CHAPTER 14

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RECOGNITION

“I am going to tell you my plans, which I have not yet mentioned to the family generally,” Elizabeth wrote to her brother George in June 1858, “so keep it to yourself for a while.”

The infirmary had been open for a year. Emily had attracted new interest with her own series of lectures for women, enlivened with anatomical illustrations borrowed from the city’s medical schools. In Albany, she had successfully lobbied the New York state legislature for a grant that would place the infirmary on sounder footing. And she had overseen the care of one particularly important patient: Lucy Stone, who was expecting her first child at thirty-nine. “I should not object to its being a boy,” Emily wrote, “but as the Blackwell family has always been distinguished by its women, I should be very well satisfied either way, and it may turn out a little Stone and no Blackwell after all.” Lucy and Henry’s only child, Alice Stone Blackwell, was born September 14, 1857, looking almost comically like her father. She would grow up to become a leader in the suffrage movement.

Emily’s capable management allowed Elizabeth to look ahead—and to recognize the itch of her own dissatisfaction, despite the slow, steady growth of their practice. “Life in New York is monotonous,” she wrote, “and it will continue so, for it arises partly from our position which is without money or connexions, partly from our nature which with the best endeavor, cannot enter into close relations with the society we meet.” The wider approbation that Elizabeth craved remained elusive. Antoinette Brown Blackwell reported that few people on her lecture-tour travels had heard of the New York Infirmary for Indigent Women and Children—though mention of her own married name frequently elicited the question, “Whatever happened to that Elizabeth Blackwell, you know, the one with the medical degree?” Elizabeth might think of herself as a beacon of enlightenment, but her light was not shining as brightly as she had expected.

Barbara Leigh Smith had recently visited New York with her new French husband, Eugène Bodichon, an eccentric doctor sixteen years her senior, who spent most of his time in Algiers and affected a flowing white burnoose over his street clothes. Though the reform-minded Bodichons had planned their American wedding tour as an educative opportunity to observe southern slavery and northern liberalism at first hand, they paused for a pleasure trip to Niagara Falls, and Elizabeth brought Kitty along for the treat. Her friends urged Elizabeth to consider bringing her work “home” to England. Surely London was ready for women doctors, now that Florence Nightingale had become a household name?

Upon her return to England, Barbara Bodichon and Bessie Parkes founded a monthly magazine, the English Woman’s Journal. The second issue, published in April 1858, included an extensive profile of Elizabeth and Emily, written with sororal pride by the Blackwell family journalist, Anna. Citing Queen Elizabeth I and the Huntress Diana as Elizabeth’s models, Anna filled her account with the kind of hyperbole usually accorded a folk hero: how teenaged Elizabeth had proved her prodigious physical strength by hoisting a skeptical (and protesting) male visitor in her arms for three laps around the parlor; or how she had severely restricted her diet while at medical school, so as to remain pale of countenance no matter how trying the anatomy lesson. Anna mentioned neither the farcical circumstances of Elizabeth’s acceptance at Geneva nor the tragic loss of her eye in Paris, and she was careful to correct the “very general misapprehension” that her sisters were American. As true daughters of Bristol, Anglophile Anna averred, Elizabeth and Emily had been “incapable of resorting to the system of puffing and self-vaunting so much in vogue among our transatlantic cousins.” Their success, earned the hard way, Anna suggested, would be all the more lasting.

Though its circulation never exceeded a thousand, the English Woman’s Journal attracted an influential readership. One of these readers was Anna Maria Helena Coswell, Comtesse de Noailles, an eccentric and capricious young English widow whose brief and childless marriage to a French count had left her in a position to be extremely helpful to good causes. She was a shareholder in the Journal and let it be known that she was interested in supporting the Blackwells’ work—in England.

It was this tantalizing possibility—a secure medical foothold in Britain, an aristocratic patron, and a chance to take her rightful place among a class of women she admired, including Florence Nightingale, whose fame had so outpaced Elizabeth’s own—that Elizabeth now confided to George. “I think it very desirable to see England again,” she told her brother, “and to test its possibilities.” She had a perfect excuse for deserting the infirmary and indulging in a trip to Europe: her glass eye was giving her trouble, making a consultation with Auguste Boissonneau, the preeminent ocularist who had originally fitted her, a necessity. Though Emily was skeptical of Madame de Noailles’s overtures, Elizabeth ignored her. “I shall pursue the investigation as I think best,” she wrote with autocratic confidence. “I am not sorry either to throw Emily for a while, upon her own resources, and force her into the responsibilities of practice—she has not yet braced herself to the work, as she must eventually, it being her only means of making money.”

