The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine

“Elizabeth preferred solitude to socializing anyway. Her voracious reading juxtaposed Shakespeare and Pilgrim's Progress with the independent heroines of novels by Maria Edgeworth and Madame de Staël. Books were a refuge from her own ineptitude in company.”

Elizabeth's tendency to prefer solitude and intellectual pursuits over social interactions is a constant throughout her entire life. The heroines she admired in novels also reflect her aspirations for autonomy and intellectual fulfillment, which ultimately led her to break barriers in the medical field.

“She had never wanted to be a man—she wanted, as a woman, to enjoy the same level of respect and freedom men took for granted.”

This quote links to The Struggle for Gender Equality in the 19th Century and summarizes the main reason why Elizabeth was determined to pursue medicine. She wanted to achieve equality on her own terms, not by adopting male attributes or disguising herself as a man, but by being recognized as a capable and accomplished woman in her own right.

“Some of the students blushed, some were hysterical, not one could keep in a smile, and some who I am sure would not hurt my feelings for the world if it depended on them, held down their faces and shook […]. My delicacy was certainly shocked, and yet the exhibition was in some sense ludicrous. I had to pinch my hand till the blood nearly came, and call on Christ to help me from smiling, for that would have ruined everything.”

Elizabeth's description of the students' reactions to a lecture on male genitalia captures some of the central issues in her attempts to break Societal Barriers surrounding medicine. In the 19th century, expectations of propriety were more socially strict. Because an understanding of all anatomy is critical to medicine, Elizabeth needed to navigate a delicate balance between professionalism, gender expectations, and personal fortitude.

“Municipal hospitals, evolving from their origins as poor-houses, remained refuges for the destitute, who entered or were deposited—as a last resort […]. […] [n]ew construction could not change old attitudes. Fifteen years on, roughly two thousand people lived and suffered within, a grim rebuke to Philadelphia's prosperity.”

This description highlights the grim reality of conditions at Blockley Almshouse. There is a stark contrast between the city's wealth and the dire circumstances of its most vulnerable residents, showing the persistence of societal attitudes toward poverty and illness despite supposed improvements.

“Women were not her peers or her equals, and she had little desire to work alongside them. Empowered by her own divine gifts, she meant to guide them toward better versions of themselves.”

While Elizabeth was a pioneer for women's rights and medical education, her view of other women was often condescending, and she saw herself as uniquely gifted. This attitude was nearly paternalistic and highlights the unique position she held by straddling the line between advocate and critic of her own gender.

“Your life interests me particularly, as it seems more nearly related to my own, than that of any other member of our family […]. Emily I claim you, to work in my reform—will you answer to the call, & let us sketch our future together?”

Elizabeth's authoritative tone in her letter to Emily is an example of her tendency to assume a leadership role within her family. This quote also shows how her ambition extended beyond her own achievements to include directing Emily's future.

“‘I listened in vain for one thought, one noble sentiment, or one mark of true refinement,’ Elizabeth complained. ‘Oh I grew very very weary of those uncongenial people, who never spoke to me, but were all the time with me.’”

This quote from Elizabeth's voyage to England captures her critical view of the societal norms and superficial concerns of her contemporaries. It also shows her sense of loneliness and isolation as her quest for deeper purpose often put her at odds with the people around her.

“As she washed the tiny affected eye, the contaminated liquid splashed into Elizabeth's face. By evening her left eye was swollen, and when she woke the next morning, the lids were stuck together with gummy discharge.”

The description of the rapid and severe progression of Elizabeth’s eye infection, a consequence of her exposure to purulent ophthalmia at La Maternité, emphasizes the precarious nature of the life of a 19th-century medical professional. They frequently worked in unsanitary conditions and were at high risk of contracting serious diseases from their patients. Such infections could, and did, have life-altering consequences.

“On August 15, 1850, the noted ophthalmologist Louis-Auguste Desmarres operated to remove what remained of her left eye and fitted her for a glass prosthetic.”

This point marks a significant and tragic moment in Elizabeth's career, and the loss of her eye is almost symbolic of the sacrifices she made in the pursuit of her ambitions. Despite this major setback, Elizabeth's resolve to continue practicing medicine remained unwavering.

