The Doctors Blackwell

by The Doctors Blackwell (retail) (epub)

  Though she may have framed her trip to England as exploratory, the family could tell that Elizabeth’s move was for the long term. “If you would take a peep at Aunt Elizabeth’s room, I think you would be rather astonished at its appearance,” Kitty wrote to her favorite “cousin,” Alice Stone Blackwell, now nearly twelve. “Trunks, boxes, books, clothes and papers, cover the floor in every direction; so that our room is in a constant and uncomfortable state of litter.” Elizabeth was leaving her ward behind for now—the extended family had come to depend on Kitty’s help both with Grandmother Hannah and with the grandchildren. But before she left, Elizabeth wrote a will, naming Emily and George as her executors and Kitty’s guardians. (Never mind that Kitty was by now in her early twenties—Elizabeth still addressed her as “child.”) Elizabeth’s modest assets were to be divided among her sisters, and her possessions shared between Emily and Kitty, with a stipulation that Kitty should have a piano. It was the tidying-up act of a woman who expected to be out of reach for the foreseeable future.

  Elizabeth sailed in July 1869 and took up residence with Barbara Bodichon in London. Though her plans for the future were unclear, she remained the only female on the British Medical Register, and she had personal ties to the young women now attempting to storm the gates of medicine in Britain. In September in her native Bristol, her attendance at the congress of the National Association for the Promotion of Social Science—where “many admirable people of large ideas” greeted her warmly—bolstered her confidence.

  She was soon writing a carefully diplomatic letter to the New York Infirmary’s board of trustees. “They claim me, on all hands, to remain here this winter, and give an impulse in the right direction, to the medical movement which is going on here,” she announced, stretching the truth. For the sake of the movement—not on her own whim, she insisted—she would remain in London, at least for the time being. By midwinter, at least privately, her mind was made up. “I am settled in England,” she wrote to Kitty. “I have not the slightest intention of returning to America and DV‡ will never cross the ocean again. . . . I belong here, and here I shall stay.” The infirmary and college annuals would continue to list her on the faculty and the board of trustees; it would be fifteen years before the title “Dean of Faculty” appeared by Emily’s name.

  Emily had no time to dwell on the manner of Elizabeth’s departure or the duration of her absence. The college’s second year was upon her. Lectures began in October 1869 with fourteen students, fewer than expected, though “I did not indulge in as sanguine expectations as some,” she was quick to point out. The college was in many ways the embodiment of its founders: admirable, impressive, and somewhat forbidding. Its term began earlier in the fall than that of other schools, its academic standards were higher, and three years of study were more expensive than two. Its advertising circulars were ineffective: “All these students have come from direct personal influence,” Emily noted. Even among enrolled students, there was a feeling “that the school is more respected than liked, that students feel more at home in the more easy indulgent and coddling tone of the Phil[adelphia] school,” she continued. “It seems to me that, as usual, we have done more by stirring & forcing others on, than by our own success.” Were the college’s expectations too rigorous for undisciplined Americans?

  Elizabeth, relieved to be free of the daily toil of hospital work—“I would sink the whole thing in the bottom of the Sound, rather than come back to it,” she wrote—exhorted Emily to follow her to England. In Elizabeth’s opinion, the new college would thrive best without either of its founding sisters. “It is, at present, the Blackwell College,” she wrote, “and it won’t succeed as long as it is, as a thoroughly American college.” She advised Emily to stay only as long as it took to lay aside a bit more money, then leave the institution to grow up American, free of the austere “Blackwell element.”

  Emily agreed that the college needed to work on its public image. “I can see very well that what is really wanted is to bring in more of the popular American element, something which neither you nor I have ever been able to fully give,” she told Elizabeth. “If I can get that I believe we shall neither of us be absolutely essential.” She was eager to “build up a little group on whom I can devolve the burden of the Institution”—but she also intended to stay with the ship they had launched and to find the crew that would help her steer it. Emerging at last from Elizabeth’s shadow, Emily would sustain the work of the New York Infirmary for Women and Children and its Woman’s Medical College for the next thirty years—ironically ensuring the persistence of her sister’s legacy in America.

