The Doctors Blackwell

by The Doctors Blackwell (retail) (epub)

  It was still raining on Tuesday, Seneca Lake a dull gray sheet beyond South Main Street. Now Elizabeth had an upper room at Hamilton’s boardinghouse, two doors down from the medical building. Though there were plenty of other lodgers, she had not yet spoken to any of them. A small stove kept off the chill. She shoved another stick of firewood into its belly and sat down to report her progress, this time to supportive Marian. She had no one to talk to and much to tell. “The weather is still gloomy,” she wrote, “but I feel sunshiny and happy, strongly encouraged, with a grand future before me, and all owing to a fat little fairy in the shape of the Professor of Anatomy!” The letter is a mixture of proud excitement and protective irony; here and henceforth, Elizabeth used the word little as a way of diminishing those who might obstruct her path.

  The rotund anatomy professor, James Webster—unlike the ambivalent dean of faculty, Charles Lee—was delighted with his exotic new pupil. Of course she would study surgery, Dr. Webster told his more cautious colleague. “Think of the cases of femoral hernia,” he enthused, “only think what a well-educated woman would do in a city like New York.” Women with complaints in unmentionable places would flock to her, her success would be ensured, her fame widespread—and her alma mater celebrated. Indeed, members of the public were already showing up at lectures to gawk at the lady student. Would she blush, or gasp—or faint? “Yes,” Dr. Lee grudgingly concurred, “we were saying to-day that this step might prove quite a good advertisement for the college; if there were no other advantage to be gained, it will attract so much notice.”

  The demonstrator of anatomy, Corydon La Ford—Dr. Webster’s deputy, in charge of dissections—had at first balked at the idea of a woman among the specimens; now, following Webster’s lead, he showed “the utmost friendliness” and even met with Elizabeth individually to help her make up the material she had missed. Working with colleagues on actual specimens—“Oh, this is the way to learn!” she rejoiced.

  Things were looking up. “Today when I came home so happy and encouraged,” she told Marian, “I blessed God most heartily.” Whatever else Elizabeth lacked, self-esteem was never in short supply; where others might seek God’s blessing, she blessed God, who seemed at this moment less a deity than another kindly old gentleman who might assist her. “I wanted to throw my arms round him & mend his stockings,” she continued, “or do something in return if I only knew what.” She felt the same kind of gratitude for Dr. Webster. “The little fat Professor of Anatomy is a capital fellow; certainly I shall love fat men more than lean ones henceforth,” she wrote. “He gave just the go-ahead directing impulse needful; he will afford me every advantage, and says I shall graduate with éclat.”

  Éclat did not wait for Elizabeth’s graduation. The Boston Medical and Surgical Journal was already gossiping about the appearance of “a pretty little specimen of the feminine gender” at medical lectures. The writer was surprisingly respectful, going so far as to ask, “Why should not well-educated females be admitted?”—though this may have been a rhetorical flourish. A month later there was a second notice in the same journal, confirming that the jury was still out: “Nothing has transpired as yet to disprove the propriety of the action taken by the Faculty and class.” Geneva College may have been the first medical school to admit a woman, but who could tell whether such a distinction would prove “meritorious or otherwise”? Other schools were not rushing to follow Geneva’s example. Harriot K. Hunt, a Boston woman in her forties who had been treating women and children with alternative therapies for more than a decade, was sufficiently emboldened by Elizabeth’s success to apply to Harvard’s medical school. The response was immediate and unequivocal: the president and fellows of Harvard College found the admission of a woman “inexpedient.” Hunt would continue to practice and go on to prominence in the women’s rights movement, but she would never earn a medical degree.

  Even Austin Flint—editor of the Buffalo Medical Journal, lecturer at Geneva College, and one of Elizabeth’s earliest supporters in print—was careful to qualify his enthusiasm. Flint applauded the advent of women in certain “special branches” of medicine—obstetrics and gynecology—and hoped that they might “conduce to the diminution of quackery” by debunking the latest medical fads for their sillier sisters. A woman’s “appropriate sphere” was of course “the domestic hearth, and the social circle,” though he saw no reason why medicine should be “the exclusive prerogative of the lords of creation.” But here his courage failed: “The discussion of the subject would, however, lead us too deeply into the metaphysics of woman’s rights, and we therefore waive it for the present.”

