The Doctors Blackwell

You may have heard this riddle before: A father and son are in a horrible car crash that kills the father. The son is rushed to the hospital, and as he’s wheeled into the operating room, the surgeon says, “I can’t operate on this boy — he’s my son!” Who is the doctor?

I first heard the riddle sometime in elementary school in the late 1970s or early 1980s. I remember being stumped by it and even being a bit flummoxed when I heard the answer — the boy’s doctor is his mother. I simply couldn’t fathom that a woman could be a physician, let alone a surgeon.

In my defense, a 1980 United States Department of Health and Human Services report states that women accounted for only 9% of active physicians in 1977. Given that the report also cites 433,600 total active physicians in the United States in 1979, that means that, at best, there were only 39,000 female physicians in the United States at that time.¹ So, even if women physicians were not readily in view in my small south Louisiana town, it would seem that many U.S. children of that era would have been similarly stumped by the riddle.

Today, women account for 36% of all licensed physicians in the United States (369,139 women out of a total physician workforce of 1,018,776).² The numbers for medical students and graduates fare better, with women accounting for 51% of students in U.S. medical schools in 2020–2021 (48,530 women out of 94,243 total students) and 50% of graduates of U.S. medical schools in 2019–2020 (10,109 women out of 20,387 total graduates).³ Given the steady growth in female physicians in the United States since the 1970s and the more readily visible presence of women in medical education and the physician workforce today, it was with interest that I read The Doctors Blackwell, a biography of Elizabeth Blackwell, the first woman to receive an MD degree in the United States — in 1849. The journey of Elizabeth’s younger sister Emily Blackwell, who became the third woman in the United States to obtain an MD degree (in 1854), is also covered, since Emily’s career choice was largely due to Elizabeth’s influence and her life closely bound with Elizabeth’s.

The Doctors Blackwell is an easy read about the Blackwell sisters’ lives and journeys. In addition to being the first (and among the first) females to graduate from medical school in the United States, Elizabeth and Emily eventually opened and ran the New York Infirmary for Indigent Women and Children, the first such health care center in the United States run and staffed solely by women. Elizabeth eventually spent her time primarily as an advocate for women’s rights and education — both in the United States and England — rather than as a medical practitioner. Emily is the one who seemed to have a true calling and desire to help patients, as well as the business acumen and personality suited to running a clinic. The sisters later started and opened the Woman’s Medical College of the New York Infirmary, an extension of their work to use the infirmary as a training ground for women physicians to hone their skills and gain practical experience with patients (for although medical schools may have been opened to women, residencies and internships were not). The opening of the college was due primarily to the sisters’ dissatisfaction with — in their opinion — the inferior education women were receiving at newly-opened all-women’s medical colleges that had sprung up since their own graduations from (all-male) medical school.

Going into the book knowing what has transpired in the 172 years since Elizabeth graduated from medical school and how the medical education system works today, it was a bit jarring to read that, in addition to having to petition a number of medical schools for the chance to be admitted, ultimately both sisters’ requests (at different schools and several years apart, it should be noted) were put to a vote by the all-male student body, who thankfully voted in their favor. Nimura’s writing of the sisters’ time at medical school is compelling. For instance, Elizabeth, despite a stern attitude and strict separation from the other students, eventually won them over with her perseverance and intelligence. If she were a bit more social, one might even imagine the famous final scene from the football movie “Rudy” playing out at her graduation (after making a heroic play, the film’s protagonist is carried off the field on his teammates’ shoulders to cheers from the stadium).

The sisters were also fortunate in finding influential men (and women) who were allies and who were willing and able to support and lend credence to them and their business. Having the public and financial backing of men was especially critical when opening the infirmary, since at the time the only other notable — or, to some, infamous — woman promoting services for women was “Madame Restell,” who, somewhat surreptitiously, but in effect, advertised and provided contraception and abortion services. Although Restell’s life and story is not explored in detail in the book, she used the moniker “female physician” or was perceived to be such, which complicated the Blackwells’ efforts — as actual medical school graduates — to practice and run their own clinic, especially one strictly geared toward serving women and children.