  Emily reached the end of April 1870 in a rush of lectures, examinations, inpatients, house calls for trustees’ children with scarlet fever and pneumonia, and the college’s first graduation ceremony—for which she wrote a last-minute speech when one speaker canceled the night before. “It seemed as though everything came to a climax, and burst upon me at once,” she wrote. But just as she reached the end of her strength, she was surprised to find board members stepping forward to help, taking over the details of the ceremony, reception, and supper to follow. Perhaps she was not quite as alone as she had thought. “Everyone felt as though the whole affair was a success,” she wrote with unaccustomed satisfaction. And more help was on the way. Mary Putnam had promised to join the college’s faculty as soon as she finished her Paris degree. Surely she would bring some of the “popular American element” that was lacking—a combination of determined “push,” scientific brilliance, and the adamantine faith in women’s potential that Margaret Fuller had put into words a generation earlier.

  Emily was moved when the class valedictorian made “a graceful & entirely spontaneous little tribute ‘to our absent professor.’ ” For all that Emily had craved distance from Elizabeth, it was bittersweet to witness this milestone in their work without her. But Kitty, who attended the graduation “with great glee and interest,” was struck more by Emily’s presence than Elizabeth’s absence. “Aunt Emily made her appearance on the occasion, in a black velvet dress with a train,” she reported to young Alice. “I heard a good many people in the audience speak of her as ‘a fine looking woman.’ ” She beamed with pride as she watched “the conferring of diplomas on the first five graduates of Aunt Emily’s College.”

  * Holy Grail

  † The first acknowledged female practitioner, that is. Half a century earlier, in 1812, the University of Edinburgh had conferred a medical degree on James Barry, a slim, smooth-cheeked young man who went on to spectacular success as a high-ranking military physician. Not until his death in 1865—the same year Garrett qualified to practice—was it discovered that Barry was originally female.

  ‡ Deo volente, “God willing.”

  CHAPTER 17

  DIVERGENCE

  The story of Elizabeth and Emily Blackwell, pioneering and collaborating sister doctors, ends here. But each of their own stories, lived an ocean apart, continued for another forty years.

  Elizabeth’s trajectory flattened in England. Her confidence that the rising generation of British medical women—led by Elizabeth Garrett and Sophia Jex-Blake—would welcome her as their mentor and colleague was misplaced. “Miss Garrett, though outwardly pleasant, is bristling with distrust and anxiety,” Elizabeth wrote to Emily from London. Over the next three years, Garrett would score a series of triumphs: the completion of her degree at the Sorbonne in 1870; the expansion of her Marylebone dispensary into the New Hospital for Women in 1872; the respect of physicians including Sir James Paget and the support of powerful philanthropists like Lord Shaftesbury; and the love of a Scottish shipping magnate, James Skelton Anderson, who not only approved of his bride’s career but bought her a carriage as a wedding gift to facilitate it. She had also learned her predecessor’s lesson—to hold other women at arm’s length, lest they reflect poorly on herself—only too well.

  Sophia Jex-Blake was achieving a different sort of recognition. Refusing to seek her medical deg
ree on the continent, she pursued admission at the University of Edinburgh. When the faculty insisted it could not allow such disruption for the sake of one woman, she recruited four more. On November 2, 1869—a year to the day after the opening of the Blackwells’ college—Jex-Blake’s group, which later grew to seven, became the first women to join a class of men at a British university. “I do indeed congratulate you undergraduates with all my heart,” Elizabeth wrote, beaming in their reflected light. “I feel as if I must come up to Edinburgh to see and bless the class!” But the Edinburgh Seven, as they became known, looked to Jex-Blake for leadership, and her take-no-prisoners style was the antithesis of Elizabeth’s measured, understated approach. Opposition in Edinburgh reached an ugly climax a year later when the women were pelted with garbage and epithets as they entered Surgeons’ Hall for an anatomy examination. The university eventually prevailed in preventing the women from completing their degrees, but the “Surgeons’ Hall Riot” generated enormous publicity for the cause of women in medicine. Though her confrontational approach alienated many—including Garrett Anderson—Jex-Blake led the way to the founding of the London School of Medicine for Women in 1874.