“Florence Nightingale, patron saint of nursing, and Elizabeth Blackwell, first woman doctor, would never agree about the role of women in health, but this first encounter was a passionate moment of recognition between two people whose choices most found baffling, if not horrifying.”

Here, Nimura highlights the similarities between these two women, whom she generally portrays as total opposites in their views and approaches regarding women's roles in healthcare. While they never agreed, the mutual acts of breaking into medicine in any capacity made them more similar than they were different.

“Elizabeth was acutely aware of Madame Restell. The abortionist's emergence into New York notoriety had coincided with the dawn of Elizabeth's interest in medicine and perhaps helped to propel it—later, Elizabeth would remember her horror of abortion as formative.”

The negative connotations linked to female practitioners due to Madame Restell's notoriety are emblematic of the societal prejudices and misconceptions that Blackwell had to overcome in order for her practice to become a success. Restell’s overshadowing reputation is an example of the Cultural and Societal Barriers that impeded women’s professional opportunities. This moment is also part of Nimura's broader explanation of Elizabeth's values and how they affected her career.

“Elizabeth's return to New York, however anticlimactic, was the catalyst Emily needed. Her sister was waiting for her. It was time to shake off her tedious teaching routine in Cincinnati and decide where and when to begin formal medical study.”

Elizabeth's struggles and perseverance in New York served as motivation for Emily to finally pursue her own ambitions. However, by referencing the fact that Elizabeth was "waiting for her," Nimura highlights how her elder sister's expectations dominated Emily's career.

“‘Now my dear,’ he instructed her, ‘if you have any difficulty up there come to me and I'll settle it for you.’ She was no closer to a diploma, but at least she would not be wasting her time.”

This quote focuses on Emily's achievements in gaining admission to lectures at Bellevue Hospital. The support from a respected figure like John Wakefield Francis provided her with both a crucial ally and a much-needed sense of validation. It was not only a personal triumph for Emily but also shows the progress she made for women in medicine in general.

“Emily’s work with Simpson proved to her that a patient’s opinion of female doctors was usually in inverse proportion to her wealth. At Queen Street, even those who warmed to the idea of confiding their intimate troubles to a woman often balked at the impropriety of expanding the feminine sphere to include the medical profession.”

During her time working with James Young Simpson, Emily encountered class-based prejudices regarding the acceptance of female physicians, yet another example of The Impact of Cultural and Societal Barriers on Women’s Professional Opportunities. While poorer patients were appreciative and less likely to complain, wealthier women viewed the expansion of women's roles in medicine as improper and unfeminine. By pointing out this fact, Nimura highlights the irony that those who could most afford progressive medical care are often the most conservative and resistant to it.

“‘With few talents and very moderate means for developing them,’ Zakrzewska would write in her memoir, ‘I have accomplished more than many women of genius and education would have done in my place, for the reason that confidence and faith in their own powers were wanting.’”

Despite her limited resources, Zakrzewska's confidence let her achieve significant milestones in her medical career. This quote from her emphasizes how crucial self-assurance and resilience in the face of adversity are, of which she is keenly aware. She succeeded because she wanted it too badly to stop.

“I feel neither love nor pity for men, for individuals they may starve, cut each other's throats or perform any other gentle diversion suitable to the age—without any attempt to stop them on my part, for their own sakes. But I have boundless love & faith in Man, and will work for the race day and night.”

This quote from Elizabeth in a letter to her brother, Henry, shows her philosophical stance on her work and motivations. She lacks empathy for the individual and has little interest in the day-to-day practice of medicine, which she left to Emily and Marie Zakrzewska. However, she has a profound commitment to humanity's progress as a whole, which marks The Intersection of Personal Ambition and Social Change for Elizabeth. She was an idealist dedicated to systemic change and societal advancement rather than compassion. Her mindset reflects a strategic, albeit detached, approach to reform.

“Very few understand the soul of this work, or the absolute necessity which lies upon me, to live out the ideal life to the utmost extent of my power. My work is undoubtedly for the few, it is labor in the interlinkings of humanity, and is necessarily difficult of appreciation to the mass, very slow in gaining their esteem.”