  In England, commentators hailed the achievement of this daughter of Bristol with less discretion. The satirical newspaper Punch pounced on the news with acidic glee. “We admire MISS BLACKWELL, though we have never seen her,” it announced. “She is qualifying herself for that very important duty of a good wife—tending a husband in sickness.” The writer hoped a thorough medical education would provide Elizabeth with “very useful information—a knowledge of the distinction between real and fanciful ailments: also, of the consequences of want of exercise, damp feet, and tight lacing.” Such information to be used only within the home, of course.

  Elizabeth ignored such publicity as resolutely as she did the smirks of her classmates, and tried to shut out the “flat, heavy feeling” that encroached like a quiet fog. The task she had set herself required a degree of self-control beyond anything she had attempted and more isolation than she had ever felt among the townsfolk of Asheville and Charleston. “I sit quietly in this assemblage of young men,” she mused, “and they might be women or mummies for aught I care.” In order to reach her goal, she needed to hold herself above the whispers and fidgety curiosity that surrounded her in the tiered rows of the lecture hall. “In the amphitheatre yesterday a little folded paper dropped on my arms as I was making notes; it looked very much as if there were writing in it, but I shook it off,” she wrote at the end of her second week. “I felt also a very light touch on my head, but I guess my quiet manner will soon stop any nonsense.”

  Her determined dignity certainly stopped the nonsense; it also drew a hard line between herself and everyone else. The windows of the medical building looked out onto those of a teaching college across the way, whose young female students were well aware of the lecture schedule at the medical school. The Geneva men passed the time before class clustered at the windows, gawking and catcalling: “See the one in pink!” “No, look at the one with a blue tie.” Elizabeth sat to the side in her usual seat, studiously reviewing her notes and pretending not to listen. “I believe the professors don’t exactly know in what species of the human family to place me,” she mused.

  Within the college no one could deny her competence and seriousness of purpose; outside, the residents of Geneva were less accepting. Women stopped and stared “as at a curious animal.” A doctor’s wife encountered at dinner refused to speak to her at all. She realized, gradually, that people had reached one of two conclusions: she was wicked, and her unscrupulous intent would eventually emerge, or she was insane. Either way she was dangerous. Though her lodgings were just a few steps from the medical building, she walked quickly and rarely ventured farther.

  In the third week of Elizabeth’s enrollment, the class turned to the reproductive organs. Dr. Webster was a popular professor with an irreverent sense of humor, renowned for his lecture on the male genitalia: a raunchy comedy routine that his audience received each term with hoots of hilarity and the thunderous drumming of a hundred pairs of feet. As the day approached, he suggested that Elizabeth should stay home, for her sake and for his own.

  He underestimated her. With calm determination, she picked up her pen to school her professor. “I told him that I was there as a student with an earnest purpose, and as a student simply I should be regarded; that the study of anatomy was a most serious one, exciting profound reverence, and the suggestion to absent myself from any lectures seemed to me
a grave mistake.” A true medical man, she wrote, one elevated by his exalted calling, would never be derailed by prudishness. And if Dr. Webster couldn’t face her in the front row, she would be quite comfortable in the back. Put it to the class, she suggested, remembering the circumstances of her original acceptance. If they balked, she would respect their feelings. “I did not wish to do so,” she wrote, “but would yield to any wish of the class without hesitation, if it was their desire.”

  To her delight, Webster applauded her pluck, admitted his error, and allowed her to attend. At last, a teacher who recognized superior moral fiber when he saw it. “He could hardly guess how much I needed a little praise,” Elizabeth wrote with relief. Still, her presence during his graphic explanation of an area no lady should dwell upon brought everyone to the brink. “Some of the students blushed, some were hysterical, not one could keep in a smile, and some who I am sure would not hurt my feelings for the world if it depended on them, held down their faces and shook,” she wrote. “My delicacy was certainly shocked, and yet the exhibition was in some sense ludicrous. I had to pinch my hand till the blood nearly came, and call on Christ to help me from smiling, for that would have ruined everything.”

