In stylish prose, Janice Nimura chronicles the lives and pioneering work of the Blackwell sisters, Elizabeth (1821-1910) and Emily (1826-1910). Along the way the reader learns a great deal about medical practice in the 19th-century, and meets a number of interesting characters, including some of the giants of the profession: James Paget, Florence Nightingale, James Young Simpson, J. Marion Sims, and Dorothea Dix.

In 1844, a terminally ill friend suggested that Elizabeth study medicine, explaining that her illness was of a delicate nature affecting unmentionable parts. “If I could have been treated by a lady doctor,” she said, “my worst sufferings would have been spared me.” After much thought, Elizabeth concluded that medicine was a noble vocation worthy of her time and effort. Unfortunately, her initial applications to several medical schools in New York and Philadelphia were rejected. In 1847 the dean of Geneva Medical College in upstate New York put Elizabeth’s application to a vote by the student body. The students thought the faculty were cowards who were too timid to reject her outright, and not bold enough to embrace the radical idea of admitting a female. The students voted unanimously to admit Elizabeth, less because they believed in equality, but more to prank their elders. These sophomoric males did the right thing for the wrong reason, thereby unwittingly starting a revolution such that today thirty-five percent of physicians, and approximately half of all medical students in the United States are female.

One day Dr. James Webster, professor of anatomy, called Elizabeth to his office to help examine a woman with a gynecological ailment. This was important, because the college had no local hospital to give their students bedside experience with real patients. Realizing that women were more comfortable confiding their most intimate problems to a female doctor, Elizabeth wrote that she “felt more than ever the necessity of my mission . . . . Women will have to save women.”

On 23 January 1849 Elizabeth graduated at the top of her class, thus becoming the first woman to receive a medical degree in the United States. She then traveled to France where she was allowed on the wards of La Maternité, the country’s largest public maternity hospital on the outskirts of Paris, not as a qualified physician but as a student. She roomed with fifteen élèves, midwives-in-training. Elizabeth delivered more than a hundred babies in her first three months. Then tragedy struck.

In November 1849 Elizabeth washed the incrusted eyes of a newborn suffering from purulent ophthalmia, an aggressive form of conjunctivitis contracted when an infant passes through the birth canal of a woman infected with gonorrhea. Contaminated fluid accidentally splashed into Elizabeth’s face. Both eyes were compromised, and she was in danger of losing her sight. The treatments were extremely painful, but she maintained a superhuman stoicism throughout the ordeal. On 15 August 1850, Elizabeth’s left eye was surgically removed, and replaced with a glass prosthesis. This ended any possibility of her becoming a surgeon.

Elizabeth returned to London the following October, and was fortunate enough to be granted permission to study at St. Bartholomew’s Hospital under the aegis of James Paget, who was then on the cusp of renown in surgery and pathology (Paget’s disease, osteitis deformans).At that time she also became close friends with Florence Nightingale, founder of modern nursing, who was likewise convinced of the unfulfilled potential of women.

Emily followed in her older sister’s footsteps, and was accepted at an all-male medical school, Chicago’s Rush Medical College, in October 1852. After completing the first term, the trustees would not allow Emily to finish her degree. She transferred to Cleveland Medical College (now Case Western Reserve), and graduated on 22 February 1854, making her only the third woman to earn a medical degree in the United States. Afterward, Emily traveled to Scotland where she studied obstetrics with James Young Simpson, the discoverer of the anesthetic properties of chloroform, and was admitted to the wards of the Edinburgh Maternity Hospital. After eight months of study, Emily returned to the states in May 1857, where she reunited with Elizabeth. With a shared vision far exceeding that of their contemporaries, the Blackwells opened The New York Infirmary for Indigent Women and Children, the lofty objectives of which were (1) to allow women to consult doctors of their own sex free of charge; (2) to provide female medical students with practical experience denied them by established male-dominated hospitals; and (3) to train female nurses.

Two years earlier, surgeon J. Marion Sims opened his Woman’s Hospital at Madison Avenue and Twenty-Ninth Street in Manhattan, specializing in his signature vesicovaginal fistula operation. The hospital was staffed entirely by men. It was clear that Sims aimed to elevate himself, not the status of women in medicine.

During the Civil War the United States Sanitary Commission enlisted females in various capacities, but not female physicians. Further, the Blackwell’s infirmary was excluded from the list of New York hospitals approved to train nurses. The coup de grâce came when the most prominent position in nursing – Matron General & Superintendent of Women Army Nurses – went to social reformer Dorothea Dix. Incensed at Dix’s appointment, the better qualified Blackwells left the war effort for good. The sisters had made many enemies, because they did not “suffer fools gladly.” They had low opinions of most people, and had difficulty making friends. “Most people have a styptic effect on me,” wrote Elizabeth. “I have never had, [and] I believe I never shall have a friend.”

Elizabeth ruled out marriage and motherhood when she was barely seventeen. There is no evidence of intimacy with another person. In fact, Elizabeth did little to make herself attractive to the opposite sex, usually dressing in serviceable black clothes. On one occasion at a soirée in London, she felt uncomfortably outshone by the other ladies’ finery. “The English ladies have very beautiful busts,” she wrote, “as round & white & full as gelatinous marble.” Since there are no known photographs of Elizabeth as a young woman, we can only speculate (micromastia ?) what underlay her awesome tone.

Believing that women needed a medical education superior to that available from any existing United States medical school, male or female, the Blackwells established The Woman’s Medical College of the New York Infirmary on 2 November 1868. The faculty was male except for Elizabeth (chair of hygiene) and Emily (chair of obstetrics & women’s diseases). Eight months later, an exhausted Elizabeth returned to England to regain her health, and stayed there for the rest of her life.(Born in Bristol, England, Elizabeth became a naturalized United States citizen on 13 April 1849.) Emily, who was better equipped to sustain the school ,remained in charge for many years. With the establishment of the Johns Hopkins (1893) and Cornell (1898) medical schools – both co-educational – the future of women in the medical profession seemed promising. The Woman’s Medical College had fulfilled its purpose and closed its doors.

It seems fitting that the Blackwell sisters, who were so close in life, should die within a few months of each other in 1910. Emily was a month shy of her 84th birthday, while Elizabeth was 89 years of age. A living testimony to the book’s subtitle, both sisters sacrificed their lives to bring medicine to women and women to medicine.