Blackwell, in contrast, was nothing if not sentimental. She entered medicine with a perfectionist conception of morality and her own role in the moral universe. Believing that the realm of medicine and health must be a fundamental area of concern for the reformer, she wrote in 1889, “The progress and welfare of society is more intimately bound up with the prevailing tone and influence of the medical profession than with the status of any other class of men.”¹ Indeed, Victor Robinson, a younger physician who knew and admired her, called her a “Swedenborgian-heosophicaltheological-Christian-metaphysiciati, instead of just an unadulterated scientist.²

To the amused Robinson, such idiosyncrasies could be tolerated in great pioneers. But, as Jacobi formulated her thoughts on that Christmas morning in 1888, she realized that Blackwell’s thinking raised her “antagonistic hairs” particularly because the woman was a pioneer. Sentimentality hurt the cause. Blackwell’s preoccupation with the abstract struggle to make a place for women in medicine, Jacobi complained, never allowed her to descend from her vision “into the sphere of practical life within which, that vision if anywhere must be realized. You left that for others to do.” What rankled Jacobi most was Blackwell’s dominant “mental habit,—princi—ple,-or method, ... the well known Transcendental method of arriving at conclusions by the force of meditative insight, and then refusing to submit these to tests of verification. “Indeed,” Jacobi continued upon further reflection,

What mystified and frustrated Jacobi was Blackwell’s inattention to clinical medicine. “You have always disliked, ignored and neglected medicine!” she wrote, and the “one real occasion where from your position you should have shown me much, yet failed to show me anything, was when I began to study medicine under your direction in New York.” Jacobi could sympathize with the “immense” obstacles in the way of Blackwell’s reading and being taught medicine at midcentury, but she confessed she had always suspected that her friend’s “greatest real difficulty” was “your own intense indifference to the work.”³

The differences between the two women were partly temperamental. But in the last third of the nineteenth century, they also reflected tensions within the medical profession created by the new discoveries in immunology and bacteriology. Women physicians, as they came to see themselves more and more as active participants in a changing profession, were not immune to the ethical and scientific debates that took place within its ranks. One of the most important was the question of the role of the physician in specific areas of reform-a debate intensified by the dramatic discoveries concerning the origin of disease which were made in the laboratory in the 1880s and 1890s. Like many male physicians, Jacobi and Blackwell disagreed sharply over the scientific meaning and ethical implications of bacteriology. Intertwined with the different responses to what became a medical issue of considerable consequence, however, were their divergent views on the role of the woman physician. Their lives and their opinions merit further exploration because each of them represents a pole in a wide spectrum delineating the various responses of female medical professionals to these crucial questions. Women physicians, by nature of their being physicians, ranged themselves on different sides of the controversies shared by their medical brethren. By virtue of their being women, they also faced dilemmas from which their male colleagues were spared. Most of these centered on the fact of their womanhood and its meaning with regard to their larger connection with the profession. But even here their solutions, as we shall see when we examine Jacobi and Blackwell’s views more closely, could dissent from one another in significant ways.

One of the most bewildering controversies to twentieth-century observers remains the reluctance of many nineteenth-century physicians and public-health advocates—known as sanitarians—to accept the discoveries of the bacteriologists. How could such men and women persist in speaking of “effluvia,” “miasma,” and “filth” when the precise experimentation of Pasteur, Koch, and their followers had, by reproducing various diseases in the laboratory and indentifying various “germs,” ushered in the concept of “specific etiology?”

To make sense of the sanitarians’ objections we must remember that bacteriological concepts called into question an older and deeply internalized view of disease that was holistic in its scope, moralistic in its implications, and fundamentally religious in its point of departure. In the minds of many sanitarians, Elizabeth Blackwell included, health was the natural order of things, a gift to be enjoyed by people if they governed their lives wisely and well. Disease was neither the abitrary visitation of an Angry God nor the quixotic outcome of Blind Fate, instead it was the inevitable result of one’s violation of the laws of Nature made manifest by a benevolent Deity. Disease, so often equated in their cosmology with sin, was permitted by God to exist, but conscience and revelation on the one hand and reason and science on the other were the tools provided by Him for man to combat these evils. Medicine’s task was to reveal and teach the laws by which people could ensure the proper balance between environment and individual behavior. Chapter 2 demonstrated the role of women and the health-reform movement in popularizing such attitudes.