  Elizabeth would serve in ceremonial roles as a consultant to Garrett Anderson’s hospital and on the faculty of Jex-Blake’s college, but these public endorsements masked an unsettling degree of personal antipathy. “Neither Miss Putnam, Miss Garrett, nor Miss Jex-Blake will ever be doctors, that as a woman I feel in the slightest degree proud of,” Elizabeth told Emily. “They are all hard, mannish, soulless; and though they are all doing excellent service as pioneers, and I am happy always to praise them . . . as women physicians such as we wish to see as a permanent and valuable feature of society, I think them not only useless but objectionable.” Such women physicians as Elizabeth wished to see were formed in her own image, devoted to health education rather than clinical practice, and inspired by right living rather than scientific advancement. It did not help that the British often confused her with another notable American doctor, Mary Walker, who had served as both a surgeon and a spy during the Civil War, spent months in a Confederate prison, and received the Medal of Honor. Even more memorable than Walker’s swashbuckling deeds was her personal style—she cut her hair short and wore trousers and frock coats. “I could not have imagined how very wide-spread and profound a mischief that little humbug could have done,” Elizabeth complained bitterly. “I am constantly addressed by her name, in mistake.”

  Elizabeth found herself companionless, especially when the Bodichons decamped to Algiers and Barbara’s lively intellectual circle disbanded. She missed Kitty, who had grown from daughter-servant into something more like the proverbial angel in the house. “You can help me so much by taking charge of all my things and telling where they are and reading and occasionally stitching for me and doing errands and keeping my rooms in first rate order and above all loving me very much,” Elizabeth wrote to her in a plaintive rush. Kitty, deeply attached to Henry and Lucy’s daughter Alice, was quietly devastated to leave America behind, but her first loyalty was to Elizabeth; a year after her departure, she joined her in London.

  Elizabeth might have spent her life fighting to open a profession to women, but she made it clear that neither career nor marriage was an option for Kitty, who remained suspended outside class or category—a young woman prematurely old, with graying hair, weak eyesight, and compromised hearing. Perhaps to compensate for the life Kitty had been denied, Elizabeth arranged to foster a baby in the fall of 1870, just as Kitty joined her in London. The child—the illegitimate son of the sculptor Susan Durant, a well-connected acquaintance—would be Kitty’s joy for the two years he remained with them.

  Bolstered by Kitty’s generous steadfastness—as Alice would later say, Kitty “fitted herself into all Dr. Elizabeth’s angles like an eiderdown quilt”—Elizabeth continued her public quest. Medicine had always been just a pathway toward a morally perfect world, and the world remained far from perfect. She might be the only woman on the British Medical Register, but she had little success—or even interest—in attracting patients. She invested more active energy in the formation, in 1871, of the National Health Society, an organization devoted to the promotion of sanitary practice. Its motto—“Prevention is better than cure”—set hygiene firmly above the arts of diagnosis, pharmacology, and surgery. Over the next three decades, Elizabeth skipped from one cause to the next, always happiest when leading the way toward a better world. Her days were full of committee meetings and long stretches at her writing desk, churning out pamphlets and articles for publication. And though she was no longer spending much time healing the human body, she was no less preoccupied with it. As a physician and a moralist, she saw it as her responsibility to address the corrupting influence of sex.

