The Doctors Blackwell

by The Doctors Blackwell (retail) (epub)

  ELIZABETH AND KITTY AT ROCK HOUSE, HASTINGS, CIRCA 1905.

  COURTESY SCHLESINGER LIBRARY, RADCLIFFE INSTITUTE, HARVARD UNIVERSITY

  Though she endorsed the good-wife-wise-mother ideal, Elizabeth’s work among the poor had made it obvious that there was such a thing as too many children, a point she made in a speech entitled “How to Keep a Household in Health,” delivered just after her return to England. Procreation, she declared, “is largely under the control of established physiological laws, which should be known to parents.” Critics assumed she was endorsing artificial contraception—in the form of condoms (by this time made from rubber as well as animal intestine) or vinegar-soaked sponges—but to Elizabeth, protected sex was just as degenerate as masturbation. The only moral way to limit family size, in her view, was to restrict intercourse to the infertile days of a woman’s menstrual cycle. “From the outset of marriage the wife must determine the times of union,” Elizabeth later wrote. “Through the guidance of sexual intercourse by the law of the female constitution, the increase of the race will be in accordance with reason.” Her serene confidence that a righteous woman could regulate her husband’s sexual needs remained, like much of Elizabeth’s thinking, on a level too idealized for most flawed humans to find useful. Interestingly, in the same pamphlet, she defined a problem few acknowledged: marital rape. “A man who commits rape in marriage is even a meaner criminal than one who exposes himself to the just punishment which is attached to violence outside marriage,” she wrote. She offered no suggestions for women on how to avoid it.

  Elizabeth’s moral crusading extended beyond the domestic sphere to the professional one. As her reform work led her further from the laboratory, she began to campaign against scientific advances she found morally questionable. Vaccination, for one. In New York. she had once lost an infant patient whose constitution was not strong enough to withstand the injection of the attenuated virus. “To a hygienic physician thoroughly believing in the beneficence of Nature’s laws,” she wrote in her memoir, “to have caused the death of a child by such means was a tremendous blow!” Wasn’t the first duty of a physician to do no harm? She developed a similar horror for vivisection. In England, she and Kitty grew attached to a series of canine companions, which explained her condemnation of experimentation on animals, but her objections increasingly included what she perceived as unnecessary surgery on human patients as well. For a woman who had come to prize prevention over cure, the idea of resorting to a scalpel seemed like mutilation, a presumptuous trespass on the divine design of the human body.

  The one area in which Elizabeth was actively interested in scientific experimentation was, ironically, the realm of spiritualism. As she approached old age, and as new truths clashed unnervingly with her own understanding of the world, she may have craved the kind of existential comfort Anna had always sought in the supernatural. Though she had never shared Anna’s devoted faith in Mesmer’s magnetism or Baron du Potet’s séances—a faith her sister shared with many of the most prominent intellectuals of the era—she had never entirely dismissed it. Confidence in life after death, Elizabeth insisted as she entered her eighties, was “really of tremendous practical importance.” So she devised a plan: she would write down specific memories and seal them away, and after her death her friends would convene to see if her spirit could convey the hidden information to them. She failed to muster much interest in her experiment but followed through with her end of it just in case: “My ‘Test’ is written and safely put away.”

  From the beginning, Elizabeth had seen medicine as a tool for showing people how to live: first in terms of opening the profession to women, and later as a way of teaching hygiene, both physical and moral. The girl who had refused to admit when she was sick grew into a woman who refused to accept human imperfection. The quest to transcend it fueled her, but her determination often hardened into a rigidity that drove potential allies away. “Doubt is disease,” she had proclaimed, but to dismiss doubt was to reject all opinions other than one’s own. Her refusal to compromise was the key both to her achievement and to her chronic isolation. She had dreamed of living in her own communal phalanx, but she never found people perfect enough to join her there.

  For Emily, the period following Elizabeth’s departure was not easy. In addition to overseeing the details of the infirmary and the college, she needed to reassure her board, staff, and faculty that Elizabeth’s indefinitely extended absence did not signal their imminent failure. In the brief calm after the college’s first commencement in the spring of 1870, she despaired at the prospect of another year alone. “I am utterly unwilling to be so overworked and harassed with detail,” she wrote to Elizabeth, “to live in the midst of students & patients—the interests of my practice and the school interfering & clashing, and my personal life entirely suppressed.” But she saw no alternative.

