Wednesday, March 21, 2012

Women's History Month - Elizabeth Blackwell - helping other women

It is not easy to be a pioneer - but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world. 
Portrait hanging in the Health Sciences Library, at the
SUNY Upstate Medical University.
Painted by Joseph Stanley Kozlowski in 1963

The final installment in my three part series about Elizabeth Blackwell, each covering one of the three main periods of her life -- her childhood and early education, her time in medical school and early career, and her professional life and efforts to improve educational opportunities for women.

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In 1853, she opened a small dispensary near Tompkins Square with the assistance of a Quaker friend of hers, Mrs. Cornelia Hussey.
Being still excluded from medical companionship, and from the means of increasing medical knowledge which dispensary practice affords, I finally determined to try and form an independent dispensary.
She gave lectures and hosted meetings in her home, promoting medical education and opportunities for women, and began mentoring a German woman pursuing a medical education, Marie Zakrzewska. Although she made a concerted effort to create a welcoming environment for women studying medicine, she would have preferred women students to be able to study freely alongside male students.
The clear perception of the providential call to women to take their full share in human progress has always led us to insist upon a full and identical medical education for our students. From the beginning in American, and later on in England, we have always refused to be tempted by the specious offers urged upon us to be satisfied with partial or specialised instruction. 

It was tough to be a career woman of any kind at the time, but probably more difficult for one in such an unusual position and who had to keep such off hours.
The difficulties and trials encountered at this early period were severe. Ill-natured gossip, as well as insolent anonymous letters, came to me. Although I have never met with any serious difficulties in attending to my practice at all hours of the night, yet unpleasant annoyances from unprincipled men were not infrequent. Some well-dressed man would walk by my side on Broadway, saying in a low voice, 'Turn down Duane Street to the right;' or whilst waiting for a horse-car at midnight by the City Hall a policeman would try to take my hand; or a group of late revellers would shout across the street, 'See that lone woman walking like mad!'
In 1857, Elizabeth, her sister Emily, now also a doctor, and her protegĂ© Dr. Marie Zakrzewska, expanded the original dispensary into the New York Infirmary for Indigent Women and Children. A remarkable institution, with women serving on the board of trustees, the executive committee, and as attending physicians, it was the first of its kind. It served as a nurse's training facility, accepted both in- and out-patients, and doubled its patient load in the second year.  This institution still exists as the New York University Downtown Hospital.

During this time, she adopted a young Irish orphan named Kitty Barry, to help assuage a sense of loneliness and to enrich her life. She provided for Kitty’s education, and even instructed Kitty in gymnastics, using the theories she had outlined in her publication, The Laws of Life with Special Reference to the Physical Education of Girls.
An amusing circumstance relating to this child is worth recording. She had always been accustomed to call me 'Doctor.' on one occasion she was present during the visit of a friendly physician. After he was gone, she came to me with a very puzzled face, exclaiming, 'Doctor, how very odd it is to hear a man called Doctor!'
Even with her work in New York, she still worked for women's health and opportunities on a larger scale. Elizabeth made several trips to England and Europe to raise funds to establish a special women's infirmary there. Under a clause in the Medical Act 1858 recognizing doctors with foreign degrees practicing in Britain, she was able to become the first woman to have her name entered on the General Medical Council's medical register. In 1860, she published Medicine as a Profession For Women.

When the civil war broke out, it's no surprise that Elizabeth sympathized heavily with the North with her history of abolitionist activities. She even stated she would leave the country if the North compromised on the issue of slavery. She and her sisters were active in the war efforts and volunteered their services to the medical corps' nursing efforts. There was some resistance on the part of the male-dominated United States Sanitary Commission, entrusted with the duty to train the nursing staff. The male physicians refused to help with the nurse education plan if the Blackwell sisters were involved. Instead, the New York Infirmary team worked with Dorthea Dix to train nurses for the Union effort.