Elizabeth was correct that Emily’s commitment to the infirmary was not as absolute as it could be. Beneath the competent composure of the thirty-one-year-old physician was the same frustrated uncertainty that had plagued Emily as a young teacher. Had she won her way to a medical degree, she wondered, only to face a life of lonely and uncredited labor, eternally eclipsed by the aggressive ambitions and prickly personalities of her sister and Marie Zakrzewska? Success as one of the world’s first female physicians, she now understood, would involve more than good doctoring. It would require a constant active cultivation of public support—what the Blackwells referred to, with distaste, as “push.” “An agony of doubt has burnt in my heart for months,” she confided to her journal. Could it be “that this life of a Physician is so utterly not my life that I can not express myself through it—and worse—worse—that I might have done more in other ways?”

Elizabeth’s departure, though it would mean more work for Emily, came at a perfect moment. In Elizabeth’s absence, Emily could manage their project as partner rather than deputy and enjoy a respite from Elizabeth’s brittle moods. “She needs change,” Emily wrote of Elizabeth’s European travel plans. “Her life in many respects would be a much happier one there than here.” And Emily would now have a chance to deepen her own relationships with the patrons and private patients who had come to know Elizabeth first. By the time Elizabeth returned, Emily hoped, “I may have formed the commencement of a practice wh[ich] will enable me to remain here on better terms.” For now, she recommitted herself to the infirmary—where, for the first time, she would be in charge.

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On her last ocean voyage Elizabeth had been grateful for the presence of her cousin Kenyon; this time her companion was ten- year- old* Kitty—half ward, half servant—who continued to dispel the gloom of Elizabeth’s habitual solitude. In fair weather the girl promenaded silently at Elizabeth’s side, watching for porpoises and the dark silhouettes of storm petrels, which the sailors called “Mother Carey’s chickens,” while her guardian chatted with the captain and the first mate—who promised to “throw Kitty overboard” if she were seasick.

Elizabeth had sailed for Europe to secure her reputation, not to look after a little girl. Once in London she consigned Kitty to her brother Howard, on leave from India, and her sister Ellen, still abroad to study painting, with instructions to find the child some clothes and deposit her at a boarding school recommended by Barbara Bodichon at Ockham, in the Surrey countryside. “Dear Kittykin,” Elizabeth wrote to her there, her handwriting and syntax enlarged and simplified for the child’s benefit. “The weeks will soon slip away and Doctor will be back to see the progress Kitty has made.” Progress, Elizabeth indicated, should be more practical than intellectual—the new generation of Blackwells, led by the toddlers Florence and Alice, needed looking after. “How nice it will be, when you can cut out little dresses for them, and sew them so fast, while they are playing around.” She sent Kitty a birthday box containing a bonnet, a book, and a skipping rope, then left to visit Anna in Paris.

As an old woman, Kitty still remembered her bewilderment that fall, alone in a new country, surrounded by wary schoolmates who could not categorize this odd Irish-American orphan but were only too eager to eat her share of treacle pudding. Tardiness resulted in a day’s banishment without meals, and as the fall deepened, chilblains bloomed on Kitty’s feet. Her letters of distress to Elizabeth, she discovered with dismay, were never mailed. Finally, on a class excursion to the nearest town, she managed to slip one directly into the postbox, and Elizabeth responded with gratifying speed. That was the end of boarding school, but now Kitty would have to make her way to Elizabeth in Paris, alone.

Howard and Ellen left her at Waterloo Station in the predawn darkness, with a passport in one cloak pocket and a Paris address in the other. A child of means would never have made such a journey without a chaperone, and a girl of the working class would never have traveled at all. Kitty, always betwixt, traveled alone by train to Newhaven, by ferry to Dieppe (a crossing more than twice as long as the Dover-Calais route), and then by train again, arriving in Paris well after midnight. The French station officials, clucking with disapproval over the unsupervised child, tucked her into a carriage, and she rumbled off into the night.

