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Dr. Steven Friedman on Dr. Elizabeth Blackwell
Elizabeth Blackwell and the 150th Anniversary of the New York Infirmary for Indigent Women and Children
Formative Years
Elizabeth Blackwell was the first female physician in the United States (Figure 1). The profound effect she had upon the practice of medicine in the United States is memorialized by the vast number of female physicians practicing today.
Blackwell was born in Bristol, England, in 1821, to puritanical Sunday school teachers. Her father, Samuel, was also a sugar refiner. Elizabeth had two older sisters, Anna and Marian; two younger brothers, Samuel and Charles; and two younger sisters, Emily and Ellen. When Elizabeth was seven, her father’s refinery burned down and her Uncle James incurred enormous business debts for the family through a series of irrational decisions. These near simultaneous financial reversals led to Samuel’s decision to emigrate to the United States, in 1832.1
Elizabeth was seasick for most of the eight-week journey aboard the Cosmo. The New York that greeted the Blackwells had a population of 220,000 and was a rural island beyond 14th street. The Blackwells initially rented a house in Manhattan, then moved to Flushing in 1835. Most of their social life centered around abolitionist activities which was ironic given the heavy reliance upon slavery of Samuel’s profession. Nevertheless, the Blackwell family attended many anti-slavery meetings, and it was through these that Elizabeth met luminaries such as William Lloyd Garrison who had a deep impact upon her.
In 1836, the Blackwells moved to Jersey City, where Elizabeth continued to be an excellent student and an avid reader. Although uncertain about her future, her confidence was manifested by this diary entry:
“How I do long for some end to act for, some end to be obtained in this life, for God has given us talents to be used in earthly pursuits, and to go on everyday in just the same jogtrot manner without any object is very wearisome.”2
While in Jersey City, Samuel Blackwell’s business affairs brought his family to the brink of poverty again, so in 1838 they moved to Cincinnati in search of new prospects. At that time Cincinnati had a population of 35,000 and was considered the “Queen City of the West.” It was also a key stop on the Underground Railroad since Kentucky, a slave state, was just across the Ohio River. Within a few months of their arrival in Cincinnati, Samuel Blackwell died, most likely from recurrent malaria originally contracted on Long Island. He left his family penniless and Elizabeth had to assume the first of several loathsome teaching positions in order to help the family survive, making her a deeply homesick and frustrated teenager:
“Lovely, lovely England, when shall I see you again? The more I think of it, the more I detest the idea of settling down in America.2
The arrival of William Henry Channing to Cincinnati, in 1839, brought Elizabeth some respite from the provincialism of the city. Channing came from a prominent Boston Unitarian family and his uncle, William Ellery Channing, was the pre-eminent Unitarian theologian of the early nineteenth century. William Henry was an early supporter of Socialism and women’s rights, and he was a prolific writer. Channing was also a Transcendentalist, believing that the path to spiritual truth lay in trusting the knowledge gained intuitively from nature rather than from centuries of ecclesiastical authority. Channing corresponded with Ralph Waldo Emerson who most likely inspired his Symphony:
“To live content with small means; to seek elegance rather than luxury, and refinement rather than fashion; to be worthy, not respectable, and wealthy, not, rich; to listen to stars and birds, babes and sages, with open heart; to study hard; to think quietly, act frankly, talk gently, await occasions, hurry never; in a word, to let the spiritual, unbidden and unconscious, grow up through the common - this is my symphony.”3
Channing had a profound affect upon Elizabeth and her sisters, leading to their conversion to the Transcendentalist/Unitarian faith. Channing was also one of the few men considered by Elizabeth to be her intellectual equal. To her regret, he left Cincinnati after two years.
