“I have no turn for benevolencies,” Elizabeth had written to Henry at the end of 1855. “I feel neither love nor pity for men, for individuals—they may starve, cut each other’s throats or perform any other gentle diversion suitable to the age—without any attempt to stop them on my part, for their own sakes. But I have boundless love & faith in Man, and will work for the race day and night.” Emily and Marie Zakrzewska were back in New York, each possessed of a diploma and substantial experience, and both of them were more interested in the practice of medicine than was Elizabeth herself. Let them manage the daily work of women’s health. Elizabeth would focus on the grander goal of women’s medical education, embracing the role she had always preferred: idealist.
There was still almost nowhere for a newly fledged female M.D. to acquire the practical experience that medical school did not provide. Elizabeth’s hopes in J. Marion Sims and his Woman’s Hospital had faded. “Dr. Sims has never called to see me, and is evidently striving to keep in with the conservatives,” she wrote with disappointment to Emily. Sims had succeeded in establishing his Woman’s Hospital in 1855, at Madison Avenue and Twenty-ninth Street, specializing in his signature fistula surgery; like Elizabeth, he understood that as an outsider he would be able to apply and refine his new ideas only in an institution of his own. It was now clear, however, that what Sims aimed to elevate was not the stature of women in medicine but the stature of J. Marion Sims. His Woman’s Hospital was staffed entirely by men, and though he had recruited thirty prominent women as a board of managers, Elizabeth was not fooled. “Half are doctors’ wives, the stiffest of the stiff,” she complained, “the rest the richest & best known New Yorkers, but all of the fashionable unreformatory set.” These society ladies were not going to solve the problem of practical training for female medical students. And thanks to the women’s medical schools in Philadelphia and Boston, not to mention the Eclectic schools that now admitted women—however much the Blackwells might disdain the rigor of their programs—there were a growing number of female graduates to train.
Instead of cultivating more powerful men as trustees, Elizabeth now turned to their wives and sisters and daughters. Where Sims expected his lady managers to play a philanthropic and decoratively feminine role, Elizabeth asked her supporters to participate more actively. On Thursday evenings, they met at her house to discuss her educational mission for women and learn how best to promote it, as her disciples.
Elizabeth crystallized her thoughts in an address, “On the Medical Education of Women,” that she published in December 1855 as a pamphlet that could serve both as a professional calling card and as a fund-raising appeal. Her thesis, elegant in its simplicity, used the obvious example of obstetrics. “Women have always presided over the birth of children,” she wrote—but in this enlightened age of forceps and chloroform, science had advanced beyond the unwritten wisdom of traditional midwifery. “The midwife must give place to the physician,” Elizabeth declared. “Woman therefore must become physician.”
Mindful of her audience—wives and mothers, not medical students—Elizabeth framed her project in terms they could embrace. “The grandest name of woman is mother—the noblest thought of womanhood is maternity,” she assured them. However: “The woman who cares but for her own children, is a feeble caricature of womanhood, not its true representative.” To realize the fullest grandeur of motherhood, women must extend their nurturing instincts beyond the fireside. Her vision neatly included both the female medical students who chose career over marriage and the society ladies whose generosity could support their training.
The benefits were obvious, Elizabeth explained. Medicine would be a broad new field of endeavor for unmarried ladies. As physicians, these women would in turn inspire and elevate a better class of nurses, a group Elizabeth continued to disparage: “their ignorance, faithlessness and inefficiency at present is proverbial.” Women doctors would also, of course, rescue female patients from the “unnatural and monstrous” necessity of confessing intimate symptoms to men—or worse, in the case of inpatients, serving as case studies for male medical students, a terrible exposure that led to “bitter mortification” and “a deadening of sensibility.” Even as she spoke on behalf of helpless hospital patients, however, Elizabeth seemed to fault the wealthier women who sought advice from doctor after doctor for their ailments, showing an “utter want of delicacy” in subjecting themselves to repeated examinations. And even as she feared for the “moral purity” of female patients both rich and poor, she laid no blame for this peril at the feet of her male colleagues, who had her “utmost confidence and respect.” In aligning herself with the men, she implicated herself in their misogyny. Then again, she had never set out to like women—only to lead the way toward a world in which they were recognized.
