real estate, betrays Emily’s state of mind. “When you write on money matters direct me personally,” she instructed, “otherwise Eliz always opens the letter.”) On November 2, 1868, trustees, friends, physicians, and a small group of students gathered at Second Avenue for the opening of the Woman’s Medical College of the New York Infirmary.
“True growth is slow (as we measure time) and silent,” Elizabeth began her inaugural address. Then, in case the implied rebuke to the “noisy,” “pushing” leaders of the other women’s colleges wasn’t clear, she went a step further: “It is an easy thing to found a poor college.” Their school would surpass its predecessors with a program even more stringent than Elizabeth and Emily had outlined in their address five years earlier. They would offer an unprecedented three years of study instead of two. Their course of lectures would build progressively year to year, rather than simply repeating the same material twice. And theirs would be the first medical school of any kind to feature a professor—Elizabeth herself—devoted to the subject of hygiene. Emily would take the chair of obstetrics and diseases of women; otherwise, the faculty was male. Students would be tested yearly by a board of examiners that included Elizabeth’s earliest allies: Austin Flint, who had published her 1849 thesis in the Buffalo Medical Journal, and Stephen Smith, her classmate from Geneva, who had gone on to help found New York City’s board of health.
“This school is the only one that the profession has confidence in, the only one it has sanctioned,” Elizabeth concluded, somewhat inaccurately. Graduates of the Philadelphia and Boston women’s medical colleges were gaining recognition, some of them as the Blackwells’ own deputies, and students at Clemence Lozier’s school—which had since moved to within a few of blocks of the infirmary on Second Avenue—had the same right to observe at Bellevue and other New York hospitals as the Blackwells’ students did. But the Woman’s Medical College of the New York Infirmary—embodying everything the Blackwell sisters had learned about effective medicine and public health—insisted upon a level of excellence at least as high as any to be found in American medical education and indisputably higher than that of the existing women’s colleges.
DISSECTION AT CLEMENCE LOZIER’S NEW YORK MEDICAL COLLEGE FOR WOMEN, IN FRANK LESLIE’s ILLUSTRATED NEWSPAPER, APRIL 16, 1870.
COURTESY NEW YORK SOCIETY LIBRARY
Henry J. Raymond, the founder of the New-York Times and trustee of Elizabeth’s original dispensary, spoke next—though, he was quick to point out, Dr. Blackwell’s remarks had left him with little to add. Echoing Henry Ward Beecher at the infirmary’s opening ceremony in 1857, Raymond declared that women’s “keen intuition of the nature of complaints, and ready perception of the best remedies; their large sympathy for the suffering and their gentle solicitude during convalescence rendered them far more acceptable to patients than were men.” Twelve years later the sisters had become only too skilled at keeping their impatience with sexual stereotypes to themselves. Raymond’s words would resonate usefully with his readers.
After a tour of the infirmary’s modest wards, the gathering dispersed, and seventeen students began their first term. One of them was a twenty-eight-year-old Englishwoman named Sophia Jex-Blake. The darling of a wealthy and well-connected family, possessed of strong opinions and high spirits, Jex-Blake had set her sights on admission to Harvard. Rebuffed, she found her way to the Blackwells, who promised an equally exacting course of study. Elizabeth reserved judgment on this rather forward young woman—“I’m afraid she won’t be very amenable to discipline”—but here at last was their first English student, and she seemed to be made of the right stuff. “If I am to be a doctor at all,” Jex-Blake declared, “I mean to be a thoroughly good one.” She wrote happily to her mother of lectures and dissections and petitioning Emily for five minutes of fresh air between classes (“to which she instantly assented as desirable”), but only two weeks into the term Jex-Blake received word that her father was dying, and rushed home. She would go on to become a pioneer of women’s medical education in England.
Elizabeth herself would not remain in New York much longer. Eight months after delivering the opening address at the Woman’s Medical College, and long before its first diplomas were granted, she returned to England forever.
In her memoir nearly three decades later, Elizabeth skated briskly over her decision to leave. “In 1869 the early pioneer work in America was ended,” she wrote. “Throughout the Northern States the free and equal entrance of women into the profession of medicine was secured.” This wasn’t true even at the time her memoir was published, let alone in 1869, but she framed her departure as a logical next step.
Our New York centre was well organized under able guidance, and I determined to return to
England for a temporary though prolonged residence, both to renew physical strength, which had been severely tried, and to enlarge my experience of life, as well as to assist in the pioneer work so bravely commencing in London, and which extended later to Edinburgh.
This was accurate. Also accurate, though unsuitable for the valedictory conclusion of a memoir, were several other motives. For a woman who thrived on new challenges, running a hospital and a medical college was exhausting, exacting, repetitive work. The pressure to raise funds—often from people who failed to pay her the personal respect her symbolic achievement warranted—was relentless. Elizabeth was tired of exile in America, tired of striving for an ideal future in a state of chronic dissatisfaction with the present. And as Emily came into her own as a practitioner and professor, she was both better equipped to sustain the institutions they had founded and more difficult to share them with.
Though Elizabeth’s crisp summary leaves out these tensions, a hastily penciled sheet in what seems to be Emily’s hand preserves them. Emily may have welcomed the prospect of Elizabeth’s departure, but the manner of it was important to her. “Partnership (of 10 years with identical names and initials and practice so intimately associated if terminated at all, ought) not to be terminated without at least six months’ notice—say July 1 1869, or Jany 1 1870,” she scribbled. The infirmary and the college were indelibly associated with the name Elizabeth Blackwell; her exit would shake the faith of the institutions’ trustees and donors and deter prospective students and patients. In order to remain effectively at the helm, Emily would need to reassure the public of her own competence and sincere intention to stay put. The notes outline the idea of Elizabeth first moving her own private practice to an office uptown as an interim step, leaving Emily in sole charge. The pattern held true to the end: Elizabeth was thinking of her own future, gazing at the horizon and eager to set sail, while Emily wrestled with the practical details.
The Doctors Blackwell Page 27
