The Blackwell Sisters: Physician Leadership and Courage

SoundPractice host Mike Sacopulos recently interviewed Janice Nimura about her latest and award-winning book, "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine," which examines the life and education of the first female physician in the United States. Nineteenth Century pioneers and practitioners, Elizabeth and Emily Blackwell helped educate a generation of female physicians and establish the emergence of women leadership in the medical community. Ms. Nimura walks us through life at antebellum medical colleges, public health of the time, changes in medical school education, and the education of women physicians since the early 1900s. Below is a transcript of the chat, which can be heard on the SoundPractice podcast .

SoundPractice Host -- Mike Sacopulos:My guest today on the AAPL SoundPractice Podcast is bestselling author, Janice Nimura. Ms. Nimura’s latest book is The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine. She holds degrees from both Yale and Columbia and has received a Public Scholar award from the National Endowment for Humanities.

Let's start off with the obvious question, who were Emily and Elizabeth Blackwell?

Janice Nimura:Thank you for having me. Well, if you are familiar with their names at all, you're probably familiar with Elizabeth Blackwell's name and the phrase, “first woman doctor pops” into your mind shortly thereafter. She was the first woman in this country to receive a medical degree in 1849. And her sister, Emily five years younger, followed her into the profession at her instruction and received her own medical degree five years later in 1854.

Mike Sacopulos:What inspired you to specifically pick these women and this topic in the field of medicine?

Janice Nimura:Well, I think that to do this kind of long-term, long form research and writing, you really have to connect to your subject matter on an identity level. My first book was about women in 19th century Japan, half of my family is in Japan. My husband was born there, so there was a deep connection to the material that was personal.

I went looking for a second project, I looked inside and said, well, what else is in there? And what else was in there was me pre-med from 1989. I graduated from high school and entered college with the intention of pursuing medicine, but then was seduced by the humanities. But that love of science and medicine always remained. And as my own daughter grew up and decided to pursue medicine herself, it was an ecstatic opportunity to circle back to a first love and really dive deep into the history of medicine in the 19th century. To tell a story of two women, not just one who really deserve to be reintroduced to the present was fascinating.

Mike Sacopulos:At the time that the Blackwell sisters were pursuing a medical education, there were different types of medical schools. Were there not? How did Elizabeth come to choose the medical school that she selected?

Janice Nimura:Well, I would say it chose her. She was rejected everywhere and kind of slid in through a loophole to tiny Geneva Medical College in Geneva, New York. It's true there were, in the late 1840s, traditional medical schools plus eclectic medical schools that focused more on homeopathy. Elizabeth knew that she wanted to prove a point about what women could do, that they could be doctors like any men. It was important to her to find her way into a medical school that, was part of the establishment that wasn't newfangled in any way, that wasn't alternative. She wanted to prove to the establishment that she could do this. She looked only at those medical schools that were allopathic -- more traditional and Geneva College finally let her in. Of course, once she got there she rose to the top of the class.

Mike Sacopulos:Can you give us a little history of the Geneva Medical School?

Janice Nimura:Well, Geneva College came first, a small liberal arts college at the Northern end of Seneca Lake in the Finger Lakes region of New York. It opened a small medical department, not that many years before Elizabeth arrived, and it has since evolved into Hobart and William Smith Colleges who probably claim Elizabeth as their own. The medical department has evolved away from Geneva. I think both Syracuse and Upstate Medical Center claim kinship to that program.

Mike Sacopulos:Is it fair to say that Elizabeth Blackwell was not welcomed with open arms?

Janice Nimura:Well, the story that's told about her admission to Geneva College is this. Elizabeth was studying in Philadelphia with a prominent physician. That physician had written her a letter of recommendation to accompany her application. When the faculty at Geneva received this, they weren't quite ready to dismiss it out of hand, sort of wary of insulting her sponsor. But, they really didn't want her to come either. So they decided to put it to the students to vote on the application. If any of them objected, in any way, she was not going to be admitted. The students being sort of a boisterous provincial bunch, decided first that their professors were being timid. They also thought that this outrageous application was probably an opportunity for some good fun. They suspected that it was a prank being played on them by a rival medical school, so they unanimously and raucously decided yes, a unanimous yes for this strange idea of a female classmate. And then the faculty had to abide by their earlier comment that they would let her in if the students decided it was okay. And then the students forgot all about it. And three weeks later in walked a small young woman into the lecture hall.

Mike Sacopulos:Surprise. So somewhat of a cowardice cloaked in democracy on how she was admitted.

Janice Nimura:Yeah. Sort of nobody really wanting to take responsibility for making change.