It was not enough for women to earn medical degrees, she continued. Just as it was impossible to become a proficient musician by listening to someone discuss music theory, it was likewise impossible to emerge from the lecture hall a competent physician. All five senses must be tuned to the observation of disease, over months of repeated experience. “A system of medical education without continual practical instruction is an absurdity, or rather an impossibility,” Elizabeth wrote. And while she had hoped her own example as a student—confirmed by Emily’s repetition of her feat—would open the doors of all hospitals to women, she was wiser now.
“There is but one way of meeting the imperative need of our women for hospital instruction,” she declared. “We must create a hospital to meet the want.” Not a dispensary—a hospital, where female students could learn without restriction. “I know the difficulty of this undertaking,” Elizabeth told the assembled ladies. It would require a huge effort of both publicity and fund-raising, guided by “sound judgment and good taste”—all of which she trusted her listeners to provide. She proposed the grand sum of ten thousand dollars and announced that the Thursday meetings would become sewing circles in preparation for a charity bazaar.
Marie Zakrzewska attended faithfully, though with growing impatience. The canny entrepreneurial spirit that had kept her afloat upon her arrival in New York recoiled from what she saw as Elizabeth’s hopeless impracticality. “There was scarcely any life in these gatherings,” she grumbled, “and when I saw ladies come week after week to resume the knitting of a baby’s stocking (which was always laid aside again in an hour or two, without any marked progress), I began to doubt whether the sale of these articles would ever bring ten thousand cents.” On Sundays, she and Elizabeth escaped for long walks on Staten Island or the Jersey side of the Hudson, refreshing themselves with sunsets and wildflowers. Their deepening friendship allowed Zakrzewska to suggest a more sensible plan: the foundation, for now, of a more modest “nucleus hospital.”
Fund-raising began in earnest. Emily collected contributions from friends in Europe; Zakrzewska made trips to Boston and Philadelphia, explaining the project to progressive supporters of the female medical colleges in those cities. Even among allies, the idea of a woman practicing in a hospital was a hard sell. “If you must talk on hospitals, do not mention women doctors,” one Fifth Avenue matron requested—though thanks to Florence Nightingale, it was perfectly fashionable to discuss nursing. A circular printed in June 1856 softened Elizabeth’s pitch, insisting that while the new hospital would indeed be a place for women to receive medical training, it was also “designed to meet another want, not supplied by Hospitals generally, viz: an earnest religious influence on the patients.” It would be a Christian charity above all, staffed by respectable nurses, in which “scientific instruction will always be subordinate to the welfare of the patient; each individual no matter how degraded, being regarded as a human soul as well as a body.”
The house on Fifteenth Street filled with boxes and baskets of handiwork to sell at the bazaar. “I shall have an Art, Book, Fancy, Useful, and Refreshment table,” Elizabeth decided—but the problem, as the ladies of Elizabeth’s committee quickly discovered, was that no one would rent them a room in which to set up their tables, even if they paid in advance. At the last minute they secured a space at the Stuyvesant Institute, the very Broadway venue that had hosted J. Marion Sims’s 1855 lecture announcing his women’s hospital. This seemed auspicious—except that the ladies would not be permitted to use the lecture hall. They were welcome, however, to an attic loft three flights above, where nailheads stuck up from the floorboards and bare rafters ascended into the gloom.
Donated rugs and drapes and borrowed chandeliers soon dressed the space, and evergreen boughs hid the raw beams. For four days in December 1856, the Ladies’ Fair charged ten cents admission for the privilege of shopping, and the New-York Tribune reported takings of more than $1,100 toward a projected $5,000, “the sum required to rent and furnish a suitable house for the accommodation and support of forty patients, with a dispensary for outside patients attached.”
The paper also provided a satisfying clarification. “This enterprise must not be confounded with the Institution known as the Woman’s Hospital, located on Madison avenue, which is now in operation, as that is a Woman’s Hospital under the care, exclusively, of male practitioners,” noted the reporter, referring to Sims’s new establishment, “while this Institution is to be under the care and control of female physicians, with some of our eminent medical men attached as consulting advisers.”
