Elizabeth Blackwell had no statistics to show her how much woman doctors were needed, nor had she herself ever needed one, but gradually she became aware that she had accidentally uncovered an enormous area for improvement. Her sense of mission grew the more she learned. She was not “called” to medicine but called to applying her energy where it seemed to be needed. The precise nature of that need was irrelevant. “The idea of winning a doctor’s degree,” she wrote, “gradually assumed the aspect of a great moral struggle, and the moral fight possessed immense attraction for me.” Medicine itself possessed none at all. Nor, at first, did any feminist considerations enter her head. The idea of being the first woman doctor was not something that attracted her in itself, not until the barriers blocking her progress were encountered. If being a woman was an essential part of her mission, because it was her femaleness which was going to help other women, then she was glad she was a woman but in no sense, in those crucial early days, did she see herself as a champion of a woman’s right to be a doctor. She saw women doctors as filling a gap. The fact that it was a deliberately manufactured gap does not seem to have occurred to her. She seems, naïvely, to have imagined that nobody had noticed before what a good thing it would be if there were women doctors and that if they had they would have gone ahead and become them.
The true nature of her mission was slow to reveal itself and meanwhile her own resolution was by no means unwavering. When all this was happening, in 1845, she was for what seems to be the first time “experiencing an unusually strong struggle” against her attraction for an unnamed gentleman. It quite frightened her to be so attracted, especially when, in this case, no commonness of mind disqualified her suitor as it had the unfortunate Mr Smith. On the contrary, this mysterious man was “highly educated” and satisfied all her requirements. But finally, she rejected him. She wrote in her diary that her mind was “fully made up . . . I have not the slightest hesitation now.”27 She did up her beau’s last bunch of flowers in a packet and labelled it “Young Love’s Last Dream” and put it in a drawer. Romance was over. She had definitely decided on a medical career and intended to marry her work. She found, to her chagrin, that medicine was an unwilling bridegroom. There began a long, depressing period of writing for advice as to how to set about studying medicine. Nobody could suggest anywhere she might be accepted, except possibly in Paris. She also discovered the cost of studying medicine should she find anywhere to do it. She was informed that three thousand dollars was a realistic figure and she saw that she would have to get yet another teaching job in order to accumulate that kind of money. It seemed to her sensible to start earning this money while at the same time continuing to explore the studying possibilities, so she took a job teaching music at an academy in North Carolina. Her brothers Sam and Howard drove her there in a horse and wagon in June 1845.
The head of the academy, with whom Elizabeth boarded, had been a doctor himself. John Dickson allowed her to use his medical books to begin preparing herself for her chosen career and guided her through various useful periodicals. She was amused to discover during her stay in the Dickson household that she could mesmerize away headaches and wrote home jokingly that she was already called Dr Blackwell. She was not, however, nearly so good at an essential part of medical study, the dissecting of insects and animals. This she was most reluctant to do but forced herself to practise, using diagrams in Dr Dickson’s books spread out before her. Meanwhile, she was doing all she could to secure her entry into some formal medical training. Anna, now in New York, scouted around for her and said she had found a practising doctor who was willing to take Elizabeth as a student but this was not what she was after. She was as well-off where she was if all she could obtain was another kind of home-study. It was her intention to stay with the Dicksons until she could get onto a recognized course somewhere but unfortunately, at the end of 1845, John Dickson closed his school and she was obliged to move. The next year was spent in another teaching job, in more private study, in more endless enquiries. It could, Elizabeth felt, go on forever. Suddenly, she had had enough. Against all advice, and without any prospects, she left her job and went to Philadelphia.
Philadelphia had some of the best medical colleges in the country and Elizabeth had decided that she ought to go personally to the leading Professors there and plead her case. She had had a letter, in reply to many of the sort she had written, from a Dr Warrington of the Philadelphia Medical School who had cautiously said that, although he thought women more suited to be nurses, she was welcome to call on him if she ever came to Philadelphia. This she now did. He suggested that her best hope was to disguise herself as a man and go to Paris. This idea Elizabeth rejected furiously – Paris, perhaps, but disguise emphatically no. The embarrassed Dr Warrington said that in that case he did not know what to advise. There was no point in applying to his college, although Elizabeth was welcome to visit his patients with him and use his library, because the authorities would reject her application outright. Elizabeth decided to go ahead all the same and while she waited for the verdict she took anatomy lessons privately. These quite changed her mind about dissecting. Her first lesson was on the wrist and “the beauty of the tendons and exquisite arrangements of this part of the body struck my artistic sense.”28 She now passionately wanted to have all the secrets of the human body and its organs revealed to her. It was a great relief to find her sense of mission re-inforced by some genuine enthusiasm.
