American History Illustrated
January, 1981

Dean Smith

Elizabeth Blackwell wanted to be a doctor. Her stubborn determination opened the profession to women in the United States.

Professor James Webster’s anatomy class at Geneva College was even more rowdy than usual. Bored with the dreary lecture on that October afternoon in 1847, the young medical students welcomed Dean Charles Lee’s interruption.

"Gentlemen, I have a most amazing request to bring to your attention," Dr. Lee announced. "A young lady, Elizabeth Blackwell, has applied for acceptance to our medical school."

The noisy room became silent.

"The faculty, although inclined to reject this application, has decided to let the class vote on the matter."

Even one negative vote, the dean said, would eliminate her.

Stephen Smith, who was to become one of America’s most prominent physicians, recalled that moment forty years later:

We thought it might be fun, and relieve the monotony, to have a girl in our class. Everybody voted "aye" except one wretch, who was pounced on from all quarters until he yelled "Aye! I vote aye!"

So it was that English-born Elizabeth Blackwell, after being refused by nineteen other schools, became America’s first female medical student.

Two years later she became the first woman physician in America, and a decade later the first of her sex to be listed in the Medical Register of the United Kingdom. She broke through seemingly impregnable barriers of male prejudice to gain recognition and eventual fame in her profession and was a founder of women’s hospitals and medical colleges in both the United States and England.

Braving outraged Victorian opposition, she advocated sex education for young women and battled the double standard in sexual morality. She was far ahead of her time in demanding strict hygienic standards in hospitals and rigorous curricula in medical schools.

The Blackwell family seemed never to tire of crusading for unpopular causes. Elizabeth’s father, Samuel Blackwell, was known throughout England in the 1820s for his opposition to slavery and his demands for reform in church and government. Her brother Henry became a fiery abolitionist and worker for women’s suffrage. Her younger sister Emily, a tireless campaigner for women’s causes, became America’s second female physician.

Elizabeth was born February 3, 1821, in an old gabled house at Counterslip, near Bristol, England. Losses incurred when the family’s sugar refinery burned and bitter opposition to the Blackwells’ liberal views forced Samuel to take his family to America in 1832.

After six years in New York City, the Blackwells moved to Cincinnati. There young Elizabeth displayed unusual academic talents, read voraciously, learned French and German, became proficient in music, dabbled in art, and enjoyed frequent romantic attachments. When her father died, virtually penniless, she earned her living with teaching jobs in Cincinnati and in nearby Henderson, Kentucky. But her life bored her, and she longed for some supreme challenge. She found that challenge one day in 1845 when she visited a friend, Mary Donaldson, a victim of cancer.

"You are fond of study, Elizabeth," said the dying woman. "You have health, leisure and a cultivated intelligence. Why don’t you study medicine? Had I been treated by a lady doctor, my worst sufferings would have been spared me."

Elizabeth was repelled by the idea, as she noted in her journal. She loved the world of literature and philosophy and beauty, not the grim discipline of science. Medical school was very expensive and she had few financial resources. Besides, women were not permitted to study medicine , perhaps never would be.

Yet she could not put the wild notion out of her mind, although every close friend tried to dissuade her. Soon her determination to become a medical doctor became an obsession.

She pursued her impossible dream for several reasons: She was inspired by the challenge and the opportunities for service in a medical career; she was at heart a reformer, born to leave the world better than she found it; moreover, she possessed a powerful intellect, and she feared her romantic nature might lead her to an early marriage that would stifle her intellectual growth. An 1846 diary entry confirms her fear of mental stagnation:

I felt more determined than ever to become a physician, and thus place a strong barrier between me and all ordinary marriage. I must have something to engross my thoughts…

Petite, blonde, serious, and soft-spoken, Elizabeth Blackwell seemed miscast in the role of rebel and reformer. She was every inch the English gentlewoman: courteous, ladylike in dress and demeanor, and uncomfortable with strident feminists who insisted on wearing pants and shouting from lecture platforms. Her unconquerable strength for the task ahead lay in a quiet determination that enabled her to ignore the most infuriating abuse and move on to achieve her lofty goals.

To raise enough money for medical school tuition in the unlikely event that she would be accepted, Elizabeth took teaching jobs, first in Asheville, North Carolina and then in Charleston, South Carolina. In the latter city she boarded at the home of Dr. Sam Dickson, who was sympathetic enough to let her spend every available hour in his medical library and even gave her some elementary instruction.

