History in the Margins

Elizabeth Blackwell was the first woman in the world to become a doctor with a degree from a certified medical school. She was determined that she would not be the last. She became, as the title of her 1895 autobiography proclaimed,* a pioneer in opening the medical profession to women.

Blackwell was born in England in 1821--a year after nursing reformer Florence Nightingale. Her family moved to the United States while she was child, where they eventually settled in Cincinnati, Ohio. After her father's death in 1837, Blackwell, her mother and her two older sisters opened a boarding school in their home to support the family.

Blackwell disliked teaching, but it was one of the few jobs open to women at the time. A family friend, Mary Donaldson, made a shocking suggestion for an alternative career: why didn't Blackwell study medicine? Donaldson was very ill, dying from what was probably uterine cancer. She told her young friend that she wished she could be examined by a female doctor rather than undergoing the embarrassment of being examined by a man.

As far as contemporary opinion was concerned, Blackwell’s decision to become a doctor was even more shocking than Florence Nightingale’s desire to become a nurse. Unlike Nightingale, Blackwell's family supported her aspirations, but she met with far more resistance from the world at large.

Blackwell was lucky enough to find an experienced physician willing to teach her despite her gender—the same career path taken by most of her male counterparts, who typically apprenticed with established doctors for several years before opening their own practice or attending medical school. After two years of study as an apprentice, she moved to Philadelphia, then the center of medical study in the United States, and began applying to medical schools. She had plenty of individual mentors, but their support made no difference. Twenty-nine medical schools refused to admit her. She became so frustrated that one of her advisors, Dr. Joseph Pancoast, suggested she attend his classes in Philadelphia disguised as a man-- a solution she rejected because it would give her the knowledge but not the degree. Finally, Geneva Medical College in upstate New York accepted her as a student.

Her acceptance at Geneva was a fluke. While in Philadelphia, she had impressed a famous physician, Dr. Joseph Warrington, who recommended her as a student to Geneva. The school’s administrators didn’t want to accept her but they also didn’t want to upset Dr. Warrington. They decided to let the students vote on whether to let her in, sure the young men would reject her. By all accounts, the students believed the application was a joke perpetrated by a rival medical school. To the administrators’ surprise and horror, the students unanimously voted to admit Blackwell. In January 1849, after a year of study, she graduated first in her class, at the age of twenty-eight.

In the fall of 1849, Blackwell went to Paris, motivated by the same quest for clinical experience that drove many of her male contemporaries abroad. In Paris, she once again faced a male medical establishment hostile to the idea of female doctors and was unable to obtain permission to attend clinical instruction. And once again, well-intentioned men suggested she attend clinical demonstrations dressed as a man.**

Instead she decided, with great reluctance, to accept the advice of Pierre Louis, a French physician who is now known for his contributions to what would become epidemiology and the modern clinical trial. At his suggestion, she entered La Maternité, then the world’s leading maternity hospital and training school for midwives, where she could gain more practical experience in obstetrics in a short time than she could get anywhere else. For four months she lived in a dormitory with twenty Frenchwomen, most of them ten years younger than she was and, by her standards, uneducated in anything other than their chosen profession. In many ways the program was more difficult than most American medical schools at the time. It was certainly more focused. In addition to a full course of lectures, students spent several days each week en service—working in the maternity wards and clinics. They were not allowed newspapers or any books unrelated to medicine. It was a world entirely separate from that experienced by male medical students in Paris. Near the end of her studies at La Maternité, Blackwell contracted a serious infection that cost her the sight in one eye and ended her hopes for a career as a surgeon.

After Paris, Blackwell spent several months as a clinical student at St. Bartholomew’s Hospital in London. She returned to New York in the summer of 1851, where she realized her struggle to be a doctor had just begun. In some ways getting a medical education had been the easy part. Her private practice was slow to develop, and she was not allowed to work in the city’s hospitals, not even the women’s wards. She faced more than institutional roadblocks. Because many people believed “female doctor” was a euphemism for abortionist, landlords did not want to rent her office space, and she received anonymous hate mail. Finally she started her own dispensary on New York’s East Side, which later developed into the New York Infirmary for Women and Children. The infirmary had three goals: to provide medical treatment to women and children by women physicians, to give clinical instruction to female medical students, and to train nurses.

Blackwell's degree did not immediately open doors for other women. In fact, after the newly established American Medical Association censured Geneva Medical College for issuing her degree, the school’s president announced that Blackwell’s acceptance had been an experiment, not a precedent. The college subsequently refused to accept any more female students, including Blackwell’s sister Emily, who instead received her degree at what is now Case Western University, becoming the third woman to receive a medical degree in the United States.

In 1868, Blackwell opened her own medical school for women, the Women's Medical College of the New York Infirmary. Beginning with seventeen students and eleven teachers, she emphasized strict entrance qualification, clinical instruction, and final exams. The education her students received was better than that of most of the medical colleges for men in the United States.

In the United States, medical schools had begun to open to women (and women had begun to open medical schools). In Britain only one woman had successfully pursued a medical diploma. In 1868, one of Blackwell's English friends wrote and asked her to "Come and help us do for women here what you have done for the women of America."

In July 1869, Blackwell turned her college over to her sister Emily and returned to England. She built a successful London practice and helped found the London School of Medicine for Women, where she taught as a professor of gynecology.

When Blackwell died in 1910, there were 7399 women doctors in the United States alone.

*She was also the author of a best selling book designed to help parents teach their children about sex. In 1874.

**Does anyone else find this odd?

LAGNIAPPE:  For anyone who's interested, here's the link to my recent interview with History News Network: http://historynewsnetwork.org/article/162377