Bessie Parkes and Barbara Smith, in turn, made Elizabeth their project, adorning her cheerless rooms with flowers and paintings and introducing her to their friends. When the hospital day was finished, she revived her idealism in the company of London’s intellectual vanguard: people whose philosophical adventurousness she recognized as Blackwellian, whose ideas and pursuits, like her own, did not always align comfortably with English mores. “I have forgotten the smoke,” Elizabeth told Marian, “I don’t miss the sunshine, I have got beyond the external world of London.”
There was the noted writer and art historian Anna Brownell Jameson, for example, whose analysis of Shakespeare’s heroines the Blackwells had read to each other back in Cincinnati; the American abolitionist and children’s author Eliza Lee Cabot Follen; the electrochemist Michael Faraday; the radical publisher John Chapman; and Chapman’s live-in assistant editor Mary Ann Evans, better known to literary posterity as George Eliot. And there was Lady Anne Isabella Noel Byron, widow of the famous and infamous poet, whose memory, even a quarter century after his death, still cast an aura of glamour around her. As she approached sixty, Lady Byron focused her considerable intellectual and philanthropic resources on education, and Elizabeth hoped she might extend that generosity to the cause of women in medicine. After all, her daughter, Ada Lovelace, enjoyed considerable renown as a mathematician, a field in which Lady Byron had encouraged her. When, in the spring of 1851, an invitation arrived to visit the great lady at her home in Brighton, Elizabeth accepted immediately.
Elizabeth found everything in Brighton delightful: the elegant stone residences with their bow windows facing the spray off the Atlantic, the vast sunset view, and her delicate and distinguished hostess, whose air of quiet melancholy seemed deliciously entwined with her tragic past. The other guests were no less captivating. Fanny Kemble, the actress, swept into the parlor in rose satin and white fur, her dark eyes flashing as she declaimed a tragic passage in a thrillingly deep voice—the first time Elizabeth had heard Shakespeare delivered by a professional. At night, the wind howled around the house with appropriately poetic ferocity. Breakfast was a cozy tête-à-tête with Mrs. Jameson, who discussed fine art and female potential with fiery intelligence. When it was time to return to London, Lady Byron, swathed in purple velvet, escorted Elizabeth to the station in person and saw her onto her train “with the most hearty shake of the hand.”
In Lady Byron, whose subdued voice belied a brilliant mind, Elizabeth found a sparring partner worthy of her respect; their correspondence would span years and continents and end only with the older woman’s death a decade later. Elizabeth pushed back politely but firmly against Lady Byron’s opinion that although a woman might become a doctor, she would always hold a secondary position in the field. “Dear Lady Byron,” she wrote, “will you forgive, what almost seems to me presumption, in this free speech to one so much older and wiser than I am?”
Women were not more likely to be repelled by anatomy and physiology, Elizabeth insisted. “I can say most decidedly from my own experience, and from that of a younger sister,” she wrote, “that what might seem the most repulsive parts of medical study, become profoundly interesting, when pursued scientifically.” A woman’s ability to study and practice was not threatened by her euphemistically “variable” health—though of course menstruation was “a subject I cannot discuss in a note,” Elizabeth added. And though a female doctor might choose to specialize in women’s health, “no one who has the true scientific spirit, when he has once obtained a glimpse of this magnificent land of knowledge, will ever be content to cultivate one little corner.” Elizabeth begged Lady Byron not to make the fatal error of “ranking human beings according to sex instead of character.”
But Lady Byron had been shaped by different forces, in a different generation. “My earliest ideal of happiness was ‘a life of devotedness to one,’ ” she wrote back, and hastened to correct Elizabeth’s suggestion that such an attitude was idolatrous. Men and women, she reassured Elizabeth, should certainly be held to the same moral standards. “But I do not desire an equality of powers & privileges,” she told her younger friend. “Where a Woman’s capacity is such as to raise her to an equality with Men, I honor the Exception, but I would not make it the Rule.” Much as she admired Elizabeth, she held to her conviction: “The oneness of dependency seems to me to constitute Woman’s greatest happiness.” They would agree to disagree.
The pain and loneliness of the previous year were receding memories. “Life opens to me in London,” Elizabeth told Emily, “social life particularly.” She could make the case that her social connections were more fruitful than her professional relationships. At St. Bartholomew’s, she would always be a peculiar figure—“they would as soon think of making Queen Victoria an April fool, as venturing to joke with me, so fearful is the awe I inspire people with”—but outside the hospital, she was finding her true peers. One of these was Barbara Leigh Smith’s first cousin, a woman named Florence Nightingale.
In 1851, just shy of her thirty-first birthday, Nightingale was wealthy, witty, well traveled, and monumentally impatient to shake off her family’s conventional expectations and fulfill her calling as a humanitarian. She had recently dismissed her eminently suitable suitor Richard Monckton Milnes with a finality that dismayed her parents.* “To be nailed to a continuation and exaggeration of my present life, without hope of another, would be intolerable to me,” she had written at the time. “Voluntarily to put it out of my power ever to be able to seize the chance of forming for myself a true and rich life would seem to me like suicide.” Since then, she had journeyed through Egypt and Greece, and on her way home had visited the Deaconess’s Institute at Kaiserswerth, near Düsseldorf, which trained laywomen in pastoral care and healing among the poor. Here, she thought, was a model of the kind of good she wanted to do in the world. Her family was appalled.
