Urbanities

Leo Trachtenberg
New York’s First “Lady Doctor”
Winter 2000

Elizabeth Blackwell is one of those extraordinary people whose careers seem to sum up what makes New York so unique and so great. The nation's first woman medical doctor, she reminds us that Gotham is one of the world's dynamos of medical innovation, the place where hypodermic syringes were first used—at Bellevue in 1856—and the first appendectomy performed—at Roosevelt Hospital in 1886. She reminds us, too, that from early on, New York has been a theater of ambition and freedom, welcoming the unorthodox and visionary, who've blossomed in its opportunity-rich environment. Her career testifies as well to the city's long tradition of private philanthropy, which helped to uplift the immigrant poor, who have so enriched and energized the city that gave them their chance.

Born in Bristol, England, on February 3, 1821, the third of nine children, Elizabeth Blackwell grew up under the watchful eye of her father, Samuel, a Unitarian sugar refiner whose enlightened political views—he hated slavery and strongly supported education for women—clearly influenced his daughter. When a fire destroyed his refinery, he moved the family to the United States, eventually settling in Cincinnati in 1834. There, he worked for the abolitionist movement and endured still further financial setbacks, leaving his family quite poor upon his death four years later. But his gifted daughter flourished in her new country. As a teenager, Elizabeth Blackwell, blonde and petite, precociously devoured medical books and the writings of Emerson and Fourier. By the time she was in her early twenties, a young schoolteacher, she spoke French and German, had read widely, and played the piano well enough to give lessons.

At the age of 24, though, Blackwell had a revelation that changed her life, taking her far from her tiny Cincinnati schoolroom. She had gone to see Mary Donaldson, a family friend dying of what was probably uterine cancer. "My friend," Blackwell later recalled, "died of a painful disease, the delicate nature of which made the methods of treatment a constant suffering to her." A "lady doctor," Donaldson told her young visitor, would have spared her the embarrassment of having male physicians examine her. Indeed, Blackwell believed, had a female physician been available, Donaldson might have sought treatment in time to save her life. For the idealistic Blackwell, moved by her friend's plight, the idea of becoming a doctor "gradually assumed the aspect of a great moral struggle."

A great moral struggle was unavoidable, since in mid-nineteenth-century America, a "lady doctor" was a radical idea. Conventional opinion then held that, if a woman studied medicine, her morals would suffer from learning the details of anatomy and of the body's reproductive system. In 1850, the student body of Harvard Medical College famously barred Harriot K. Hunt of Boston from entering the school. "No woman of true delicacy," the students resolved, would want to study medicine.

The weight of convention may have cost Blackwell a chance at being happily married. "At this very time when the medical career was suggested to me," she confided in a private memorandum, "I was experiencing an unusually strong struggle between attraction towards a highly educated man with whom I had been very intimately thrown, and the distinct perception that his views were too narrow and rigid." Knowing that her friend would never accept her medical calling, she broke off the relationship. She never married.

Blackwell's first steps toward becoming a physician were her most difficult. The doctors she first asked for advice tut-tutted her. But in 1845, John Dickson, a retired doctor, gave her her first tutorials in medicine, in exchange for her teaching piano and music in his North Carolina school. The following year, Dickson's brother Samuel—also a medical doctor—kindly took her into his Charleston, South Carolina, home, gave her access to his well-stocked medical library, and tutored her in premedical studies. The next year, armed with knowledge gleaned from Sam Dickson's books and with her mentor's encouragement, Blackwell traveled to Philadelphia to talk to Dr. Joseph Pancoast about enrolling in Jefferson Medical College, where Pancoast was an influential professor of surgery. Pancoast "thoroughly approved" of women studying medicine, but he would only allow Blackwell to attend class disguised as a man—a deception she rejected as insulting.

Perhaps thanks to a letter of introduction from Sam Dickson—the records of Blackwell's life are inconsistent, and no serious full-scale biography exists—she studied medicine privately with another Philadelphia physician, Jonathan M. Allen, who gave her a first lesson in practical anatomy, dissecting a human wrist. It took her breath away. "The beauty of the tendons and the exquisite arrangements of this part of the body," she enthused, "struck my artistic sense." She was now even more firmly committed to becoming a doctor—indeed, a surgeon. "I must accomplish my end," she wrote a friend. "I would sooner die than give it up. I consider it the noblest and most useful path that I can tread, & if one country rejects me, I will go to another."

For a while, it seemed as if America would reject Blackwell: she applied to more than 20 U.S. medical schools during early 1847; none granted her admission. It was an anxious, disheartening time. In October 1847, though, a letter arrived from tiny Geneva Medical College in upstate New York that proved decisive for Blackwell and for American medicine. It simply stated that the college faculty had voted to admit her if the student body unanimously approved. A short time later, the students—playing along with what they thought a professorial joke—voted to let her in. Much to their surprise, a 26-year-old Blackwell, wearing a simple gray frock and bonnet, showed up in Geneva on November 6, 1847, to begin her medical education.