  Soon afterward, in the heat of August, Hannah Blackwell died, her long decline accelerated at the end by gangrene in her foot. Emily, suspended uncomfortably between the roles of daughter and physician, bound Hannah’s jaw with a handkerchief for her laying out. “I cannot describe the shock it gave me to perform that last office,” she wrote to Elizabeth. “The visible family link seemed broken in her loss.” Though they had never provided her with much emotional support, Hannah and Elizabeth had been fixed stars for her to steer by, one the center of the family circle, the other the driving force of her career. Now one was dead and the other distant. As she reached her mid-forties, Emily began for the first time to make her own choices.

  Coming to her aid at last was Mary Putnam, her graduation from the Sorbonne having been delayed by the impact of the Franco-Prussian War. Emily had yearned for a competent colleague who shared her commitment to rigorous medical education; Putnam, having triumphed in the vibrant academic atmosphere of Paris, was if anything a more demanding instructor than Emily. Appalled by the caliber of the students she found at the Woman’s Medical College, Putnam caused an uproar by immediately expanding the scope of the curriculum. “I do not know whether she can adapt herself to circumstances and learn to be a good teacher for an American class studying after American modes,” Emily worried. Putnam seemed equally doubtful, dashing off an aggrieved letter to Elizabeth in which she announced the “thorough contempt” in which she held her new students. From England, Elizabeth attempted to mediate, advising Putnam to take things slowly. “It is utterly impossible to attempt to teach unless you are thoroughly in accord with your pupils,” Elizabeth wrote. “Do, my dear Mary, be very prudent and patient!”

  Mary Putnam Jacobi—as she was soon to be known after her marriage to the pioneering German-Jewish pediatrician Abraham Jacobi—would become both a passionate scientist and a highly respected physician: a practitioner like Emily rather than a proselytizer like Elizabeth. She stayed on as Emily’s colleague at the college, always pushing for higher standards, and she eventually created a dedicated children’s ward at the infirmary. She wrote scores of respected articles, including one—“The Question of Rest for Women During Menstruation”—that debunked the conventional wisdom and won Harvard’s Boylston Prize. She became the first female fellow of the New York Academy of Medicine in 1880. Nearly two decades after Elizabeth’s departure, having reached a professional height from which she could regard her former mentor as a peer, she addressed Elizabeth with characteristic candor. “It is your mind that conceived the idea of women physicians in modern life, and on a plane at which few have ever thought of it,” she wrote, giving Elizabeth her due. But: “You never really descended from your vision, into the sphere of practical life within which that vision, if anywhere, must be realized. You left that for others to do.”

  With Putnam Jacobi and a growing cohort of promising students to help realize the vision, for the first time Emily had space to consider her own domestic happiness. She began to construct a new family for herself. In the fall of 1870, immediately following her mother’s death, she adopted a baby girl and named her Hannah—“Nann
ie” within the family. “She is a bright sociable affectionate little thing and a wonderful pet,” Emily wrote to Kitty. “She is not exactly a pretty child, but she has pretty eyes.” As an infant, Nannie slept in a nest of cushions on Emily’s examining table; as a curly-blond “chatterpye” toddler, she stood clutching the banister rails and watching the carriages roll by in the street when Emily returned at the end of the day. While Kitty never addressed her guardian as anything but Dr. Elizabeth, Nannie called Emily “Mama,” and as an older child, she signed her affectionate letters with rows of kisses. She would go on to marriage and motherhood and would delight Emily with a quartet of towheaded grandsons.

  The youngest Blackwell sister, Ellen, who had shelved her painterly aspirations and now served as Emily’s rather haphazard housekeeper, also adopted a baby: Cornelia, or “Neenie.” Nannie and Neenie would grow up together, often left in Ellen’s charge when Emily was preoccupied at the infirmary and supported mostly by Emily when Ellen—who had a large-hearted but short-sighted habit of accumulating stray orphans—ran short of money.

