The Fevers of Reason

by Gerald Weissmann

  However, there was a small medical faculty in Geneva, New York, that was empowered to give the degree of doctor of medicine if a candidate attended lectures for two years and wrote a thesis. The school’s requirements for the MD degree were par for the course, and the faculty put the question of a woman’s admission to the students of the little upstate school; to their credit, the young men passed the following two resolutions, a copy of which remained with Blackwell to her death:

  1. Resolved: That one of the radical principles of a Republican Government is the universal education of both sexes; that to every branch of scientific education the doors should be open equally to all; that the application of Elizabeth Blackwell to become a member of our class meets our entire approbation; and in extending our unanimous invitation we pledge ourselves that no conduct of ours shall cause her to regret her attendance at this institution.

  2. Resolved: That a copy of these proceedings be signed by the chairman and transmitted to Elizabeth Blackwell.

  Blackwell matriculated in November 1846, was more or less well received by town and gown, and performed splendidly in all her courses, especially therapeutics. In the summer of 1848, she took her clinical instruction at the Philadelphia Hospital, where an epidemic of typhus was in progress. This outbreak in an Irish immigrant population prompted her to collect the records of its victims and to describe how it was spread from case to case; the account became her doctoral thesis. Recommending light, air, and soap, her small treatise is only somewhat less professional than Holmes’s on puerperal fever. Blackwell’s thesis also relied on the work of Dr. Charles Louis, quoting his 1829 book on the distinction between typhus and typhoid. (That is the volume, we recall from Middlemarch, to which Lydgate turns before he gives up his dreams of research to marry Rosamond Vincy.) By February 1849, Blackwell’s thesis had been published in the Buffalo Medical Journal and Review, and all that remained for her doctorate was to finish the two-year course of study, which she did with distinction. Her younger brother Henry described the scene of her graduation:

  The President taking off his hat rose, and addressing her in the same formula [as the others but] substituting Domina for Domine, presented her the diploma, whereupon our Sis, who had walked up and stood before him with much dignity, bowed and half turned to retire, but suddenly turning back replied: “Sir, I thank you; by the help of the Most High it shall be the effort of my life to shed honor upon your diploma.”

  The occasion was an event in both the United States and England, and the press by and large commented favorably. London’s Punch chimed in with lines that would have made Rosamond Vincy cringe:

  Young ladies all, of every clime

  Especially in Britain,

  Who wholly occupy your time

  In novels or in knitting,

  Whose highest skill is but to play

  Sing, dance, or French to clack well,

  Reflect on the example, pray,

  Of excellent MISS BLACKWELL! . . .

  For DOCTRIX BLACKWELL—that’s the way

  To dub in rightful gender—

  In her profession, ever may

  Prosperity attend her!

  Punch a gold-handled parasol

  Suggests for presentation

  To one so well deserving all

  Esteem and admiration.

  The degree won, Blackwell determined to become a surgeon. She was advised to seek the best clinical training possible and told that France was the place to obtain it. As we have seen, young American doctors properly regarded Paris as the fount of clinical science, and plucky Blackwell sailed off to the City of Light. Her adventures in Paris and afterward are described in a sparkling memoir, Pioneer Work in Opening the Medical Profession to Women, a volume that can stand comfortably on the shelf of meliorist literature somewhere between Thomas Wentworth Higginson’s Army Life in a Black Regiment and Middlemarch. Blackwell picked Paris as

  the one place where I should be able to find unlimited opportunities for study in any branch of the medical art. . . . On May 21, 1849, with a very slender purse and few introductions of any value, I found myself in the unknown world of Paris, bent upon the one object of pursuing my studies, with no idea of the fierce political passions then smoldering amongst the people, nor with any fear of the cholera which was then threatening an epidemic.

