by Adele A. Wilby
Over recent times, many books have been published with the aim of writing women into history and crediting them for the achievements they have made to the benefit of humanity more broadly. Janice P. Nimura’s The Doctors Blackwell is in that genre of women’s history and she effectively narrates the biographies of the first two remarkable women to study and practice medicine in the United States: Elizabeth Blackwell and her younger sister, Emily.
In this modern world where the sky is literally the limit for women should they have the ambition, determination and the opportunity, it is sometimes difficult to think of them being stifled in such a way as to constrain their potential, yet that has been the plight of women throughout history, and indeed remains the situation for many women across the globe. Gender has been a crucial factor in defining the lives of women, probably exacting a terrible toll of lifelong intellectual frustration and stifling ambition for many of them. As Nimura’s book reveals, Elizabeth Blackwell, a ‘solitary, bookish, uncompromising high-minded’ young woman was one such woman, until she found her way into medicine.
The Blackwell sisters’ path to history began after their arrival in America from England with their family in 1832, and it was there that they broke gender barriers when they entered medical college and qualified as doctors. Elizabeth was the originator of their histories. Once she had decided to pursue a career in medicine, her road to medical college, as the book tells us, was paved with the usual gendered obstacles that questioned the intellectual ability and physical endurance of women, not to mention whether male students would ‘tolerate’ a woman in the class trying to assert a place amongst men. And of course, there was always that moral retort: what type of woman would choose to expose herself to the naked realities of the body in the company of men? Elizabeth Blackwell, and eventually her sister Emily, did indeed wish to do so.
Rejection after rejection from various medical colleges failed to deter Elizabeth from her project. To her credit she pushed on undeterred, applying to one medical college after the other for a place to study. Eventually, she found herself the recipient of a letter from the head of the faculty at Geneva Medical College in New York State in 1847: she was being informed that she had at last been accepted to ‘become a member of our class’ of medical students.
The book narrates her experience at the college and the reader cannot help but smile at the prudishness of the male lecturers, confining at times Elizabeth’s attendance at dissections to when it was ‘appropriate’ for Elizabeth to join such classes. She however, showed neither squeamishness nor was she burdened with all this supposed modesty, but rather viewed medicine objectively as a science. For a bookish woman such as Elizabeth, exposure to medicine was all about the development of her mind and she seems to have totally subordinated herself to the project of studying the discipline. She went on to pass her exams at the top of her class in 1849, and indeed earned the respect of her fellow male students, an achievement that played into Elizabeth’s thinking on gender politics.
Despite her gender breaking achievement by qualifying as the first female doctor in the US, Elizabeth, as Nimura comments, was ‘no radical’. Although an anti-slavery activist, her opposition to oppression did not extend to sympathy for women. Indeed, one of the surprising aspects of the book is just how little regard she had for them. She looked upon women with disdain, which is difficult to understand from such a well-read woman, a person with a ‘dedication…to the life of the mind’. She seems to have been devoid of any wider insight and understanding of the social constraints that might have contributed to the position of women in society.
There are moments in the book when some readers might feel a degree of outrage at what can be considered Elizabeth’s demeaning and offensive comments about women. An example of her ‘misogyny’ is evident in her response to an invitation to speak at the national convention of a women’s right movement where she comments, ‘I believe that the chief source of the false position of women is, the inefficiency of women themselves – the deplorable fact that they are so often careless mothers, weak wives, poor housekeepers, ignorant nurses, and frivolous human beings’. Rather a disappointing perspective from a woman with extra-ordinary self confidence in her intellectual ability, and who aspired to work in a profession where human understanding and compassion are fundamental. We get more of her disparaging views about women in a letter to Emily. She says women are: ‘petty, trifling, priest ridden, gossiping, stupid, inane… what can we do with them!’. Also, Elizabeth responded to a woman who had written to her praising her achievements. Women’s oppression, was not, she argued, the making of men, but women were ‘…feeble, narrow, frivolous…, ignorant of their own capacities, and underdeveloped in thought and feeling’ and their ‘exclusion…has arisen naturally, without violence, simply because woman has desired nothing more’. Tough rebukes of women indeed. Given our more contemporary understanding of historical patriarchy, her views make for uncomfortable reading. Indeed, she seems to have been out of step with wider social trends of the times as women were organising and demanding the right to suffrage. Elizabeth had no time for such sentiments. For Elizabeth, exceptions should not be made for women, but rather the onus was on them to get themselves educated, work hard and earn the respect of men in whatever field they took up, a not unfamiliar conservative view of women and work today. Moreover, for Elizabeth such views applied to single women only. The duty of the remaining women, for her, was to stay at home and improve on their mothering skills, a role she elevated as ‘natural’ to women with their compassion, and tenderness and all those other stereotypical images that are used to define, and ultimately confine, women’s potential and role in society.
