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Elizabeth Blackwell: Opening the Door of the Medical Career to Women
On January 23, one unusually warm winter day in Geneva, New York, the graduation of the Geneva Medical College’s Class of 1849 was held in a local Presbyterian church. The church was packed with families and friends of the graduates, faculty, and many guests. In the midst of the male graduates in the front pews, a lone woman solemnly sat among the class. The president of the college summoned the graduates to the platform one by one and presented them their diplomas, addressing them as Domine (“male doctor” in Latin). Finally, the woman graduate was called. He conferred the medical degree upon her and saluted her as Domina (“female doctor”). The audience was witnessing a historic moment. Elizabeth Blackwell had became the first woman physician of the United States after prevailing over social barriers that excluded women from the study of medicine. She devoted her career and life to paving the path that enabled future women to successfully pursue medical careers, and inspired women for generations to pursue careers in medicine.
In 1845, twenty-four-year-old Elizabeth Blackwell visited a dying acquaintance, Mary Donaldson. During their conversation, Elizabeth spoke about her dislike of her career as a teacher. “It is superficial and unsatisfactory. I always desired something challenging that would benefit humanity.” Her friend abruptly inquired, “Elizabeth, you are fond of study. Why don’t you become a doctor? Had I been treated by a lady, my worst sufferings would have been spared me.” She recounted the suffering and embarrassment of her uterine cancer that would have been more bearable if a woman doctor had treated her. Though deeply moved by her friend’s suffering, the suggestion astonished Elizabeth. So many obstacles appeared to be insurmountable, both personal and societal. The human body repulsed her: “The very thought of dwelling on the physical structure of the body and its various ailments filled me with disgust.” She also lacked the money needed to attend medical school. However, her supreme obstacle would be society. Even in America, the nation of reform and freedom, a woman studying the human body was considered abominable. Nevertheless, the thought of becoming a doctor took seed on that day and never left Elizabeth’s mind.
Mid-Victorian society in America considered women so inferior to men that they could not vote, possess property, or pursue a career. Girls received a basic education at home from a governess, one of the few jobs to which a woman could aspire. Women were child-bearers, residing mainly in the home raising children, facing exclusion from public life and lacking rights in society.
Women's struggles for equal rights began in the late 1700's and early 1800's. Influential thinkers of the time began to question established authority and stressed the importance of reason, equality, and liberty, sparking the women’s rights movement. The new intellectual atmosphere justified women's rights to full citizenship. In the mid-1800s, women gained employment, property, and voting rights, but society continued to shun emancipated women.
Medical care and treatment for women remained dismal. Women received terrible care from physicians. “Victorian prudishness banned male physicians from looking at their female patients if they needed examination for vaginal or uterine illness or for breast cancer. A broken ankle was carefully examined, but little else was,” says Nancy Dubler, describing the neglect of women’s health in the 1800s. Many women were reluctant to see a doctor when they needed medical attention. The thought of being examined nude and touched by a man violated every rule proper women were taught.
Aware of a woman’s place in society at the time, Elizabeth approached her unorthodox friends in Philadelphia, asking if there was a possibility of acceptance to medical school, only to receive uniform discouragement. Refusing to accept defeat, she contacted physicians and deans, but received similar answers in every reply. Most common was the shocked exclamations: “Unthinkable! No normal medical school in the country has or ever will accept a woman.” Determined, Blackwell traveled to Ashville, North Carolina to resume her job as a teacher in order to earn money for tuition. She lodged at the home of a family friend and retired physician, John Dickson, and obtained elementary medical training from him. By summer, Blackwell had acquired enough money and knowledge to begin applying to medical schools. She applied first in Philadelphia, but only encountered frustration. "You cannot expect us to furnish you with a stick to break our heads with," one dean wrote. Friends suggested that she resort to male disguise and study abroad in Paris. When an advisor, the distinguished Dr. Joseph Warrington, warned her against going to Paris because it was a sinful city of degradation. Blackwell replied, "If the path of duty led to hell, I would go there!"
Still hoping to gain admission to an American school, Elizabeth tried repeatedly. Nineteen schools declined her application. Finally, with her hopes almost depleted, she applied to Geneva College, a tiny, little-known institution in rural New York. Dr. Warrington sent a letter of recommendation for Blackwell to Dr. Charles Lee, dean of the school. Soon after, Blackwell received a letter from the Geneva Medical College. Dated October 20, 1847, it read:
“…Resolved…, that the application of Elizabeth Blackwell to become a member of our class meets our entire approbation; and in extending our unanimous invitation we pledge ourselves that no conduct of ours shall cause her to regret her attendance at this institution.”
