The Doctors Blackwell
Page 18
Daniel Brainard, Emily understood, felt much the same. She was a credit to him, certainly, but his institution came first. Brainard “would I believe admit any woman he had confidence in,” Emily wrote to Elizabeth, “but he would not seriously injure the college to carry the point.” And while he admired Emily, he doubted there were many women as committed as she. Emily, frankly, agreed with him: “When I saw the women who came to consult him at his office, I could hardly blame him for having no very high opinion of them.”
Under Brainard’s tutelage, Emily’s attraction to medical practice, and her determination to pursue surgery, began to equal or even surpass her sense of medicine as moral mission. She enjoyed what she was doing and wanted to keep doing it for its own sake. Brainard, Emily told Elizabeth, “has liked me thoroughly ever since I told him if I could not study to my satisfaction here I would study in disguise at Paris”—a step Elizabeth had always refused, on principle, to consider. Heartened by Brainard’s approval, Emily began to think of herself as a surgeon. “I would choose certain branches”—obstetrics and gynecology—“make myself the most skillful surgeon in America in that department, if possible—and I think it would be hard to keep me from succeeding,” she wrote in her journal, with new confidence.
“I have come to the conclusion that operations though the showiest are by no means the most difficult part of Surgery,” she wrote, with an acuity that belied her experience. The surgeon’s true challenge, she saw, was not the bravura sawing of bone or the dramatic removal of a disfiguring tumor; it was deciding when and upon whom to operate, then managing the patient’s recovery with meticulous attention—this more than a decade before Joseph Lister introduced the idea of antiseptic postoperative care. Her farsightedness extended to nonsurgical obstetric issues as well. “I feel convinced that some means might be found placing conception under the control of the individual,” she mused in her journal. “Also of making the whole process of Gestation much more endurable—attended with fewer bad results to the health, strength and person than at present.”
“Physicians have hitherto been men, who felt no special interest in the matter, the female side,” she continued. “I have already planned a series of experiments with regard to it, some day I will carry them out.” Where Elizabeth imagined a distant future of female achievement, Emily focused on the flawed present and what she could do to help women through the perils of pregnancy and childbirth. She confined these thoughts to her journal, however, and kept them out of her letters to Elizabeth.
A kind dinner invitation from the Brainards rescued Emily from her first solitary Christmas, but she preferred wind-whipped walks along the ice-piled shore of Lake Michigan to socializing. Soon she would be back in New York between terms, with no access to medical books or specimens. After dark one evening, she frightened the demonstrator of anatomy when he heard the sound of soft footsteps in the dissecting room. Leaving the premises as fast as dignity would permit, he returned with a light only to find “nothing more ghostly than Milly.”
In quiet moments, Emily’s thoughts turned toward Elizabeth, struggling to find professional traction in New York. “Her letters often make me sad—not from what she says but from a sort of unhappy atmosphere,” she wrote. It was clear that Elizabeth was not getting anywhere by sitting and waiting in her consulting room, skimping on food and fuel. “I do hope you don’t starve yourself,” Emily admonished her. “I think you ought to burn a little more wood. It is excessively trying to be always shivering.”
For years she had bobbed in Elizabeth’s wake. Now she was gathering information and experience that matched Elizabeth’s and in critical ways improved it. Having failed to attract a steady clientele among the wealthy, Elizabeth was thinking of offering her services gratis to the poor, to gain experience and win the sympathy of philanthropic New Yorkers. She outlined her idea for Emily, who discussed it at length with Daniel Brainard. Brainard was unequivocal: advertising such services would make Elizabeth sound like another Madame Restell. “He said any young physician advertising that he would practice free on certain days at a certain place would be turned out of any society and stamped as a quack henceforth,” Emily warned her sister urgently. A woman like Elizabeth—without a pedigree, an independent fortune, or any interest in making herself charming—could achieve her goal only by creating something larger than herself. Where the public would condemn an individual, it might endorse an institution. It was time to create one.
For the urban poor, private doctors were an undreamed-of luxury and public hospitals a nightmare of last resort. Those who needed something for a bad cut or a bad cold went to a dispensary: a free clinic for the poor. The idea had originated in London in the 1770s—as a way to serve those turned away from overcrowded St. Bartholomew’s—and the first New York dispensary had opened in 1791. As the city spread northward and its population grew, more were added, each attending to its own neighborhood. By 1852 there were five major dispensaries and counting, funded by grants from the state and donations from the wealthy. They were important centers for the promotion of public health and had begun to serve an equally vital role in training young physicians. Establishing a small dispensary was an achievable goal. It would afford Elizabeth the medical autonomy she craved and perhaps become a place where other female medical graduates could learn.
Brainard was generous with his advice, and Emily conveyed his ideas to Elizabeth in fine detail. She would need a name (“say, the New York Institution for furnishing free med advice to indigent women & children, or any other title you pleased”), a board of influential trustees, a consulting physician and surgeon with impeccable reputations, and if she really wanted to make it stick, perhaps a charter from the state of New York. Given that the work involved matters of life and death, she needed to pick her people carefully. They must be true allies, such that “if ever a case should turn out ill and you should be criticized [they would] not come out & say they really didn’t know anything about it.”