“Having read, small as I was, too much about the Revolution,” Kitty remembered, “I expected to be carried off to the Conciergerie”—the infamous prison that was Marie Antoinette’s last stop before the guillotine. When the carriage halted unexpectedly, she feared the worst. Peeping white-faced out the window, she saw an oncoming cab and heard a familiar voice: “Is that you, child?” Elizabeth, informed that Kitty’s train had arrived, had set out to meet her at the wrong station and caught up with her carriage at last, having recognized the child-sized trunk strapped to the roof. Kitty’s memoir recorded fear and relief, but no blame. Certainly a true bond existed between the doctor and the grateful child she had rescued from the Nurseries on Randall’s Island. But in the letters that survive from their yearlong stay in Europe—during which Kitty began to suffer from vision and hearing problems that would plague her for the rest of her life—Elizabeth makes almost no mention of her.

Her preoccupations were elsewhere. Barbara Bodichon had delivered a formal letter of “heartfelt welcome” signed by more than fifty of the influential Englishwomen in her circle, most notably Lady Byron, inviting Elizabeth to speak publicly on women’s health and the importance of women doctors. Elizabeth was eager to accept, but the lectures she had delivered to Quaker ladies in New York church basements—and subsequently published as The Laws of Life—seemed inadequate for London’s urbane elite. She remained in Paris to rewrite them and try them out on Anna, who, she told Emily, “represents an exaggeratedly English audience.” She also needed to update her wardrobe: perhaps a black velvet hat “to give a little height & importance to the head.” She hesitated at the expense but refused to allow wealthy patrons to underestimate her. “If it all falls through,” she rationalized to Emily, “I shall bring back the clothes & we’ll divide them between us.”

A dignified appearance would also help put her audience at ease—an important consideration, given that her material was likely to make them uncomfortable. In a draft manuscript, she quoted a distinguished London matron who had once exclaimed to her, “You can hardly have an idea of the state of complete ignorance I was in, with regard to everything relating to the body, when I married!” Elizabeth’s first lecture subject, therefore—approached with appropriately “reverential admiration” for an audience strictly limited to women—would be the reproductive organs.

Her explanation proceeded methodically from the almond-shaped ovaries, to the Fallopian tubes—lined with pulsing cilia “like a host of energetic little sweepers to be keeping their house constantly clean”—and onward to the uterus, which expanded from fist-sized quiescence to a “great industrial palace” of muscle and artery during pregnancy. To this point, the anatomy lesson was straightforward, full of domestic and mechanical imagery for these wives and daughters of capitalists. But as she turned to the external structures—vagina, labia, clitoris—Elizabeth’s tone shifted.

“Let me here call your attention to a marked distinction which we observe in the functions of the Genital organs,” she wrote. “We find that the Creator in his supreme goodness & wisdom, while endowing us with senses that place us in communication with the external world,” she continued, “has connected the power of exquisite enjoyment with the proper exercise of those senses.” She detoured into euphemistic metaphor—the flaming glory of the setting sun, the heart-piercing song of a bird, the slaking of a traveler’s thirst with cold water—but soon returned to her point: “We find in the special organization which we are considering, a more abundant provision for exquisite sensation . . . than in any other part of the body.” The clitoris, she pointed out, had no practical function except as a receptor of acute feeling. Her choice of image for female erectile tissue—“a spongy vascular body—in size and form, something like a great swollen leech”—was not unexpected for a woman raised in a culture that regarded sexual desire as a perilous temptation, but the fact that she was addressing physical pleasure at all, that she considered it an important part of a woman’s physiological education, was startling. The women who attended this first lecture would surely return for its two sequels, when Elizabeth would make her larger point about the importance of training female doctors.

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Before Elizabeth could take the stage in London, she needed to pay two important calls. The first was to Florence Nightingale, whom she found in January 1859 taking the water cure at Great Malvern. Nightingale had returned from the Crimean War in poor health, bedridden and complaining of chest pain—though she was still managing to churn out reams of cogent testimony on sanitary conditions in the army. Her friends and physicians feared the worst, but Elizabeth was not so sure. “I cannot help thinking that her condition is not understood, and that she is not going to die yet,” she reported to Emily. “She converses with me, precisely as usual, her head clear, her enthusiasm alive, from two to three hours, twice a day.” (Though Nightingale’s invalidism would become part of her mystique, she would live another fifty years. Modern commentators attribute her symptoms to a combination of brucellosis—a bacterial infection acquired at the British camp in Turkey—and emotional health issues including post-traumatic stress disorder.) Public gratitude for Nightingale’s work during the war had ballooned into the forty-five-thousand-pound Nightingale Fund, intended for the training of nurses. Three years after the war’s end, it remained unspent.