She had promised her family to hold her tongue in Charleston and not become labeled as a hated abolitionist. But this experience "face to face with slavery: was almost more than she could bear. Still her determination to become a doctor was so strong that she would allow nothing to spoil her grand plan.

By early summer of 1847 she had enough money and enough self-acquired knowledge to move on to the next step: applying for entrance to medical school. She went first to Philadelphia, whose four medical colleges were among the nation’s finest. But she met with nothing but frustration there.

"You cannot expect us to furnish you with a stick to break our heads with," one medical school dean told her. Other deans were more subtle, but no more encouraging. Several suggested that her only hope might be to go to Paris, disguise herself as a man, and try for entrance there. One friendly adviser, the distinguished Dr. Joseph Warrington of Philadelphia, warned her against going to Paris because it was a city of sin and degradation. "If the path of duty led to hell," Elizabeth replied," I would go there!"

Still hoping to gain acceptance at an American school, she tried again and again. Nineteen schools declined. Then, with her list and her hopes almost exhausted, she applied to the medical department of tiny Geneva College, a little-known institution in rural west-central new York State. Dr. Warrington sent a letter of recommendation to Dean Lee of the struggling little school. The dean and his faculty, unwilling to take full responsibility for offending Dr. Warrington, turned the matter over to the students, who shocked the educators by approving.

Stunned, Dean Lee tried to look on the bright side of the disastrous vote. "This step might prove quite a good advertisement for the college," he told his faculty. History has proved him right beyond all expectations. In later years his college’s greatest claim to fame was its pioneering acceptance of the first woman into medical education.

Elizabeth Blackwell arrived at Geneva on November 6, 1847 and soon found herself a pariah in that little New York community. Elizabeth evaluated the furor her presence caused:

I had not the slightest idea of the commotion created by my appearance as a medical student in the little town. Very slowly I perceived that a doctor’s wife at the table avoided any communication with me, and that 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...

Although she had joined her class late, she caught up rapidly, studying far into the night to earn the highest grades possible. She starved herself in those early weeks at Geneva, partly because she had little money for food, and partly to keep her cheeks pale so that she would be less likely to blush in a delicate class discussion of anatomy.

Professor Webster at first asked that she absent herself from any anatomy lab which might prove embarrassing for mixed company. But she politely demanded the right to attend all such sessions, and her fellow students supported her.

Her journal entry of November 22, 1847 casts some light on the private war she was waging:

That dissection was just as much as I could bear…My delicacy was certainly shocked…I had to pinch my hand till the blood nearly came, and call on Christ to help me from smiling.

When the first term at Geneva ended in January she applied for practical experience in several hospitals but each refused her. Finally Philadelphia’s Blockley Almhouse, an infirmary for the poor, accepted her and she was assigned to the ward for female victims of venereal disease.

Again Miss Blackwell’s "delicate sensibilities" received a shock. Must as she had studied, she was not prepared for these horrors. Her introduction to "the hideousness of modern fornication: and its results led to a life-long battle against venereal disease and the white slave traffic.

Resident physicians and interns at Blockley Almshouse made her life there difficult. They snubbed her openly and refused to enter diagnosis and treatment information on patients’ charts while she was in attendance. Even some of her patients resented her presence. One destitute woman told her: "I may be poor and cast out by the Lord into a pauper’s bed, but I’ll have no woman to take care of me in my illness!"

She swallowed her resentment and worked all the harder. Returning to Geneva in the fall, she completed her medical studies in four months. For her graduation on January 23, 1849, she raided her dwindling savings to buy a black silk dress so that she might "be a credit to my college and my sex." The Blackwell family, who had cheered her through Geneva with frequent letters, exulted at her achievement and sent her brother Henry to represent them at the graduation ceremony. Geneva’s radical experiment had been a success. Miss Blackwell graduated first in her class, and even some of the village ladies who had snubbed her came up to offer grudging congratulations.

Several Eastern newspapers took note for the first female medical graduate, but the Boston Medical and Surgical Journal expressed regret that she had been "led to aspire to honors and duties which, by the order of nature and the common consent of the world, devolve upon men."

Britain’s humor magazine, Punch, commented in rhyme:

Young ladies all, of every clime,
Especially of Britain,
Who wholly occupy your time
In novels or in knitting,

Whose highest skill is but to play,
Sing, dance, or French to clack well,
Reflect on the example, pray,
Of excellent Miss Blackwell!

Secretly pleased over the attention showered on her, she noted the press comments in her journal.

