Steady, Uphill Work
Previously a student of the metaphysical, Elizabeth needed to discover if she could overcome the repulsion she felt for the corporeal nature of medicine. Her first exposure to anatomical studies was shepherded by a Dr. Allen who, knowing of her aversion, helped her to see the artistry of the body, igniting a newfound appreciation for the aesthetics of the subject. With this initial hurdle surmounted, Elizabeth sent letters of inquiry to medical schools in Philadelphia and New York. Invariably, she received rejections with repeating themes; either women were not physically able to withstand the rigors the education and training required, or it was considered immoral for them to have intimate knowledge of the body. Most especially, the idea of a woman receiving anatomical training along-side men was unconscionable.
When her letter of acceptance finally came, from a small school in Upstate New York, she had no idea that her admittance was actually the product of a practical joke. The faculty of Geneva College of Medicine, not wanting to refuse her entrance outright, had put the question of her admittance to the student body, assuming the young men would balk at the idea of studying along-side a woman. The students, assuming the application could only be a hoax, unanimously voted to admit Elizabeth.
To their surprise, the product of their joke arrived in November, 1847 to begin her studies. Though the citizens of Geneva gave her a wide berth and suspicious stares, she found her classmates to be ultimately accepting of her presence and respectful of her person. Her self-contained demeanor and commitment to her studies soon won the respect of the faculty. When one of her greatest supporters, Dr. James Webster, tried to dissuade her from attending anatomy lectures with the rest of the class, she sent a letter that was roundly applauded by the group and cemented her presence in the front-row for all demonstrations. When she graduated at the top of her class on January 23, 1849, the valedictory address, delivered by Dean Charles Lee, exalted Elizabeth as a novelty. Despite proof that a woman could fulfill the requirements of a medical course of study, even those who witnessed it first-hand were not prepared to agree that it was anything more than a fluke.
"…I commenced my anatomical studies in the private school of Dr. Allen. This gentleman by his thoughtful arrangements enabled me to overcome the natural repulsion to these studies generally felt at the outset. With a tact and delicacy for which I have always felt grateful, he gave me as my first lesson in practical anatomy a demonstration of the human wrist. The beauty of the tendons and exquisite arrangement of this part of the body struck my artistic sense, and appealed to the sentiment of reverence with which this anatomical branch of study was ever afterwards invested in my mind."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Gray's Anatomy was not published until ten years after Elizabeth completed her medical studies; but this illustration clearly demonstrates the beauty Elizabeth observed in these anatomical lessons, which ultimately helped her to overcome some of her aversions.
"But neither the advice to go to Paris nor the suggestion of disguise temped me for a moment. It was to my mind a moral crusade on which I had entered, a course of justice and common sense, and it must be pursued in the light of day, and with public sanction, in order to accomplish its end."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Before Elizabeth received her acceptance to Geneva, she was encouraged to travel to Paris to obtain her medical education. French society was more liberal and their medical knowledge more advanced; but Elizabeth's goal was not simply to become a practitioner, she was determined to complete the normal course of study required for a man to call himself a doctor. She would travel to London and Paris after graduation and avail herself of the empiricism adopted by French physicians. French students were educated at the bedside and the French did not abhor dissection as unnatural. The result was half a century of medical advances that American medical students clamored for, to increase their knowledge and their prestige.
"I therefore obtained a complete list of all the smaller schools of the Northern States…and sent in application for admission to twelve of the most promising institutions, where full courses of instruction were given under able professors. The result was awaited with much anxiety...At last, to my immense relief (though not surprise, for failure never seemed possible), I received the following letter from the medical department of a small university town in the western part of the state of New York."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Medical education of this era was sparse at best, with the American Medical Association being formed in 1847 to address the inconsistent and ineffective education most medical students received. Attendance at lectures for 16 weeks was required, two years in a row, with some preliminary years of study under the guidance of a practitioner. If a student managed to scrape together some observations in between terms, that was likely to be their only exposure to a real patient before receiving their diploma.
" I afterwards found that I had so shocked Geneva propriety…Feeling the unfriendliness of the people…hastening daily to my college as a sure refuge, I knew when I shut the great doors behind me that I shut out all unkindly criticism, and I soon felt perfectly at home amongst my fellow-students."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Despite the respectful distance most of her fellow students maintained, Elizabeth was regarded with suspicion by the citizens of Geneva. If they did not regard her with outright hostility, their interest was almost always salacious. Any friendship or comradary she developed with another student, led to rumours of marriage or inappropriate associations. She preferred the isolation this afforded her.
"The behavior of the medical class during the two years I was with them was admirable…I learned later that some of them had been inclined to think my application for admission a hoax, perpetrated at their expense by a rival college. But when the bona-fide student actually appeared they gave her a manly welcome, and fulfilled to the letter the promise contained in their invitation."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Dr. Lee's valedictory address highlights many crucial points in envisioning the medical sphere Elizabeth was entering. He laments the general public's limited understanding of medicine and thus, disappointingly low regard for physicians, while promoting the need to elevate the profession and advance understanding of the body and illness. He simultaneously acknowledges the first woman physician among their ranks, while directing his entire address to "the gentleman" of the graduating class.
"Knowing very little of practical medicine, I finally decided to spend the summer, if possible, studying in the hospital wards of the great Blockley Alms House of Philadelphia."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
As the medical curriculum afforded almost no practical training, students were responsible for seeking their own clinical opportunities between terms. The awakening Elizabeth experienced at Blockley, where the poorest of Philadelphia society suffered through debilitating illness in inhumane conditions, was pivotal. Though she chose to write her thesis on the typhoid cases she observed here, significant time spent in the women's Syphilis wards opened her eyes to the moral degeneration of society, which she would proselytize against for the duration of her career.
"But this terrible epidemic furnished an impressive object-lesson, and I chose this form of typhus as the subject of my graduation thesis, studying in the midst of the poor dying sufferers who crowded the hospital wards."
Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Elizabeth Blackwell (1895)
Elizabeth observed throngs of Irish immigrants fleeing the famine, exiting ships infected with typhoid fever, spilling into the halls of Blockley Almshouse. Her thesis shows great insights regarding how little was actually understood about disease; germ theory was mocked as quakery, in favor of the miasma theory that blamed "bad air" for the spreading of illness. Yet, her writings also demonstrate little sympathy for the patients, who she observed in a rather calculated manner.
"After the degree had been conferred on the others, I was called up alone to the platform. The President, in full academical costume, rose as I came on the stage, and, going through the usual formula of a short Latin address, presented me my diploma. I said: 'Sir, I thank you; it shall be the effort of my life, with the help of the Most High, to shed honour on my diploma.' The audience applauded..."
Excerpt from Journal (1849)
The same residents of Geneva who had ridiculed her turned out in droves to witness the conferring of diplomas. When she was invited to process down the aisle with the rest of the graduates she refused, pointing out that parading in public was inappropriate for a lady. After the ceremony, her brother Henry escorted her out of the First Presbyterian Church past an enthusiastic crowd that included many women.