Mike Sacopulos:I was interested to learn that it was not just men that objected to female physicians at the time, women such as Harriet Beecher Stowe, and Florence Nightingale objected to the idea of a female physician. Were you surprised by that opposition?

Janice Nimura:Yeah. I would say that in the case of Harriet Beecher Stowe and Florence Nightingale, well, in the case of Harriet Beecher Stowe, who was a friend of the Blackwell's, it wasn't so much that she objected to the idea of a woman doctor. It was that she thought that the path toward proving that a woman could be such was so arduous that she would not advise any friend of hers to try it. Florence Nightingale was actually a friend of Elizabeth Blackwell's, but her vision for the role of women in medicine was as nurses, promoting hygiene and prevention.

Women in general objected to the idea of a woman doctor largely because the very phrase “female physician” at the time in the 1840s and 50s tended to connote an abortionist, someone who was working in the shadows on the wrong side of the law, whether her intentions in women's health were good intentions. A woman doctor was not seen as someone you would consult unless you were involved in a scandal. So genteel women who had money to choose their own healthcare often shied away from the idea of a lady doctor and preferred to see the men that they had always seen, which was not what Elizabeth was expecting, I think.

Mike Sacopulos:Well, it seems to have irritated her, at least you quote Elizabeth is denouncing women as petty, trifling, gossiping, and in desperate need of leadership from a superior, like herself.

Janice Nimura:Right. Well, I think that's part of what makes this story quite modern. Elizabeth Blackwell. like many strong female leaders today, could be quite misogynistic. She had a dim view of women who were not as accomplished as she was. She was wary that aligning herself with women who were not as accomplished as she was, as it might undermine her accomplishment. That to me was very familiar from right now. I think, unfortunately that is something that a lot of women can recognize from both sides.

Mike Sacopulos:We've spoken a good bit about Elizabeth. Maybe you could tell us a little bit more about her sister, Emily.

Janice Nimura:Certainly. Emily oddly was better suited to the field than Elizabeth was. Elizabeth sort of anointed Emily, she realized that this path that she had chosen to be a woman doctor was lonely and difficult, and she was going to need some company. The Blackwell’s had a kind of a clannishness and they tended to esteem each other more than most other people. So she looked at her four sisters and chose Emily as being the most brilliant sister. Emily had already proved great interest in natural science and really took to the field in a way that was much more passionate, in some ways, than Elizabeth.

Elizabeth diverged toward the ideas of public health quite early in her career. But Emily became a surgeon, a practitioner, an obstetrician, a medical professor. She thought a woman in medicine should be a practitioner as skilled and talented as any man. Elizabeth thought women in medicine as being more teachers armed with science, people who would show the world better ways to be. Elizabeth and Emily diverged in that way. I think it's interesting that Emily is mostly eclipsed by Elizabeth Blackwell's reputation because she certainly worked more as a doctor. And they sustained the institutions that they founded together, the New York Infirmary for Indigent Women and Children and it's women's medical college.

Mike Sacopulos:Where did Emily train?

Janice Nimura:It's interesting. You would have thought that Elizabeth’s success at Geneva College would have opened the doors of more medical institutions, but in fact they closed more firmly after Elizabeth. Most people were shocked that she had been able to be so successful. Even Geneva College did not want Emily to follow her sister. So Emily struggled to find a place. Also, by this time women's medical colleges had begun to open. If women's medical colleges were open, the men could easily say, “please don't come here there's a women's college for you.” So Emily eventually found her way to Rush in Chicago and had a wonderful first year there, after which the trustees got cold feet and asked her to not return. Undaunted, she pivoted and found her way to Cleveland Medical College and finished there. Cleveland Medical College is now a Case Western.

Mike Sacopulos:You mentioned the New York Infirmary. What became of that institution

Janice Nimura:Well, it persisted, it existed on Livingston place in New York for most of the century. And it has since been absorbed into what is now part of Weill Cornell Medicine, New York Presbyterian, Lower Manhattan Hospital. They proudly preserved some of the artifacts of the Blackwell Sisters and medicine of the time.

The original location of the New York Infirmary for Indigent Women and Children in 1857, still stands in Greenwich village, a small building, proudly bearing a plaque to that effect. The infirmary didn't stay long in that space and moved several times, but none of the other original buildings remain. They've all been replaced by modern buildings unfortunately.

Mike Sacopulos:Let’s talk about what the what did the Blackwell sisters did during The Civil War.