Epiphany
Elizabeth was also influenced by Margaret Fuller, a coeditor of “The Dial” with Ralph Waldo Emerson, and a luminary in the budding women’s rights movement. Fuller’s writings gave Elizabeth confidence in her own views that women deserved greater opportunities and that men’s attitudes should be changed by persuasion rather than militancy. In 1845, Fuller published Woman in the Nineteenth Century, an early attempt to articulate an expanded role for women in society.4
While contemplating these possibilities, a friend of Elizabeth’s mother was diagnosed with uterine cancer. The friend complained to Elizabeth that being examined by crude, inept male physicians was as bad as having cancer. She further confided to Elizabeth that had a woman doctor been available, her final weeks would have been eased considerably. The woman then asked Elizabeth why she didn’t become a doctor.5
Elizabeth initially recoiled from this question because she found the human body repellant. Try as she did, however, the idea was unshakeable. Becoming a physician would allow her to support herself as well as provide a distraction from, “…the disturbing influence of the other sex.”2 The Transcendentalists had always encouraged women to think boldly and so Elizabeth began to seriously consider becoming a physician. She was attracted more by the opportunity to improve society than by any desire to heal the sick. Being rebellious by nature, the outrageousness of the notion also had great appeal. Besides, there were untold numbers of women in need of care and advice who were too modest to see a man. To her diary she confided:
“I felt that I was severing the usual ties of life, and preparing to act against my stronger inclinations. But a force stronger than myself then and afterwards seemed to lead me on; a purpose was before me which I must inevitably seek to accomplish.”2
In another entry, Elizabeth confessed:
“Winning a doctor’s degree gradually assumed the aspect of a great moral struggle, and the moral fight possessed immense attraction for me.”2
The Struggle
Everyone Elizabeth initially consulted attempted to discourage her from becoming a physician. Women were excluded from all forms of higher education and the thought of a woman dissecting a human body besides men was unthinkable. Elizabeth briefly considered studying in Paris, but abandoned the plan. Recognizing that she would need money for her medical studies, Elizabeth accepted a job as a music teacher in Asheville, North Carolina, in 1845. She worked for Reverend John Dickson who was a retired physician and she hoped to become his quasi-apprentice. Dr. Dickson encouraged Elizabeth and gave her access to his entire medical library. When his school closed, Elizabeth taught music for a relative of Dr. Dickson’s younger brother, Samuel, in Charleston. Samuel also encouraged Elizabeth and gave her access to an even greater medical library. 6
In May 1847, Elizabeth moved to Philadelphia where she was befriended by Dr. Joseph Warrington, a prominent Quaker physician. Although he was not sanguine about her goal, he did write a letter of recommendation for her to the Geneva Medical College in upstate New York (Figure 2). Elizabeth applied to Philadelphia’s four medical schools and was rejected by each of them. Elizabeth was also rejected by all of the New York schools to which she applied, so Warrington advised her to apply to many smaller colleges, like Geneva. It soon became apparent to Elizabeth that in addition to believing that women were intellectually incapable of studying medicine, men also had a healthy fear of competition from them. As one doctor said to Elizabeth, “You cannot expect us to furnish you with a stick to break our heads with.”2
Elizabeth could not have known how much weight Warrington’s letter to Geneva Medical College carried. He was a distinguished physician and the Geneva faculty did not wish to offend him. The Geneva administrators decided to allow the students to vote upon Elizabeth’s application, confident that it would be rejected. Even one “nay” vote, the students were told, would be sufficient to turn Blackwell away. In this way, good relations with Warrington could be preserved. Many of the students believed the vote was a practical joke and as one of them later recounted, the plan went seriously awry:
“For a minute or two after the departure of the Dean, there was a pause, then the ludicrousness of the situation seemed to seize the entire class, and a perfect babble of talk, laughter, and catcalls followed. Congratulations upon the new source of excitement were everywhere heard, and a demand was made for a class meeting to take action on the Faculty’s communication.
