Shin Kickers From History: Elizabeth Blackwell, MD
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
In which I consider Lord Acton’s Axiom.
One of the advantages of doing a written Q & A instead of a live interview is that you have time to check things out instead of just burbling on. My most recent blog post, in which I answered questions from long-time History in the Margins reader, Bart Ingraldi, is a wonderful example of this. In it I quoted George Santayana's famous statement that "Those who cannot remember the past are condemned to repeat it." In doing so, I may have probably left you with the impression that I had the details about Santayana and the quotation right on the tip of my mind. That was not entirely accurate.
I certainly knew the quotation, but I wasn't sure who had said it. I suspected it might have been Winston Churchill.* Or perhaps nineteenth century historian Lord Acton. A quick search of the internet gave me the proper attribution.**
It also caused me to look more closely at Lord Acton's own famous aphorism: "all power corrupts; absolute power corrupts absolutely". I had never never looked at Acton's pithy line in context. Having done so, I find myself uncertain, uncomfortable, and eager to share.
As best I can tell, Acton used the line twice, with a slightly different twist each time.
In 1881, he wrote to Mary Gladstone, daughter and secretary to then Prime Minister William Gladstone:
And remember, where you have a concentration of power in a few hands, all too frequently men with the mentality of gangsters get control. History has proven that all power corrupts; absolute power corrupts absolutely....The danger is not that a particular class is unfit to govern. Every class is unfit to govern.
That's a version of the aphorism I can live with.
It's the later version that makes me bite my lip, squirm in my chair and go "but, but but...". Writing to the Anglican Bishop of London, Mandell Creighton in 1887, Acton moves from discussing the corruption of a class to discussing the corruption of an individual:
I cannot accept your canon that we are to judge Pope and King unlike other men, with a favourable presumption that they did no wrong. If there is any presumption it is the other way, against the holders of power, increasing as the power increases. Historic responsibility has to make up for the want of legal responsibility. Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men, even when they exercise influence and not authority, still more when you superadd the tendency or the certainty of corruption by authority. There is no worse heresy than that the office sanctifies the holder of it. [emphasis mine]
Great men are almost always bad men???!!!! Really??
I'd love to here what you smart people out in the Margins think about this. I want rants and pontification. Examples and counter-examples. Let the discussion begin.
*Churchill is sometimes given credit for a pithier version of Santanya's line: "Those who fail to learn from history are doomed to repeat it." But the folks at the National Churchill Museum say it's not so.
**And an answer to the question "George who?" Mid-20th century philosophers are not one of my strongest subjects.
In Which Paper Sleuth Interviews Me About Writing, History, and Writing Heroines of Mercy Street
This post is an object lesson in being careful what you ask for. Long-time reader Bart Ingraldi, who blogs about history at Paper Sleuth using paper ephemera as a lens for writing about issues that are anything but ephemeral* recently suggested I interview myself here on the Margins. Instead I turned the suggestion around and asked him to do the honors
Bart has graciously put together some tough and thoughtful questions about writing history in general and writing >Heroines of Mercy Street in particular. Let's roll!
Bart: One question I'm always curious to hear a historian's answer to is: "How would you explain the importance of History to someone?"
I'll admit that history first caught my attention through the stories. And sometimes I think that enjoying the stories is enough. Stories are, after all, the most basic way we learn how the world works. (Sometimes to our detriment. I'm looking at you, Cinderella, Sleeping Beauty, and your fairy tale sisters.)
Looking beyond the question of storytelling, for me, the importance of history comes down to the fact that we are all shaped by the past, whether we realize it or not. If we ignore the past, we walk through the world with blinders on. I don't think it's as simple as George Santanya's often quoted aphorism that "Those who cannot remember the past are condemned to repeat it.”** Looking at a one-sided, un-nuanced version of the past is almost as limiting as not considering the past at all. I feel strongly that as a society we need to learn versions of history that aren't often taught in high school history classes (or at least they weren't taught in mine): the history of other parts of the world as well as history from the other side of the battlefield, the gender line, or the color bar.
Which I guess brings me right back to stories.
Bart: For Heroines of Mercy Street you spent a lot of time researching and writing about amazing women. Did you develop a special kinship with any of your characters?
I'm pretty squeamish, so the odds that I would have volunteered as a nurse are pretty slim. On the other hand, I can organize things like nobody's business, so I felt more kinship with the unsung heroines on both sides of the war who turned their homes and churches into factories to produce luxuries and necessities for the troops. I was particularly taken with Louisa Lee Schuyler, who at the age of 24 was the youngest woman to manage a branch of the United States Sanitary Commission.*** Her experience with the USSC laid the groundwork for what would be a long and successful career as a reformer.
That said, two nurses in particular caught my imagination. Georgeanna Woolsey was a New York socialite who took all the trimming off one of her dresses and a bonnet, dressed her hair as plainly as possible and, to the amazement of her family, bluffed her way into a slot in the nurses training program run for a brief time by the Women's Central Association of Relief. She brought that same sense of bravura to her work on the United States Sanitary Commissions hospital transport ships during the Peninsular Campaign. At the other end of the social scale was Amy Bradley Morris, a cobbler's daughter from Maine who reinvented herself several times over the course of her life and was a tireless advocate for the soldiers under her care in the war. The thing they had in common was a refusal to be defined by social expectations.