The arrival in London of a woman within a year of her own age and a fully qualified M.D. only fueled Nightingale’s dreams of escape. Elizabeth was like no one she had ever met: a woman with ideals as lofty as her own, who had likewise turned her back on marriage and was actively in pursuit of her goals far from her family. In mid-April, Nightingale invited her new American acquaintance to visit her family’s estate at Embley Park, a sprawling redbrick pile at the edge of the New Forest, with clouds of flowering azalea and rhododendron outside and lavish heaps of books within, overflowing the shelves onto tables and sills.
Elizabeth was equally taken with her swan-necked hostess, who kept in her pocket a diminutive pet owl named Athena, rescued during her visit to the Acropolis. “Walked much with Florence in the delicious air, amid a luxury of sights and sounds, conversing on the future,” Elizabeth wrote. “A perfect day.” Not only did Nightingale share her interest in health and hygiene, she also had similar thoughts about the unfulfilled potential of women. “Woman stands askew,” Nightingale had written. “Her education for action has not kept pace with her education for acquirement.” Nightingale’s own education had likewise emphasized polish over pragmatism. That summer she would return to Kaiserswerth for three months as a nursing intern and begin to move in a new direction.
“Do you know what I always think when I look at that row of windows?” she asked Elizabeth now, gazing up at the monumental facade of her home with its ranks of stately gables and chimneys. “I think how I should turn it into a hospital ward, and just how I should place the beds!” In her vision, however, she was the matron in charge of the nurses, not the attending physician. Florence Nightingale, patron saint of nursing, and Elizabeth Blackwell, first woman doctor, would never agree about the role of women in health, but this first encounter was a passionate moment of recognition between two people whose choices most found baffling, if not horrifying. “She said she should be perfectly happy working with me, she should want no other husband,” Elizabeth recorded. “As we crossed the fields, conversing on religious matters, it was a true communion.”
Nourishing
as it was to spend time with all these accomplished women, the stubborn question of making a living remained. Elizabeth had reluctantly accepted her cousin Kenyon’s financial help, but after two years of study in Europe, she was impatient to support herself. And though London felt more like home than any American city ever had, it remained as rigid as ever, while in America there were signs that attitudes toward women in the medical profession were shifting. Medical colleges expressly for women had recently opened in Boston and Philadelphia. “My own mind is therefore made up to return, and that as speedily as possible,” she told Emily. Her destination: not intellectual Boston or progressive Philadelphia but brash New York, her first American home, where no female medical institution yet existed.
As the weather warmed, Elizabeth made a final circuit of the London hospitals and drawing rooms in which she had found mentors and friends. At St. Bartholomew’s, both Paget and Burrows offered written testimonials to her “zeal and assiduity” and told her that her example had prepared a path for women in the future. It was bittersweet: “They have learned to know and welcome me as I am going away, and are, as Mr. Paget said, sorry to lose me.” Bessie Parkes was especially sad to part from her inspiring friend. “I very nearly astounded the opposite neighbors,” she confessed, “by rushing in a dramatic way back again, which would have been exceedingly undignified & unsuitable to your respectable appearance.”
* Milnes was by all accounts a kind and generous man and was soon happily married to another; he was also a dedicated collector of homoerotic sadomasochistic pornography and led a double life to which his accommodating wife turned a carefully blind eye. Nightingale, who held exalted ideas regarding sexual purity, would not have made him a successful partner.
CHAPTER 9
PRACTICE
New York had changed in the thirteen years since the Blackwells lived there. The imaginary grid that city planners had laid over rural hills and streams in 1811 was now built up as far as Fourteenth Street and beyond. Famine in Ireland and revolution in Germany had pushed the city’s population over the half-million mark. The spine of Broadway connected a teeming spectrum all the way from the Battery, past the throngs queuing at Barnum’s American Museum, past the simmering squalor of Five Points, and northward to the elegant environs of Washington Square and the newly completed Grace Church—the length of the thoroughfare choked by white-topped omnibuses, darting shop boys, nervous pedestrians, and the carriages of the rich. Until recently the gridlock would have included thousands of the city’s roaming pigs, but they had been rounded up and banished northward a few years earlier by the newly established police force. The completion of the Croton Aqueduct in 1842 brought clean water to the manure-encrusted southern end of Manhattan, drastically reducing the threat of epidemics, though the mechanism of disease remained mysterious. New York was maturing into a cosmopolitan capital. Surely there were enough open-minded women—and sympathetic men—in this expanding hive of humanity to support one female physician.
On September 12, 1851, a small item appeared in the New-York Daily Tribune, the city’s largest and most progressive newspaper. “Miss Elizabeth Blackwell, M.D., has recently returned to this City, from a two years’ residence abroad,” it announced, generously exaggerating her experiences at La Maternité, St. Bartholomew’s, and Gräfenberg. “Miss Dr. B., we understand, has just opened an office at No. 44 University-place, and is prepared to practice in every department of her profession.”