Now she was at last Elizabeth Blackwell, M.D. But the doors to her chosen profession remained as tightly closed as before. Unable to find a hospital that would permit her to gain clinical experience, either in the United States or England, she went at last to Paris’ famed lying-in hospital, La MaternitJ . There she entered midwife training on the same footing as any illiterate peasant girl.

Angry, humiliated, but still as determined as ever, she bolstered her resolve with a journal entry: "Work on, Elizabeth!"

La MaternitJ , an ancient convent converted to hospital use, treated its students much like the nuns of earlier centuries. Confined within its walls for weeks at a time, Elizabeth Blackwell loved her rare free days, roaming the streets of Paris and surrounding herself with the beauty of Luxembourg Gardens.

It was at La MaternitJ that she suffered a catastrophe which threatened to end her medical career before it began. Her journal describes the tragic incident:

In the dark early morning [November 4, 1849] whilst syringing the eye of one of my tiny patients for purulent ophthalmia, some of the water had spurted into my own eye.

Within hours her left eye had swollen shut, and soon both eyes were sightless. Months of torture followed, relieved only by the kind ministrations of a young French intern named Hippolyte Blot, for whom she developed a strong romantic attraction.

Physicians at last removed her left eye, and sight slowly returned to the other. Thanking God for her deliverance, she resumed her quest for a medical career, although, as she noted, "my intentions of making surgery a specialty were necessarily abandoned."

From her girlhood days in Cincinnati when she became a close friend of Harriet Beecher Stowe, Elizabeth Blackwell exhibited a remarkable ability to meet and impress prominent people. In London, both before and after her Paris experience, she befriended leading intellectuals. Young Barbara Leigh Smith introduced her to such luminaries of science as John Herschel and Michael Faraday; Florence Nightingale, the future patron saint of nurses; and Lady Noel Byron, widow of the famed British poet. Lady Byron opened still more doors for the young doctor. She invited Blackwell to her seaside home, where she met authors and artists and heard Fanny Kemble read Macbeth.

One of her new London friends was the highly respected Dr. James Paget, who became sympathetic with her desire for more clinical experience. Dr. Paget helped Dr. Blackwell gain an unprecedented entry into St. Bartholomew’s Hospital in London during the winter of 1850-51.

With the invaluable St. Bartholomew’s experience behind her, she decided to return to America, confident that she could now begin her medical practice. But every effort to gain a hospital staff position in New York City met with scornful rebuff. If Dr. Blackwell hoped to practice medicine in New York, she would have to do it alone. Renting rooms at 44 University Place, across the Hudson in Jersey City, she hung out her shingle and waited for patients to appear. But, she wrote later:

Patients came very slowly…I had no medical companionship; the profession stood aloof, and society was distrustful of the innovation.

Reared in a large family and accustomed to having friends around her, Dr. Blackwell found those early years of New York practice among the loneliest of her life. By this time she knew she would never marry. So in 1854, at age 33, she decided to adopt a child. The Randall’s Island Orphanage had several hundred waifs longing for a home, but one bedraggled 7-year-old named Katherine Barry captured her heart at first glance. "Kitty," as she became known from that time forward, filled the emptiness in Elizabeth’s life.

Writing to a friend about the adoption, she explained: "I have recognized the truth of this part of my nature, and the necessity of satisfying its wants that I may be calm and free for the wider work," Her adoring Kitty remained at her side until her death in 1910, a span of fifty-six years.

Inspired by Elizabeth’s medical pioneering, her younger sister Emily was able to gain entrance to the Western Reserve University medical school in Cleveland, and become America’s second female physician in 1854. After additional study in Scotland, she joined her sister in her New York practice in 1856. That same year Dr. Marie Zackrzewska, whom Elizabeth had encouraged to take up medical studies at Western Reserve, joined the sisters. Marie became Blackwell’s ardent disciple, as she later wrote in her autobiography:

On our delightful long walks [on Weehawken Heights] she was the speaker, and her reasoning was so sound, her determination so firm, her love for humanity so true, that she seemed to me a prophet of no ordinary insight and foresight.

In May 1857 the intrepid trio rented a house at 64 Bleecker Street, in a New York slum, and launched the New York Infirmary for Women and Children. It was an exciting concept: a hospital for women, staffed entirely by women.

Funding for the infirmary came from bazaars, from a group of supportive Quaker women, and from some impassioned begging by the three founding doctors. Horace Greeley and Henry Ward Beecher, both old friends of the Blackwell family, gave their moral support, as did a courageous group of New York physicians, including Dr. Valentine Mott and Dr. Richard Kissam, two of the city'’ most respected physicians. Among the trustees were Cyrus Field of later Atlantic Cable fame, and prominent editor Charles Dana.