  She felt her professor’s predicament as least as keenly as her own: “Dr. Webster, who had perhaps the most trying position, behaved admirably.” Describing the physiology of the penis in mixed company seemed, even to Elizabeth, a more daunting challenge than listening to such a lecture as the only woman in a sea of men. God might be on her side, but her own sympathies lay, to a surprising extent, with the men who were nonplussed by her presence. She was determined to prove herself, but not at their expense.

  When the ordeal was over, Dr. Webster asked if he could share her original letter of protest with the students, “saying if they were all actuated by such sentiments the medical class at Geneva would be a very noble one.” She retired to the hallway while Webster read her words aloud to the men and declared that Elizabeth was a student in the tradition of Galen, the Greek physician of antiquity, who said, “The study of anatomy is a perpetual hymn to the gods.” When he opened the door to invite her back in, the room erupted in applause. “The lectures on anatomy proceeded in regular order to their conclusion,” Stephen Smith remembered, “and it was the universal testimony of the oldest students that they had never listened to such a complete and thorough course.”

  What passed for “complete and thorough” medical education in 1847 was, even then, being called into question; the American Medical Association was founded that very year in an attempt to raise standards. For now, however, medical schools were only as good as their faculties, and these were often loose groups of independent physician-entrepreneurs, collecting fees directly from each student and issuing admission tickets—ornately engraved pasteboard squares bearing the professor’s name and specialty—to lectures in their particular subject for the term. Jolly Dr. Webster adorned his tickets with a mournful-looking skull. The subjects included anatomy and physiology, surgery, pharmacology (or “materia medica”), clinical practice, pathology, chemistry, medical jurisprudence, and obstetrics.

  JAMES WEBSTER’S ANATOMY LECTURE TICKET.

  COURTESY HOBART AND WILLIAM SMITH COLLEGES ARCHIVES AND SPECIAL COLLECTIONS

  All this was squeezed into a term of sixteen weeks, and the achievement of a diploma required only that students attend the identical course of lectures in two successive years, preceded by a few years of study with “some respectable practitioner or practitioners” and supplemented with whatever practical observation they could scrape together in the lengthy interval between the two terms. Often the only method of instruction was the lecture itself: students learned by watching and listening, and rarely touched any instrument other than the pen they used to take notes. If they were lucky, they had access to specimens for dissection; most never got within reach of a living patient. Once past their final examinations—evaluated by their own instructors and not by any objective governing organization—they entered the profession with a terrifying level of ignorance. This was partly due to their sketchy training, and partly to the primitive state of the healing arts.

  The first half of the nineteenth century was the high-water mark of what came to be known as “heroic medicine.” Doctoring had become an established profession, but the state of medical knowledge had not evolved much beyond the Hippocratic doctrine of the four humors (black bile, yellow bile, phlegm, and blood), the four elements (earth, air, fire, and water), and the four qualities (hot and cold, wet and dry) whose imbalance was thought to be the root of all illness. In the premodern world, governed by agricultural rhythms, human health had drawn its metaphors from the garden, and healers, like gardeners, had seen their role as helping time and nature to correct and restore the body’s blooming life force. But as empirical science and then industrialization took hold in the public imagination, the body-as-garden was giving way to the body-as-machine: a mechanism that, when broken, needed to be fixed.

  Healers who focused on long-term care—the village midwife, the monk-infirmarian—had been overtaken by doctors fixated on short-term cure. Watching passively while letting nature take its course did not inspire patients to pay their fees; a good doctor, it was thought, produced results you could see. Most of those results were painful if not actually dangerous, and few contributed to healing—the importance of hygiene was as yet poorly understood, and the discovery of truly effective pharmaceuticals lay mostly in the future. There were no governmental sanitary commissions to recommend best practices or hold individual practitioners accountable. Physicians built reputations largely on the placebo effect of charisma, with self-assurance substituting for science. They used the same handful of drugs and procedures, trying each in turn, often regardless of the complaint, until the patient either recovered or died.

