A metrotome sounds like a more pleasant device than it is. A switchblade of sorts, it was once used to treat fertility issues. A doctor would push the metrotome into a woman’s uterus, press the handle, and release the blade; when he pulled it out, it cut through one side of her cervix. After that, the doctor reinserted the tool and repeated the procedure on the other side. Eventually a version of the metrotome was made with a double blade that could cut both sides of the cervix at once—a supposed improvement on the original design.
Elizabeth Blackwell did not approve of metrotomes, or much of anything else that male doctors recommended for female patients in the nineteenth century. When one of her relatives faced the prospect of being treated with one, she argued for less invasive interventions and cautioned that the scarring resulting from the procedure might make pregnancy even less likely. Blackwell, who was born in England in 1821, and immigrated to the United States with her family as a child, was America’s first female doctor. Her younger sister Emily was the third. Although neither sibling was especially interested in women’s health, the lack of opportunities available to them in the field of medicine meant that they mostly treated female patients and were often limited to obstetric and gynecological care. In order to expand their practice, they opened the New York Infirmary for Indigent Women and Children, the first hospital staffed entirely by women, which went on to treat more than a million patients in its first hundred years.
The Blackwells were medical pioneers, but, except for a few professional awards named in their honor and a plaque commemorating the location of their infirmary, they have largely been forgotten. A new biography by the writer Janice P. Nimura, “The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine” (Norton), attempts to redress that situation by considering their lives in the broader history of medicine and social reform. It is an admirable project, even though, as the story of the Blackwells makes clear, context is not always flattering.
Elizabeth Blackwell was admitted to Geneva Medical College as a joke. She was twenty-six years old and had already apprenticed herself to two physicians, but she was rejected by more than a dozen schools. The only acceptance letter came from the students of Geneva Medical College, an Episcopal school in upstate New York. Dated October 20, 1847, it contained the following resolutions: “That one of the radical principles of a Republican Government is the universal education of both sexes; that to every branch of scientific education the door should be open equally to all; 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.”
Although this promising letter purported to reflect the deliberations “of the entire Medical Class of Geneva Medical College,” it failed to explain why Blackwell’s admission had been relegated to the student body. The answer was that the faculty had opposed it but did not wish to offend one of her recommenders, and so punted the issue to the students. Nor did the letter explain how those students had come to unanimously support her application: aware of the faculty’s opposition, delighted by the prospect of pranking them, and knowing that their decision had to be unanimous, they menaced the only dissenter until he relented. In the end, the motives of Blackwell’s fellow-students did not matter; she set off right away, starting the fall term a few weeks behind the men in her class.
It was a return of sorts for Blackwell, since her family had initially settled in Manhattan. Her father, Samuel, worked in the sugar trade, running highly combustible refineries that processed raw sugar from the Caribbean, first in Bristol, England, until that facility was destroyed by fire, and then on New York’s Duane Street, until that one burned down, too. The British had already outlawed the slave trade, but plenty of industries still depended on the labor of the enslaved elsewhere; though Samuel was an advocate of abolition, and his children gave up sugar in their tea to protest slavery, he never gave up his career.
The elder Blackwells were English Dissenters, and their religious ideals manifested not only in their abolitionism but also in domestic thrift, moral zealotry, and a commitment to their children’s education—for their five girls as well as for their four boys. The family got to know William Lloyd Garrison in New York, and when they later moved to the Midwest they worshipped in Lyman Beecher’s church and befriended his children, Henry Ward Beecher and Harriet Beecher Stowe. When transcendentalism arrived in Ohio, some of the Blackwells began attending William Henry Channing’s church, the Unitarian Society.
All nine of the Blackwell children inherited the reformist energies, moral seriousness, and social daring of their parents. Some of the girls attended the feminist lectures of Lucretia Mott and the Grimké sisters, one went on to translate the novels of George Sand and the philosophical works of Charles Fourier, and one was welcomed into the parlors of Lord Byron’s widow and George Eliot. Although none of the Blackwell daughters ever wed, one of the sons married Antoinette Brown, the first female ordained minister in the United States, and another married the suffragist Lucy Stone, one of the first American women to earn a college degree and the first one on record to keep her maiden name. These relationships and much else are thoroughly chronicled in the more than two hundred thousand pages of letters, diaries, speeches, and other family writings that survive. Yet those copious documents contain a maddening elision: nothing in them adequately explains why two of the sisters went into medicine.
Neither of the Blackwells showed any early interest in the subject. “I hated everything connected with the body, and could not bear the sight of a medical book,” Elizabeth writes in an autobiography that she published in 1895. “I had been always foolishly ashamed of any form of illness.” She did, however, watch steadfastly as her father died of complications from what was likely malaria a few years after immigrating, tracking his pulse and breathing as both weakened and noting those measurements in her journal, along with the amount of brandy, broth, and laudanum he was spoon-fed in his final days. Many accounts have suggested that this was formative for her career, but Elizabeth did not cite her father’s death as contributing to her decision to become a doctor. Instead, she describes how a female friend encouraged her to consider medicine: “If I could have been treated by a lady doctor,” Blackwell remembers her saying, “my worst sufferings would have been spared me.”