"The anatomy lecture room at the Woman's Medical College of New York Infirmary."
Frank Leslie's Illustrated Newspaper, April 16, 1870. Library of Congress
Although the war certainly took precedence, she continued her advocacy for opportunities for women in medical programs, and in 1864 she published Address on the Medical Education of Women.  After the war, she returned to her infirmary, and worked to broaden its services. By 1866, they were treating nearly 7,000 each year. While she was unable to establish a special hospital in Europe, in 1868 she opened a medical college for women as part of her New York infirmary. This was her opportunity to enact her ideas about improving the general method of medical education, increasing the customary 16 months of study to a four-year training period, with much more extensive clinical training. Her first class had fifteen students and nine faculty members, including Elizabeth and her sister Emily.

In 1869, she return to England, where she spent the last 40 years of her life. This may have been because she and her sister Emily had a falling out, but it had also always been her plan to return to London to try to establish medical education for women there. While she was there, she also spent time on her other interests, including reform and intellectual activities. She moved into more powerful social circles. She traveled frequently. And in 1871, she co-founded the National Health Society.

In 1874, she joined forces with Sophia Jex-Blake, a former student from the New York Infirmary,  and together they established the London School of Medicine for Women, with the primary goal of preparing women for the licensing exam of Apothecaries Hall. After the establishment of the school, though, Elizabeth ceded much of the school leadership to Sophia, and instead served as a lecturer in midwifery. In 1877,  she resigned, and officially retiring from her medical career.

Her retirement did not mean she gave up her other activities. Instead, she focused her attention on several reform movements popular at the time, including family planning, eugenics, preventative medicine, women's rights, medical ethics and sanitation. She moved from movement to movement, looking for a position of authority in each. She held a rather high goal of evangelical moral perfection, and even donated heavily to the founding of two utopian communities in the 1880s.

Like other transcendentalists of the time, including Ralph Waldo Emerson and Henry David Thoreau, her faith guided her professional beliefs. She believed that morality ought to play as large a role as scientific inquiry in medicine, and that medical schools ought to instruct students in Christian teachings.
Medical experience was daily showing the influence of the mind over the body, and I eagerly longed to see an embodiment of Christian principles in society, which embodiment was, as yet, far from attainment.
She believed that disease came from moral impurity, not from microbes. She campaigned heavily against licentiousness, prostitution, and contraceptives, arguing instead for the rhythm method. Her 1878 Counsel to Parents on the Moral Education of their Children arguing against the Contagious Diseases Acts, in an effort to protect young adults from the dangers of prostitution, and prepare them for marriage. She was rather conservative in many of her beliefs, except when it came to sexual passions. She broke with the commonly held belief of the time that stated women had very sexual appetite, and thus made them solely responsible for sexual morality. Instead, Elizabeth believed women were as much sexual beings as men, and that men and women were equally responsible for controlling their passions.
My enlarging experience in various countries in respect to the relations between men and women -- the customs, the diseases, the social disaster springing from errors as to human physiology and neglect in education with regard to the most important functions -- showed me the imperative work which devolved upon the physician in this matter. I realized that the mind cannot be separated from the body in any profound view of the scope of medical responsibility. 
Elizabeth Blackwell and her daughter Katharine "Kitty" Barry Blackwell
at home in the study, ca. 1905
She also remained active in women's rights efforts, and in 1883, she met Elizabeth Cady Stanton.  In 1895, she published her autobiography, Pioneer Work in Opening the Medical Profession to Women (quoted here extensively). Afterwards, Elizabeth slowly withdrew from her public reform activities, and spent more time traveling. In 1906, she visited the United States in 1906, but her old age began to limit her activities. In 1907, she fell down a flight of stairs, and was tragically left mentally and physically disabled. On May 31, 1910, Elizabeth Blackwell suffered a stroke and died at her home in Hastings. Her ashes were buried at Kilmun, in Argyll.


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