Sims had recently disappointed the Blackwells again. Despite Elizabeth’s dim opinion of the women on his board, and perhaps due to her inspiring example, they had included in their bylaws a clause stipulating that Sims must hire a female assistant surgeon. The obvious candidate was Emily Blackwell, who upon her return from Europe was the best qualified—in fact, the only—female surgeon in New York. Sims ignored her, flouted his own board, and appointed Thomas Addis Emmet, a well-connected young surgeon whom Sims knew socially. The Blackwells’ disillusionment with Sims was complete.
The Tribune was Horace Greeley’s paper, and the bias of the article was clear. The Blackwells’ project, it noted, had technically predated the founding of Sims’s hospital, which was already receiving funds from the state; surely a similar level of support for the Blackwells would shortly follow. There it was, in print: affirmation that the Blackwells’ goal was valid and should be realized, written by someone who seemed familiar with Elizabeth’s “On the Medical Education of Women.” Women, the Tribune declared, had always been healers—and now “manifested the capacity and the inclination to resume their old place in the modern profession.”
The brick house on the corner of Bleecker and Crosby had been the home of the Roosevelt family, the branch whose most famous scion, later in the century, would be christened Franklin Delano. A remnant of privilege, it was built in the Dutch style with four chimneys and a dash of architectural elegance in its quoined corners. Its painted shutters and neatly swept stoop looked toward the fading elegance of Bond Street and the Corinthian flourishes of Colonnade Row, but the best addresses had already migrated farther north, to Washington Square and up Fifth Avenue. To the south and east, in the notorious slum of Five Points, wood-framed tenements sported broken windows like black eyes, and ramshackle stairways climbed crookedly up exterior walls from squalid cellars to airless attics, every square foot of living space claimed by too many of the city’s most recent arrivals. On a visit a decade earlier, Charles Dickens had toured it with a police escort. “Debauchery,” he wrote, “has made the very houses prematurely old.” The Blackwells’ New York Infirmary for Indigent Women and Children stood on the threshold between high and low, patron and patient.
Having raised just enough to secure the lease—from both private donors and the New York state legislature, which had allocated the same one thousand dollars it directed to all the city’s dispensaries—the Blackwells planned to open on May 12, 1857. It was Anniversary Week, when progressive organizations like the Temperance Union and the Anti-Slavery Society held their national meetings in New York. The city would be full of sympathetic supporters.
It was also Florence Nightingale’s thirty-seventh birthday. Though the “Lady with the Lamp” hewed firmly to nursing as the appropriate role for women in medicine, she had conferred a cautious blessing on the Blackwells’ endeavor during her correspondence with Emily. The advent of women doctors was inevitable, Nightingale agreed; it was just a matter of the right woman leading the way. “She must have both natural talent and experience and undoubted superiority in her knowledge of Medicine & Surgery,” Nightingale wrote. “She must be entirely above all flirting or ever desiring to marry, recollecting that to her, the Apostle of the cause, her cause must be all in all.” Both Blackwells could recognize themselves in those terms, even if they disagreed in theory with Nightingale’s insistence that medical women must remain forever celibate. Whether the Blackwells were the right women Nightingale did not say, but she retained a deep respect for Elizabeth despite their divergent opinions. “Pray remember me most affectionately to your sister, whom I shall never forget,” she had closed her letter to Emily. The Blackwell sisters were abundantly aware of the usefulness of Nightingale’s fame, even if their opinions diverged. The date was not an accident.
NEW YORK INFIRMARY BUILDING AT THE CORNER OF BLEECKER AND CROSBY STREETS .
COURTESY NEW YORK ACADEMY OF MEDICINE
Henry Ward Beecher, their keynote speaker, was another wise choice. Congregants and tourists flocked to his sermons at Brooklyn’s Plymouth Church, familiarly known as “Beecher’s theater”; on Sundays the Brooklyn ferries were dubbed “Beecher boats.” For his exuberant homilies—encouraging seekers to pursue the truth of their individual natures—he was paid a salary of five thousand dollars a year, his success unmatched even by his best-selling sister, Harriet Beecher Stowe. The Blackwells understood the power of Beecher’s rhetoric to propel their project. In its coverage of the infirmary’s opening, the New York Herald devoted more column inches to Beecher’s remarks than to any other aspect of the event.