That remark does not go very far in explaining the persistence with which Elizabeth pursued her medical education and encouraged one of her sisters to do the same, or the perseverance both showed in trying to put their degrees to use. When Elizabeth started medical school, in 1847, the American Medical Association had only just been founded, in part to standardize education, and an M.D. could be earned in two years. While she was at Geneva, townspeople came to gape at her during classes, fellow-students disparaged her, and medical journals covered her enrollment as if it were some new disease that needed to be observed and possibly cured. Even the British humor magazine Punch took notice, initially, if facetiously, applauding the first female doctor for “qualifying herself for that very important duty of a good wife—tending a husband in sickness,” later belittling her with a mocking poem called “An M.D. in a Gown,” and eventually publishing a caricature of her sister treating a dog.
Emily started medical school just four years after Elizabeth completed her degree. She was rejected by Geneva, which had decided not to admit any more female students; instead, she began her studies at Rush Medical College, in Chicago. But she was forced to leave after her first year, when the trustees decided that their new ban on admitting female students required that they expel the one they had already enrolled. She finished her degree at Cleveland Medical College, graduating on February 22, 1854, in a ceremony also attended by that school’s only other female graduate. Both of the Blackwells struggled to find places where they could practice medicine. Elizabeth worked one summer at Philadelphia’s Blockley Almshouse, where she cared for the indigent and the mentally ill. After that she went to Europe, working first in obstetrics at La Maternité, in Paris, then studying surgery at St. Bartholomew’s Hospital, in London. Emily managed to find a slot attending lectures and observing operations at Bellevue Hospital, in New York, but, ultimately, she, too, had to go abroad, moving to Scotland, where she trained with the queen’s physician, James Simpson, a professor at the University of Edinburgh whose thriving obstetrics practice included some of the earliest experiments with chloroform and ether.
Among the many women who sought treatment from Simpson during Emily Blackwell’s time in Edinburgh was a cousin’s wife, Marie Blackwell, who had been unable to have children. Simpson, a champion of the metrotome, recommended surgery for Marie right away. Emily spent the rest of the year tending to her cousin, whose procedure was technically a success, since her cervix was widened, at least temporarily, and she did not hemorrhage, but whose convalescence included bouts of inflammation, peritonitis, and ovaritis, along with painful mouth sores from the mercury in the drugs she had been prescribed. “The whole case from beginning to end strikes me as a horrid barbarism,” Elizabeth wrote from New York when she heard about all the complications. Be that as it may, Emily insisted that her close supervision of Marie’s care had “made a Dr of me.”
Marie Blackwell’s experience was like that of many patients before the arrival of antibiotics and antiseptics, and “The Doctors Blackwell” is best on the fascinating and harrowing history of modern medicine. As Nimura explains, the sisters entered the field at a time when it had hardly advanced beyond the four bodily humors. “Thermometers were not yet in use to diagnose fever, and aside from poking, listening, peering, and taking a patient’s pulse, there was no accurate way to divine what might be happening inside the body, and even less certainty about why,” Nimura writes. “Treatment was a matter of better-out-than-in: trying to expel the problem with a toxic arsenal of emetics, laxatives, diuretics, and expectorants, not to mention lancets, leeches, and blisters.”
Neither sister was satisfied with the way medicine was being practiced or taught. “Medicine is always an evil,” Elizabeth once wrote, “though sometimes a necessary evil.” She experienced both realities firsthand after losing her eyesight to gonorrheal conjunctivitis, which she contracted while she was treating a newborn. Her own subsequent treatment included three weeks of cauterizing her eyelids, leeching her temples, painting her forehead with mercury, and applying belladonna and opium ointments. She regained vision in her right eye, but not her left. When the pain and swelling did not subside, she went for hydrotherapy in what is now the Czech Republic. The naturopath who ran the water-cure sanatorium had grown famous for surviving a near-fatal accident as a teen-ager by treating himself with wet bandages and drinking water, and Blackwell hoped to experience his alternative cures for herself. But the sight in the left eye never returned; eventually she had it removed and replaced with a glass prosthesis.
The failures of her own case did not entirely sour Elizabeth on novel treatments, and when she and her sister opened the New York Infirmary for Indigent Women and Children, in 1857, they promoted practices borrowed from hydrotherapy and hygienic cures—basic routines of bathing and sanitation that were so contrary to mainstream methods that they attracted protests for “killing women in childbirth with cold water.” In fact, they were saving women; one of the greatest innovations in health care at the time was hand washing, which doctors had previously failed to do even when moving between morgues and maternity wards. Despite the opposition, the Blackwells and their staff treated nearly a thousand patients in their first year, and performed three dozen surgeries. Both sisters also began giving lectures and teaching classes on public health.
Although their degrees and their methods made them pioneers, that word implies a radicalism they rejected. Elizabeth, in particular, disdained the poverty and the alleged promiscuity of some of her patients. Even as germ theory was taking hold, she came to regard disease as a moral failing. She espoused phrenology, opposed contraception, and campaigned against vaccinations. Neither sister was especially supportive of other women seeking medical degrees, even going so far as to refuse them the honorific of “Doctor.” Only begrudgingly and for financial reasons did they finally add a female medical college to their infirmary, after long dismissing women’s schools as inferior.