Above all, Emily reported, Elizabeth needed to play by the rules, which were increasingly codified. The American Medical Association, founded in Philadelphia in 1847, had that same year published its Code of Ethics, which Emily exhorted Elizabeth to acquire and embrace; Emily’s own professor, Nathan Davis, had been one of the sponsors of the document. The rules, of course, were part of a game created and controlled by men. Emily’s letter concluded with a postscript. “Dr B thought it would be more imposing for you to have men’s names for your officers than women,” she wrote. “Alas poor women! But I believe it’s true.”
“I have often thought that if I followed solely my inclinations I should assume a man’s dress and wander freely over the world,” Emily wrote, once she was back in Elizabeth’s cramped New York quarters. Where Elizabeth strove to stand alongside her male allies as an exceptional woman who had proved herself their equal, Emily yearned to shuck off her gender and make her way in anonymity.
Alone with her prickly sister and narrower opportunities for study, Emily found the productive momentum of her months in Chicago difficult to sustain. To her satisfaction, Daniel Brainard, visiting New York for a meeting of the American Medical Association, took the time to call upon his prize pupil. “He told me the trustees would make no difficulty about my graduation, so my way is clear,” she wrote with relief. Elizabeth and Emily hosted the Brainards for an oyster supper—their living space so small, the guests had to file in and pull their chairs up to the tiny table one at a time—and Dr. Brainard regaled the party with tales of Emily’s advent at Rush, and the stodgy opposition to her presence that he had handily dispatched. “We had quite a merry time,” Emily wrote.
But as the New York summer grew sultry, doubts crept back. “I do not feel perfectly clear that I can establish myself in N.Y. and work in concert with E,” Emily confided to her journal. Elizabeth’s “nervous oppressive discomfort” was difficult to endure, and life in New York meant too much time shut up in places where she could not see the sky. To make thin
gs worse, her champion Daniel Brainard suddenly decided to spend the coming term in Europe. He reported that although Rush’s board of trustees had, dismayingly, passed a resolution against admitting women henceforth, he assumed the decision was not meant to apply to her, as she was already midway through her studies.
Emily decided her way forward was clear enough to proceed—no other paths presented themselves. On her twenty-seventh birthday, October 8, 1853, she surveyed her position with stubborn conviction: “The future lies black with a golden glow beyond it.”
She was right about both the darkness and the light. “I find I shall have more to contend with than I supposed,” Emily wrote with impressive understatement from Chicago. The day after her return, and without her knowledge, the Rush trustees gathered for an emergency meeting and decided her fate. Rush Medical College would not allow her to finish her degree.
The decision was a case of moral cowardice that the Chicago Tribune was quick to call out, praising Emily’s initiative and demanding an explanation for her shameful treatment. “It is too absurd,” an editorial declared staunchly, “to suppose that any educated and reflecting female, who had the boldness to enter upon, and the perseverance to pursue this science, could not comprehend its truths, and administer its practice as well as a majority of the half-fledged youth who dabble in salts and soda.” A letter from an anonymous Rush student appeared in response. “In behalf of the medical class, I wish it distinctly understood, by all concerned, that the young gentlemen composing that class are possessed of too much gallantry to repudiate the ladies in any shape,” he wrote, with a roguishness that undermined the affirmation. This was followed by an editor’s note: as far as the Tribune could ascertain, the trustees said they were acting at the request of the faculty, the faculty said the students had demanded it, and the students denied any such thing. “Now, it is very evident there is duplicity and double dealing somewhere,” wrote the editors. “Who is guilty?”
Emily did not wait to find out. She had already left for Cleveland Medical College, Nancy Clark’s alma mater. The school’s dean, John Delamater, had once been Daniel Brainard’s own mentor. Many of the Cleveland faculty members had been encouraging when Emily first sought admission two years earlier. And she was already halfway to her degree—surely Delamater could convince his faculty to admit her for a single term.
Her staccato journal entries attest to furious activity and flinty resolve, as well as a severe cold that left her shivering with fever and aching in every limb. But she was finished with uncertainty, and the Cleveland faculty seemed to recognize it. Within a few days of her arrival, she had taken her lecture tickets. “I am beginning to feel rested and settled,” she wrote.
After that, finishing out the term was straightforward. Less than three months later, Emily sailed through her final examinations and was mightily amused, as she left the examiners’ room, to overhear one curmudgeon mutter, “That is the only student you have passed whom I would introduce to practice in my family.” Afterward, the school’s co-founder, Jared Potter Kirtland, a copiously bearded old gentleman with kindly eyes behind his spectacles, presented her with a bouquet of flowers from his own hothouse—no small gift in the middle of February—and told her “it was not often that roses bloomed in winter, and it was not often professors had such a student,” as Emily recorded proudly. “To which I of course replied that it was not often a student received flowers with so much pleasure.”
