Hobart and William Smith Colleges

Nineteen ninety-nine marks the 150th anniversary of the entrance of women into the modern regular medical profession. On January 23, 1849, Elizabeth Blackwell (February 3, 1821 – May 31, 1910) received her M.D. from Geneva Medical College (the precursor of the Syracuse Health Science Center College of Medicine), the first such degree earned by a woman anywhere in the world.

She was born in Bristol, England, the third daughter among the nine children of a sugar refiner, Samuel Blackwell, and his wife, Hannah. The family was very close-knit, and all felt a spirit of reform, dissent, and progressive political thinking. For example, they believed in free and equal education for both sexes, a radical notion in those days. Most of the children, not just Elizabeth, would later become prominent in social reform movements. When the father’s business collapsed in 1832, the family left England to start over in America. By her mid-20s, Elizabeth had lived in New York, New Jersey, Cincinnati, Kentucky, North and South Carolina, and Philadelphia, mostly under adverse financial circumstances. She taught school, but also studied medicine privately under Dr. Samuel Dickson in Charleston, South Carolina and Dr. Joseph Warrington in Philadelphia. Her circle in Philadelphia consisted mainly of Quaker liberals, abolitionists, and other reformers, who noticed her talent for medicine and urged her to try to break the gender barrier in that profession.

Dr. Blackwell was not the first woman to practice medicine or to be recognized as a physician. Women have been practicing medicine, both openly and secretly, since ancient times. She was not even the first to practice in America. That distinction probably belongs to Harriot Kesia Hunt (1805-1875), who practiced openly for about 20 years in Massachusetts before being allowed to attend lectures at Harvard Medical School in 1850 and receiving an honorary M.D. from Woman’s Medical College of Pennsylvania in 1853. But by modern educational and credentialing standards, Blackwell was the first woman in the world to earn a regular M.D. degree from a regular or accredited medical school by means of satisfying the standard requirements of a full course of study.

Reacting to the general outrage of the medical community, Geneva Medical College immediately shut its doors to women following Elizabeth Blackwell’s graduation. Even though she had been graduated at the top of her class, the powers-that-be declared her a freak whose unnatural example ought not to be followed by other women. In the early 1850s not even her sister Emily could persuade Geneva to relax its new policy (although there is a record of a Martha A. Rogers receiving an M.D. from Geneva in 1865). Emily Blackwell (1826-1910) finally received her M.D. from Cleveland Medical College in 1854, after having been rejected by several other American medical schools besides Geneva, and after having been expelled from Rush Medical College in Chicago because of her gender.

As schoolmate Stephen Smith tells the tale in his appendix to Blackwell’s autobiography, when her application reached Geneva in 1847, her rejection was a foregone conclusion. The faculty saw in it an opportunity to improve their relations with the students. They submitted the decision to the students, but with the stipulation that the decision must be unanimous. The students, for their part, saw a great opportunity to play a tremendous practical joke on the faculty by letting the woman in. They achieved unanimity by beating up the lone holdout until he capitulated. The astonished faculty, against their will but bound by their word of honor, had no choice but to admit her.

The story of Elizabeth Blackwell’s 15 months as a student at Geneva Medical College epitomizes the nature of mid-nineteenth century prejudice against women physicians and medical students. With few exceptions, the Geneva community treated her terribly. Doctors’ wives refused to speak to her. Townies stared at her as if she were an exotic animal. Many regarded her as either a lewd woman, or insane, or both, and in any event someone sure to be a bad influence on children. Professor James Hadley, the registrar, promised her letters of recommendation but never sent them.

Professor of Anatomy James Webster was her only champion among the faculty. He supported her forthrightly, personally, and actively.

Geneva was a rowdy place in 1847. Webster’s colorful vulgarity made him exceedingly popular in this macho environment. Prior to Blackwell’s arrival, he enjoyed a grand reputation among the students for his jovial manner and especially for the ribald jokes he would tell in connection with his dissections of the male reproductive system. Although he had welcomed Blackwell from the start, he politely suggested that she not attend that particular session. But when she offered him sound reasons why she should attend, he relented, and confessed to the whole class that he had been justly rebuked. Stephen Smith discusses this incident at some length in her autobiography and concludes that her presence in Webster’s course lifted the minds of professor and students alike out of the gutter and forced the students to concentrate instead on actually learning the material.