Elizabeth recognizes that very few of her contemporaries would understand her mission of advancing women's medical education and its significance to humanity as a whole. As a result, her acknowledgment reflects the arduous process of societal change. As her somber tone here notes, her path was one of isolation, marked by personal sacrifice for something she viewed as greater than herself.

“‘I can hardly tell you how disgusted I felt by the luxurious self-indulgent objectless life of the wealthy English abroad,’ Elizabeth declared—but Madame de Noailles spoke of giving the Blackwells a small fortune, and for that Elizabeth was willing to look past her excesses.”

As a woman who devoted her life to a cause, Elizabeth valued hard work, discipline, and the pursuit of meaningful goals. The "objectless" lifestyle of the wealthy clashed with her ideals of moral responsibility and social contribution. However, despite her repulsion, she was also pragmatic enough to recognize the benefits of the financial support of someone like Madame de Noailles. While she disapproved of the irresponsibility of the aristocracy, she was also acutely aware of the financial realities necessary to sustain her medical practice and advance her cause.

“‘If ever I come to the conclusion that this is not to be hoped—that our success is only exceptional,’ Emily wrote, ‘then as far as I am concerned the life is an utter & miserable failure even if I made a fortune by it.’”

For Emily, the stakes of her career are existential. Her main concern is that if her and her sister's achievements are seen as anomalous and not replicable for women as a whole, it undermines the entire point of what they've done. Her professional life is meaningful only if it contributes to a systemic change and the start of a new norm.

“Elizabeth was named chair of the registration committee—the only female officer in the organization—charged with identifying and training the most promising individuals among the flood of women eager to do more than knit socks and roll bandages at home.”

Elizabeth’s appointment as the chair of the registration committee in a male-dominated organization shows both her exceptional position as a woman in medicine and the limited space that was allowed for women in professional leadership at the time. It also shows the shifting perception by women of their own capabilities during war. They, like Elizabeth, wanted to make more substantial contributions.

“The Blackwells had founded their New York Infirmary as a place for newly fledged female M.D.s to train, but the graduates who joined them over the next decade were less than impressive. Young women had weaker educational backgrounds than their male counterparts, and at the women's medical colleges they studied with professors who were often mediocre—by definition, or else why would they be teaching at a women's medical college?”

Female students of the time were not only hindered by societal expectations but also by the quality of instruction they received. Women's medical colleges often lacked the academic rigor and resources of male-dominated schools, which only perpetuated the cycle of under-preparation. The Blackwells’ frustration stems from the fact that women were capable if given the proper education, yet the Societal Barriers in place made it nearly impossible to provide that level of training. Thus, their struggle was not just against external barriers but also against the limitations of the institutions meant to serve the very women they were trying to empower.

“‘This school is the only one that the profession has confidence in, the only one it has sanctioned,’ Elizabeth concluded, somewhat inaccurately. Graduates of the Philadelphia and Boston women's medical colleges were gaining recognition, some of them as the Blackwells' own deputies, and students at Clemence Lozier's school—which had since moved to within a few blocks of the infirmary on Second Avenue—had the same right to observe at Bellevue and other New York hospitals as the Blackwells' students did.”

The Blackwells emphasized the importance of maintaining high educational standards. By stating that her school was the "only one" with professional confidence, she downplays the progress and success of other women’s medical colleges. This competitive spirit demonstrates Elizabeth’s deep commitment to creating a rigorous and respected path for women in medicine, but it also shows her need to set her own achievements apart from others.

“Medicine had always been just a pathway toward a morally perfect world, and the world remained far from perfect. She might be the only woman on the British Medical Register, but she had little success—or even interest—in attracting patients. She invested more active energy in the formation, in 1871, of the National Health Society, an organization devoted to the promotion of sanitary practice. Its motto—‘Prevention is better than cure’—set hygiene firmly above the arts of diagnosis, pharmacology, and surgery.”

For Elizabeth, medicine was not a profession but a vehicle for her to achieve a morally perfect society. The larger battle for societal well-being was more significant for her than the treatment of the individual. Her involvement in the National Health Society and her promotion of sanitary practices are a continuation of her lifelong commitment to using medicine as a tool for social reform and aligning health with moral righteousness.