But nothing came easily for the new project. Many people still mistrusted lady doctors, and they frequently spread gossip about the morals of these brazen women who defied the laws of nature.

Emily Blackwell soon took over as the guiding force of the new hospital, freeing Elizabeth to return to England to campaign for opening the doors of medicine to women. Soon Marie Zackrzewska left, too, to open a women’s hospital in Boston.

Elizabeth’s speaking and writing rapidly attracted wide notice. Her once-flickering flame was now lighting a conflagration on two continents, and sentiment was swinging her way at last. "On all hands we make converts," she wrote triumphantly to Emily, "and those who are indoctrinated make converts!"

The name of Dr. Elizabeth Blackwell had become well-known in London by 1859, the year she became the first woman ever admitted to the Medical Register of the United Kingdom. "From the Queen downward," she wrote to Emily, "I see signs of favor."

As eager listener at one of her 1859 London addresses was a rich and talented girl named Elizabeth Garrett, who was brought immediately under Elizabeth’s spell. Miss Garrett later became England’s first female medical school graduate and a founder of London’s New Hospital for Women. Dorothy Wilson, one of Blackwell’s biographers, wrote of Garrett’s first impressions of Elizabeth:

She looked like a demure little Quaker in her plain bonnet and simple gray silk….The features framed by the blonde graying hair looked drawn and colorless….But from the first word in the low, resonant voice, the first gesture of the slender, expressive hands, the girl was held captive.

Through the 1860s and 1870s, Dr. Blackwell continued to rally support in Great Britain for acceptance of women in medicine. Princesses, dukes, bishops, and captains of industry were numbered among her adherents when she and Dr. Elizabeth Garrett Anderson led the campaign to establish the London School of Medicine for Women in 1875. Dr. Blackwell proudly accepted the Chair of Hygiene in the new medical school.

Meanwhile, she had rallied sufficient support to add a women’s medical school to her new York women’s hospital, which opened its doors in November 1868. The course of study was much more rigorous than in most medical schools of the day, and its graduates were turning doubters into believers.

Medical education would never again be the same.

There was still more pioneering ahead for Dr. Elizabeth Blackwell. In countless public lectures she had shocked Victorians by urging young ladies to learn more about their bodies and how to care for them. In 1876 she wrote a treatise on a very forbidden subject, sex education, and titled it Counsel to Parents on the Moral Education of Their Children in Relation to Sex. She submitted it to twelve different London publishers, all of whom recoiled in horror from the subject matter and refused to print it.

But a courageous editor at Hatchard and Co., London, at last agreed to publish the explosive book. No sooner had the manuscript been set in type, however, when the widow of Bishop Thomas Hatchard, a late senior editor of the firm, read the proofs and heaved them into the fire.

It was not until 1879 that the book was published, both in London and New York, with reaction ranging from outrage to cautious approbation. Twenty years later Elizabeth was to write:

Looking now at the very reticent way in which the subject is treated in this little book, it is difficult to believe that such an episode could have occurred.

Dr. Blackwell did not actively practice medicine during the final two decades of her life, but she was a tireless worker for a score of causes: women’s suffrage, better hygiene, the abolition of prostitution and white slavery, morality in government, and the liberalization of Victorian prudery, among others.

She set up court at her home, Rock House, at Hastings, England, receiving a stream of prominent visitors from all over Europe and America. At 85 she was strong enough to make one last visit to America to see her family and visit her hospital.

Her battle had not been completely won, but her successes had been monumental. She had won the enthusiastic support of some prominent medical figures—and the grudging acceptance of women into medicine.

When she died at Hastings on May 31, 1910, a total of 7,399 women had become licensed physicians and surgeons in the United States.

In 1949, on the 100th anniversary of her graduation from Geneva, her alma mater (since renamed Hobart College) named a new student dormitory in her memory. And in 1958, Hobart and William Smith Colleges established the Elizabeth Blackwell Award for outstanding service to mankind.

The serious young rebel in the Quaker bonnet had joined the ranks of America’s most honored medical pioneers.

A veteran author of ten books, Dean smith is currently Director of Publications and University Editor at Arizona State University in Tempe. Among other sources, The First Woman Doctor, by Rachel Baker (1944) and Elizabeth Blackwell’s own Pioneer Work in Opening The Medical Profession to Women (1895) provide interesting reading on the doctor’s career.