As Dean of the Faculty of Medicine, it was Dr. Charles Alfred Lee who delivered the valedictory address at her commencement. In this speech he invariably called his audience just “Gentlemen” — as if sarcastically alluding to the fact that not all of the people in his audience were physically capable of ever becoming gentle “men.” Yet his rhetoric, if he had been sincere (and Blackwell apparently thought he was), may have been applauded even by feminists, for he lavishly and specifically praised the thoroughness and integrity of Blackwell’s study of medicine. But then he added: “Such cases must ever be too few, to disturb the existing relations of society, or excite any other feeling on our part than admiration at the heroism displayed, and sympathy, for the sufferings voluntarily assumed!” In other words, Lee and most of his colleagues would have been quite happy if she had been not only the first, but also the last woman ever to receive a degree in medicine.

The Grand Debate

Immediately after Blackwell’s graduation, a vigorous debate about women physicians arose in the Boston Medical and Surgical Journal (now the New England Journal of Medicine). The pseudonymous “D.K.” wrote a particularly venomous letter to the editor. Lee went on the defensive. Referring to himself in third person, Lee replied to D.K. in a footnote to the published version of his valedictory address: “... he acknowledges the validity of the argument, so far as it is founded on the general physical disqualifications of the sex for the medical profession, and the incompatibility of its duties, with those properly belonging to the female portion of society, believes, nevertheless, that instances occasionally happen, where females display such a combination of moral, physical, and intellectual qualifications for discharging creditably and skilfully the duties belonging to our calling, that it would seem equally unwise and unjust, to withhold from them those advantages and those honors, which are open to nearly all others, whether deserving of them or not. While he holds this opinion, he at the same time feels bound to say, that the inconveniences attending the admission of females to all the lectures in a medical school, are so great, that he will feel compelled on all future occasions, to oppose such a practice, although by so doing, he may be subjected to the charge of inconsistency.”

Defending his institution for having admitted and graduated a woman and apologizing to male medical students for having “inconvenienced” them with her, Lee thus admitted that he would rather be both “unwise and unjust” than participate in creating any further “inconveniences” for men.

D.K.’s letter was answered the following week by the pseudonymous “Justus”: “Even admitting the correctness of D.K.’s remarks in general, with respect to woman’s unfitness for engaging in the practice of medicine, it would be strange indeed if exceptions did not occasionally occur. From all we have been able to learn respecting Miss B., she is emphatically an exception. Exceptio probat Regulam.”

The names “D.K.” and “Justus” are both phonetic puns on the word “justice,” the latter directly, the former indirectly by way of the Greek dikê. Why did these two authors, presumably each secure in the courage of conviction, feel the need to hide behind the veil of noms de plume? Plainly the greatest obstacle that Blackwell had to overcome was neither the alleged physical, intellectual, and moral limitations of her sex nor even the open hostility of conservatives such as “D.K.,” but rather the entrenched hypocrisy or crypto-misogyny of liberals like Lee, “Justus,” and their fellow “gentlemen” who believed that the only way for a woman to become a doctor legitimately would be first to “defeminize” herself and assume instead the purely “masculine” moral and intellectual characteristics of medical men.

Opening Medicine to Women

Facing such deterrents in America, and wanting to become a surgeon, Blackwell decided — correctly — that she could best further her postgraduate medical education in Europe. She arrived in Paris in May 1849 to begin her residency at La Maternité in June. In November of that year, while syringing the eyes of a child with purulent ophthalmia, she accidentally splashed her own eye and contracted the disease herself. The resultant blindness of her left eye effectively precluded a career in surgery.

Throughout her life, her self-control, perseverence, and optimism were remarkable. Progressive women of that era managed to survive and prosper professionally and personally in many different ways, e.g., M. Carey Thomas by her iron will, Susan B. Anthony by her unusual political alliances, Emily Blackwell by her keen administrative ability, Matilda Joslyn Gage by her absolute, almost fanatical devotion to liberty; but Elizabeth Blackwell seemed to do it by sheer optimism, her unshakable belief that everything would turn out all right in the end. Her example inspired countless women, and she in turn was inspired by them.

She left Paris to pursue postgraduate medical studies briefly at St. Bartholomew’s Hospital in London, then returned to America in 1851, but not before she had begun a lifelong friendship and collaboration with Florence Nightingale. She became increasingly interested in social causes, especially those regarding the political and educational status of women. Unable to overcome the prejudice against her, unable to establish herself in New York City either in private practice or as a hospital-affiliated physician, she resolved to found her own infirmary in New York City. After 1854 Dr. Marie Elizabeth Zakrzewska and after 1856 Dr. Emily Blackwell helped her with this project. The result was her greatest achievement. The New York Infirmary for Women and Children, now known as the Beekman Downtown Hospital, opened in May 1857 with “Dr. Zak” as chief resident and Emily as chief of surgery. It grew steadily, developing programs of medical social work and nurses’ training as well as caring for pediatric, obstetrical, and gynecological patients. Under Emily Blackwell’s administration, it ran a medical school for women from 1868 to 1899. Emily closed the school only after she was satisfied that Cornell University Medical College would give equal training to both sexes and after she had arranged for all of her students to transfer to Cornell.