  Like young Oliver Wendell Holmes, who had come to Paris after the July Revolution of 1830, she arrived in the middle of social unrest. Like Holmes, she was thrilled by French sights and sounds; unlike Holmes, her first purchase was a new bonnet, “choosing plain grey silk, although I was assured again and again that nobody wore that color.” Blackwell required a new bonnet because, again unlike Holmes, she was no unknown quantity; and her few introductions of any value included one to the poet Alphonse Lamartine, the short-term head of the short-term Second Republic. Tocqueville had said of him, “I do not think I ever met in the world of ambitious egoists in which I lived any mind so untroubled by thought of the common good as his.” Blackwell was only somewhat more impressed:

  I was asked if I was a lady from America, for Lamartine is to most people in the country. I was shown through several antechambers into a drawing-room, where stood the poet entertaining some visitors, he bowed, requested me to wait a few moments and withdrew to his apartment: a lofty room, carved and richly gilded, three long windows opening on to a balcony and commanding a garden full of trees. The room contained a rich carpet and purple velvet couches, some portraits, an exquisite female profile in bas-relief, a golden chandelier from the ceiling, some antique vases, etc. and a soft green light from the trees of the large garden suffused the room.

  Lamartine received her with Gallic poise, appearing “very tall and slender, but the most graceful man I have ever seen, every movement was like music; grey eyes and hair.” Blackwell transmitted messages to him from friends in Philadelphia of the French Republic; Lamartine made amiable chatter in English—his wife was English—and said he was pleased to have these expressions of solidarity from friends of reform overseas. “There was perfect harmony in the man and his surroundings. Doubtless he is a true man, though unable to work into practice the great thoughts he cherishes.” So went the meeting between the liberal poet-politician of France and the first Anglo-Saxon female physician. (Her book makes livelier reading these days than his poems.)

  The next letter brought to her door none other than Dr. Louis himself, “then at the height of his reputation.” She felt instinctively that his visit was one of inspection. She told him she was in need of practical work in surgery, and after a long conversation he informed her of what she must do to be permitted to work at La Maternité hospital, where she would in a very short time become expert in “one small field of surgery, obstetrics and gynecology.” Shortly thereafter, with Louis’s intervention, she was admitted to the Maternité in the autumn of 1849 for a six-month course.

  In the enclosed world of the Maternité, teaching and practice were conducted by midwives (sages-femmes) in a convent-like atmosphere supervised by men. Her most intellectually stimulating companion was neither a midwife nor the professor in charge but the intern Hippolyte Blot. The two exchanged lessons in English and histology, spending hours at the young man’s microscope. Blackwell wrote in Pioneer Work,

  By such examination different formations can be distinguished from each other; thus cancer possesses very distinctive elements. It is necessary to examine bodies of varying shapes under different foci of the microscope, otherwise illusions may be created. In illustration he placed some blood globules and showed us that what appeared to be a central spot in each globule was owing to the convexity not being in focus, and it disappeared when the focus was a little lengthened.

  He is busy himself now in preparing for an examination of internes; if he gains the gold medal, he has the right to enter any hospital he chooses as an interne for a second term, and receive also his M.D., not otherwise granted to an interne. What chance have women shut out from these instructio
ns? Work on, Elizabeth!

  Today M. Blot spoke of a friend, Claude Bernard, a distinguished young inquirer, who is now, he thinks, on the eve of a discovery that will immortalize him . . . of the power which the liver has of secreting sugar in a normal state when animals are fed on certain substances which can be so converted; also of the curious experiment by which a dog was made, in his presence, to secrete albuminous or diabetic urine.

  Claude Bernard (1813–1878), who may be called the founder of experimental medicine, once remarked that science is like a brilliantly lighted banquet hall which can only be reached after walking through a warren of ghastly and ill-lit kitchens. Young Drs. Blot and Blackwell were in no bright hall at the Maternité. They were like Rosencrantz and Guildenstern in a Denmark of physiological chemistry, and Bernard’s finding that blood sugar came from liver glycogen was a towering Elsinore of mid-century science. This discovery, now called glycogenolysis, has led to an understanding of sugar and energy metabolism as well as of diabetes, did in fact make the “young inquirer” immortal, and one can construct a line of descent from Claude Bernard to the heroes of modern molecular biology—to James Watson and Francis Crick, François Jacob and Jacques Monod, David Baltimore and Paul Berg and Jim Bishop and Harold Varmus.