Though now officially enrolled, Blackwell still faced deep and widespread disapproval. "I afterwards found that I had so shocked Geneva propriety," she wrote, "that the theory was fully established either that I was a bad woman . . . or that being insane, an outbreak of insanity would soon be apparent." But the faculty, at least, soon became grateful for Blackwell's demure presence: when she attended a lecture the normally rowdy male students suddenly grew reserved and studious.

As part of her two-year degree program—medical instruction was far less rigorous in the mid-nineteenth century than it would be even 50 years later—Blackwell worked for a time at the Blockley Almshouse in Philadelphia, where she had to steel herself against her colleagues' rejection. Blockley's chief physician treated her well enough, but the young resident doctors huffily vacated the wards whenever she came in and refused to help her diagnose and treat the impoverished patients. In a way, the doctors' hostility worked to her advantage. "It meant I'd have to figure out what was wrong without the doctors' help," she later recalled. "It pushed me way ahead." As for the patients themselves, Blackwell wrote to a sister in the spring of 1848, "at first it was very trying for me—all eyes, & such queer eyes, were fixed on every movement." But with time, she discovered, the patients grew accustomed to "the quiet apparition," as she called herself, and began to tell her their ailments.

Back in Geneva from her fieldwork at Blockley, Blackwell worked so diligently, and with such keen intelligence, that in January 1849 she graduated first in her class. It was a historic moment: Blackwell's teachers, classmates, and even the suspicious Genevan townspeople realized that she had set a pioneering example for other women to follow. Local pride over her achievement swelled. The dean of Geneva Medical, Dr. Charles Lee, extolled her for "perseverance under difficulties and obstacles next to insurmountable." And the Geneva Gazette gave her a warm send-off: "Affable in her manner she pleases you; intelligent and witty, she amuses you; amiable and confiding she wins upon you. . . . ELIZABETH BLACKWELL, the world cannot thank thee too much. God speed thee in thy work of mercy."

Blackwell spent the next two years in Europe doing postgraduate studies, mostly at La Maternite, the great Parisian school for midwifery. But even in au courant Paris, Blackwell inflamed public opinion. Some women, in particular, found her odious. "I'm sure I could never touch her hand!" exclaimed a Parisian lady. "Only to think that those long fingers have been cutting up dead people." Ignoring the controversy, Blackwell learned much at La Maternite about obstetrics, but she also received a major blow that prevented her from becoming a surgeon. In late 1849, while she was syringing the eye of a baby suffering from purulent ophthalmia, a pus-discharging disease, infected water spurted into one of her own eyes, permanently blinding it. Six months later, she had the eye removed and replaced with a glass replica. But Blackwell didn't let this mishap deter her from a medical career, even if surgery was now out of the question. She left France for London in late 1850 and spent several months studying under the esteemed Sir James Paget at St. Bartholomew's Hospital.

Mid-nineteenth-century New York, though it boasted good private and public hospitals, sorely needed doctors, especially in its poorer neighborhoods. As the city's trade and industry expanded, so did the population—during the 1830s and 1840s, more than 250,000 opportunity-seeking foreign immigrants flooded into squalid ramshackle tenements in lower Manhattan. With so many people crowded together in unsanitary conditions, disease flourished. Epidemics of cholera, tuberculosis, and typhoid swept through the city; an army of prostitutes made syphilis a menace. Seeing the need for better public health, Blackwell moved to New York in 1851, renting a floor at 44 University Place as her home and office. Despite her landlady's objections, she proudly hung up her shingle—ELIZABETH BLACKWELL, M.D.—and waited for patients.

They didn't come. Gotham wasn't yet ready for a woman doctor. Passersby insulted Blackwell as she walked through the streets. Trying to stay financially solvent—her eye operation had left her impoverished—she asked for work as an assistant physician at a dispensary but had the door shut in her face. No hospital ward would let her visit to observe patients. Deeply discouraged, she wrote to her sister Emily, who also wanted to become a doctor, that "a blank wall of social and professional antagonism faces the woman physician that forms a situation of singular and painful loneliness, leaving her without support, respect, or professional counsel."

Adding to her troubles was the great success in New York of Madame Restell, a vendor of powders for "married ladies whose health forbids a too rapid increase of family." Restell—an abortionist—falsely advertised herself as a "female physician and professor of midwifery." To see the untrained and unethical Restell prospering while she, a legitimate medical doctor, lived hand-to-mouth, was galling. (Arrested on morals charges, Restell later committed suicide by slashing her throat.)

Despite insults and penury, Blackwell persisted. At last a few patients, most of them female—and most of them Quakers, traditionally a tolerant group—began to seek her services regularly at 44 University Place.

