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

In this section of the book, Nimura focuses on Elizabeth and Emily’s establishment of the New York Infirmary for Indigent Women and Children, the tensions between the sisters, and the broader landscape of 19th-century medicine and a world not yet ready to fully embrace women as equals. Emily continues to be rejected by medical schools, first by Dartmouth, then by Berkshire Medical Institution, and finally by Rush Medical College. These rejections represent the broader systemic resistance women faced in professional spheres at the time and speak to The Struggle for Gender Equality in the 19th Century. Despite having the support of individual male faculty members, such as Dr. Daniel Brainard, the institutions at a broader scale were subject to societal pressures that kept women from these spaces. This is the case with Rush, where the board ultimately decided to stop admitting women. Despite this setback, Emily was still able to move on to Cleveland Medical College, where she was finally able to complete her studies. Her graduation with honors was not only a personal victory but was also representative of a larger breakthrough for women in medicine, showing that persistence can eventually overcome systemic barriers. After a brief time in New York, where Elizabeth had just established her dispensary, Emily again follows her sister’s earlier path by traveling to Europe for continued medical education. The contrast between the sisters is clear as Emily reflects on her time there. Although she helps Elizabeth at the dispensary, her lack of detailed commentary in her journal suggests she didn’t find it intellectually stimulating enough. This illustrates her growing divergence from Elizabeth’s mission, as Emily is less drawn to the social aspects of medicine and more interested in practical medical innovations.

Emily’s arrival in Edinburgh represents a significant step forward in her professional development but also shows the ongoing issue of navigating a profession that remained suspicious of women. Even though she excels and gains Simpson’s approval, she is barred from fully participating, a testimony to The Impact of Cultural and Societal Barriers on Women’s Professional Opportunities. Her request to walk the female wards of Edinburgh’s Royal Infirmary is rejected, and the press’s subsequent reaction to her departure reflects the 19th-century societal discomfort with women stepping into professional roles traditionally held by men. This discomfort is also built along class lines. The wealthy patients she encounters at Simpson’s clinic are more resistant to the idea of female doctors, viewing them as an unfeminine American development. In contrast, the poor patients Emily treats in Edinburgh’s Old Town are far more accepting. This difference shows how class often influences societal attitudes toward gender roles, with wealthier individuals being more invested in preserving traditional norms, while the lower classes, who are more focused on survival, are less concerned with what may be considered proper. Emily’s growing interest in surgery, particularly gynecology, becomes central to her professional identity. She sees herself as an emerging specialist in this field, and Simpson’s support helps her further this ambition. However, Simpson’s surgical techniques, including cervical incisions, were often risky and experimental. Nimura contrasts Simpson’s particular blend of brilliance and recklessness with Emily’s belief in careful, methodical progress.

With Emily in Europe, Elizabeth is again alone, although she finally attempts to change this. First is the arrival of Marie Zakrzewska. Elizabeth’s quick recognition of Zakrzewska’s potential as a collaborator contrasts with her previous attitude toward women in medicine. The inclusion of Zakrzewska in her dispensary work and her efforts to help her enter Cleveland Medical College reflect Elizabeth’s growing acknowledgment that she needs allies. Of note is her decision to adopt Kitty, which can be seen as a way for Elizabeth to fill the void left by her lack of personal relationships and her frustrations with her career. Kitty is not just a child but a personal and professional project for Elizabeth. Her affection for the girl is tempered by a desire to shape her into a useful member of the household, and the relationship is ultimately transactional.

The Intersection of Personal Ambition and Social Change is shown in Elizabeth’s focus on broad societal reform rather than direct caregiving. Her preference was to advance women’s roles through systemic change rather than daily medical practice. This mindset drives her to hand over much of the hands-on work at the infirmary to Marie Zakrzewska and to Emily, once her sister makes her triumphant return from Europe. In contrast to their direct care, Elizabeth concentrates on establishing women’s medical education and gaining institutional recognition. While Elizabeth is preoccupied with her loftier goals, Zakrzewska manages the hospital’s operations, from patient care to housekeeping. Zakrzewska’s dedication is vital to the success of the infirmary, but her efforts are overshadowed by Elizabeth's public persona as the hospital's founder. The disparity between Elizabeth’s lofty vision and the day-to-day work becomes a point of tension, particularly as Zakrzewska grows impatient with the lack of tangible progress from Elizabeth’s attempts at fundraising.

By the end of this section, Elizabeth’s restlessness becomes more pronounced. Despite the infirmary’s success, she remains frustrated by her exclusion from New York’s elite social circles and the skepticism surrounding female doctors. This dissatisfaction with her life drives her decision to return to Europe. However, London’s allure is short-lived as her efforts to raise funds in England fall short. In the meantime, with Elizabeth’s departure, Emily takes charge of the infirmary, which finally allows her to step out from her sister’s shadow, although Zakrzewska’s presence is an issue at first. She was a vital part of the infirmary’s early success and began to overshadow the Blackwells in terms of popularity and connection with the patients, which threatened the Blackwells’ control. However, her departure for Boston allows Emily to regain control of the infirmary and solidify her position as a leader.