  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. 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. The more violent the reaction, the more effective the therapy, most doctors—and most patients—agreed. “Medicine is always an evil,” Elizabeth noted, “though sometimes a necessary evil.” Necessary evils described in Dr. Lee’s pharmacology lectures included castor oil, calomel (a powerfully laxative compound of mercury that also caused extreme salivation, not to mention the eventual neurological damage of mercury poisoning), lobelia (the “pukeweed” prized by the Thomsonians), mustard plaster (which could produce first-degree burns), and turpentine (used both externally and internally). Dosages varied not just by age and weight but also by temperament, sex, and even class. “A delicate woman should not be dosed like an Irishman,” Elizabeth dutifully recorded. The legacy of the Hippocratic humors persisted, and one’s medical complaints were thought to correspond to one’s type: sanguine people were prone to inflammation, while spiteful temperaments were more vulnerable to stomach problems.

  Bloodletting was relied upon in cases of all kinds, the idea being that “blood is the fuel which feeds the fire of inflammation”—subtract blood, and infection would abate. “The more important the organ, the more necessary to be prompt in bleeding,” wrote Elizabeth. For a serious illness involving the brain, forty ounces was not considered excessive. (As reference, modern blood donors in certified good health give no more than a pint—sixteen ounces—at a time.) The production of “laudable pus” was believed to be a sign that the body was expelling infection, so physicians blistered the skin of patients with mustard plaster and then punctured the blisters to release the accumulated fluid. For pain relief, thankfully, there was laudanum, a mixture of alcohol and opium. Opium, Elizabeth’s notes record, was “the most valuable article of the Materia Medica—differs from most other narcotics, in being a safe remedy.
”

  Though privately unsure of the efficacy of any of these therapies—they certainly hadn’t helped her father back in Cincinnati—Elizabeth threw herself into the task of absorbing all that her professors could teach her about preserving the mechanisms of health. Now was not the time to wonder about phrenology, mesmerism, or the water cure, or about letting time and nature take their course: If she wanted to earn an official diploma from a mainstream medical school, she needed to set her own doubts and interests aside. And much of what she was learning made sense to her. “The human body is a laboratory,” she wrote. “The excretions are its refuse; they are both the result and the measure, of the exchanges which go on between the outside world, and our own organization.” For a young woman who felt uncomfortable with strong emotion and social interaction, reducing blood, sweat, and tears to scientific secretions was a relief.

  Actual sick people were a different undertaking entirely. In early December, barely a month after her arrival, Dr. Webster summoned Elizabeth to his office, where a woman waited to be examined. A poor woman by definition—well-heeled patients summoned doctors to their homes. There is no record of the woman’s complaint, but the fact that Webster made a point of including Elizabeth suggests a gynecological problem, a chance for his new prize pupil to gain some practical experience. Geneva, too small to boast a public hospital, afforded little opportunity for its medical students to observe patients.

  Elizabeth was shaken to the core by the sight of the woman before her: not a cadaver to be anatomized but a living individual in pain, vulnerable to the gazes of strangers. “’Twas a horrible exposure; indecent for any poor woman to be subjected to such a torture; she seemed to feel it, poor and ignorant as she was,” Elizabeth wrote. “I felt more than ever the necessity of my mission.” If she achieved her goal, women would at least be able to confide their most intimate ailments to other women. But the encounter unnerved her. “I went home out of spirits, I hardly know why,” she wrote. She was abundantly aware of all the noble challenges involved in breaching the male bastion of the medical profession; what she hadn’t yet reckoned with was the intimacy of contact with patients. The presence of a partially disrobed stranger in extremis was disturbing. How could she fulfill her destiny as a physician if she recoiled from contact with her patients? “I felt alone,” she concluded. “I must work by myself all life long.” Even if other medically minded women someday joined her, how could they empathize with a visceral discomfort she could barely articulate to herself?