In 1852, a year after her arrival in New York, Blackwell gave a lecture course on "the laws of life" to middle-class New York women. The course marked an important turn in her fortunes. Stressing the importance for expectant mothers of "regular habits, early hours, periodic exercise, cold bathing, plain wholesome food, and loose comfortable clothing," her talks presaged a central theme in her future practice and teaching—the key role that good hygiene plays in preventive medicine, a truth that not even all of Blackwell's well-educated listeners would have grasped in 1852. At about the same time Blackwell was establishing herself in New York, the famed Viennese physician Semmelweis became the first doctor to insist that his attendants scrub their hands before operations.

The lectures were a big success. Blackwell had touched something in her audience; her message, spreading by word of mouth, even began to reach women who hadn't attended the talks. The talks sparked so much interest that they later came out in book form. An admiring Charles Lee, her former dean, praised her: "You have done yourself and your alma mater a very great honor, and rendered a most important service to your sex."

Her practice picking up, Blackwell set out to bring medical service and better hygiene to the immigrant poor of lower Manhattan. She had long believed in the possibility of human progress—perhaps it was reading Fourier as a teenager or the lasting influence of her father—but here was a group of people truly needing help. An agent of the American Female Guardian Society described a typical New York slum tenement of the time: "Drunken men, debased women, young girls, helpless children, all packed together in a filthy, under-ground room—reeking of filth, and surrounded with a poisoned atmosphere." Hygiene was all but unknown. Garbage piled up in hallways and streets, and families slept on flea-infested sacks. Slaughter pens of swine bordered poorly ventilated housing. Medical care was nonexistent. Only 60 percent of infants survived their first year.

In 1853, with the help of a Quaker benefactor, Blackwell set up a one-room free dispensary on East 7th Street near today's Tompkins Square. At first opened only three days a week—Blackwell continued to treat her paying patients privately during the rest of the week—the facility served the 53,000 destitute residents of the Eleventh Ward, most of them recent Irish and German immigrants. Distressed but undeterred by the heartrending conditions, Blackwell offered her medical expertise and spread a gospel of personal cleanliness. She went into slum dwellings to treat sick patients too weak to come to the dispensary. Her work in the Eleventh Ward won her growing respect from her peers and love from her needy patients, some of whom affectionately called her the "doctress"—though she much preferred "doctor."

The modest Tompkins Square dispensary soon was far too small to handle the burgeoning number of poor patients. Nor was the next address the dispensary temporarily moved to, at 150 East 3rd Street, big enough. It was time, Blackwell reasoned, to set about establishing a hospital; and on January 20, 1854, she filed a certificate of incorporation for the "New York Dispensary for Poor Women and Children." It listed three goals: providing medical aid to the poor, particularly women and children; training nurses to serve the community; and "to secure the services of well-qualified female practitioners of medicine."

Hustling to make the hospital a reality, Blackwell proved an adept organizer and fund-raiser. She asked several influential New Yorkers to serve as trustees or medical consultants; all agreed, not only because they approved of her mission, but also because they admired her sterling character. Among the trustees were philanthropist Charles Butler; businessman Cyrus W. Field (famed for laying the Atlantic Cable); and Horace Greeley of the New York Tribune, an early supporter. A group of leading New York doctors—including the inventor of the binaural stethoscope, George Camman, and the founder of Bellevue Hospital Medical College, Isaac Taylor—joined as medical consultants, lending further prestige to the project.

By the fall of 1856, Blackwell and her supporters had raised sufficient funds to purchase the former home of a branch of the Roosevelt family, at 64 Bleecker Street, to house the new hospital. Blackwell's Quaker friends donated linens and ward beds; an appeal in the New York Times scared up some donated furniture; William Lloyd Garrison, the prominent anti-slavery advocate, drummed up support in his influential journal, The Liberator. As the new dispensary took shape, it had an improvised air—after all, the Roosevelt house wasn't designed for such a purpose. Two ground-floor parlors and the second floor became wards; a maternity area and an operating room occupied the third floor; the attic housed students and servants. But it was big enough to handle additional patients.

Blackwell's New York Infirmary for Indigent Women and Children, as she re-christened it, opened on May 12, 1857, the 37th birthday of another famous healer—Florence Nightingale, whom Blackwell had befriended during her student days at St. Bartholomew's Hospital. Two other "lady doctors" who had followed Blackwell's lead in studying medicine joined her to help run the Infirmary: her sister Emily and Marie Elizabeth Zakrzewska, both recent graduates of Western Reserve Medical School in Cleveland, which had started to admit a few female students. In welcoming the large turnout of well-wishers for the opening, though, Blackwell was cautious. "The full, thorough education of women in medicine is a new idea," she observed, "and, like other truths, requires time to prove its value. Women must show to medical men, even more than to the public, their capacity to act as physicians." To prove their capacity, Blackwell and her two colleagues went zealously to work, at times living frugally on bread, oranges, and dates. "We sleep in the garret and dine in the cellar, when we dine at all," said Blackwell, wryly.