If Nightingale and Beecher provided the sparkle of celebrity for the new undertaking, Elizabeth’s steadfast ally, the Quaker doctor William Elder, supplied the heart. Elder had traveled from Philadelphia to witness the birth of an institution that would not only promote the progress of women in medicine but also, he predicted, correct the folly of current medical instruction. “All scientific medical works begin at the wrong end,” Elder insisted, condemning the “fogyism and humbug” that infected the profession, and praising the Blackwells’ intention to “educate the medical student in the Infirmary, by the bedside.” He was sure they were standing in what would become not just a hospital but a female college. The Blackwells, he averred, were women of “broad faith,” and the public could trust the virtue of their work. The abolitionist minister Dudley Atkins Tyng, another Philadelphian, arrived late, breathless and dusty from a delayed train, to confirm the spiritual fitness of the lady physicians. And lest anyone fail to mark the significance of the date, he cited Florence Nightingale, yet again, as proof of women’s potential before offering a closing prayer.
The day was an undeniable success, but Elizabeth and Emily left the celebrating to others. Marie Zakrzewska found their restraint exasperating. “Elizabeth Blackwell seemed to feel some sort of gratification at the day of the opening,” she wrote, “though she tried hard to conceal.” Zakrzewska thought she could detect a more obvious flush of pleasure on Emily’s face, though nothing like the triumph she felt was warranted. “It seems to me so strange that some natures always will be in opposition to themselves,” she continued. “These two women for instance, have all right to be satisfied with their work and efforts . . . but still they won’t acknowledge it either to others nor to themselves.” Did they not realize that their supporters needed emotional satisfaction—good fellowship as well as good reform? “In spite of all I love them and feel sad that nothing can cheer them up,” Zakrzewska wrote. “Or do they perhaps show their joy in their bedroom where nobody sees them?”
ANNUAL REPORT OF 1857, THE YEAR OF THE NEW YORK INFIRMARY’S FOUNDING.
COURTESY NEW YORK ACADEMY OF MEDICINE
The infirmary building itself was an apt metaphor for an institution channeling middle-class largesse toward the needs of the poor, “fully respectable on the Bleecker Street side, and full of patients and misery on the other side and at the rear,” as Zakrzewska described it. Around the corner on Crosby Street, the decorative touches of the facade vanished along with the middle-class complacency of the neighborhood. The dispensary was in the dining room on the ground floor—a luxurious space compared to its original incarnation on Seventh Street. There was a desk for the attending physician, an examination table behind a screen, and a workbench for preparing prescriptions. It was attended every morning by the lady physicians or one of their assistants: a series of new graduates from the women’s medical colleges in Philadelphia and Boston who paid for a practical opportunity that was as yet unavailable to them anywhere else.
In the entrance hall, patients waited their turn on donated secondhand settees. The building was chilly in winter and airless in the hot weather, but it was spotless and well staffed, a paradise compared with the hellish conditions awaiting the sick poor at municipal institutions like Bellevue or Blackwell’s Island. The second floor held two inpatient wards, with maternity cases on the third. The slant-ceilinged attic story was a warren of tiny rooms: sleeping quarters for students, nurses, servants, and Marie Zakrzewska, who had moved in as resident physician. Though Blackwell was the name most closely associated with the infirmary, it was Zakrzewska who devoted every waking hour to it during its first two years, tending not just to the patients but also to the building, the larder, the linen closets, the medicine cabinets, and the staff. She was up before dawn to order provisions at the market, and after evening rounds she gathered the students to review the day’s patients while mending sheets. She made sure everyone was in bed by midnight, unless a crisis—or a baby—emerged. People might refer to the infirmary as the Blackwell hospital, but it was Zakrzewska who kept it going.
Elizabeth and Emily remained at Fifteenth Street, making the twenty-minute walk to staff the dispensary in the mornings and, in Emily’s case, to treat surgical patients. At this early stage, the infirmary didn’t actually provide full-time employment for three physicians. Two-thirds of the beds remained empty. This was not for lack of patients but lack of funds; Elizabeth refused to spend money she didn’t have. “It is a principle distinctly laid down, that no debt shall be contracted by the Institution,” read the annual report. Although the hospital’s mission was to provide free care to the indigent, once it reached the limits of its meager resources, it accepted only those inpatients who could afford to pay four dollars per week. There weren’t many of them. The Blackwells and Zakrzewska spent a substantial amount of time away from Bleecker Street, attending to private patients. It was their only source of medical income; the infirmary paid them nothing.
