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Certain of her own exceptional nature, physician Elizabeth Blackwell dismissed those who aided her

The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women—and Women to Medicine

Janice P. Nimura
Norton
2021
336 pp.
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In 1849 Elizabeth Blackwell became the first woman to receive a medical degree from an American college. She was a resourceful, dedicated, and imaginative thinker. She was also a greedy, racist, and rivalrous snob. In The Doctors Blackwell, Janice Nimura shifts between Blackwell’s own account of her singular greatness and the story of her relationship with her medical colleague, occasional roommate, and little sister, Emily. Nimura’s smart and skillful collective biography layers an account of an exceptional individual onto a narrative of the interdependence and political structures that made the myth of Elizabeth Blackwell possible.

The Blackwell sisters were immigrants from a large, loyal family that financially deteriorated as they grew up. The family business was sugar, and it profited directly from slavery, imbuing the sisters with the values of racist capitalism: competition, individualism, and hierarchical organization. Before medical school, Elizabeth apprenticed in the U.S. South, where she witnessed the cruelty of slavery firsthand. Yet she clung to the notion of racial hierarchy convenient to white political power. She spared respect for only her blood relations and clipped any threads of friendship and ties of political solidarity when such alliances were no longer of use. It takes a brazen tongue to bad-mouth Florence Nightingale, and Elizabeth Blackwell had one.

Elizabeth benefited from the early women’s movement, although she refused to support its political efforts. She jeered women’s rights advocates, labor organizers, and abolitionists who might have been natural allies in her projects. She spurned political organizing aimed at opening opportunities to more people and promoted access to medical care and education for women to build her own renown.

Throughout her life, Elizabeth had an unintuitive, self-serving view of women’s rights. She neither wanted to be seen as a man (no bloomers for her) nor did she think that women and men were equal. It was important to her to be seen as a woman—as a member of a group believed to be generally inferior—in order to demonstrate her own exceptionalism.

White women in science are allowed to be ambitious and successful, so long as they are tenderhearted or at least tactful. Elizabeth Blackwell was neither. But the energy it takes to judge Elizabeth harshly is better spent, Nimura tacitly suggests, exploring the gendered standards of judgment behind ideas of good doctoring.

Elizabeth showed a vexing combination of dependence and public disavowal in her relationship with her sister Emily. A few years after Emily graduated from Cleveland Medical College in 1854, the sisters started a clinic for poor women and children in New York City. The eventual success of the clinic was largely Emily’s doing. Elizabeth had only one eye—the other was removed after it was infected with gonorrhea at the hospital in Paris where she apprenticed after medical school—so Emily did most of the doctoring in the clinic for which the elder Blackwell is remembered.

Elizabeth also dreamed of starting a medical school with her sister for the exceptional few women whom she saw fit to train in her image. Shortly after the school opened, however, Elizabeth decamped for England, their mother country, where she remained for the rest of her long life, while Emily remained and ran the school.

In 1910, both Blackwell sisters died. Although not mentioned in Nimura’s insightful biography, that year also saw the publication of the infamous Flexner Report, which laid out uniform criteria for medical training that ultimately shuttered most medical schools in the United States. The schools that remained open were primarily in urban areas of the U.S. Northeast. Most admitted only white men and typically came with a steep price tag—ensuring that only elites became doctors.

In the book’s last lines, Nimura writes that “when the Blackwell sisters died, there were more than nine thousand women doctors in the United States, about six percent of all physicians.” “Today,” Nimura continues, “thirty five percent of physicians—and slightly more than half of all medical students—are female.” There are two ways to read these final words. The comparison might suggest the success, over time, of efforts to expand access to medical training, of which the Blackwell sisters were important drivers. Yet it is far from clear whether either Elizabeth or Emily were interested in democratizing medical education.

Nimura’s closing comparison, interpreted differently, shows how unequal the U.S. medical profession remains more than 100 years after the Blackwell sisters’ intrepid, institution-building work: The preponderance of medical students are women, and yet women make up a mere third of all American doctors. Nimura’s closing lines are brilliant because they allow the implications of the Blackwell sisters’ work to remain ultimately ambiguous.

About the author

The reviewer is at the Department of History and the Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN 37235, USA.