All the Blackwells’ fund-raising efforts were a molehill compared to the mountain of money Nightingale now controlled. Her hope, she told Elizabeth, was to establish new standards for nurses, eventually spreading her ideas regarding hygiene to mothers, teachers, and servants across Britain. Doctors, Nightingale felt, tended only to make things worse, interfering with nature’s beneficence—but nurses, if properly taught, had the potential to restore vitality to humanity with attentive hygienic care. “She feels,” Elizabeth wrote to Emily, “that I am the only person in the world that can help her, and she would be immensely relieved from the responsibility of the fund, which weighs heavily upon her, if I would throw [my] life into it.”

Central to Nightingale’s vision was the role of sanitary professor, to be installed in a major London hospital and placed in charge of training the nurses. “She thinks moreover that it ought always to be filled by a woman,” Elizabeth wrote to Emily, “and that woman ought to be an M.D. She thinks I should fill it much better than she.” It was an alluring prospect. The combination of Nightingale’s influence and Elizabeth’s credentials would be potent, and there was considerable overlap in their ideas; both women believed absolutely in the importance of hygiene and education, and Elizabeth frankly preferred the role of professor to that of clinician. But Nightingale’s plan was to improve public health, not to elevate women. “She does not think that England is prepared to educate women Doctors,” Elizabeth wrote. “She would really take me as a valuable exception.”

Elizabeth could not reconcile their divergent perspectives. “She wishes, I see, to absorb me in the nursing plan, which would simply kill me,” Elizabeth confided to Barbara Bodichon. The practice of medicine was Elizabeth’s answer to Margaret Fuller’s call to arms; it made her a model to others, living proof of woman’s true potential, and she refused to give it up. Nightingale, meanwhile, saw the promotion of female physicians as an indulgence. “I remember my impression of your character—that you & I were on different roads (altho’ to the same object),” Nightingale wrote to Elizabeth after her visit. “You to educate a few highly cultivated ones—I to diffuse as much knowledge as possible.” They might have renewed their personal friendship, but on the professional level each would always conclude that the other was missing the point. From New York, Emily summed things up succinctly: “FN’s idea evidently is not to aid you in yr work, but to engage you in hers,” she wrote. “Keep quietly clear of her.”

Elizabeth made her way back across the Channel and southward to the Italian Riviera for her first encounter with Madame de Noailles, another woman who spent most of her time supine—though any similarity to Miss Nightingale ended there. The indolent countess moved through the Mediterranean countryside lounging full-length in an oversized carriage; she retired early, slept late, and enjoyed three extravagant meals during her limited waking hours, with a chamomile-infused bath before dinner. She had exasperatingly little sense of the value of either money or time. “The most characteristic adjective for her is scatterbrain,” Elizabeth wrote to Emily, “impulsive almost to insanity, full of whim.” Elizabeth had intended to give her a private reading of her lectures, but over the course of her five-day visit, she found it impossible to capture the countess’s attention long enough to get through them.

“I can hardly tell you how disgusted I felt by the luxurious self-indulgent objectless life of the wealthy English abroad,” Elizabeth declared—but Madame de Noailles spoke of giving the Blackwells a small fortune, and for that Elizabeth was willing to look past her excesses. “She has true instincts and certain aspirations which may be relied on,” Elizabeth insisted to Emily—among them “great faith in women, & the desire to help them, and a great interest in the question of health.” Her impulsiveness, in fact, might work to the Blackwells’ advantage. “She told me frankly, she could not bear being bored,” Elizabeth wrote. Regular annual donations were boring, so instead the countess gave Elizabeth a thousand pounds on the spot and the promise of five thousand more, with the expectation that Elizabeth would open a women’s hospital in the English countryside. Buoyed by this windfall, Elizabeth returned to London, ready to win more allies with her newly revised lectures.

Their frank content alarmed even her closest friends. Bessie Parkes thought the ladies would recoil with a “shriek of horror,” but Elizabeth was undeterred: “I simply laugh, and disbelieve her.” On March 2, 1859, she faced her first audience—“about 150 people, of considerable influence”—and even the popular press seemed to approve. “Now, let us for a moment imagine a person intrusted with a complicated and delicate piece of machinery,” noted the popular monthly Chambers’s Journal. “Imagine that person to be ignorant of the principles of the construction of that machine,” it continued—such was the plight of women expected to guard their families’ health in ignorance of physiology. Of course, “in a journal of this character, we can only allude to the more purely medical portion of Dr. Blackwell’s discourse,” the article concluded delicately—but its sympathetic tone was clear: intimate knowledge of physical health, imparted to women by fully trained female doctors, was “subject for much earnest thought.”