From a modern perspective, nineteenth-century sanitarians and health reformers may have been scientifically naive, but their ideas exhibited an internal consistency which linked together a perfectionist world view with the more personal concerns of men and women interested in active and dramatic social reform. They reasoned that, since disease was always accompanied by ugliness, want, and pollution, health could be achieved by replacing these modern blights with the pure food, air, water, and the pleasant surroundings enjoyed in the preindustrial age.⁴

Louis Pasteur’s discovery of germs in the laborabory created a tension between environmentalism and the concept of specific etiology which agitated the medical community at the end of the nineteenth century both in America and abroad. To be sure, the controversy represented different points of view on a continuum rather than a conflict between two opposing camps. As early as the 1840s and 1850s individual physicians spoke of “germs” and used the term to identify a cause of disease that defied mere cleanliness and purity. Some even suggested that conscience and clean living were not always enough to keep people well.⁵ Enlightened Americans, like Lemuel Shattuck or Dr. Henry Ingersoll Bowditch, for example, carefully balanced traditional sanitation theory, with its emphasis on filth, against new concepts pointing to a specific microbial invader. Nevertheless, the social implications of the two poles of thought can be usefully contrasted. Blackwell, perhaps because her scientific opinions exhibited none of the subtlety of contemporaries like Shattuck, Bowditch, or Mary Putnam Jacobi, stands as an appropriate representative of an older, more conservative tradition, still unmoved by the startling new discoveries of laboratory experimentation.

One clue to Blackwell’s thinking lies in the fact that her interest in moral reform antedated her attraction to medicine. In part this was due to her remarkable family background. The children of the abolitionist Samuel Blackwell immersed themselves in the traditions of Christian perfectionism and reformist activity. Elizabeth’s brothers, Henry and Samuel, supported antislavery and women’s rights: the former married the feminist Lucy Stone and the latter married Antoinette Brown, the first formally ordained woman minister in the United States. Sister Emily also became a physician, and another, Anna, a poet and translator. Several family members dabbled in spiritualism. Blackwell’s approach to medical issues confidently bore the stamp of her family’s progressive tendencies.

The idea of studying medicine did not come easily to Blackwell, for she admitted in her autobiography that as a young adult she “hated everything connected with the body” and “the very thought of dwelling on ... its various physical ailments filled me with disgust.” Yet other circumstances pushed her toward her life’s work. One was her burning desire for engrossing, ennobling activity. When she finally decided to become a physician, Elizabeth could hardly “put the idea ... away.” She knew even then that the term “female physician” referred primarily at that time to abortionists, the most notorious of whom was New York’s Madame Restell. Such misuse of female power directly offended her growing mystical fascination with what she later termed “the spiritual power of maternity.” The Madame Restells of the world represented “the gross perversion and destruction” of womanhood and “utter degradation of what might and should become a noble position for women.” With determination she concluded to do what she could to “‘redeem the hells’ ... especially the one form of hell thus forced upon my notice.”⁶

Blackwell seems to have consciously chosen a life that would protect her from marriage and intimacy with men. Her autobiography reveals that her choice of career came in part from fear of her susceptibility to romantic longings. Although she was constantly “falling in love” she shrank from the implications of those feelings, “repelled” by the idea of intimacy and a “life association.” Soon after seizing upon the idea of medical practice, she confided to her journal:

Like Cordelia Greene, and many other women physicians of her generation and the next, Blackwell often used a traditionally religious vocabulary to articulate these goals. She turned for aid “to that Friend with whom I am beginning to hold true communion,” and shortly after she began preparing for her future course her fears and doubts were dispelled by a mystical experience which left her confident that her individual work was divinely inspired and “in accordance with the great providential ordering of our race’s progress.”⁸ This conversion of religious impulses into paths of professional activity was characteristic of many sanitarians during the antebellum period, both in America and in England.⁹

Similar themes pervaded Blackwell’s writings as she formulated her two major concerns, the role of the physician in society and the place of women in the profession. Because her approach to disease was holistic, she argued that the physician had more to do than merely cure. She constantly spoke of the union of the spiritual and the physical, warning her students frequently against the dangers of materialism. “True science,” she wrote, “supports the noblest intuitions of humanity, and its tendency is to furnish proof suited to our age of these intuitions.” When “the recognition of the higher facts of consciousness is obscured, and the physician is unable to perceive life more real than the narrow limits of sensation,” she warned, the loss to practical medicine was “immense.”¹⁰