But the outlook remained bleak. All the colleges she wrote to refused her, as had been predicted, with varying expressions of regret. None of them was very clear about why being a woman barred her from study but she had by this time divined the reason: she was a threat, part of all the new fangled “cures” and quack methods flooding the medical world at the time. The admission of women into medicine was simply seen as another crazy idea. Faced with this situation Elizabeth showed some degree of cunning. Looking at her letters of rejection she noted the carefulness with which these eminent institutions had turned her down and it struck her that she could turn their words, however hypocritically meant, to her advantage. The next batch of applications she sent out in October 1847 was to twelve country medical schools. In each letter she cleverly included the names of those who had turned her down, together with their excuses, and without needing to falsify anything made it sound as though these same influential gentlemen would be pleased if someone else did accept her. Her letter to Castleton Medical College read:
“Will you allow me to make an application . . . to the Faculty of the Castleton Medical College for permission to attend the lectures of the institution?
“. . . Dr Jackson of the University of Philadelphia and Dr Mitchell of Jefferson Medical College expressed regret that the size and character of their classes would prevent my becoming a member of them but declared their hearty approval of my endeavour and both advised me to seek aid from your institution.
“I desire earnestly to obtain the education I need in America . . .”29
This letter, sent on October 20th, was answered on November 15th. It accepted Elizabeth Blackwell as the first female medical student ever admitted to a formal medical institution. But it came too late. Before it came, Elizabeth had been accepted elsewhere and had already left for Geneva Medical College in the state of New York where the term had already begun two weeks before.
Her admission was a fluke. The dean and faculty of the college, not wishing to offend either Elizabeth, who was as qualified technically as any man, or the doctors she quoted in her support, had put the matter to a student vote with the understanding that even one vote against admission would see it turned down. But the students, in a boisterous mood, all voted in favour. On November 6th, 1847, at eleven o’clock in the evening, an extremely excited and nervous Miss Elizabeth Blackwell arrived in Geneva to begin the studies she had decided on three years before. She did not know what to expect but she hardly cared – the first momentous step had now been taken. In fact, Geneva was luckier to get her than
she was to get Geneva. As a medical college it was of doubtful reputation. It was barely ten-years-old, under-equipped, under-staffed and it did not draw its students (150 of them) from a very select band. None of this was at first apparent to Elizabeth who was much more bothered about finding somewhere to live. No landlady wished to take her in. When one kindly soul was prevailed upon she agreed only on condition she was not held responsible for the behaviour of her other lodgers whom she knew would be scandalized. Nor were Elizabeth’s fellow-students any more welcoming. The joke being over, they were rude and sarcastic, but once Elizabeth appeared in their midst the transformation began almost at once. Half of them fell in love with her and the other half were either intimidated by her seriousness or alarmed by her competence. It was absolutely clear, right from the beginning, that no. 130, the first lady student, was in this particular class going to lead the field.
At the end of the first term Elizabeth passed her exams with ease. The work was no problem. What was a problem was loneliness. Even when her fellow-boarders, the students and the townspeople had all grown used to her she was lonely. It was the beginning of an experience which, as the years went on, she recognized as the price of her success. Women like her, who entered spheres where there were no other women, suffered a peculiar kind of deprivation hard to appreciate. What they wanted were friends, people with whom they could discuss absolutely everything, people with whom they could relax and be at ease. They did not find them. Elizabeth found she had colleagues but not real friends. Men were either suspicious and therefore at the best stiff and at the worst hostile in their attitude towards her, or else frankly admiring and amorous. It depressed her to discover how isolated she was, even though she was encouraged by her progress. Her professor of anatomy, Dr Webster (whom she described as “a fat little fairy”) left her in no doubt that she had a great future. He was wholeheartedly delighted at her arrival and went out of his way to be helpful and encourage her. He also tested her. Soon after she arrived he sent for her to his consulting rooms where he was examining a poor woman of the town. He asked Elizabeth to examine her. Whatever it was Elizabeth saw appalled her. “My delicacy was certainly shocked . . . t’was a horrible exposure”30 she wrote in her diary. But Dr Webster had no need to make his point: this was why she was becoming a doctor.
She had the same reminder in her first vacation, in 1848, when she went to work in the Blockley Almshouse in Philadelphia. There, she worked in the Women’s Syphilitic Ward, a truly horrible place. Writing many years later she confessed that at the time she had absolutely no idea how these women got to be in the state they were in. She knew nothing of their world nor of the sort of women they were. All she knew was that they suffered terribly and that these sufferings were somehow connected with being women and that therefore they were of particular concern to her. She saw that they were treated with indifference. Attention was paid to their disease and that was all. There was none of the caring she had expected to find – caring was a luxury for which no doctor had time. The brutality and roughness with which the women were examined made her think that there must exist a feminine sympathy which would make women even more valuable as doctors than she had suspected. She began to have a vision of what women doctors could do which far transcended anything she had thought of before. Women doctors would care, they would know the value of kind words and gentleness, would realize that fear as well as disease must be treated, they would appreciate a patient’s hunger for touch and sympathy. She tried to put into operation her beliefs but this roused the open enmity of her Blockley colleagues. Not only did they not help her but they now tried to obstruct her, resorting to mean little tricks of sabotage and petty destruction. “I must work by myself all life long,”31 she wrote sadly. She wondered if the fault lay in herself. Was she failing to communicate properly? “I would I were not so exclusively a doer,” she wrote. “Speech seems essential . . . but mine is at present a very stammering, childish utterance.”32 No one, in any case, listened to her. A new bitterness crept into her diary and letters and with it a dangerous notion gained ground. She began to believe that what was needed was female solidarity. She, who hated anything “anti-man”, was nevertheless beginning to entertain the idea that women were better than men, that gender did have something to do with this superiority.