  A hospital was not a good place to raise children. Now that Emily had a child, she could justify a house of her own. In 1873 she moved to 53 East Twentieth Street, a few steps from Gramercy Park, with room for her office, a nursery for Nannie and Neenie, and accommodations for Ellen, Marian, and George. It was a profound relief to be able to leave the infirmary for a home at last. As the moving cart loaded with furnishings rumbled away toward Twentieth Street in the dusk, Emily paused for a moment on the hospital steps, remembering the day that she and Elizabeth had first mounted the brass plate with their two names beside the door. Now it would hang at the new address; even as Emily became head of her own household, Elizabeth’s presence persisted. But the quiet delight with which Emily described the smallest details of her new home was palpable. “They have put down in the hall a sort of oilcloth called Linoleum,” she wrote to Elizabeth. “Mine has a dark red brown ground with a small red & black figure, very neat and harmonious with the carpets.” She planned to invite Henry and Sam and their families for Christmas, reuniting all the siblings who remained in America.

  George would soon find a wife—Lucy Stone’s niece, Emma—and start a family of his own; Ellen would escape the city to spend extended periods with Nannie and Neenie at Blackwell properties in the suburbs. But Emily was not alone for long. In 1870 a new student had arrived at the Woman’s Medical College. Elizabeth Cushier, ten years younger than Emily, had come to medicine late, constrained by the care of her younger siblings after the death of their mother. Having spent a disappointing term at Clemence Lozier’s New York Medical College for Women, she found the level of seriousness she sought at the “Blackwell college” under the tutelage of Emily and Mary Putnam Jacobi. Cushier received her degree in 1872, and with the exception of eighteen months of further study in Europe, she never again left Emily’s side. She became an accomplished gynecological surgeon—eventually bringing J. Marion Sims’s fistula repair technique to the infirmary—and taught both obstetrics and surgery at the college as the only female clinical professor. In Cushier, Emily recognized a kindred spirit: an independent woman who approached her responsibility both to her family and to her career with good-natured, unfussy pragmatism and skill. And even as she graduated from Emily’s student to her colleague and then her closest friend, Cushier preserved the deep respect she had initially felt for her first medical mentor.

  In the fall of 1882, Elizabeth Cushier moved in with Emily on East Twentieth Street. In her relationship with this new Elizabeth—as senior rather than junior partner—Emily found a steady source of something that had always been scarce: contentment. The two women were as compatible sharing a home as they were sharing an operating theater, and Cushier’s sister Sophie became a more competent helpmeet than flighty Ellen had ever been. “You ought to have a partner like Dr Cushier,” Emily wrote jovially to her niece Alice, “who has just superintended the making of my cloth suit, as she was not content with the unaided efforts of my dressmaker.” Emily was even more admiring of Cushier’s facility with a surgical needle. The two doctors, swathed in blue and white pinafores—“like a butcher’s apron, but a little more dandy”—performed operations at the infirmary regularly, sometimes with a double row of students as an audience. “Dr Cushier is really a skillful surgeon,” Emily wrote, “and very ambitious in that line.” It was her highest praise.

  Even the formidable Mary Putnam Jacobi approved. Cushier was “a remarkably lovely woman, spirited, unselfish, generous and intelligent,” she wrote to Elizabeth in England. “I do not know what Dr. Emily would do without her. She absolutely basks in her presence; and seems as if she had been waiting for her for a lifetime.” When Elizabeth—feeling displaced?—clucked over Emily’s isolation from the rest of the Blackwell clan, especially when Emily suffered a bout of ill health, her sister set her straight. “No one could be more kind, devoted, and helpful than Dr Cushier was,” Emily retorted. “There is not one of my own family who could or would have done so much for me.” Cushier, she told Elizabeth, “is like a younger sister or elder daughter to me.”

  Emily’s partnership with Elizabeth Cushier was warmed by love. “The last days have been busy ones dearest,” Cushier wrote while Emily was visiting Henry and Lucy. In Emily’s absence, Cushier was not only managing their patients but also having the house painted and polished. “Much as I want to see you dear, I am not sorry you will not be here until next week, for I do not wish you to come into an unsettled house,” Cushier wrote. “By this time next week you will be quietly settled in just what will then be the nicest little house in the world & my own dear doctor what a happy winter we shall have! Shall we not?” They lived together for the last three decades of Emily’s life.