The bacteriologists obscured “the higher facts of consciousness,” according to Blackwell, because bacteriology appeared to develop at the expense of sanitation, hygiene, preventive medicine, and most important, morality itself. By equating disease with a specific microbial invader, laboratory scientists seemed to be challenging the older view of health as equilibrium and threatening the work of those reformers who supported massive sanitary measures to remove the filth, want, and pollution that they believed caused disease. The traditional art of medicine, whose monistic pathologies bid the physician treat only after a careful balance of emotional, environmental, and physio-psychological factors, was rendered obsolete. Not laboratory experimentation, dissented Blackwell, but “pure air, cleanliness, and decent house-room secured to all ... form the true prophylaxis of small-pox.”¹¹ “The arbitrary distinction,” she continued elsewhere, “between the physician of the body and the physician of the soul ... tends to disappear as science advances.”¹²

Blackwell continued to explore these themes when she turned her attention to the role of women in the profession. In 1889 she wrote that the sense of right and wrong must constantly govern medical research and practice, “the Moral must guide the Intellectual, or there is no halting-place in the rapid incline to error.” Because she shared with many feminists the belief that women innately exhibited a higher moral sense than did men, she saw the role of medical women as integral to the proper and healthy progress of the profession as a whole. Indeed, a “distinguishing characteristic” of the nineteenth century, she argued, was the “increasing devotion of women to the relief of social suffering” through the “spiritual power of maternity.” By this she meant “the subordination of self to the welfare of others; the recognition of the claim which helplessness and ignorance make upon the stronger and more intelligent; the joy of creation and bestowal of life; the pity and sympathy which tend to make every women the born foe of cruelty and injustice.” Women were accomplishing great deeds. Such “spiritual mothers of the race,” she judged “often more truly incarnations of the grand maternal life, than those who are technically mothers in the lower physical sense.”

Women physicians, she argued, must monitor medical progress so that it did not violate moral truth. “Whatever revolts our moral sense as earnest women,” she reminded her students, “is not in accordance with steady progress” and “cannot be permanently true.” It was through the “moral, guiding the intellectual” that the “beneficial influence of women in any new sphere of activity” would be felt.

Bacteriology and its penchant for vaccination offended Blackwell because its concept of specific etiology undermined her sense of the moral order. A concomitant of modern laboratory science-animal experimentation—represented something much worse: the triumph of the intellect over morality. Blackwell probably opposed vaccination primarily because early in her practice she lost a young child whom she had vaccinated against small pox. Vivisection, however, represented to her an attempt to do good by evil means. Animal experimentation, she felt, hardened the heart, blunted the moral sense and injured the “intelligent sympathy with suffering” which was the mark of a good physician. Ultimately it led to the dangerous habit of treating the poor and helpless with indifference by regarding them merely as “clinical material.”¹³ Blackwell regretted this tendency particularly among younger physicians, and she felt it the responsibility of women doctors to discourage such inhumane practices. In 1891 she addressed a letter of protest to the Alumnae Association of the Woman’s Medical College of the New York Infirmary in which she opposed their endowment of a new experimental laboratory. She reminded her female colleagues of their “duty” as potential mothers to oppose the cruelty and narrow materialism of which, to her mind, the new laboratory was symbolic.

Blackwell even connected the corruption of the moral sense resulting from “unrestrained experiment on the lower animals” to the increase in gynecological surgery at the end of the century. To her, ovariotomy represented “mutilation” and was especially heinous because it rendered women incapable of having children. Again she looked to women physicians to remind the profession that “moral error may engender intellectual error” and talked often of returning to the United States to rally women’s attention on these issues. ¹⁴

Fascinated and energized by recent events in laboratory medicine, Mary Putnam Jacobi could muster little enthusiasm for Blackwell’s views. In her private life she too confronted the moral dilemmas of the reformer, and she enthusiastically supported numerous meliorist efforts, including the Consumer’s League, woman’s suffrage, and the reform of primary education in the direction of manual training and physical culture. But though she understood that the pursuit of truth could never be divorced totally from moral life, she approached the acquisition of medical knowledge as something quite independent of morality. Believing in science with an earnestness that was almost extreme, she nevertheless remained uncomfortable with Blackwell’s traditional religious vocabulary, and she viewed scientific research as an absolute good because it added to the fund of human knowledge.