The New-York Times ran an enthusiastic notice of their efforts—“What the Lady Doctors Are Doing”—two months after the infirmary opened. The item cheered the infirmary’s modest beginning, noting the founders’ “ambitious plans for the future” and highlighting their “mortal horror of debt, quite unusual in similar enterprises.” The “homelike” establishment was “as fresh and clean as if just swept by the proverbial new broom,” and the nursing care was unusually good, “if one may judge from the physiognomy of the motherly-looking dames who have charge of that department.” Surely the infirmary would prove to be the kernel of women’s medical education in New York: “The plan is well laid, and only needs a refreshing shower of endowments and donations to hasten its growth materially.”
All this was excellent publicity, but the article mentioned the Blackwell sisters only briefly before devoting a full paragraph to the credentials and merits of Dr. Marie Zakrzewska. “She is an enthusiast in her profession, and is of the timber from which good artists are made,” the reporter enthused. “She is aided by the Drs. Blackwell.” It is likely the reporter was Mary Louise Booth, a frequent visitor to Zakrzewska’s attic quarters at the infirmary, and later the first editor of Harper’s Bazaar. Dr. Zak had recognized the young reporter as a sister across disciplines: “I found that she also was a beginner in her career and had obstacles to overcome; as, for instance, hiding her sex by signing only her initials to whatever she wrote, or not signing at all.” Their friendship had yielded exactly the kind of warm support Elizabeth and Emily found so hard to attract.
Policemen walking the night shift became accustomed to seeing the women of the infirmary coming and going at all hours. The doctors and their students spent significant time in “out-door practice,” visiting patients and laboring mothers in the slums. Given the infirmary’s limited finances, it was a good way to expand its reach and reputation without the extra expense of feeding and housing inpatients. Some nocturnal calls surely rattled the composure of even the bravest visitor, but those moments had their own value in plucking at the heartstrings of potential donors. “Night after night is spent by the young physician in these dens of misery,” read one early annual report, “when the only bed is a heap of rags on the floor, and that heap is shared, perhaps, by a drunken husband, and here the newborn child is ushered into a world of woe.” There is no record of either doctors or students coming to any harm beyond “unpleasant annoyances from unprincipled men.” Though uptown ladies might draw in their breath and their skirts at the sight of a female with a doctor’s bag, women of the tenements welcomed the unusual physicians into their private spaces. Women had always helped each other in sickness.
Their menfolk were not as sure. Who knew what really went on upstairs at Bleecker Street? When one woman died on the maternity ward, gossip flew: Weren’t those lady doctors known to promote hygiene over calomel and leeches? What kind of doctoring was that? Though relatives had been present at the woman’s bedside throughout her ordeal, by early afternoon members of her extended family—including men armed with axes and shovels—were pounding on the Bleecker Street door, condemning the infirmary for “killing women in childbirth with cold water.” Their shouts drew a crowd that expanded to fill the sidewalk as far as Broadway; a few ran around and battered at the back door as well. The infirmary staff were trapped, their calls for help inaudible over the noise of the mob. At this point two policemen arrived, and the doctors had reason to be grateful for the reputation they had built in the neighborhood. Bellowing for silence, the officers ordered the rioters to disperse. Didn’t they know the lady doctors did the best they could for their patients? After all, they scolded, “no doctor could keep everybody from dying some time.”
This was not an isolated incident. On another occasion, a similar mob responded to the news that appendicitis had claimed a victim, though the patient had been attended repeatedly by Richard Sharpe Kissam, an eminent Bellevue surgeon who was one of the infirmary’s consultants. This time Zakrzewska was able to send a note summoning Kissam, who told the angry gathering to fetch the coroner and have him examine the body in the presence of a “jury” of a dozen of them. “It was a sight to behold,” Zakrzewska remembered. “These poor distraught men in overalls, with dirty hands, disheveled hair and grim faces, standing by during the autopsy, and at its close, declaring their satisfaction that death had been an unavoidable consequence of the disease.” It was good to have champions like Kissam in a crisis, but the women he had just rescued must have wished they could do without his help.