Bart: In the book’s Introduction you offer a sweeping overview that perfectly sets the stage for what follows. And what follows is a story that both entertains and informs. Is the ability to keep the balance between the two - entertainment and information - something that comes naturally to you?
When it comes to writing, the tightrope walk between entertaining and information is my natural home. My advisor in graduate school often referred to my work as "Pam's Purple Prose." No matter how serious or scholarly the subject, I like to play with words, make smart-mouthed asides, and wander off into the weeds of historical trivia. (This will not come as a surprise to members of the Marginalia.) Which isn't to say that it isn't work. And I often err on the side of too dry or too self-indulgent--sometimes in the same manuscript. Thank heavens for editors, beta readers, and the chance to revise!
Bart: The fact that two thirds of deaths were caused by disease and not by battlefield wounds shows a monumental lack of preparedness concerning the handling of wounded troops. Do you feel that was due to the government’s thinking that the war would come to a speedy end, and victory assured?
Certainly the fact that both sides expected the war to be over quickly played a role. The army's Medical Bureau, which included some of the best trained doctors in the country, did not have the manpower or the supplies to cope with the sheer number of casualties in the early stages of the war.
But the prevalence of death by disease was more a function of the state of medical knowledge than a lack of preparedness. In the ten years following the Civil War, Joseph Lister would introduce carbolic acid as the first antiseptic, Louis Pasteur would pioneer the germ theory of disease and lay the foundations for the study of epidemiology, and Sir Thomas Allbutt would invent the first clinical thermometer--a revolutionary tool in light of how many deadly diseases initially manifest themselves as fever. But none of that was available to Civil War doctors and their patients.
With no understanding of how diseases were transmitted, the overcrowded and often unsanitary camps and hospitals were breeding grounds for contagious diseases.
Bart: Two powerful images from the book will stick with me. First, is the amount of human suffering caused by ignorance, greed and apathy. The second, is the transformation nursing made. The heroines you presented fought to take nursing from being a last resort or punishment for women, to an indispensable part of life. What are one or two things that impressed you the most?
I think the thing that impressed me most was the role volunteer nurses played as advocates for better care for the men they nursed. They took the domestic skills of running a household and applied them to running hospitals. Cleaner wards and better food made a tremendous difference. For that matter, so did cleaner men. A committee appointed by the Confederate Senate to investigate complaints about military medical care reported a ten percent mortality rate among soldiers nursed by men in male-run institutions compared to a mortality rate of five percent among soldiers nursed in hospitals with a strong female presence. So much for the common argument that nursing was no job for a woman!
Bart: If you had the power, what would you have added, deleted or tweaked in the television presentation?
As a whole, I think the PBS program did a good job with its presentation of Civil War nurses and medicine. I would have liked to see more of Dorothea Dix--on the other hand, she was such a powerful personality in real life that she might have taken over the show.
Bart: Did you visit Alexandria while doing research for the book?
Unfortunately, I did not. There simply wasn't time. We finalized the deal for the book on July 15. I turned in my final revisions on October 18. (If you do the math, the correct answer is "not long enough".)
I did visit Alexandria shortly after the book came out, thanks to an invitation to speak at Alexandria's historical museum. Mansion House no longer exists, but it was thrilling to walk the streets in real life that I knew so well in my head and a delight to meet the local history professionals. If you're looking for a history nerd weekend, I highly recommend it.
Bart: Writing is hard work. Considering the research, the writing, editing, rewriting, etc, etc. What routine do you have to make the writing process filled with less angst?
In the best of all possible worlds, I write or revise in the morning and read and research in the afternoon. When that schedule crumbles under the pressure of a deadline, I count on two things to get me through. First, I let the back of my brain to do its job. It's amazing how the mind works its way through problems while you sleep, or chop vegetables, or lift weights--assuming that you get out of the way and give it a chance. Second, I count on input from My Own True Love, who listens to me talk through the sticky points, reads my drafts, and tells me when I've drifted off topic or leaned too hard on a joke.
Bart: I guess a good follow-up to the previous question would be - do you agree with Dorothy Parker’s quote, “I hate writing, I love having written.”
On the good days, when the ideas flow and the words sparkle, writing is like dancing. On the days when I struggle for every word, it's like lifting weights. The funny thing is, both dancing and lifting weights leave you feeling better for having done it. Writing is the same way. Sometimes I love writing. Sometimes I hate writing. I always love having written.
One additional item from Bart: Towards the end of your book you talk about Mary Phinney von Olnhausen's second nursing career during the Franco-Prussian War, her heroics, and how she was awarded the Iron Cross. And how in 1902 she subsequently met Prince Henry, Kaiser Wilhelm's brother, in Boston.
You may find it interesting that in 2002, papers were discovered in a German military archive that detail the Kaiser's plan to invade the United States. He first started formulating his plan in 1897. It went through various incarnations before the final plan, Operation Plan III, was settled upon, around 1903 or 04. The plan called for the invasion of New York and Boston. It's unlikely that the Princes' visit to Boston in 1902 wasn't connected to the planned invasion. And your heroine,
selfless Mary, was once again touching History. The invasion is called off in 1906.
This is the kind of tidbit that keeps me hooked on history!
Thank you, Bart, for taking on the task.
*If you're not already familiar with his blog, I strongly urge you to check it out.
**Though sometimes it is. That's why I write an occasional blog post in the category I call Déjà vu All Over Again.
***She beat out her own mother for the job.