  Elizabeth had arrived in London days before the passage of the third and final Contagious Diseases Act, a measure—intended to curb the rampant spread of syphilis, especially in the military—that inflamed reform-minded women across Britain. The acts placed the burden of public health not on the soldier, whose need for sex was considered natural, but on the prostitute, who could now be arrested, forcibly examined, and confined to hospital if she was found to be infected. Elizabeth was outraged twice over: Not only did the law hold men and women to wildly different standards of sexual behavior, it also failed to condemn the evil of prostitution, punishing its victims instead of eliminating its causes. After her sojourns on the syphilis ward in Philadelphia and among the indigent women of Paris, London, and New York, Elizabeth understood how promiscuity and poverty converged in “that direful purchase of women which is really the greatest obstacle to the progress of the race.” She would leave the issue of eradicating poverty to others, but she was determined to make war on promiscuity. The repeal of the Contagious Diseases Acts became a clearly defined battle.

  In the world Elizabeth envisioned, children would learn to venerate chastity at their mother’s knee, growing into men and women who honored the sanctity of procreation. Sanctity, indeed, had eclipsed science in the formulation of her opinions. Louis Pasteur’s recent experiments confirming the concept of germ theory had not yet convinced the general public, including Elizabeth, who could not embrace the idea that amoral microbes might be responsible for disease. Germ theory detached health from virtue—but for Elizabeth the two were inseparable. As a student she had written that ship fever found its victims among the fearful; now she refused to relinquish the conviction that venereal disease was caused by licentious behavior. In order to break the cycle of depravity, it was critical that parents teach the paramount importance of sexual propriety. And therein lay a paradox: in order to promote purity, Elizabeth insisted that parents should talk to their children about sex.

  The book she eventually wrote on the topic—Counsel to Parents on the Moral Education of their Children in Relation to Sex—had nothing to do with the reproductive anatomy, though its subject remained incendiary enough that the publisher marketed it as a medical text. Her point was simply that men and women needed to live according to the same sexual standards, prizing the “exquisite spiritual joys” of marital intercourse over the “slavery of lust,” and teaching their children to understand and value the difference. Though Counsel to Parents did touch upon the dangers of autoerotic “self abuse,” its content was otherwise remarkably innocuous. “It might almost be read aloud in mixed company,” Emily wrote, shaking her head at the delicate sensibilities of British publishers. The book, released in 1879, would become the most widely read of Elizabeth’s works.

  For nearly ten years, Elizabeth moved restlessly, with Kitty dutifully packing and unpacking in each new lodging, nursing her guardian through repeated attacks of undefined gastric illness, and accompanying her on extended convalescent trips to Europe. It became clear that London was not a healthy home for either of them, and with Elizabeth employing her pen far more than her stethoscope, they had no reason to stay. They settled at last in the seaside town of Hastings,
in a trim brick cottage known as Rock House, perched on the edge of the English Channel and close enough to London that Elizabeth could remain active in organizations including the Social Purity Alliance, the National Vigilance Association, and the Moral Reform Union, all of them devoted to the cause of upright sexual conduct. Eventually Anna and Marian would join Elizabeth in Hastings, in a double house with two entrances that allowed them both proximity and distance. The Blackwells, to the end, loved and annoyed each other in equal measure.

  Though Elizabeth’s primary message was one of chaste restraint, emphasizing the virtuous influence of wives and mothers in elevating the baser instincts of husbands and sons, she made detours into more eyebrow-raising areas, using her medical credentials to deflect criticism. In a pamphlet entitled The Human Element in Sex, she declared it “a well-established fact” that for happily married women, “increasing physical satisfaction attaches to the ultimate physical expression of love.” Furthermore, she insisted, “a repose and general well-being results from this natural occasional intercourse, whilst the total deprivation of it produces irritability.” It’s tempting to see this as a bracingly direct statement about female libido, but Elizabeth’s point reached straight back to the antique orthodoxy of Hippocrates and Galen. Furor uterinus, wandering womb, hysteria, nymphomania: since the dawn of medicine, men had been blaming female ailments on the unsatisfied uterus. “Let her marry, and the sickness will disappear,” went the ancient adage. In this as elsewhere, Elizabeth did not include herself among the women she counseled. She never ascribed her own irritability to her unmarried state, and never acknowledged that her authority on the health benefits of wifely sex might be questionable.