The Doctors Blackwell: How Two Sisters Brought Medicine to Women and Women to Medicine by Janice P. Nimura

W. W. Norton, 336 pp.

By Ann Fabian

Maybe you remember Elizabeth and Emily Blackwell from a grade school project for Women’s History month. Elizabeth was the first woman to earn a degree from an American medical school, graduating from Geneva Medical College in western New York in 1849. Emily, four years younger, followed in Elizabeth’s footsteps, earning a degree from Case Western, just the third American woman with an M.D. Together, the Blackwells ran an infirmary in New York and launched a medical school for women.

Somewhere along the way, I learned this outline of the story of sister doctors and then filed the pair away in my cabinet of heroic pioneers. I’m happy now to open the Blackwell file with Janice P. Nimura’s compelling new book about them, The Doctors Blackwell: How Two Sisters Brought Medicine to Women and Women to Medicine. Elizabeth and Emily still have a place among our feisty pioneers, but Nimura gives their history the complexity it deserves, setting their lives and ambitions in the unsettled world of the early nineteenth-century United States.

Elizabeth was the third of nine children, born in 1821 to a prosperous middle-class sugar refiner in Bristol, England. The Blackwells were “idealists,” Nimura writes, “advocates of education, temperance, hard work, and self improvement.” And after a fashion, active opponents of slavery, despite Samuel Blackwell’s dependence on a commodity produced by enslaved laborers in the Caribbean.

Samuel thought he might find a slave-free future for sugar by refining beets instead of cane. So in 1832, he packed up the family and moved to the United States. The 1830s were not the most auspicious decade to set up in America and Samuel never got his footing in the new world. The family arrived in New York to find the city in the grip of a cholera epidemic. Plagued by his own ill health and by the country’s economic collapse following the panic of 1837, Samuel struggled. He moved the family to Cincinnati in the spring of 1838, but died there a few months later leaving a widow and nine children, “newly deposited on the edge of the world with twenty dollars,” in Nimura’s succinct phrasing.

Cincinnati had an intellectual life and reformist culture that helped sustain the family. The two eldest daughters had already begun teaching in New York. Elizabeth, bookish and somewhat dour, took up teaching too, first near home in Cincinnati and then in Kentucky. So began a peripatetic life that meant the siblings often lived apart—homes in Cincinnati, New York, Philadelphia, London and Paris. Family separations inspired a life-long correspondence that provides the remarkable life-blood of this book; letters, diaries and journals to elaborate the private side of their public lives. The Blackwells had a “penchant for over-sharing,” Nimura writes. It must have sometimes complicated their relationships, but what a trove they left for historians.

Of course, we know the sisters managed to get their degrees and open their clinic and college, but Nimura’s gift is to use the Blackwell family’s writings to set us down in the thick of things and then move us through the world as the Blackwells saw it, with all the struggle and uncertainty that shaped their lives. Nimura is a remarkable biographer and sits gracefully in the background and lets characters speak and act.

The Blackwells’ story, half-remembered from those grade-school reports, is less eye-opening than Nimura’s earlier Daughters of the Samurai: A Journey from East to West and Back (2015)—an extraordinary book about three Japanese girls (aged 11, 10, and 6) sent by their government in 1871 to study in the United States. A planned brief stay stretched into a long decade. But the books, both beautifully written, share an appreciation for the sensibility of past actors and capture the drama behind the choices they made.

In the early 1840s, Elizabeth decided to study medicine, although it was not clear how or even what exactly it meant to be a doctor in those years. Women had always been healers, of course, midwives and caregivers, but as medicine professionalized in the 1840s, doors closed to women. Nimura gives us a sense of the medical field in flux. Steam doctors, mesmerists, and homeopaths competed with doctors practicing the kinds of bloodletting and purging that came to be known as “heroic medicine.” The only explanations offered for disease were in bodily humors out of balance and miasmatic emanations, putrid air arising from swampy places. Remedies were often as brutal as the diseases they were meant to cure. And the only places for women in the emerging medical establishment were as nurses or as clandestine (or notorious) abortionists.

Nevertheless, Elizabeth was determined to get a medical education, turning to medicine as a sort of moral crusade. Geneva Medical College in western New York admitted her to study with male students, who came to appreciate her serious purpose. She spent a grueling semester at a Philadelphia asylum, working with female patients in the syphilis ward. She lost an eye to an infection she contracted at La Maternité in Paris. But Elizabeth persisted and with the help of a few sympathetic allies and money from a generous cousin, she succeeded.

Elizabeth brought Emily along. The younger Blackwell emerges as a sympathetic figure, a talented surgeon and an able administrator, but she always “bobbed in Elizabeth’s wake,” Nimura remarks, still the more obscure of the two.

It’s humbling to picture how hard the two worked. And how slow the medical establishment was to recognize the talents of women. Even in the urgent months of the Civil War, male doctors maintained barriers against women physicians.

Beyond the Blackwell family, Nimura has recruited a generous cast and captured the reformist tumult of the American 1840s. They read transcendentalist Margaret Fuller and utopian reformer Charles Fourier. They crossed paths with abolitionist William Lloyd Garrison, newspaperman Horace Greeley, preacher Henry Ward Beecher, along with Florence Nightingale, Lady Byron, table-rapping spiritualists, and a host of prominent medical men in the United States and Europe.

Most satisfying, perhaps, is the appearance of Lucy Stone and Antoinette Brown, leading lights of the women’s rights movement who married two Blackwell brothers. Elizabeth’s relation to the movement was complicated. She disdained the struggle for woman’s suffrage, labeling woman’s rights “wrong headed,” not in her mind the right way to go about achieving women’s professional aspirations.

But the brothers’ affections ran in a different direction and their marriages added allies to the work for women’s equality. And their daughters sparked up life in the extended family and carried the family’s work in medicine and reform to another generation.

Nimura’s last paragraph sings the sisters’ accomplishments. “In 1910, when the Blackwell sisters died, there were more than nine thousand women doctors in the United States, about six percent of all physicians. Today, thirty-five percent of physicians—and slightly more than half of all medical students—are female.”

But let me pause now at the book’s back cover, where Nimura acknowledges a Public Scholar award from the National Endowment for the Humanities that supported her work on this book. I know we sometimes hear that the humanities are a luxury, something expensive to add to our lives once our work is done. On the contrary, the humanities are cheap and necessary. Here’s a book with an archive to give it a long life, and I’m pleased to think that pennies from my tax dollars paid Nimura pennies an hour to research and write this wonderful book.

Ann Fabian is a historian who writes about books.