After her doctoral dissertation on epidemic louse-borne typhus was published in the February 1849 issue of the Buffalo Medical Journal, Elizabeth Blackwell became a prolific author. Her masterpiece was her autobiography, Pioneer Work in Opening the Medical Profession to Women (1895).

Some of Elizabeth Blackwell’s published books and pamphlets are:

 

• Medicine and Morality (1850)
• The Laws of Life with Special Reference to the Physical Education of Girls (1852)
• An Appeal in Behalf of the Medical Education of Women (published anonymously, 1856)
  Address on the Medical Education of Women (1856)
  Medicine as a Profession for Women (co-authored with Emily, 1860)
  
• Address on the Medical Education of Women (co-authored with Emily, 1864)
• How to Keep a Household in Health (1870)
• Lectures on the Law of Life (1871)
• The Religion of Health (1878)
• Counsel to Parents on the Moral Education of Their Children (1878 second edition published in 1879 as The Moral Education of the Young in Relation to Sex, Under Medical and Social Aspects)
• Christian Socialism (1882)
  
• Rescue Work in Relation to Prostitution and Disease (1882)
• Wrong and Right Methods of Dealing with Social Evil, as Shown by English Parliamentary Evidence (1883)
• The Human Element in Sex (1884)
• On the Decay of Municipal Representative Government (1885)
  
• A Medical Address on the Benevolence of Malthus, Contrasted with the Corruptions of Neo-Malthusianism (1888)
  
• The Influence of Women in the Profession of Medicine (1889)
• Why Hygienic Congresses Fail (1892)
• Pioneer Work in Opening the Medical Profession to Women (1895)
• Scientific Method in Biology (1898)
• Essays in Medical Sociology (1899).

Professional Refuge

In 1854, when she was 33 and had already determined not to marry, she adopted Katharine (Kitty) Barry, a 7-year-old American orphan. Kitty became absolutely devoted to her, always living with her, always calling her “Doctor,” and not changing her own name to “Blackwell” until after Elizabeth’s death.

From the late 1850s until she finally settled in England in 1869, Elizabeth Blackwell was back and forth across the Atlantic. One curious consequence of her seeking professional refuge in Europe was that, in addition to being the first woman doctor in America, she was also the first woman doctor in Great Britain. In 1858, largely through the influence of Sir James Paget, who had secured her internship at St. Bartholomew’s eight years earlier, she became the first woman to be entered in the British Medical Register. This was no mean feat. Such listing is tantamount to being licensed to practice medicine in Great Britain. In 1859 the young British feminist Elizabeth Garrett Anderson (1836-1917) was inspired by meeting Blackwell to try to become the first woman to earn a medical degree in Britain. She was refused admission by every British medical school but found a loophole in the British Society of Apothecaries regulations, sat for their qualifying examination, passed it in 1865 and thus became in 1866 the second woman in the British Medical Register. The Society of Apothecaries immediately changed its regulations specifically to bar women. A third woman did not appear in the British Medical Register until 1877 when Sophia Jex-Blake and four other women, all with Swiss M.D.s, were added.

In the American Civil War Elizabeth Blackwell, with guidance and support from Florence Nightingale, organized relief efforts, promoted sanitary services, and trained nurses. She established a prosperous private practice in England in the 1870s, helped to found the British National Health Society in 1871, and held the Chair of Gynecology at the London School of Medicine for Women from 1875 until she retired in 1907 at the age of 86. She died at her home, Rock House, in Hastings, and is buried in Kilmun, Scotland, a place that she and Kitty particularly enjoyed visiting in later life.

By the 1870s, women were well established as co-educational medical students in the United States. America was slightly ahead of Europe in this regard. At the Syracuse University College of Medicine, for example, no fewer than 11 women received the M.D. between 1873 and 1878. Sarah Van Tuyl was the first of these, and there is no indication that she was the victim of any sort of sustained or systematic gender prejudice as a medical student. Syracuse University, founded by socially progressive Methodists in 1870, was co-educational in all departments from the start. Its medical school was the reincarnation of Geneva Medical College, which had recently been abandoned by its parent institution, Hobart College. In 1876 it graduated Sarah Loguen Fraser, the country’s fourth African-American woman physician (see the Summer 1998 Alumni Journal).