  With her appetite for the new, young Dr. Blackwell in Paris tasted not only real science but also the mock. On a rare day off from the sagesfemmes, she visited her sister Anna, who was living with another young American woman on the rue Fleurus (a street destined to become popular with American women: it was the future home of Gertrude Stein and Alice B. Toklas). From there the sisters went to a magnetic séance at the atelier of a socialite mesmerist, the Baron Dupotet. He, too, was at the height of his power, having recently converted half the alienists of England to the cause of what was to be known as “hypnosis.”

  The Blackwells were brought to a large, darkened room at the top floor of a large house on the Île de la Cité. A great portrait of Mesmer himself dominated the antechamber of the baron’s quarters, its frame encrusted with firebrands and anchors and other significant images; he looked fixedly at a pale lady opposite to him who had evidently undergone several magnetic crises. A great number of indecipherable verses were tacked to the walls and hanging from the ceiling. In this large waiting room, a shifting population of fifty or so people went to and fro. This included a lady with a hole in her cheek, the painter to the king of Sweden, the son of the English consul in Sicily, and “a remarkable fat dame, seated just within the folding-doors, who had powerful fits of nervous twitching, which gave her a singular appearance of pale tremulous red jelly,” as Elizabeth recalled in Pioneer Work. The baron’s inner chamber was smaller and ornamented by mystic symbols and black letter books of the Black Art. There was housed the inevitable oval metallic mirror “traced with magic characters which exerts a truly wonderful effect upon impressionable subjects, exciting an ecstasy of delight or a transport of rage.” One or another of the crowd would rush to grab it from the mesmerist; small amiable spats broke out over its possession.

  No miracles were wrought that day, Blackwell assures us. Nevertheless, the faithful audience hung with great interest on every example of hypnotism: “the aspiring features assumed a higher aspect, the downward ones bent more determinedly, and the red jelly became more tremulous at every fresh magnetization; and when the séance closed everybody shook everybody’s hand, and found it good to have been there.” Blackwell judged the baron an honest man who for twenty-five years had been pursuing difficult and arcane subjects; “how much truth he may possess I am quite unable to say, for my position . . . has given me no power of really investigating them.”

  Back with her patients at the Maternité for only a few days, a grave accident befell Dr. Blackwell: “in the dark early morning, whilst syringing the eye of one of my tiny patients for purulent ophthalmia,” some of the liquid spurted into her left eye. By nightfall on November 4, the eye had become swollen, and by the next morning, the lids were “closely adherent from suppuration.” The diagnosis of purulent ophthalmia, the dreaded venereal disease of newborns and those who attended them, was made by a young staff physician, and the twenty-eight-year-old Blackwell was placed in the student infirmary.

  We now know that the disease is caused by the gonococcus bacterium, is due to chronic gonorrheal infection of the female reproductive tract, and was part of the load borne by the prostitutes and working women who gave birth in the public hospitals of Paris. The bacteriological revolution has all but eliminated it, but Albert Neisser did not discover the microbe until 1879, and it was not until 1884 that Karl Credé showed that eyedrops of 1% silver nitrate on the lids of newborns were an effective prophylactic. Thanks to rigorous maternal health laws, by the beginning of the twentieth century prophylaxis had pretty much eliminated neonatal ophthalmia from advanced countries; today, unfortunately, it is making a comeback in Africa and Asia. But this was 1849, and Elizabeth Blackwell was treated by accepted methods of the day: cauterization of the lids, leeches to the temple, cold compresses, ointment of belladonna, opium to the forehead, purgatives, and footbaths. She was placed on a broth diet, and the eye was syringed every hour. “I realized the danger of the disease from the weapons employed against it,” she remembered. Her friend Blot consulted his chief and he was given permission to devote the first days of the illness entirely to her case. He came in every two hours, day and night, to tend the eye. But despite his efforts, after three days it became obvious to her doctors that the eye was hopelessly infected. “Ah! how dreadful it was to find the daylight gradually fading as my kind doctor bent over me and removed with an exquisite delicacy of touch the films that had formed over the pupil! I could see him for a moment clearly, but the sight soon vanished, and the eye was left in darkness.”

