As 19th Century Females, Sisters In 'The Doctors Blackwell' Achieve Many Firsts

Smashing the patriarchy is hard work.

The Doctors Blackwell, by historian Janice P. Nimura, profiles two sisters who faced what was a daunting lack of choices for 19th century women. They achieved a series of near-impossible feats to become America's first and third certified women medical doctors. Nimura's account is not only an exhaustive biography, but also a window into egregious 19th century medical practices and the role these sisters played in building medical institutions.

Elizabeth Blackwell was born in Bristol, England in 1821; Emily in 1826. Nine Blackwell children survived past infancy. The family emigrated to New York in 1832. The parents were ardent abolitionists, despite Samuel Blackwell's sugar investments profiting from backbreaking slave labor. To atone for his sins, Blackwell moved his family to Cincinnati where he hoped to plant sugar beets rather than participate in the odious Caribbean sugar trade. He died too soon, leaving his family with few resources other than brains and grit.

The Blackwell family were copious letter writers. Author Nimura has combed through mountains of documents to bring all of the siblings alive through their own words. The book is illustrated with photographs that bring the era to life.

Elizabeth takes center stage in The Doctors Blackwell. She had no interest in marriage and chose medicine as a path to self-sufficiency, although she did not want to treat patients. Standards of treatment were primitive. "Medicine is always an evil," she wrote, "though sometimes a necessary evil." Phrenology was considered a valid science and so-called treatments such as leeches and toxic drafts made patients worse and often killed them.

Objections to women in the medical establishment were all but universal. On one hand, "no true lady [sh]ould leave the purity of the domestic sphere to study the corruptions of the human body," and on the other, "what if female doctors were a resounding success, and female patients preferred them?"

Elizabeth went to exhaustive lengths to qualify for medical school, arranging unorthodox apprenticeships in Ashville, NC; Charleston, SC; and Philadelphia, Penn. She received her diploma at Geneva College in upstate New York after the dean jokingly had the male students vote on whether to admit her. She became a local celebrity. Her fame followed her as she took grueling post-graduate positions in Paris and London. All the while, she looked behind to egg on Emily to follow in her footsteps.

The sisters' travels had them intersecting with a 19th century female brain trust on both sides of the Atlantic. Harriet Beecher Stowe (author of Uncle Tom's Cabin) discouraged Elizabeth from trying to become a doctor because the obstacles were too formidable. Emma Willard (founder of Troy, NY's Female Seminary and an authority on history and geography) helped Elizabeth get a medical apprenticeship in Philadelphia. Florence Nightingale, a celebrity in Europe, was opposed to female doctors. The Blackwell sisters criticized her attention-getting and jealously complained about her copious fundraising. They corresponded with leading feminist journalist Margaret Fuller. In London, Elizabeth met George Eliot and came to know Lady Byron, whom she sought out for years to be a patron.

The Blackwell sisters disdained the budding suffragette movement and declined to endorse it. Yet their two brothers married leading women's rights activists—Lucy Stone and Antoinette Brown.

The Doctors Blackwell is very much the story of Elizabeth's zeal for institution building. In 1857, Elizabeth and Emily opened the first hospital staffed by women, the New York Infirmary for Indigent Women and Children. Elizabeth kept sharp watch on her place in history. Her conviction that women doctors would inspire women "with higher objects — loftier aspirations — to teach them there is a strength of woman as well as of man," took precedence over any interest in medicine. This, despite the desperate need for women physicians who understood women's physiology and could provide alternatives to the brutality of birthing techniques, fatal abortions, and poorly understood female diseases.

Elizabeth Blackwell comes across as highly disciplined and anti-social. She held strong and sometimes unappealing beliefs. In addition to opposing women's suffrage, she was condescending and viewed herself as a "deity." She found slavery abhorrent, but "rescued" an Irish orphan girl in New York City, kept her as a lifelong servant, and declined to grant her any freedoms in adulthood.

Emily profited from Elizabeth's fame, but suffered in her long shadow. Yet Emily was the better doctor, an accomplished surgeon with compassionate bedside manner. Marie Zakrzewska — "Dr. Zak" — a Polish immigrant, joined them in the 1850s, having lost an unprecedented appointment as chief of midwifery at the University of Berlin when her mentor died. The Blackwells recognized her strength and accomplishments, insisting that she qualify to practice in America.

When Elizabeth moved permanently back to England leaving Emily in charge of the clinic with its accompanying administrative headaches, Emily came into her own. She formed a lasting professional and love relationship with Dr. Zak. Elizabeth wrote and lectured for the rest of her life, a moral crusader. She advocated for the "good-wife-wise-mother ideal," for family planning, and for health education.

Slowly, America followed the Blackwells' lead. By 1910, the year both sisters died, there were 9,000 women doctors in the United States — about six percent of the total. Today, 35 percent of physicians in America are women, and women comprise about half the medical students.

The Doctors Blackwell not only testifies to Elizabeth and Emily's iron determination but also chronicles evolving medical practices. Nimura places the sisters within the broad intellectual context of their time, creating an important and engaging history lesson.

Martha Anne Toll just completed 26 years at the Butler Family Fund, a social justice philanthropy. She won the 2020 Petrichor Prize for Finely Crafted Fiction and her novel, Three Muses, is forthcoming in 2022.

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