Two Sisters — Pragmatists, Not Idealists — Who Changed the Medical Profession

It’s tempting to presume a clear line between intention and accomplishment, but Janice P. Nimura, in her enthralling new book, “The Doctors Blackwell,” tells the story of two sisters who became feminist figures almost in spite of themselves.

Elizabeth Blackwell was the first woman to receive a medical degree in the United States, in 1849, and she later enlisted her younger sister Emily to join her. Together they ran the New York Infirmary for Indigent Women and Children and founded a women’s medical college — even though, as Nimura puts it, opening a separate school for women was just about the last thing they had planned to do.

The Blackwell sisters had initially cast themselves as exceptions, seemingly content to be the only women allowed into the room. Their temperaments were decidedly different: Elizabeth was self-assured and occasionally grandiose; Emily was quieter and more methodical, though her apparent equipoise concealed an inner turmoil. They treated the women in their care with sympathy, but empathy — the sense that they inhabited the same ordinary plane as their patients, or even other women — seemed mostly to elude them. Elizabeth, especially, would rhapsodize about humanity in the abstract, even as actual experiences of clinical intimacy could unnerve her. “I feel neither love nor pity for men, for individuals,” she declared as a young doctor, in a letter to one of her brothers. “But I have boundless love & faith in Man, and will work for the race day and night.”

The broad outlines of their lives could have made for a salutary tale about the formidable achievements of pioneering women; instead, Nimura — a gifted storyteller whose previous book, “Daughters of the Samurai,” recounted another narrative of women’s education and emancipation — offers something stranger and more absorbing. She begins with her subjects’ early lives in Bristol, where their father, a sugar refiner, introduced his young children to antislavery politics. Samuel Blackwell’s eight British-born offspring — a ninth would be born after they immigrated to the United States — “grew strong on a diet of nature, literature and political consciousness,” Nimura writes.

There was an obvious contradiction between the father’s beliefs and the source of his livelihood, and squaring it wouldn’t be easy. One daughter recalled that the Blackwell children had given up taking sugar in their tea, as a form of protest against slavery. “Then again,” Nimura writes, with a characteristic balance of delicacy and bite, “the unsweetened tea had been paid for by sugar.”

Nimura traces the family’s journey to New York, where they arrived amid a cholera epidemic, and their subsequent decampment to Cincinnati. Samuel, an undisciplined businessman, died a few years later, leaving his widow and nine children with a total of $20 — along with an awareness that having a husband was no guarantee of financial security. None of the five Blackwell daughters would ever marry.

Elizabeth set out to make a living as a schoolteacher in the antebellum South. An upbringing steeped in the antislavery cause “had not prepared her for daily life among enslaved people,” Nimura writes. Elizabeth deemed them “degraded to the utmost in body & mind,” though she considered herself superior to the enslaver class, too, “striving dreadfully to take an interest in their little miserabilities.”

She clung to this view from on high, and eventually landed on the idea that pursuing medicine would be, in her words, “a noble, glorious aim.” Nimura says that Elizabeth was admitted to the Geneva Medical College in upstate New York as a joke; her male classmates, consulted by their skittish professors on whether her application should be accepted, agreed only because the prospect of a lady doctor sounded so silly — and therefore too potentially entertaining to refuse.

Elizabeth proved herself to be an assiduous and determined student. She traveled to Europe to gain practical experience, and continued to work even after losing an to eye an excruciating bout of gonorrheal conjunctivitis, which she had contracted on the job. She would speak derisively about “the hideousness of modern fornication,” and seemed to find the body distasteful, if not disgusting. As far as Nimura can tell from her subject’s diaries and letters, Elizabeth would remain forever faithful to the celibacy vow she made when she signed a temperance pledge, at 17.

Emily followed her sister’s example and instruction, becoming the workhorse practitioner alongside the high-minded Elizabeth. “The Doctors Blackwell” presents Elizabeth in full, and gives Emily her due. The sisters were entering a profession in flux. In the mid-1800s, the germ theory of disease had yet to be accepted as orthodoxy. The first half of the century was a time of “heroic medicine,” when more traditional forms of healing and long-term care were marginalized by doctors fixated on short-term cures — treatments that were often painful and dangerous, and of dubious efficacy.

The sisters were pragmatic physicians. Even the supremely confident Elizabeth approached her work with a sense of curiosity and a willingness to keep in mind what was known and what wasn’t. Again, she saw herself as standing apart. Through careful observation, she wanted to obtain “that bedside knowledge of sickness, which will enable me to commit heresy with intelligence in the future.”

Their pragmatic impulses also pushed them to open their infirmary in Manhattan and, later, the accompanying women’s medical college. Elizabeth and Emily saw a need for women doctors, who in turn had a need for clinical training and experience. Neither sister had much use for the idea of solidarity, and Elizabeth blamed women for their plight in a patriarchal society. “Women are feeble, narrow, frivolous at present, ignorant of their own capacities,” she complained. Rigorous medical training would help women do as she and Emily had already done: embark on a life of accomplishment by embracing a meritocratic ideal. On the subject of “woman’s rights,” Elizabeth was disdainful, insisting the movement was “anti-man.”

A culture that valorizes heroes insists on consistency, and the Blackwell sisters liked to see themselves as unwavering stewards of lofty ideals. But Nimura, by digging into their deeds and their lives, finds those discrepancies and idiosyncrasies that yield a memorable portrait. “The Doctors Blackwell” also opens up a sense of possibility — you don’t always have to mean well on all fronts in order to do a lot of good.

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