Seneca Falls, New York, the site of a historic feminist convention, in 1848, was not far from where Elizabeth got her medical education, but she criticized the activists who gathered there, and when the second Woman’s Rights Convention later praised her as “a harbinger of the day when woman shall stand forth ‘redeemed and disenthralled,’ and perform those important duties which are so truly within her sphere,” she condemned the movement. “I’m very sorry my name was mixed up with the Rochester absurdity,” she wrote. “I understand all the good that’s in them & esteem it for as much as it’s worth, but they mistake the matter & make themselves very foolish.”
Blackwell’s rejection of the suffragists is both curious and confounding. “Women are feeble, narrow, frivolous at present: ignorant of their own capacities, and undeveloped in thought and feeling,” she explained in a letter, but then emphasized that this was their own fault: “The exclusion and constraint woman suffers, is not the result of purposed injury or premeditated insult. It has arisen naturally, without violence, simply because woman has desired nothing more.” This is a surprising conclusion from a woman who had desired something more, only to face resistance at every stage of her career from all-male institutions—and who then watched her sister suffer the same systematic exclusion. And yet, Blackwell also held in that letter that “when woman, with matured strength, with steady purpose, presents her lofty claim, all barriers will give way, and man will welcome, with a thrill of joy, the new birth of his sister spirit.”
But some of the only men who actually did so were Elizabeth’s brothers, and she excoriated them for it. She disapproved of their marriages to feminists and was appalled when her younger brother Henry wrote to ask for her help in editing a protest statement he planned to read during his wedding ceremony. He and his fiancée wanted to denounce the laws that “refuse to recognize the wife as an independent, rational being” and grant the husband powers “which no honorable man should possess.” Elizabeth called the statement foolish, and she accused him of acting “in bad taste” and performing “vulgar vanity” by politicizing his marriage.
Today, Lucy Stone, Henry’s wife, is better known than Elizabeth Blackwell, and their brother Samuel’s wife, Antoinette Brown, is better known than Emily Blackwell. This is hardly surprising: in addition to their own accomplishments, both of those women joined movements that championed the cause of other women, who, down through subsequent generations, had reason to honor and remember them. By contrast, the Blackwells come across in Nimura’s book as careerist, and what interiority we glimpse of them can feel cramped and ungenerous. Elizabeth, in particular, envied the popularity and financial success of Florence Nightingale and looked down on nursing. She dismissed Dorothea Dix, who helped to organize medical care for the Union during the Civil War, as “meddler general,” and serially alienated both her colleagues and members of her own family.
“First” is a tricky designation: sometimes it is genuinely significant, and sometimes it is essentially trivial. For one thing, it can obscure the rate of change and minimize the backlash such firsts often leave in their wake. Nimura ends her book on the celebratory note that, while only six per cent of physicians in the U.S. were women when the Blackwells died, thirty-five per cent are today. That seems to imply slow and steady progress, but, in reality, there was a higher proportion of female doctors in 1900 than there was in 1950—evidence of a more complicated trend that involved both discriminatory admissions policies and increasing social pressures that discouraged women from entering medicine in the first place.
As the Blackwells illustrate, the championing of firsts can also overshadow more interesting stories—about the two of them, for starters, since Emily was the more talented and devoted physician and kept the infirmary going for decades after her sister left it. More broadly, there have been other women who were abler practitioners but were never admitted to medical school, who completed rigorous schooling but were never awarded a degree, who obtained their degrees by passing as men, or who earned their degrees slightly later but had more accomplished careers.
Take St. Fabiola, born in the fourth century, who spent much of her life healing the sick. Or James Miranda Barry, born a woman three decades before Elizabeth Blackwell, who lived as a man, obtained a medical degree in 1812, and rose to the rank of inspector general as a surgeon in the British Army. Or Rebecca Lee Crumpler, the first Black woman in America to earn a medical degree, fifteen years after Blackwell, who used her education to care for emancipated slaves through the Freedmen’s Bureau. Around the same time, another woman offended the Blackwells by appearing beside them as a “Female Physician” in the New York City directory: Ann Trow Lohman, an abortionist better known as Madame Restell, who had no medical degree, but who was one of the most popular health-care providers in the country.
Such women come and go in the pages of “The Doctors Blackwell,” but Nimura largely fixes her focus on the two sisters. Her book hews closely to the structure of Elizabeth Blackwell’s autobiography—a questionable decision, since it means that, like Blackwell, she is slow to get into the actual practice of medicine and quick to leave it. The last forty years of the sisters’ lives are confined to Nimura’s final chapter, which is called “Divergence,” because it describes the period when their collaboration ended. Elizabeth left their infirmary in 1869 and returned to England, where she gave up medicine and focussed on her moral crusades against “social evil.” Emily practiced until she was seventy-three, retiring only after closing the women’s medical college, in 1899. She raised an adopted daughter and lived for the rest of her life with Elizabeth Cushier, an obstetrician who had graduated from the Blackwells’ college. The sisters died just a few months apart, in 1910.