A unanimous vote had granted her admission. The story behind her acceptance, revealed later, was quite comical. Though the administration of Geneva Medical College had no desire to be part of the first medical school to accept a female student, they could not reject such a qualified candidate or offend Dr. Warrington. Therefore, the dean and the faculty deferred the decision to the students, expecting no one to tolerate such a folly. However, students took the request as a joke and shocked the faculty by voting unanimously to admit the ‘lady student.’ Nevertheless, Elizabeth Blackwell had finally received her single, groundbreaking acceptance to medical school and changed the course of history.
The “lady student” arrived at Geneva Medical College on November 6, 1847. Both students and faculty were genuinely shocked to see Elizabeth Blackwell arrive at class that day. The students, who had long forgotten the event, were baffled and curious. Inquisitive strangers entered the lecture room to observe the rumored phenomenon. Elizabeth’s gender made her the instant scandal of Geneva. The townspeople avoided her, deeming her either immoral or insane. Elizabeth recalls:
“I had not the slightest idea of the commotion created by my appearance as a medical student in the little town …. As I walked backwards and forwards to college, the ladies stopped to stare at me, as at a curious animal. I afterwards found that I had so shocked Geneva propriety that the theory was fully established either that I was a bad woman, whose designs would gradually become evident, or that, being insane, an outbreak of insanity would soon be apparent.”
Her attendance at anatomy lectures produced enough embarrassment from the students that the professor, Dr. John Webster, requested that she miss class on days with lessons and dissections in reproductive anatomy. She replied that she desired to be treated simply as another medical student and regarded the study of anatomy with profound reverence. Dr. Webster writes in his journal after class:
“November 22.--A trying day, and I feel worn out…'tis a terrible ordeal! That dissection was just as much as I could bear... My delicacy was certainly shocked, and yet the exhibition was in some sense ludicrous.”
Blackwell’s solemnity, extensive knowledge, and perfect decorum eventually won the acceptance and respect of faculty, students, and townspeople. She later accounted that the behavior of her peers became "gradually admirable and of true gentlemen."
In Seneca Falls, twelve miles away from Geneva, the First Women’s Rights Convention was held in 1848. Elizabeth had long been in correspondence with influential suffragists and other women’s rights advocates, and took the time to write a letter supporting the convention’s cause despite her challenging studies.
Begun with such difficulty, Blackwell’s academic career ended with triumph--Elizabeth graduated at the head of her class. In his graduation address to the 1849 medical class, Dr. Charles Lee, Dean of Geneva Medical College, referred to the extraordinary event of the day with wholehearted admiration for the first female medical doctor. However, when his graduation address was printed, he added a footnote stating that, though he “supported medical education for qualified women, the… inconveniences… of females to a medical school are so great that [he] would be compelled on future occasions to oppose such a practice." Even though the press took notice of the first bestowal of a medical degree on a woman, their coverage was mostly neutral or tepidly positive at best, reflecting the prevailing attitude of society. A month later, a Boston journal even condemned "the farce enacted at the Geneva Medical College…as the first case of the kind that has been perpetrated either in Europe or America, for the honor of humanity, it must be the last."
Soon after graduation in 1849, Dr. Blackwell left for Europe to receive her postgraduate medical education. All medical school graduates needed clinical experience in different areas of medicine. Hospitals in the United States refused to grant her admission to their residency programs.
Though told that the teaching hospitals of Paris would welcome her, the only opportunity Blackwell was offered was at La Maternité. There, her medical training gave her no status above illiterate village girls who were to become midwives. Nevertheless, she considered the training excellent because of its intensive pre/post-natal care.
On November 4, 1849, Blackwell suffered a catastrophe that almost ended her medical career. While syringing the infected eye of an infant, pus spurted into her eye. Within hours, her eyes were sightless and swollen shut. She had contracted ophthalmia neonatorum, a severe form of conjunctivitis that rendered her nearly blind. Physicians removed her left eye and sight slowly returned to the other, but not enough to accommodate her goal of becoming a surgeon. Blackwell resumed her quest for a medical career, training at St. Bartholomew's Hospital in London to become a gynecologist.