While the book is a pleasurable read, as a woman but not a physician I found myself defaulting to reading and reflecting on the book through the lens of today and the role that not only gender, but also race (not to state the obvious, but the sisters were white) and privilege play in each of our journeys and, especially as women, in achieving our goals. The sisters grew up in an advantaged household with parents who believed in equality in all things — even education — for all people, regardless of gender or race, and who were opposed to slavery even before moving their family from England to the United States, where they developed long-standing friendships with abolitionists and other progressive, free thinkers of the day.

As I read, I was also struck by repeated references to the sisters’ looks and personalities. I found myself bristling at the picture painted by Nimura of Elizabeth Blackwell’s looks and personality — stalwart, stern, uninviting, non-sexual — and wondering if such attention would be paid if telling the story of the first male to get a medical degree in the United States. While Nimura notes on multiple occasions that the English press in particular published disparaging articles about Elizabeth (parodying not only what she was trying to do, but also her looks and personality), and that the sisters themselves often negatively commented on Nancy Talbot Clark’s looks (Clark being the second woman to obtain a medical degree in the United States), it is hard to tell if the discussion of the sisters’ personalities and looks are an artifact of the materials and personal correspondence Nimura reviewed when researching and writing the book, or if it is simply a reflection of what resonated with the author. Regardless, it seems that the specter of the influence of appearance and sociability on a woman’s career and success and on society’s perceptions of women in general has long been there, haunting us.

During a webinar this summer, Nimura noted that children’s books written today about Elizabeth Blackwell tend to portray her as pretty and fashionable, with a perky personality, perhaps as a way to get children and especially young girls interested in the subject; but in reality, she was not pretty (at least by society’s standards), nor did she have a warm, inviting personality. Emily seems to have been the more genial and outgoing of the two sisters, although it should be noted that neither apparently had close friendships or a social circle to speak of (although Elizabeth did adopt a child and Emily eventually settled into a partnership with a fellow female physician colleague), having devoted themselves to their careers. Again, without the benefit of first-hand experience, one wonders how much weight is placed on looks and personality and a “career first” attitude for female medical students and physicians today. Certainly, whether we care to acknowledge it or not, looks, personality and “commitment to the job” play an undue or outsized role in women’s careers and successes in general. So why should medicine be an exception? Whether the Blackwell sisters felt impeded by any of this is unknown, based on what is provided in the book, but it raises the question of whether (or how much) females now entering the medical profession feel this.

I won’t speak to the role of race in regard to the sisters’ success, as that was not a central theme in the book and is a topic that could be an entire book unto itself. However, the book does mention the first Black woman to earn a medical degree, Rebecca Lee Crumpler, and also notes that another early Black female medical graduate, Rebecca J. Cole, was an intern at the Blackwells’ then-renamed New York Infirmary for Women and Children and even treated (white) patients in their homes, a rarity for the time, when most graduates of Black medical schools remained or moved to the South and solely treated Black patients. Reading the few paragraphs Nimura devotes to this discussion did lead me to want to learn more about both Crumpler and Cole and about the paths available to and journeys taken by early Black physicians in the United States.

I am sure women physicians, and their male counterparts, will reflect on their own journeys in comparison to the Blackwells and will read the book and reflect on the progress that has been made in a much different manner than my untrained eye. However, as I sat with the book for a few months after reading it (and it did take a few months to process a life like the Blackwell sisters had), I was ultimately left with admiration for the sisters, and to Elizabeth especially as the public face and unflagging advocate for women’s education and right to become physicians. I’ll admit that, as a patient at least, I did initially struggle with Elizabeth’s motives for getting a medical degree — to show that women could do the same thing as men when given the same footing as men, rather than out of a desire to care for patients — but after much reflection, I found myself at peace with that because of the end result. Ultimately, Elizabeth Blackwell not only started a movement, she started a transformation. She transformed the face of medical education — and thus medical practice and patient care — in the United States. To borrow a phrase I heard recently, she “passed along courage”⁴ to other women — to become physicians, to insert themselves into places they are not allowed, to assert that women should be on equal footing as men (and to prove that they can be) — and for that, we should all be grateful.