  She lay in bed with both eyes closed for three weeks, but then the right eye gradually began to open and she could start to do little things for herself. She immediately wrote to her uncle, an English army officer—her father had died in Cincinnati when she was much younger—assuring him of her resolution to continue her career in medicine: “I beg uncle to feel quite sure that a brave soldier’s niece will never disgrace the colours she fights under but will be proud of the wounds gained in a great cause.” She downplayed her injury and told him that the accident could have been worse—the left eye was not greatly disfigured and would in time appear less so. She finished her letter with the assurance that she could write without difficulty, read a little, and hoped very soon to return to her studies: “I certainly esteem myself very fortunate and still mean to be at no very distant day the first lady surgeon in the world.”

  As soon as she was up and about, she conspired with her sister to find a present for Hippolyte Blot, whose constant attention and compassion touched her deeply. “My friendship deepened for my young physician, and I planned a little present for his office.” A very elegant pair of lamps were secured by Anna, which Elizabeth, she wrote, “bundled up in my dressing gown and shawl, looking and feeling very much like a ghost,” hurried through the corridors to receive. That night she brought the lamps to Blot’s consulting room, and in the morning, the young intern “came to me evidently full of delight, and longing to be amiable, yet too conscientious to infringe the rules of the Maternité by acknowledging the present.” She was discharged on November 26 permanently blind in one eye. Despite her passionate ambition to be “the first lady surgeon in the world,” because of this handicap she disqualified herself from surgery or obstetrics as a career.

  She went to various spas in Germany to convalesce, and while there resolved to continue her training in medicine. She applied to St. Bartholomew’s Hospital in London, then perhaps the strongest teaching hospital of the city. The illustrious English physician Sir James Paget endorsed her admission as a student “in the wards and other departments of the hospital,” and on May 14 she was accepted at Bart’s. Once on the wards, her zeal for medical science was as high and her dreams of reform as ambitious as thos
e of any Lydgate or Holmes. She soon spotted the difference between the medicine of Paris and London at mid-century:

  I do not find so active a spirit of investigation in the English professors as in the French. In Paris this spirit pervaded young and old, and gave a wonderful fascination to the study of medicine, which even I, standing on the threshold, strongly felt. There are innumerable medical societies there, and some of the members are always on the eve of most important discoveries; a brilliant theory is almost proved, and creates intense interest; some new plan of treatment is always exciting attention in the hospitals, and its discussion is widely spread by the immense crowds of students freely admitted.

  Bart’s had its pleasures as well. Blackwell was courteously treated, saw the best of empirical medicine, and walked with men who, while not experimental or quantitative in approach, still felt clinical medicine in their sinews and knew how to examine patients. She wrote to her sister:

  This famous old hospital is only five minutes’ walk from my lodgings, and every morning as the clock strikes nine, I walk down Holborn Hill, make a short cut through the once famous Cock Lane, and find myself at a gate of the hospital that enables me to enter with only a side glance at Smithfield Cattle Market. . . . Mr. Paget spoke to the students before I joined the class. When I entered and bowed, I received a round of applause. My seat is always reserved for me and I have no trouble. There are so many physicians and surgeons, so many wards, and all so exceedingly busy, that I have not yet got the run of the place; but the medical wards are thrown open unreservedly to me either to follow the physician’s visits or for private study.