In January 1849 Elizabeth graduated from Geneva medical school, the acknowledged leader of the class. The Geneva Gazette reported “She is good-looking – a face that wins favourably on you; affable in her manner she pleases you; intelligent and witty she amuses you; amiable and confiding she wins upon you.” Much has been made of her refusal to walk through the town in a procession with the other students but this had more to do with distaste at the nature of the procession, which was led by “a well-instructed brass band composed entirely of native Indians”, than any desire to be ladylike. In any case, she was more interested in the fate of the thesis on Ship Fever which she had written in Blockley and which was published at the time of her graduation in the Buffalo Medical Journal. The pleasure its favourable reception gave her far outweighed applause from any crowd. But, in spite of this success and in spite of the solid qualification she had gained, Elizabeth appreciated only too well that she had yet another beginning to make. The problem now was to gain hospital experience, to become a practically qualified doctor as well as a theoretically qualified one.
Immediately after graduation she returned to Philadelphia. The same charade was gone through again with the same result: no entry into the hospitals. But she had been prepared for this and did not in fact let it worry her because she had already decided that Paris was her destination. Everyone told her Paris was the medical centre of the world so there she would go and somehow obtain experience. After that, no American institution would dare keep her out. Besides, she wished very much to travel a little after her gruelling course of study. She said goodbye to her family, wrote to Anna, who was in Europe already, that she was coming and then set sail in April 1849, shortly after receiving her American naturalization papers. She docked in Liverpool, then went on to London where to her amazement and delight she was warmly received. The medical profession showered her with invitations and although not used to socializing she found she greatly enjoyed being fêted (and developed a taste for iced champagne which she pronounced “really good”). But in Paris, where she arrived at the end of May, her reception was rather different. There were no dinners or other invitations and she was lucky to have her sister Anna with whom to share a flat. Her French was poor, she had little money and her introductions to medical people were few. Her fame had not preceded her and she had instead some difficulty establishing her identity. Nobody seemed the slightest bit impressed by her degree. She was rapidly forced to face the fact that a degree, said to be vital before it was won, suddenly became, in the case of women, of no importance once it was. The question changed to one of experience and it looked as though the chance to gain that was not to be given to her.
But Elizabeth had come a long way and had no intention of returning empty-handed. Luckily, she had learned to be thick-skinned and to persevere. To all suggestions that she should just be content and perhaps start a women’s medical career she turned a deaf ear. She was not going to be caught on that one. Women had to become qualified in exactly the same way as men or they would always be inferior. So she went on seeking out medical men who might help her and finally hit on one – a man called Pierre Louis who advised her to enter La Maternité, the major lying-in hospital in France, and said he would back her application. Elizabeth promptly took his advice and accepted his help even though she was not immediately attracted to La Maternité, a grim old convent of little appeal. Nor was she attracted by the conditions of admission when they were presented to her. No concessions were to be made to her doctor’s degree. She would enter with the same status as all the other young girls who came to train as midwives, would live communally with them and be subjected, as they were, to the same schoolgirl discipline. She accepted b
ecause she had no alternative. On June 30, 1849, aged twenty-eight, she entered La Maternité, but privately hoped only to use it as a stepping stone to greater things – she intended only to stay three months and then use her experience there to gain entry to another more general hospital.
It was a strange experience for her. She slept in a huge dormitory, took a bath with six others, was served poor food and had not a moment to herself. Most of the girls were around eighteen and naturally behaved quite differently from Elizabeth who felt ancient beside them. They came from all over France so there was every variety of accent for her to learn. The day was extremely long – fourteen hours at a stretch was common – and the work hard. La Maternité delivered 3,000 babies a year and the students were present for all “interesting” cases which happened at the most inconvenient times. But Elizabeth, in spite of what she always called her “hermit-like tendencies”, settled in well. She felt more camaraderie among those young girls than among her colleagues in either Geneva or Blockley and enjoyed helping and mothering them. And she came to have enormous respect for some of the staff who were efficient and as hardworking as the students. She learned so much in her first three months that she realized she would be stupid to leave and ought instead to complete the course. So she decided to stay on. What also influenced her was the attitude of some of the staff who were helpful and interested in her (she was disgusted by the immorality of others) and encouraged her to believe she would make a good obstetric surgeon. One in particular, Hippolyte Blot, a young resident physician, went out of his way to assist her. Elizabeth described him in a letter home – “He colours, or passes his hand through his hair, and looks intently at the baby – in a very unfrenchmanlike manner – I think he must be very young, or much in awe of me, for he never ventures to give me a direct look and seems so troubled when I address him that I very rarely disturb his life that way.”33 But Blot asked her to give him English lessons; she agreed and they became quite close. He helped her study outside the prescribed curriculum and drew her attention to any interesting papers.
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