As a young medical student Jacobi had written her mother that her vision of Heaven was “simply the Region of Pure Thought” emancipated from “the overwhelming dominion of personal emotion and instinct.” Her desire to pursue a scientific career developed early, and she hesitated only when deciding whether to concentrate on medical practice or laboratory research. The oldest daughter of the publisher George Palmer Putnam, Jacobi, like Blackwell, received considerable support from her family. Although the Putnams were not active reformers, they were nevertheless New Englanders who remained sympathetic to many of the progressive causes of the day. Mary’s Aunt Elizabeth Peabody, for example, kept her in touch with every new social “ism.” Yet Mary remained too hardheaded and practical to identify herself with trends and fads. She once wrote to her mother, “I detest vulgarity, pretention, ... inanity, twaddle, insipidity and pretention in velvet. I will have none of either. No homeopaths, no spiritualists, few “female orators” ...”¹⁵

The Putnams were not pleased with their daughter’s choice of career, but their disappointment did not hinder their providing emotional and material support. Jacobi’s father considered medical science to be a “repulsive pursuit” but nevertheless took great pride in Mary’s success. He begged only that she shun the company of “strong-minded women,” saying, “Your self-will and independence ... are strong enough already,” and asking that she preserve her “feminine character:” “Be a lady from the dotting of your i’s to the color of your ribbons,” he wrote to her in 1863, soon after she began her studies at the Woman’s Medical College of Pennsylvania, “and if you must be a doctor and a philosopher, be an attractive and agreeable one.”¹⁶

Jacobi appreciated and respected her parents’ advice because she understood the significance of their liberalism with regard to her aspirations. “You have always been such a dear good father,” she once wrote to George Putnam. Grateful to them particularly for the “liberty” they gave her to make her own decisions and correct her own mistakes, Jacobi felt that she could not have succeeded without her parents’s open-minded support.“” ¹⁷

Their tolerance of her plans was indeed remarkable for Victorian parents. Jacobi was headstrong, and she spent long years stubbornly pursuing her goals—years that the oldest girl of an upper-middle-class New York family might have passed making more of a contribution to home life as daughter, sister, and eventually, a wife. After receiving a degree in 1863 from the New York College of Pharmacy, Jacobi attended the Woman’s Medical College in Philadelphia and was graduated a year later, the only student in the history of the school to write her thesis in Latin. She spent the next several months studying clinical medicine with Marie Zakrzewska and Lucy Sewall at the New England Hospital for Women and Children. Yet, neither experience satisfied her thirst for formal medical training, and in 1866 she left the United States for France, where she hoped to be admitted to the Ecole de Medicine in Paris. Looking back on this decision in 1871, she wrote to her mother, “I cannot do a thing half way. When I was in Boston, Lucy Sewall considered me stupid, because I could not do things without having studied them, and could not accept her methods without question. In Paris, I am considered one of the most successful students, because I have been able to ‘go the whole horse.’ Explain it as you may, I always find the whole of a thing easier to manage than the half.”¹⁸

Jacobi’s time in Paris testified to her persistence and determination. Although she immediately began attending hospital clinics, lectures, and laboratories, it took her two years of dogged perseverance to achieve her goal of admission to the Ecole. Characteristically, she passed her examinations with high honors and won a bronze medal for her graduating thesis in 1871.

In Paris Jacobi pursued the most advanced medical science of her day. Soon after her arrival there she wrote nthusiastically to her mother, “I have a fair prospect here of becoming a thoroughly educated physician,” adding that “unless I am, I certainly will never undertake to practice medicine.” Her commitment to the laboratory made it easy to welcome the discoveries of the bacteriologists and seek to stay abreast of their findings. She perceived early that opportunities for medical study in America did not begin to compare with those abroad. In another letter to her mother she spoke of New York City’s inadequacies:

In 1871 Jacobi returned to New York to join the faculty of the Woman’s Medical College of the New York Infirmary as professor of therapeutics and materia medica. She also set up private practice, feeling satisfied that “few young physicians could have a better opening.” Family considerations and a sense of duty determined the subordination of chemistry-her first love—to private practice. As she explained to her mother, “After all the sacrifices you have made ... I see more chance of satisfying you if I am a practical physician than if, without fortune, I try to become a scientific chemist.”²⁰