Two weeks after docking in New York harbor, Elizabeth had secured the endorsement of the Tribune’s founding editor, Horace Greeley, an intimate of Transcendentalist luminaries including Margaret Fuller, whom he had hired as his first literary editor. Hannah, Marian, and Ellen had come to New York as a welcoming party, and after some hunting, Elizabeth managed to rent part of a building within a few blocks of Washington Square, at the corner of Eleventh Street and University Place. Furnishing the empty rooms ate up much of her modest capital, and as it was not a boardinghouse—none of which would admit a woman who proposed, outrageously, to see patients in her rooms—she would be responsible for her own meals and housekeeping. But companionship was at hand: Marian planned to stay on with her in New York.
MARIAN BLACKWELL.
COURTESY LIBRARY OF CONGRESS, MANUSCRIPT DIVISION, BLACKWELL FAMILY PAPERS
If Elizabeth claimed Emily as a professional colleague, she had long imagined Marian as a kind of helpmeet, her calm encouragement an emotional bedrock for the life Elizabeth envisioned. “I think I have mentioned the comforting word you once spoke about my music, ‘play on, people like to hear you, faults & all,’ ” she had written to Marian. “That little sentence has certainly given me courage a hundred times, & has helped me to conquer my nervousness . . . so you see you have laid the foundation of my fortune, & it will be absolutely necessary that you finish the good work, by taking care of it when it comes.” It is unclear whether Marian’s fragile health was the origin or the outcome of her circumscribed role as the family’s caregiver, but Elizabeth was grateful for her presence, and kept a close eye on her headaches and dyspepsia.
Elizabeth’s long and peripatetic apprenticeship was at last finished, her health restored, a permanent address established. She had letters of praise from some of the most prominent physicians in Europe, and allies on the American side of the Atlantic as well. From Paris, Anna sent confident congratulations. “I do not think there can be any doubt as to her success,” she wrote. It was time to get to work. But in 1851 the term female physician meant something quite different from “woman with a medical degree.” For most New Yorkers, it meant one person: Madame Restell.
Two decades earlier a woman of twenty named Ann Trow Summers had emigrated to New York from England with her husband and baby daughter. She found work as a seamstress but was soon widowed. Her second husband, the St. Petersburg–born Charles Lohman, was a printer and freethinker who admired his wife’s independence. Surveying the opportunities for advancement, the couple settled on the thriving trade in patent medicines. Between her entrepreneurial spirit and his expertise in print advertising, they were soon in business, with a nom de guerre that became a household name. In March 1839 a substantial notice ran in the pages of the New York Sun, addressed “TO MARRIED WOMEN,” and laying out the argument for birth control forty years before Margaret Sanger was born. “Is it not but too well known that the families of the married often increase beyond the happiness of those who give them birth would dictate?” the writer asked. “Is it desirable, then, is it moral for parents to increase their families, regardless of consequences to themselves, or the well being of their offspring, when a simple, easy, healthy, and certain remedy is within our control?” Interested parties were directed to an office on Greenwich Street and the services of a Mrs. Restell.
The debate on limiting family size had begun to appear in print in the early 1830s, tracing its origins to the British Utilitarians and their emphasis on the greatest good for the greatest number. This approach to reproduction—that it was a virtuous act to avoid conception for the sake of those already born—at first repelled most Americans, unaffected by overcrowding and influenced by a Puritan tradition that saw procreation as God’s will and woman’s holy purpose. But as advances in science and engineering fueled American expansion and prosperity, the idea that medical knowledge could enable a family to take control of its own future had become easier to embrace. By the middle of the nineteenth century, family size had begun a downward trend.
The Lohmans, however, promised not to prevent pregnancy but to end it. Within a few months, their ads had moved from the theoretical to the entirely specific:
FEMALE PILLS.—MRS. RESTELL, Female Physician, informs the ladies that her pills are an infallible regulator of ******. They must not be used when ********. Prepared and sold only by herself.
The unprintable words were menses and pregnant, but the implication was unmistakable. Business was brisk, and the clientele broad. For the middle-class mother terrified of anoth
er dangerous delivery, no less than the servant girl frantic to avoid the result of unwanted attentions, Mrs. Restell offered hope. Within the year, Mrs. became the more fashionable Madame. And it wasn’t just women who noted the address at the bottom of the ads. Not infrequently, patients were delivered to Madame Restell’s door by gentlemen who hoped to erase the evidence of their improprieties.
There was nothing infallible about those female pills, of course. Madame Restell’s remedies were herbal nostrums with active ingredients like tansy and ergot, used by midwives as abortifacients for centuries but hardly failsafe. When they did fail, there were other services she could offer. Women in a more advanced stage of pregnancy were invited behind a curtain, where, for a fee dependent on means, Madame Restell or her husband would rupture the amniotic sac with a pointed probe made of metal or whalebone. The patient was then sent home and instructed to seek the attention of a regular physician once the miscarriage began, a fabricated story of accident or illness preserving the ignorance of anyone who attended the woman during her recovery.
The Doctors Blackwell Page 15