No One Knew How to Regard Me
Furnished with her diploma, Elizabeth had attained her initial goal; but in order to fulfill the work and duties of a physician, she knew she would need considerable clinical training, which was even more difficult to obtain than the degree had been. American Medical schools of the time, unlike their European counter-parts, or even law schools and liberal arts colleges, had no entrance requirements beyond the payment of fees. The only difficulty had been in getting a school to accept her application. Once admitted, she had only to attend the lectures and pass the examinations and no one could deny her the degree. Access to clinical settings was another matter entirely. She had to scheme her way into Blockley Almshouse in Philadelphia, where she went to study during the summer break from Geneva. Knowing of the in-fighting among Trustees at Blockley, she made sure to introduce herself to members representing all political parties. Through her determination and modesty she convinced the leaders of the Whig, Democratic and Know-Nothing factions of her worthy petition and sent them all to the meeting prepared to argue on her behalf, only to discover themselves in unanimous agreement. Blockley was always short-staffed and the indigent patients were in no position to complain about the gender of a willing physician. Her experiences here furnished her with enough clinical knowledge to write her thesis, which was published with praise.
After graduation, the newly-minted Dr. Blackwell returned to Philadelphia and continued to make inroads, even gaining entrance to lectures at the esteemed Jefferson School of Medicine. But like many medical students of the time, she knew the best course of clinical study was to be found overseas. She set sail for Europe in April of 1849, intent on a brief stay in her native England before continuing on to Paris.
Upon arriving in London she was furnished with professional and social engagements to enthrall her mind and exhaust her energies. She toured the Hunterian Collections of the Royal College of Surgeons, attended lectures and toured the wards at St. Thomas’s and St. Bartholemew’s Hospitals, and was invited into the homes of many esteemed physicians. While her welcome was collegial it was confined to shallow encounters that did not serve her need for continuing clinical experience. She soon moved on to France, where the practice of medicine was more advanced, and where the emphasis on egalité could work to her advantage.
Disappointed in the atmosphere of Paris and frustrated at the lack of opportunity it afforded her, she committed herself to a term of service at La Maternité. Though they would not accept her as a qualified doctor and she was forced to reside and train as a student, along with the other young midwives in training sent from each province, she gained a wealth of experience in dealing with a spectrum of issues caused or related to the process of birth. She would struggle with the restrictive lifestyle and the exhausting work, but would acknowledge the breadth of experience it afforded her. It was during this time that she was infected during a routine treatment of an infant born with a syphilitic infection of the eye. While syringing the eye, infected liquid was rebounded into her left eye. Perhaps due to the care of her colleagues at la Maternité, she retained sight in her right eye. After taking the water cures available in Switzerland, a severe attack found her back in Paris where what was left of her damaged eye was removed and replaced with a glass prosthetic. Her dream of being a practicing surgeon was abruptly ended, even while the invaluable experiences gained had her feeling like a physician in the truest sense.
"This morning I called on Dr. Carpenter, who has written those admirable works on physiology…I have just returned from Dr. C's delightful little party…His microscopes, said to be the most beautiful in England, were there. His preparations were exquisite: the lung of a frog most minutely injected, a piece of shark skin which seemed covered with innumerable teeth and piles of other specimens."
Excerpt from letter of (May 1849)
William Benjamin Carpenter was an English physician and physiologist, with a scientific interest in marine zoology. His most famous work was The Use and Abuse of Alcoholic Liquors in Health and Disease (1850); considered a temperance book, it was the first to appropriately classify alcoholism as a disease. He was instrumental in the establishment of the University of London, and his research in marine zoology led to a growth in deep-sea exploration culminating in the 1868 oceanographic survey with the HMS Lighting and the more notable Challenger Expedition.
"Thursday morning I visited my first hospital, St. Thomas's…The surgeon to whom I sent my letter of introduction knew nothing about me, thought it was a very indelicate undertaking, and simply sent me a line to one of the nurses, with the request that I would not enter any of the men's wards. I swallowed the indignity...the senior surgeon, who had come on purpose to meet me and show me everything...paid me the utmost attention, and pointed out everything."
Excerpt from letter (May 1949)
Experiences at St. Thomas's were typical of her sojourn in Europe. At St. Bartholomews in London, as well as La Maternité and other hospitals in Paris, she was often shunned by many of the clinicians. They would refuse her access to the wards or contact with the patients. All instruction and explanations would cease upon her entrance, and charts and notes were removed from patient beds. Usually, one or two doctors would welcome her and assist her where they could, giving her enough access to make the effort worthwhile.
"But he [Dr. Webster of Geneva Medical College] tells me my thesis was commented on in the Report on Medicine at the National Medical Convention in Boston, and their [Geneva College of Medicine] course in relation to me justifed and approved. The thesis was received with applause."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Elizabeth's thesis was published at the insistence of Dean Lee, who felt it did her and the college credit. She demurred and felt strongly that it was a student's composition and nothing more, but she showed herself to be a keen observer and staunch believer in the relationship between good health and moral living. She would retain these convictions for the duration of her life and many of her publications exalt this theme.
"I felt all afternoon a little grain of sand, as it were, in one eye. I was afraid to think what it might be, for in the dark early morning, whilst syringing the eye of one of my tiny patients for purulent ophthalmia, some of the water had spurted into my own eye. It was much swollen at night, and in the morning the lids were closely adherent with suppuration."