Dr. Blackwell returned to the United States in 1851 and settled in New York City. In 1853, she founded the New York Dispensary for Indigent Women and Children. However, patients were slow in coming and she described "A blank wall of social and professional antagonism facing the woman physician… and a situation of singular, painful loneliness leaving her without support, respect or counsel." In 1857, she closed the dispensary and opened the New York Infirmary for Indigent Women and Children, a charity clinic for medical and surgical patients intended to provide training for female medical students and jobs for women physicians. The medical staff initially consisted of Dr. Elizabeth Blackwell, her younger sister Dr. Emily Blackwell and Prussian midwife Marie Zakrzewska.
Dr. Elizabeth Blackwell initiated another important venture: to create a women’s medical college. Dr. Blackwell believed that women should receive their medical education alongside men in established medical schools. However, since women trained in her infirmary could not gain admission to male medical colleges, she decided to establish her own women's medical college. The Woman's Medical College of the New York Infirmary opened its doors in 1868 with fifteen students and a faculty of nine, including Dr. Elizabeth Blackwell and Dr. Emily Blackwell.
Having set stable groundwork for the medical college, Dr. Blackwell left for England to pursue her medical career in 1869, leaving the college under Emily's directorship. She spent her remaining years in England practicing medicine and expanding opportunities for women seeking medical careers. She led the campaign to establish the London School of Medicine for Women in 1875, the first women’s medical college in England. In 1879, Dr. Blackwell’s ailing health forced her to retire and move to Hastings, a rural town near the English Channel. She spent the rest of her life there writing about medicine and continuing to advise and inspire young women who sought medical careers. After leading a pioneering life, Dr. Blackwell died in Hastings on May 31, 1910 at the age of eighty-nine.
In 1849, Elizabeth Blackwell was the only woman female medical student in the United States. By the 1870s, women were attending co-educational medical schools in the United States. The year of Blackwell’s death, 7,399 women were licensed physicians in the United States. Dr. Blackwell’s accomplishments and successes were monumental, but her battle for women’s equality in the field of medicine continued after her death. Discrimination against women who sought medical careers remained prevalent. Women made up a very small percentage of medical students throughout the twentieth century. “When I was in medical school in the early 1970’s, people did not consider women studying medicine immoral, but inappropriate. I was one of only eight women out of a class of 88,” says Dr. Pamela Davis. “When I obtained a position at the NIH during the Vietnam War, some people resented me because they thought I was taking up the spot of a man who would be drafted,” says Dr. Davis, recalling the prejudice shown against her.
Today at the dawn of the 21st century, women have gained status and influence in medicine. Women comprise 48.6 % of medical school enrollment in the U.S. and the number of female physicians in medicine continues to increase. Currently, 37.8% of physicians in the U.S. are women.
Elizabeth Blackwell’s triumphant struggle for equality not only opened the door for women to become physicians, but also led many women to hold leadership positions in the medical field. “Dr. Blackwell paved the way for women who followed her to truly make a significant mark in medicine. Not only can we take care of patients, we can chair departments, run hospitals, lead the NIH, or be a Surgeon General,” says Dr. Kathleen Franco. Nearly 550 women hold important administrative positions in medical schools, three U.S. Surgeon Generals have been women, and nine presidents of the AMA have been female. Dr Franco aptly reflected on this: “It all started with one woman. We should all be grateful to her and to God that she persisted courageously to achieve her goal of becoming a physician.”
Dr. Elizabeth Blackwell was a true pioneer, opening the medical profession to women and enabling them to become practicing physicians and leaders in medicine. During a time when even the most progressive thinkers deemed a woman’s acceptance to an American medical school impossible, Dr. Blackwell’s superior qualifications and unwavering determination ultimately earned her admission to medical school. Her perseverance, her exceptional competence, and professional demeanor won Dr. Blackwell respect and acceptance. Her graduation was a declaration to society that women were as capable of a career in medicine as men. Dr. Blackwell’s legacy did not stop at her graduation. Even with a disability from a clinical accident, she tirelessly dedicated her life to expanding opportunities for women in medicine by opening women’s medical colleges and establishing facilities to provide women physicians with clinical experience. Dr. Elizabeth Blackwell is a remarkable historical figure who paved the path for educational and professional equality for women, beginning with the medical career.