A meeting was accordingly called for the evening, and a more uproarious scene can scarcely be imagined. Fulsome speeches were made in favor of admitting women to all the rights and privileges of the profession, which were cheered to the echo. At length the question was put to vote, and the whole class arose and voted ‘Aye’ with waving of hankerchiefs, throwing up hats, and all manner of vocal demonstrations.
When the tumult had subsided, the chairman called for the negative votes, in a perfectly perfunctory way, when a faint ‘nay’ was heard in a remote corner of the room. At the instant, the class arose as one man and rushed to the corner from which the voice proceeded. Amid screams of ‘cuff him,’ ‘crack his skull,’ ‘throw him down the stairs,’ a young man was dragged to the platform screaming ‘Aye, aye! I vote aye.’ A unanimous vote in favor of the woman student had thus been obtained by the class, and the Faculty was notified of the result.”6
Elizabeth received a formal acceptance letter from Dr. Charles Lee, Dean of the Geneva faculty, dated October 20, 1847. She would also always treasure a welcome letter penned the same day from the Geneva students.
Elizabeth’s time in Geneva was surprisingly uneventful. Despite some rough going in her anatomy class, her single-mindedness and disdain of jokes or inappropriate behavior quickly won her the respect of her classmates and teachers. Elizabeth was also older than most of the other medical students and many of them looked up to her. Elizabeth wrote a thesis on typhus while at Geneva, and graduated at the top of her class on January 23, 1849. Upon receipt of her diploma from President Hale, Elizabeth said, “I thank you, Sir. It shall be the effort of my life, by God’s blessing, to shed honor on this diploma.”2
Postgraduation
Following her graduation, Blackwell decided to pursue further study abroad. After becoming a United States citizen, she left for England in April 1849. After one month in England, Blackwell went to Paris. Only 15 months earlier, the French revolution had led to the Second Republic. Unable to attend public lectures or obtain private medical instruction, Blackwell entered training at the midwifery school at La Maternité in Paris. While there she suffered a gonococcal eye infection when some of the irrigant she was using on a baby with ophthalmia neonatorum rebounded into her own. Despite application of leeches, all manner of compresses to the head, purgatives and hydropathy, Blackwell underwent enucleation on August 15, 1850. Her goal to become the first female surgeon was dashed.
Blackwell returned to England in October 1850 and worked at St. Bartholomew's Hospital with Dr. James Paget. Paget was impressed by Blackwell’s determination and remarked that her motives for pursuit of such a strange profession appeared pure and good.6
Medical Practice
Blackwell returned to New York in August 1851 to a vastly different city than the one she had emigrated to as a child; the population was now 500,000. Despite the assistance of Horace Greeley in the form of advertisements and accolades in his Tribune, Blackwell was refused employment in city clinics and remained patientless. She was even refused lodging and office space by landlords when they learned she wished to practice medicine. To drum up business, she began lecturing and writing about the education of girls. In 1852 she published The Laws of Life With Special Reference to the Physical Education of Girls.7 In February 1853, Blackwell was joined by her younger sister, Emily, who was attending Rush Medical College (Figure 3). The sisters realized that the only way they could launch a practice would be to create their own dispensary. In March 1854 they opened The New York Dispensary for Poor Women and Children. It was located on East Seventh Street near Tompkins Square and was intended for competent female physicians to minister to the poor, receive additional training, and to train nurses. The dispensary closed before the end of the year due to financial problems, but not before Elizabeth had earned $615 and decided to reopen it on a larger scale.