Excerpt from letter (November 4, 1849)
During her stint at La Maternité Dr. Blackwell had an unfortunate accident. While syringing the eye of an infant with purulent ophthalmia, a syphilitic infection, some of the infected liquid rebounded into Elizabeth's left eye. The ensuing weeks would be filled with pain and uncertainty, knowing full well what havoc this kind of infection could cause.
"I dispatched a note to my sister, and then active treatment commenced -- the eyelids cauterised, leeches to the temple, cold compresses, ointment of belladonna, opium to the forehead, purgatives, footbaths, and sinapisms, with broth for diet. The eye was syringed every hour, and I realised the danger of the disease from the weapons employed against it."
Excerpt from letter (November 5, 1849)
The treatments described are indicative of medical practice at the time. Though syphilis is easily treated with penicillin it would not be discovered until 1928. Syphilis was very commonly treated with mercury and other harmful methods. Luckily, Dr. Blackwell's infection was contained to one eye and she did not suffer ill-effects from the various treatments. She did lose the sight in her left eye, and her intentions of practicing surgery were never realized.
"In truth, dear friends, the accident may have been so much worse, that I am more disposed to rejoice than to complain. Even in its present state the eye is not a very striking disfigurement, and it will gradually become less so. As to the more serious consideration -- loss of vision -- I still hope to recover that in time, and meanwhile, the right eye grows daily stronger. I can write without difficulty, read a little, and hope soon to resume my usual employments. I certainly esteem myself very fortunate, and I still mean to be at no very distant day the first lady surgeon in the world."
Excerpt from letter to her uncle (undated)
In the attached letter, Dr. Blackwell discusses plans to remain at La Maternité, despite the deprivations of the lifestyle. Acknowledgement of the invaluable experience is weighed against the loss of personal freedoms, as she was only allowed to leave the grounds one day each month, the hours were long and the outcomes often poor for infants and mothers.
"At first no one knew how to regard me…Mr. Paget, who is very cordial, tells me that I shall have to encounter much more prejudice from ladies than from gentleman in my course. I am prepared for this…But a work of the ages cannot be hindered by individual feeling. A hundred years hence women will not be what they are now."
Excerpt from letter (November 1, 1850)
The doors opened in the medical field could have far reaching impacts for women. The stirrings of the Women's Rights movement were beginning and more and more women were looking for employment outside the home, which often meant they would forgo traditional roles of wife and mother.
"I am obliged to feel very sceptical as to the wisdom of much of the practice which I see pursued every day. I try very hard to believe, I continually call up my own inexperience and the superior ability of the physicians whose actions I am watching; but my doubts will not be subdued, and render me the more desirous of obtaining the bedside knowledge of sickness which will enable me to commit heresy with intelligence in the future, if my convictions impel me to it."
From letter to Dr. Dickerson (c. November 28, 1850)
A month before she was to graduate, the almost-Dr. Blackwell spent a solitary New Year in Geneva. With little social engagement and no funds, she spent her time testing her skills. She paid house calls to a family suffering from flu and stayed two days. When she fell sick, she eschewed the remedies prescribed in her textbooks and treated herself with sleep, baths and walks in the cold air. She saw her recovery as proof that her skepticism was well-founded, and she retained it for the rest of her career.
"In both Philadelphia and Boston attempts were being made to form medical schools for women. My sister Emily also had adopted the medical life. She had entered the Medical College of Cleveland, Ohio, and was looking forward to joining me ultimately in the medical work."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Dr. Blackwell was joined in her work by her younger sister Emily. At her sister's insistence, Emily followed in her footsteps and their careers would be interwoven for the duration. Elizabeth would prefer study to the actual practice of medicine while Emily would fulfill the ultimate goal of becoming a surgeon after Elizabeth's accident in Paris resulted in the loss of sight in one eye.
"The first seven years of New York life were years of very difficult, though steady, uphill work. It was carried on without cessation and without change from town, either summer or winter. I took good rooms at University Place, but patients came very slowly to consult me. I had no medical companionship, the profession stood aloof, and society was distrustful of the innovation. Insolent letters occasionally came by post, and my pecuniary position was a source of constant anxiety."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895), pg. 190
After her study in Paris Dr. Blackwell returned to London and began to transition from student to practitioner. When she returned to New York she received praise from such influential persons as Horace Greeley and word of her practice spread. Despite her notoriety, patients were in short supply. The term female physician was still closely connected to the women who supplied early birth control and, if those failed, abortives. With these predecessors to contend with, Elizabeth found herself with no patients and no income.
"In 1852, warmly encouraged by Mrs. Dr. Bellows, I published the lectures I had given, under the title, 'The Laws of Life in Reference to the Physical Education of Girls'. This little work was favourably regarded by physicians; it drew forth an encouraging letter from the dean of my college, to my great gratification. It also happened to fall under Mr. Ruskin's notice, and gained his valuable commendation."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
With few patients to treat in her early years of return to America, Dr. Blackwell spent considerable time drafting essays and offering lectures on issues pertaining to healthy children, especially girls. In these lectures, she expounds the benefits of hygiene and exercise as the source of good health and makes little mention of curatives or treatments.
"The most painful experience which I met with in practice was the death of one of my little patients from the effects of vaccination. This baby, though carefully tended and the lymph used guaranteed pure, died from phagedenic ulceration set up by vaccination in a rather scrofulous constitution. To a hygenic physician thoroughly believing in the beneficence of Nature's laws, to have caused the death of a child by such means was a tremendous blow!"
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Dr. Blackwell firmly believed in the curative effects of fresh air and water, and was often skeptical of the materia medica of the times.