One member of Elizabeth’s audience responded with particular earnestness. Elizabeth Garrett, the twenty-two-year-old daughter of a prosperous Suffolk businessman, had read Anna’s profile of the medical Blackwell sisters in the English Woman’s Journal. Inspired by the thought of “something definite & worthy to do,” Garrett attended each of the three lectures with growing interest, attention that was reciprocated once Barbara Bodichon introduced the two Elizabeths. “Last night I saw a Miss Garrett who very much pleased me—a young lady who is quietly forming her determination to study medicine,” Elizabeth reported to Emily. “I think she has the pluck to take it up.” Garrett was not nearly as decided as Elizabeth assumed—“I remember feeling very much confounded & as if I had been suddenly thrust into work that was too big for me,” the younger woman wrote—but to her own surprise, the study of medicine suited her. Six years later she would become the first woman in Britain to qualify as a doctor.

As she prepared to repeat her lectures in Birmingham, Manchester, and Liverpool, Elizabeth allowed herself a moment of delighted optimism. “There is an immense charm in this fresh field, where solid English heads receive the highest view of truth, where generosity and largeness of idea meet you at every turn,” she exulted to Emily. “I like working and living in England, immeasurably better than in America, and there is no limit to what we might accomplish here.” Surely the material support she and Emily needed to establish themselves in this far more congenial setting would soon present itself. For the moment, she resolutely ignored a recent warning from Florence Nightingale. “I do not think you know how little your audience represents the public opinion of England,” Nightingale wrote. “I do not draw discouragement from this—but neither should I draw encouragement from them as you do.”

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In Elizabeth’s absence, meanwhile, Emily was starting to believe in a future for the institution they had founded in New York. But she had no one to discuss her thoughts with, and visiting her brothers—now decamped to more spacious suburban quarters in New Jersey—was not restorative. “They have got so completely to look upon me as a Dr that I can’t go near them without being pounced upon with regard to the baby’s bowels,” she complained. With the Fifteenth Street house now filled with boarders to cover expenses, Emily spent most evenings alone in her attic room, reading Elizabeth’s rose-colored reports on establishing a new future in the old country, and writing two worried pages back for every one she received.

Emily understood the seductive allure of London, but there were good reasons to resist. The New York Infirmary had one advantage over anything England could offer: it existed. It would not be easy to create a similar institution in England. The graduates of the American women’s medical colleges who arrived at Bleecker Street fed its purpose as a training hospital for female physicians; in England, women were not yet allowed to study medicine at all. And as Emily became more comfortable with leadership, it was hard for her to imagine trotting off in Elizabeth’s wake once again, “a younger, less well known partner, to make my position by extraneous efforts upon the outskirts of yours.” How could they abandon what they had struggled so hard to create in New York? “My liking is for Europe—if circumstances were favourable,” Emily told Elizabeth. But: “My judgment is for America, and for completing our work here.”

Uncertainty complicated the decisions Emily faced in Elizabeth’s absence. Should she search for a building that could serve more efficiently as both hospital and residence in one? What should she tell their patients and donors, now that rumors had begun to fly that Elizabeth wasn’t coming back? Impetuous Bessie Parkes had published a line in the English Woman’s Journal expressing the assumption that Elizabeth would now establish herself in London, “as her sister, Dr. Emily Blackwell, is well fitted to supply her place across the Atlantic.” And then there was the question of Marie Zakrzewska.

Elizabeth had been right in her original estimation of Dr. Zak: she brought enormous energy and skill to her work. Perhaps too much. Her role as the infirmary’s resident physician meant that hers was the face its patients and staff saw most, and her talent as a practitioner, her knack for self-promotion, and her easy openness won her enviable popularity. “In looking over the book I see she has at least twice as many patients every week as I have,” Emily complained to Elizabeth. “She is evidently desirous to get a position which we can not let her occupy—the superintending woman influence in the Hospital.”

Dr. Zak had begun to upstage the Blackwells in their own institution, yet she did not hold herself to Blackwellian standards, whether in terms of her housekeeping (“Z doesn’t even make her bed,” Emily tutted) or her clinical practice. On one occasion, Zakrzewska—herself recovering from illness, probably from overwork—called in reinforcements for a difficult delivery. Emily and her consulting surgeon, Richard Sharpe Kissam, found the mother’s vagina lacerated and the infant’s scalp cut and bruised by Zakrzewska’s clumsy use of forceps—an error she at first denied. Mother and child survived, but Emily was incensed: not only had Zakrzewska shown poor judgment and sloppy technique, she had made an unfavorable impression on their male colleague, something a woman doctor must avoid at all costs. “The whole affair has greatly shaken my confidence in her as an intelligent authority in difficult obstetric cases,” Emily wrote.