  The years passed rhythmically, with hospital practice and college instruction punctuated by summer escapes, first to Henry Blackwell’s property on the south shore of Martha’s Vineyard, and later to Emily and Cushier’s own retreat at York Cliffs, on the coast of Maine. The infirmary and college prospered; in 1876 the hospital moved to new quarters on Livingston Place, on the edge of Stuyvesant Square Park, leaving more room for the college on Second Avenue, and in 1888 the college moved as well, around the corner from the hospital on East Fifteenth Street, to create a more compact campus for its students. The financial strains of the early days faded as generous patrons relieved Emily of the burden of fund-raising; there was even the beginning of an endowment. Two of Sam and Nettie’s daughters, Edith and Ethel, received medical diplomas under Aunt Emily’s supervision.

  One April afternoon in 1897, Emily—in her seventies, but still serving as dean of the college—took the opportunity of a quiet Sunday to start a letter to Elizabeth. The city was on holiday; the distant sounds of a parade celebrating the completion of General Grant’s tomb filtered toward them from uptown. “The doorbell has rung but once today, an unheard of calm,” Emily wrote. It had been nearly half a century since her sister sat idle on University Place, wishing desperately for patients to arrive.

  It was typical of Emily to bury catastrophe in the middle of home news and the weather. Days earlier a messenger had woken the household in the middle of the night: the college was on fire. Construction debris from the installation of a new boiler had ignited, and the flames had climbed an airshaft to the roof. The building was gutted, all its equipment lost. “On the top floor was a dissecting-room, in which there were several corpses, which were cremated,” the Tribune noted ghoulishly. But the infirmary next door was unharmed, and discipline among the resident staff was so strong that many of the patients slept through the emergency.

  “We have taken the next house, and made the best arrangements we can,” Emily wrote. “We shall go to work at once to rebuild.” She had stood by the institution from the beginning; she would not abandon it now. Neither would her trustees, who immediately printed a new appeal. “Women students need as much space to work in and as good material to work with as men do,” the pam
phlet insisted. It was in the interests of both skeptics and progressives that the college, “which represents the life work of Elizabeth and Emily Blackwell, is so equipped and endowed, and its standards kept so high, that its diploma represents the best that can be had in medical education.” In the name of both Blackwells, then—the long-absent symbol and the present and active leader—the college was rebuilt and expanded, welcoming an unusually large class the following year. What had once been dubbed “the woman doctors’ college”—“at first in derision, and, later, with respect,” noted The Sun—had achieved a reputation sturdy enough to survive the blaze.

  CODA

  On a Tuesday evening in May 1899, a reporter from the New-York Tribune arrived at Emily’s house on East Twentieth Street and asked for an interview. Was the rumor true, he wanted to know, that the Woman’s Medical College was about to close its doors forever?

  “I understand that is the intention,” Emily said.

  Warming to his scoop, the reporter asked, “Will the students of the institution enter the Cornell Medical College?”

  “The students of the school have the right to go where they choose” came the tart reply. She would say no more.

  The world was catching up to the Blackwells. In 1893, Johns Hopkins University in Baltimore had opened a medical school that included women in its first class; in 1898, in New York City, Cornell did likewise. “They have a million and a half dollars to start with, and will have more if they need it,” Emily told Elizabeth. “So far they seem inclined to treat their women students fairly.” Cornell was allowing women to teach as well and to serve as trustees. “This is very encouraging, for Coeducation means both sexes represented above as well as below,” Emily added. Thirty years earlier the Blackwells had reluctantly decided to open a women’s college because the best medical schools remained closed to women, but now that was changing. “The Infirmary is really a beautiful and admirably managed little Hospital, and I don’t believe it will ever be closed,” Emily wrote. She was right: the New York Infirmary for Women and Children would anchor the eastern edge of Stuyvesant Square until 1981.* The college, on the other hand, had fulfilled its purpose.