By midsummer things were running smoothly enough that Elizabeth took a vacation, a solo weeklong ramble along the Connecticut shore near Lyme. Charmed by the blue and green and gold landscape, she filled her lungs with sea breezes, sometimes walking twenty miles in a single day. One afternoon an elderly gentleman driving a wagon in her direction offered her a ride, assuring her that he was a married man and she should feel no anxiety, despite the remote spot in which they found themselves. “I informed him that I had great faith in humanity,” Elizabeth wrote, “& believed in men, not in tigers.”
The infirmary’s annual report for 1857 announced that nearly a thousand women and children had received care, though only forty-eight as inpatients. There had been thirty-six surgical cases, with Emily performing admirably as attending surgeon. “I have been delighted with the sound judgment and ability she showed, at every step,” Elizabeth wrote after Emily’s first successful operation. “I think a reputation in surgery will be sure to make her fortune in time, for it will be the very thing that will overcome the distrust women still feel in employing women Doctors.” While a skeptic might insist that a feverish patient’s recovery would have happened more rapidly under a male doctor’s care, no one could question the skill of a woman who safely removed a tumor or corrected a clubfoot.
Word was spreading among the communities the infirmary served, and the trustees were happy to report that “the kindly, home-like way in which this charity is conducted, attaches the poor people to it, and they gladly return there.” In fact, too many returned, and lack of funds forced the painful necessity of turning many of those patients away. But Elizabeth’s adamant refusal to borrow money was prudent. The political turmoil that followed the Supreme Court’s Dred Scott decision—which unexpectedly opened western territories to slavery—and the subsequent collapse of the market in western railroad securities led to a financial panic in the fall of 1857 that convulsed the country, closing New York banks for two months. Even as commercial credit evaporated, the infirmary proceeded with its work, unaffected. “Its funds have been managed with great economy,” the Times wrote approvingly, “and, notwithstanding the commercial embarrassments of the past year, it is free from all debt, and has even increased the number of its beds.”
Despite such proofs of success, Elizabeth, at least, remained unsatisfied. Though the Blackwells could claim staunch allies, most of New York’s elite still looked at them askance. Remembering her enthralling encounter years earlier with Fanny Kemble in Lady Byron’s parlor, Elizabeth brought Zakrzewska to pay a call when the actress visited New York, hoping she might offer her talent in support of the infirmary. Kemble listened attentively, but when she realized the attending physicians of this hospital for the poor were women, her reaction was immediate and thunderous. “She sprang up to her full height,” Elizabeth wrote, “turned her flashing eyes upon us, and with the deepest tragic tones of her magnificent voice exclaimed: ‘Trust a woman—as a doctor!—NEVER!’ ” Elizabeth and Zakrzewska left the hotel bemused and disappointed.
Elizabeth was increasingly unafraid to declare that America wronged its accomplished women. “When a woman has won herself an honorable position in any unusual line of life,” she wrote in the Philadelphia Press, “she is still excluded from the companionship and privileges of the class to which she should belong, because her course is unusual.” Her hard work had won her admirers, but she was still mostly unwelcome in the drawing rooms of the prominent people who could help her the most—people whose approval she craved more than she would admit. “Stop the sneer at any effort because it is unusual,” she wrote with unguarded frustration. “Let us learn to regard women as human beings as well as women.” She was weary of the gossips who wondered whether female doctors dressed like ordinary women, or cut their hair short like men.
It was good to have allies like Lady Byron, who had remained a flatteringly faithful correspondent in the years since Elizabeth had returned from Europe. “Your kind thought for our Hospital cheers me,” Elizabeth wrote to her at Christmas 1857. To a woman as sophisticated and well respected as Lady Byron, Elizabeth felt no need to soften her sense of her own value.
Very few understand the soul of this work, or the absolute necessity which lies upon me, to live out the ideal life to the utmost extent of my power. My work is undoubtedly for the few, it is labor in the interlinkings of humanity, and is necessarily difficult of appreciation to the mass, very slow in gaining their esteem. It has been my most toilsome lesson, to translate my thought into the common language of life, and I labour at this translation perpetually, and too often remain still incomprehensible.
At least, she told her friend, she now had a loyal companion on her difficult path. “My sister is a noble helper, and we shall stand, I trust, shoulder to shoulder, through many years of active service.” But even in her gratitude, Elizabeth saw her younger sister as an aide, not a partner: someone to hold the ground they had won, even if she herself was too restless, and too ambitious, to settle there.