The New York Infirmary for Indigent Women and Children
Elizabeth’s plan was to create a fully equipped hospital for women and children, staffed by women. In this way she could also deliver quality medical education and clinical training to women. Because her dispensary had already been granted a New York State charter, all she needed to realize this dream was money. With the help of Marie Zakrzewska (Figure 4), Emily, and the Quaker community, enough money was raised to purchase a house on Bleeker Street in March 1857.8 In less than two months it was transformed into a small hospital. The New York Infirmary for Indigent Women and Children opened its doors on May 12, 1857. Henry Ward Beecher, William Elder and Reverend Dudley Tyng were among the speakers at the opening ceremony. Elizabeth also spoke:
“The full thorough education of women in medicine is a new idea and like all 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; their earnestness as students of medicine before the existing institutions with their great advantages of practice and complete organization will be opened to them. They must prove their medical ability before expecting professional recognition.”2
The Infirmary was an instant success. Indigent women and children were given free care. Those with means were charged $4 a week. In its first eight months the Infirmary treated 866 outpatients, 48 inpatients, and 12 house calls were made. The next year these numbers doubled. Students from women’s medical schools in Boston and Philadelphia worked at the Infirmary between semesters and less skilled women trained as nurses. Two new concepts were important features of the Infirmary: an outpatient department that provided care after discharge and maintenance of medical records. On November 2, 1868, The Women’s Medical College of the New York Infirmary was officially opened and Elizabeth had realized another dream. Elizabeth’s medical school required applicants to pass an entrance examination, and offered longer training periods and more extensive clinical experience than most men’s medical schools, which consisted of two 16-week semesters. The Women’s Medical College produced highly qualified female physicians until 1899, when its student body was subsumed by the Cornell Medical College in recognition of the equal rights of women to receive a medical education. The New York Infirmary eventually became The New York Downtown Hospital. Today New York Downtown Hospital is the only hospital in lower Manhattan.
Final Years
Elizabeth Blackwell returned to England permanently in July 1869. She left direction of the medical college to Emily and Marie Zakrzewska. In England Elizabeth championed a woman’s right to become a physician with the same enthusiasm she had manifested in the United States. In a similar manner she was eventually successful. In 1874 the London School of Medicine for Women was opened. Elizabeth continued to travel and lecture on subjects dear to her such as medical ethics and antivivisection.9 In 1895 she published her autobiography, Pioneer Work in Opening the MedicalProfession to Women.2 In 1906 she returned to the United States for a brief visit, at the age of 85. On May 25, 1910, Elizabeth Blackwell suffered an incapacitating stroke. She died six days later.
Elizabeth Blackwell not only paved the way for women in medicine, but she significantly elevated practice standards for all physicians. Years before her death she remarked,
“I think we are really happy in this medical movement. We must have acted in the right time, for how seldom it is, that those who are privileged to initiate an important reform see such wonderful results from the effort during their lifetime.”2
Appendix
In 1979 The New York Infirmary merged with the Beekman Downtown Hospital. In 1991, The New York Infirmary - Beekman Downtown Hospital was renamed The New York Downtown Hospital. Today New York Downtown Hospital is the only hospital in lower Manhattan. Its importance to New York City was vividly demonstrated on September 11, 2001, when it treated more than 1,500 patients, including 269 rescue workers, despite the loss of electricity, steam, gas, phones, water pressure and computer services.
References
1. Hays, ER. Those Extraordinary Blackwells. New York: Harcourt, Brace, & World, Inc., 1967.
2. Blackwell, E. Pioneer Work In Opening the Medical Profession to Women. London : Longmans, Green, and Co., 1895.
3. Frothingham, OB. Memoir of William Henry Channing. Whitefish : Kessinger Publishing Company, 2006.
4. Fuller, M. Woman in the Nineteenth Century. New York: Dover Publications, 1999.
5. Baker, R. The First Woman Doctor. New York: Julian Messner, 1944.
6. Boyd, J. The Life of the First Woman Physician; The Excellent Doctor Blackwell. Sparkford : Sutton Publishing, Ltd., 2005.
7. Blackwell, E. Laws of Life, with Special Reference to the Physical Education of Girls. Abingdon : Taylor & Francis, Inc., 1986.
8. Zakrzewska, ME. A Practical Illustration of Woman’s Right to Labor. Boston : Walker, Wise & Co., 1860.
9. Blackwell, E. Essays in Medical Sociology. London : Longmans, Green, and Co., 1899.
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