After 1849 the percentage of women physicians in America steadily increased, until it was about 10 percent in 1914. The situation had improved so much by 1889 that Blackwell wrote: “The avenues by which all may enter into the profession are now so much more widely thrown open, that there is little difficulty in the way of any man or woman who may wish to acquire a legal right to practice medicine.” Ever the optimist, she painted perhaps too rosy a picture of the reality. After 1914 began a decrease and a leveling off that did not rebound until the 1970s. Women were only about 6 percent of all American physicians in 1924, 7.8 percent in 1970, 9.1 percent in 1975, and 11.6 percent in 1980. But the most recent statistics available from the AMA show that as of December 31, 1997, 22 percent of American physicians were women, the highest percentage ever, and still climbing.

Women as Percentage of all Practitioners in Selected Medical Specialties
Pediatrics 46.2%
Medical Genetics 41.2%
Ob/Gyn 31.9%
Dermatology 30.2%
Psychiatry 27.9%
Public Health 25.9%
Family Practice 25.4%
Internal Medicine 25.3%
Radiation Oncology 22.1%
Anesthesiology 19.9%
General Surgery 9.2%
Plastic Surgery 8.8%
Otolaryngology 8.2%
Cardiology 7.0%
Aerospace Medicine 6.4%
Proctology 5.7%
Thoracic Surgery 4.8%
Neurosurgery 4.4%
Orthopedic Surgery 3.3%
Urological Surgery 2.6%

Source: AMA Physician Characteristics and Distribution in the U.S., 1999 (data as of December 31, 1997)

The struggle of women physicians since the time of Elizabeth Blackwell has been threefold:

1. To gain acceptance as doctors, i.e., to be allowed to be licensed, to join medical societies, to receive hospital admitting privileges, and in general to be allowed to use to their medical credentials as freely as their male colleagues.
2. To gain acceptance as women. In the nineteenth century, both the proponents and opponents of women’s medical education agreed that a woman as a woman could not become a doctor; in order to become a doctor she must first become “manlike” in the appropriate ways. Also, such “defeminization” always had to remain the exception. As long as the consensus of the medical community was that women doctors were to be “exceptions,” society placed women doctors in the psychological dilemma of having to choose between success as physicians and identity as women.
3. To be allowed to specialize in whatever field they choose. Even after the female M.D. was more widely accepted toward the end of the nineteenth century, women physicians were still expected to provide only obstetrical, gynecological, pediatric, or public health services. Men were willing to accept women physicians as glorified midwives, but as little else. Society saw female physicians as “female physicians,” not “female physicians.” Typically they were associated in some way with sexual matters and were expected to go into the “softer” specialties or to take care of only children and other women. Gender-neutral specialties such as ophthalmology, orthopedics, and surgery have until very recently been mostly off-limits to them.
4. As regards the specialties, nineteenth-century views of women in medicine still appear to hold sway statistically.

Blackwell wrote in 1889 that the duty of medical women was not to imitate medical men, but to define ever more clearly what is morally right and wrong in medicine. For her, the entrance of women into medicine made the profession in general more moral, i.e., more responsive to a wider variety of human needs than men alone recognize. This is because the “high moral life, enlarged by intelligence” is the natural “ideal of womanhood.” “It is through the moral, guiding the intellectual, that the beneficial influence of women in any new sphere of activity will be felt.”

Honoring the Struggle

Since 1986, the Health Science Center at Syracuse has set aside one day in February each year as “Elizabeth Blackwell Day” to provide an opportunity for reflection on her legacy and the continuing odyssey of women in medicine. This annual celebration usually includes a distinguished visiting lecturer, a local speaker, and a reception. It is organized by a faculty advisor, currently Associate Professor of Anatomy and Cell Biology Susan B. Stearns, Ph.D., and a committee of students.

The portrait of Elizabeth Blackwell on the cover of this issue is an oil painting by the late J.S. Kozlowski of East Syracuse. It was commissioned as a gift to Upstate Medical Center in 1963 by Alpha Epsilon Iota, the medical student sorority, whose president at the time was third-year medical student Patricia J. Numann, M.D. ’65, now professor of surgery at University Hospital. Among the significant events at the dedication ceremony for the portrait in 1964 was Upstate President Carlyle F. Jacobsen’s announcement of the naming of “Elizabeth Blackwell Street” on campus. The portrait now hangs in the Health Sciences Library and has become quite famous, having appeared on a U.S. postage stamp and the cover of JAMA.

Eric v.d. Luft, Ph.D., M.L.S. is Curator of Historical Collections, Health Sciences Library. lufte@mail.upstate.edu.