Janice Nimura:Well, that was interesting. Right after Fort Sumpter in 1861, they called a meeting of their supporters and donors to the infirmary to talk about how to focus the energies of the women of New York toward the Union cause. They drafted an appeal, involved The New York Times and invited interested women to join a gathering at Cooper Union. And the next day, thousands of women showed up at Cooper Union to find out how to help. Out of that meeting grew what was called the Women's Central Association of Relief. And out of that organization grew the US Sanitary Commission. So you can draw a straight line from Elizabeth and Emily Blackwell's living room to the US Sanitary Commission if you want to.

In addition, The Blackwell sisters oversaw identifying, vetting and training women to send as nurses to the front, but they quickly became disillusioned with the war effort, even though they were eager to put their best efforts toward it.

They quickly discovered that New York's male physicians were not really interested in partnering with female physicians in the training of nurses. For instance, their own infirmary was excluded from the institutions that were tasked with training nurses for the front. And then Dorothea Dix was appointed to the main leadership role in Washington, she was not a healthcare professional in any way. She was a lobbyist. They called her the “Meddler-in-Chief,” and they became disillusioned and frustrated. And eventually after a year of effort withdrew their support for the Sanitary Commission and turned their attention to their next project, which was the opening of a women's medical college attached to their infirmary.

Mike Sacopulos:Tell us a little bit about how that endeavor went?

Janice Nimura:Very well. I mean, it was an irony really. They had never wanted to support the idea of women studying medicine separately from men. They disdained the women's medical colleges that existed in Boston and Philadelphia and in New York. But those women's institutions were turning out female medical graduates, who the Blackwell sisters thought were poorly trained. And in the end they said, okay, we will change our minds. We will open a women's medical college, but it will be more rigorous and more progressive and more practical than any of the existing men's medical institutions, including the ones that we attended ourselves.

So they opened a college that had a longer term, three terms instead of two courses that built on each other, instead of repeating much more practical training at the bedside. And Emily ran that college through the end of the 19th century until institutions like Cornell and Johns Hopkins began to admit women themselves, at which point she closed it saying, okay, it is no longer necessary.

Mike Sacopulos:So, do you agree that initially the women's medical colleges provided inferior training to the more traditional or the ones that were male-based?

Janice Nimura:Well, I mean, the brightest lights of the medical establishment were not choosing to teach at female medical colleges. So in terms of prestige, in terms of being able to say I was trained by the best, it wasn't possible at that point for women to say that. Also some of those graduates were arriving for further practical training at the New York Infirmary to be trained by the Blackwells as graduate residents. And the Blackwells were not impressed with the level these students were arriving with.

Mike Sacopulos:Did some of the change in curriculum that the Blackwell sisters instituted carry over to other medical colleges?

Janice Nimura:Things like the Flexner Report are outside the scope of the story I was telling. That happened just as the Blackwell sisters died. But yes, I think they were very forward-looking and a lot of the practices that they were putting in place became incorporated into the idea of what a properly accredited medical school should be.

Mike Sacopulos:Tell me a little bit about the end of Emily and Elizbeth’s lives.

Janice Nimura:Well, interestingly after being so closely in partnership in the founding of these institutions in New York, as soon as the Women's Medical College was underway, they parted ways. Elizabeth went back to England for good, for the last four decades of her life, where she had always preferred to be. The Blackwells had been born in England and had lived there as young children. Elizabeth focused more and more on public health, on prevention policy, on writing and lecturing. Emily remained in New York at the helm of the infirmary and the Women's Medical College and ran them extremely competently for the last 40 years of her life. They both died in 1910.

Mike Sacopulos:As we wrap things up, are there lessons that we can apply today from Emily and Elizabeth Blackwell's story?

Janice Nimura:For me the biggest takeaway is the fact that they changed the world for women, and they were often out of step with the emerging women's movement of the time. They for instance, did not believe that suffrage should be the first priority of the women's movement. They believed that giving women the vote when they were still likely to vote the way their husbands and fathers told them to, was thinking backwards.

There's a lesson there about how we see heroes, and how sometimes our heroes are out of step with our own ideas of what is right. And just because they may be out of step doesn't mean we necessarily need to discard their achievements. I think this is a moment where, as we see new female leaders taking positions, like our new Vice President. It's really important to make sure that we don't slide back into an earlier mode of needing heroines to be a certain way -- pretty and perky and adorable. Often, especially female heroines weren't, and that's okay. I would say it is important to be able to honor them with their flaws intact.

Mike Sacopulos:Well said. Leadership intelligence and grit comes in all forms and packages, right?

Janice Nimura:Exactly.

Mike Sacopulos:

Ms. Nimura, thank you very much for your time and I highly recommend The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine. It is a fascinating read. Janice Nimura has been my guest today on the SoundPractice Podcast.

https://www.soundpracticepodcast.com/e/the-blackwell-sisters-physician-leadership-and-courage/