Notwithstanding Elizabeth’s gender politics, there is also another story in the book with wider implications for women, and that is her actual contribution to women and medicine after she qualified as a doctor. A big-hearted reader can ‘forgive’ Elizabeth for being such a reactionary for her achievements did, ultimately, open up opportunities for women in medicine. Moreover, her apparent dislike of women is offset by hints of acknowledgement that women do have potential and they could be anything they aspired for, if only they made the effort and worked hard. For Elizabeth, that was the path to making a contribution to humanity also, a high ideal to be aimed for in her scheme of things.
Ultimately, in 1857 Elizabeth, well supported by her sister Emily, by now herself a qualified doctor, established the New York Infirmary for Indigent Women and Children, a place where women could consult doctors of their own sex, a not insignificant issue for many women to this day. There would be no charges for women either, another radical project that resonates now with the perennial debates over medical costs and how they should be paid. But equally as significant was the opportunity the Infirmary offered female medical students to study medicine, and nurses could be trained also.
At this time in America, more female medical colleges had been established, and women rejected by medical schools found their way into these segregated colleges. Elizabeth, with her usual critical eye, found female doctors trained in these colleges wanting in skill and efficiency, and this fed into her growing interest in medical education. She saw the opportunity and need for establishing a medical college for female students, a radical turnabout from her previously entrenched views on integrated medical colleges.
Elizabeth and Emily’s vast medical experience made them well equipped to establish such an institution where they could teach also. Not only would the college take on female medical students, but it would offer a new, wider curriculum than other medical colleges. Examinations would be held in the laboratory and by the bedside and students would have to demonstrate their skills rather than repeat them; participation in class and working individually with professors was also encouraged, practices taken for granted today. The course would also be extended from two to three years. The Women’s Medical College of the New York Infirmary, as their college became known, would be as high in standards as any American medical college, reflecting Elizabeth’s view that only with such training would women be qualified to take their rightful place as equals to men in the profession. Certainly, the college would be far better than any other female medical college of the time. Quite some ambition and achievement for Elizabeth and Emily Blackwell in the mid nineteenth century, challenging the domination of men in the medical profession. As we now know, generations of female doctors have benefitted from her arduous task of establishing women in medicine, and it was a personal triumph for Elizabeth in the realisation of what she considered a task given to her by god.
Emily went on to become the first female surgeon in the United States. She trod a similar path as Elizabeth to gain entry into medical school, but we see in the book how Emily lived in the shadow of her older sister. Perhaps Emily deserves a biography of her own: she, rather than Elizabeth, actually practiced medicine. It would be interesting to learn more about how the first female surgeon flourished running the Infirmary and the medical college after the departure of Elizabeth to England for the remainder of her life.
Nimura’s book provides an historical account of the pioneering work of the sisters Elizabeth and Emily Blackwell in medicine, and, for those interested, it certainly has its gender politics. When considering the wall of male resistance to women studying and practising medicine that had to be overcome for them to become doctors, and the establishment of a hospital for women and a medical college of repute for female medical students, the Blackwell sisters made not only individual history, but contributions to women’s history and indeed medical history. Nimura is to be credited for bringing to life the stories of these remarkable women. Importantly, there would be no turning back time on the social and gender progress that these women initiated. At the time of the deaths of the Blackwell sisters in the early twentieth century, six per cent of the physicians were women, compared to thirty-five per cent today in the United States, and slightly more than half the present-day medical students are female. Elizabeth, no doubt, would be proud of such an achievement. Women, she would probably think, finally asserted their potential to make their mark in medicine and society. It is a shame though, that Elizabeth could not have appreciated and respected the women whose lives she changed, in the same way that Nimura’s book accords the Blackwell sisters the respect they both deserve.