The Infirmary was open seven days a week. Elizabeth Blackwell served as director, Emily as surgeon—doing what her sister, because of her eye injury, could never do. When necessary, the three tireless doctors made house calls. Women and children too poor to pay for medical services received them for free; those who could afford it paid $4 a week. During its first seven months, the bustling Infirmary served 645 medical, 227 gynecological, 36 surgical, and 18 obstetrical patients. During the 139 years of its existence, in which it would relocate twice to bigger buildings—finally closing in a 1996 merger with New York University Medical Center—the Infirmary treated more than 1 million patients, many of them poor immigrants.

The Infirmary's innovations went beyond women doctors to include new ways of making the public healthier. With Blackwell's emphasis on good hygiene as critical to prevent disease, the Infirmary bathed ailing patients and encouraged them to keep clean. Blackwell also inaugurated a "Sanitary Visitor" program to visit filthy slums and improve hygiene—the first Sanitary Visitor, Rebecca Cole, was also the first black woman M.D.—and the program later expanded into the Infirmary's "Out Practice Department," a precursor of the Visiting Nurse Service.

As with any novel venture, of course, the Infirmary faced its share of problems in the early years—and most people retained suspicion of female doctors. In one scary incident, relatives of a patient who died of puerperal fever, joined by an armed mob, surrounded the Infirmary, blaming it for her death. Only the fortunate intervention of a beefy Irish ditchdigger and a local watchman, who together dispersed the angry crowd, staved off disaster. When another patient died of a ruptured appendix, a mob again gathered, throwing rocks at the Infirmary, terrifying patients, and screaming that women cranks were running the show. To mollify the crowd, a colleague of Blackwell's from Bellevue Hospital invited in two of the demonstrators to watch him perform an autopsy that proved that the case was already hopeless when the patient first arrived, as the witnesses repeated to other demonstrators, still waiting outside the door. In time, however, the Infirmary gained the public's trust.

Blackwell aimed to use the Infirmary not only to treat needy patients but also to train women doctors and nurses, so that other women could follow in her path more easily. The Infirmary launched a nurses' training program in 1860, that year's annual report noting, "All respectable women who have applied to the Infirmary have been admitted in turn for three months in the wards. . . . The instruction is given free and board and washing is also provided." Unfortunately, some of the aspiring nurses disappointed Blackwell. "While a fair sprinkling . . . were women of character and intelligence," she confided to her diary, "a large part of the classes of these early schools were made up of . . . eccentrics of all sorts." When the Civil War broke out in 1861, Blackwell organized the Ladies' Sanitary Aid Association to enlist and train volunteer women to serve as battlefield nurses for the Union. In 1872, with the quality of her applicants much improved, Blackwell officially named her nursing program the Infirmary Training School for Nurses.

In 1859, after a brief tour in England to campaign for the medical education of women, Blackwell raised $50,000—a significant sum at the time—toward starting an Infirmary medical school. The next year, the Infirmary began to train a few young women as assistant physicians. Since established hospitals wouldn't allow female doctors onto the wards, the Infirmary was almost the only place that female physicians in training could get any practical experience. As a frustrated Blackwell observed, "Consider how women stand in this matter; how alone; how unsupported; no libraries, museums, hospitals, professorships, prizes to stimulate and reward study; . . . all of these things men have, none of these are open to women."

The Women's Medical College of the New York Infirmary officially opened at 126 Second Avenue in November 1868. The school became the first four-year medical program in the nation. A model of educational rigor, it quickly rose to the front rank of America's medical institutions, graduating many distinguished doctors and professors of medicine. Following its lead, other medical schools for women began to open, and eventually prominent medical schools, including those of Cornell and Harvard, started to admit women, too. The Medical School closed in 1899, its mission of educating women doctors no longer unique. Today, thanks significantly to Blackwell's bravery and vision, nearly half of all medical students are women.

In 1869, leaving the Infirmary in her sister Emily's capable hands, Blackwell sailed for England, noting that "the early pioneer work in America was ended." She would spend the next 41 years, before her death in 1910, in England, serving on the executive council at the London School of Medicine for Women and lecturing on midwifery at the school, becoming an ardent anti-vivisectionist, writing numerous books, and embracing some disreputable ideas, including eugenics. The woman who couldn't find a single patient less than two decades earlier was now famous.

It had taken a kind of heroism to complete the journey. When Elizabeth Blackwell first clutched her cherished diploma from Geneva Medical College in January 1849, she told the college president, "It shall be the effort of my life, by God's blessing, to shed honor on this diploma." Honor it she did, benefiting her sex, her city, and the thousands of poor New Yorkers whose lives she touched and improved.

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