Her graduation on February 22, 1854, was warmed by such expressions of solidarity on all sides. “Emily is now Dr. Emily Blackwell,” Elizabeth wrote with satisfaction to Anna. “You have the honour of possessing two professional sisters!” On the day appointed for the graduating students to read their theses—Emily’s was titled “The Principles Involved in the Study of Medicine”—she was surprised to see a woman enter the hall and sit down; after the readings, Delamater introduced her as none other than Nancy Clark herself, who had traveled from Boston to support Cleveland’s second female medical alumna. The highest performance grade was 10, but the faculty awarded Emily 11 and, in addition to her diploma, presented her with a special commendation bearing all their signatures. Clark told her she had graduated “not only successfully but triumphantly.”
The attention was gratifying, but Emily understood too well how ephemeral such enthusiasm could be. She had heard from allies in England, via Lady Byron, that the illustrious Scottish physician James Young Simpson would allow her to continue her training with him. She hoped her next mentor would be worth the journey to Edinburgh.
CHAPTER 11
EDINBURGH
Emily remained even-keeled even when seasick. “Judging from the fine flavor of carrot with which the operation ended, the greedy old ocean coveted even the soup I had eaten for dinner,” she reported. “Probably when I am shut down in the cabin tonight I shall have another tussle with destiny, but if this weather continue I shall not know much of the horrors E was so troubled by.” She had sailed from Boston at the end of March 1854, spending her last night with Nancy Clark, who saw her aboard with a bouquet of roses and a generous supply of biscuits.
The Royal Mail Steamship Arabia, built for the Cunard line only a year earlier, was magnificent: nearly a hundred yards from stem to stern, with two masts, two smokestacks between them, and two huge paddlewheels on either beam. The main dining saloon, with seating for 160, was paneled in bird’s-eye maple and ebony, hung with crimson drapes, and upholstered in velvet, with glowing stained-glass sconces depicting camel caravans “and other Oriental sketches” in keeping with the ship’s name. Steam pipes beneath the floor warmed the staterooms, which were similarly done up with Brussels carpets and more red velvet.
Emily ignored its luxurious charms, perching contentedly in the lee of a smokestack, watching gulls tumbling in the sea-salted wind. Cresting waves foamed like spouting whales, and real whales spouted among them; icebergs resembled mountains or ruins or, in one case, “a little solitary watch tower.” Even rough weather was gorgeous, and once she was safe in her berth, the crashing sea rocked her to sleep. Her young roommate—“an inoffensive Irish girl”—might wake her screaming that a ghost had invaded their cabin, and her fellow passengers might weary her with their “drinking smoking cardplaying & crowding,” but these were passing irritations. The natural world continued to be Emily’s solace.
Her solitary hours offered time to reflect on the three weeks she had just spent in New York. A month after Emily’s graduation, Elizabeth had reached a milestone of her own: the opening of her dispensary. Following Daniel Brainard’s instructions scrupulously, she had obtained a charter from the state and stacked her board of trustees with prominent men—many of them Quaker and several the husbands of satisfied patients. They included the Tribune editor Horace Greeley and his deputy Charles Dana; Henry J. Raymond, politician and recent founder of the New-York Times; and the jurist Theodore Sedgwick.
“The design of this institution is to give to poor women an opportunity of consulting physicians of their own sex,” Elizabeth’s carefully crafted mission statement began. “The existing charities of our city regard the employment of women as physicians as an experiment, the success of which has not yet been sufficiently proved to admit of cordial cooperation.” At the end of a list of respected doctors who would serve as consultants, Elizabeth’s name was tucked in discreetly as “attending physician.” The minutes of an early board meeting suggest that even her trustees considered female physicians a hard sell. The original draft of their incorporation certificate softened the mission by stating that they would employ “medical practitioners of either sex,” though it was “the design of this Institution to Secure the Services of well qualified female practitioners of Medicine for its patients.”
The institution’s name—the New York Dispensary for Poor Women and Children—was the grandest thing about it. Elizabeth had found a single small damp room on East Seventh Street, near Tompkins Square in the heart of Little Germany. She tacked a card to t
he door announcing the hours—Monday, Wednesday, and Friday, from three o’clock—until a more permanent tin sign could be painted. And three afternoons a week, instead of sitting in her room on University Place, she walked the mile to Seventh Street, and sat there.
The homely dispensary might not have matched what Elizabeth had imagined during her months of training in Europe, but it suited her approach as a physician. The tenement-dwelling seamstresses and cigar-makers who came for basic remedies also received guidance on household hygiene, ventilation, diet, child care—everything Elizabeth had described in Laws of Life for the wealthier women uptown. She dispensed job advice, recommended charities, and even handed out “pecuniary aid” to the most desperate. Sometimes she followed up with a visit to a patient’s home. Elizabeth was practicing social work as much as medicine, and she was gratified to note that “in many cases the advice has been followed, at any rate for a time.” The flow of patients wasn’t more than a trickle, but that was beside the point: Elizabeth’s institution existed at last, and it was a place to start.