At this fraught moment, a providential offer arrived from Boston: would Dr. Zakrzewska consider taking a newly created clinical professorship at the New England Female Medical College? “I felt that a larger field for my efforts might be opened there in connection with a medical school,” Zakrzewska wrote pointedly, “rather than in New York where the two Drs. Blackwell controlled the direction of efforts toward what seemed to them wisest and best.” Emily heartily agreed. “We can not make the hospital what it should be while she is living in it,” she told Elizabeth. Sending Zakrzewska off with their blessings to a prestigious new position in Boston was a happy ending for everyone. “The Lady Doctors in Bleecker Street” were at last winning the approval both of their patients and the male physicians whose respect they craved. As Zakrzewska prepared to leave, Emily laid out her vision for the future.

First they needed to consolidate home and work in a single larger building, one plain enough not to intimidate the patients, elegant enough to make their genteel patrons feel at home, and substantial enough to attract the female medical students who would become the next cohort of women doctors. For that, Emily reminded Elizabeth, was the point: to be not the first female M.D.s but the first of legions. “If ever I come to the conclusion that this is not to be hoped—that our success is only exceptional,” Emily wrote, “then as far as I am concerned the life is an utter & miserable failure even if I made a fortune by it.” This was the best argument for staying in New York: despite England’s charms, Emily had seen little sign there of prospective medical women “as hopeful as these young green independent Americans.”

Once everything was properly arranged in one building—perhaps “one of those old fashioned 2nd Avenue houses,” Emily suggested—they would need to adjust the public perception of their own relationship. “I have had our names put as a firm in the Directory this year,” Emily announced: where the previous city directory had listed “Blackwell Elizabeth, physician” just above “Blackwell Emily, physician,” the new edition had “Blackwell Elizabeth & Emily, physicians”—a small thing, perhaps, but not to Emily. It was inefficient, not to mention demoralizing, when private patients insisted they would see only the elder Dr. Blackwell. If Elizabeth returned, she and Emily must “get people to regard us as medically on the same footing.”

It was increasingly clear that Elizabeth was going to return. The applause in Britain was not translating itself into cash, and “half crazy” Madame de Noailles had proved a difficult patron, insisting on terms that Elizabeth could not grant. “I confess I’ve had a good cry about it,” Elizabeth wrote to Emily. “I find that my feelings were beginning to take strong root in England, and it will be somewhat of a struggle to give all this new life up.” But she would not return empty-handed. She had a thousand pounds, earmarked by Madame de Noailles for the creation of a small sanatorium outside New York City, which could double as a country retreat for herself and Emily. She had new allies in London, who promised to send over young Englishwomen for training at the infirmary—if the English were not ready to educate female medical students, the Blackwells would teach them in New York. And she had realized a historic and symbolic goal.

“I have only one piece of information viz that the Medical Council has registered me as Physician!” Elizabeth scrawled to Emily just before her departure. Britain’s Medical Act of 1858 had required the registration of all medical practitioners, and Elizabeth’s foreign degree, and the fact that she had treated a few private patients while in London, allowed her to slip through. She was now the only woman included in Britain’s first Medical Register. The loopholes that had enabled her admission were swiftly closed, but when the medical profession at last opened to women in Britain, Elizabeth would be ready.

“Your registration is a good thing,” Emily wrote with understated approval in August 1859. “I am glad the old fellows got so far.” But the recognition seemed to her less important than getting on with the work. She closed this last letter before Elizabeth’s return with a pragmatic reminder of her original errand: “Mind you are well provided with eyes.”

* Kitty’s birthdate is obscure. In old age, she remembered celebrating her tenth birthday in the fall of 1859. Other sources place her birthdate in 1847.

Frances Hodgson Burnett—author of the beloved children’s novels The Secret Garden and A Little Princess—would caricature Madame de Noailles’s notorious excesses in “Piccino” (1894), the story of an English noblewoman abroad who, captivated by a peasant child, decides to buy him for her amusement. De Noailles actually did exchange money for a young Italian girl when she saw a painting of her in a Paris salon; the painting was not for sale, so she bought the original.