Plunging herself into the world of New York medicine, Jacobi fulfilled her ambitions to become a first-rate physician and scientist. She was the first woman to be admitted to the New York Academy of Medicine and later chaired their section on neurology. She gained admission to numerous other medical societies as well and sustained her interest in research by publishing nine books and over 120 medical articles. The respect of her male colleagues was never in doubt. One younger member of the Pathological Society, for example, remembered her as a woman “whose knowledge of pathology was so thorough, whose range of the literature was so wide and whose criticism was so keen, fearless and just that in our discussions, we felt it prudent to shun the field of speculation and to walk strictly in the path of demonstrated fact.”²¹

Perhaps Jacobi’s successes in the male professional world were due at least in part to her willingness to accept men as equals. Certainly Jacobi did not share Blackwell’s ambivalence toward romantic attachments to men, and her private correspondence never reveals the suspicion of marriage characteristic of many accomplished women of her generation. Nevertheless, she sought in a mate a rare thing in the nineteenth century—an intellectual and spiritual companion who could fully support her commitment to her work. Although she was capable of passion, she was prepared to forgo marriage if she did not find such a man and broke two engagements before she joined the ranks of New York’s professional medical elite. While still in Paris she had written on the subject of marriage to her mother:

Fortunately, Jacobi did meet such a man. In 1873 she became the wife of Dr. Abraham Jacobi, a German-Jewish refugee from the revolutionary upheavals of 1848. Jacobi was already one of the most distinguished physicians in America and has often been called the father of modern pediatrics. ²³ The couple shared common medical interests and collaborated occasionally. Although the marriage was occasionally tempestuous, it remained a relationship of equals, despite Jacobi’s assuredly ironic remark to her students that “it is desirable that every woman remain as inferior to her own husband as may be feasible and convenient.”²⁴

Jacobi’s personal and professional history made her understandably impatient with Blackwell’s rigid theorizing, and glimpses of irritability appear in her comments concerning Blackwell’s proposed trip to America. On Blackwell’s antivivisectionism she remarked coolly, “Of course ... you know ... I should oppose you,” adding with humor and a touch of wistful regret that a campaign among women physicians would be useless because “I am tolerably confident that I am the only woman in the United States who experiments on animals!” was for the “problem” of gynecological surgery, Jacobi was less polite: “When you shudder at ‘mutilation,’ ” she wrote,

In the end, it was on the question of the role of women in medicine that their divergent attractions to the potentialities inherent in medical practice led Blackwell and Jacobi to differ most intensely. Blackwell’s thought derived from the ideology of domesticity, which emphasized not the essential identity between men and women but their differences. Women should become physicians because they exhibited unique qualities which would allow them to make a distinct contribution to the profession.

In her writings Blackwell constantly underscored the singular capabilities of women as physicians, which led to a peculiar kind of female chauvinism. The purpose of teaching women medicine was not to convert them into “physicians rather inferior to men,” but to occupy “positions which men cannot fully occupy,” and exercise “an influence which men cannot wield at all.” Those positions had mainly to do with women, children, and the family. Women physicians must bring science to bear on daily life. This could be done best as family physicians, obstetricians, public-health advocates, and teachers of preventive medicine and hygiene, because it was in these areas that women could excel. Other branches of medicine reeked to Blackwell of the tyranny of male authority unmitigated by the dictates of conscience. She cautioned her students against the “blind acceptance of what is called ‘authority’ in medicine,” which she equated with the “male intellect.” “It is not blind imitation of men, nor thoughtless acceptance of whatever may be taught by them that is required,” she wrote. Women students, she regretted, were as yet too “accustomed to accept the government and instruction of men as final, and it hardly occurs to them to question it.” They must be taught that “methods and conclusions formed by one-half of the race only, must necessarily require revision as the other half of humanity rises into conscious responsibility.”²⁷

In advocating this position Blackwell voluntarily set herself and women physicians apart from the mainstream of professional developments. Rather than assimilate women into the larger group, she preferred to give them special esponsibilities in order to achieve what she believed was a higher social and moral purpose. Women physicians were to be “in” the profession, but not “of” it.

This stress on the primacy of the maternal qualities of sympathy and instinct troubled Jacobi because she objected to female-centered, moralistic, and separatist standards for women. Her concern for objective science and the centrality of intellectual endeavor remained fundamentally universalistic and assimilationist. For Jacobi the physician dwelt in two realms, the intellectual and the practical. Although she admitted that moral considerations occasionally entered into the equation, she hailed the liberation of science from the mystic and demonic influences of the past and believed that the physician should deal with rational concepts based on objective knowledge. Ideally his business was to “take conditions which science has abstracted for the purpose of thought and to recombine them for the purpose of life. In the absence of the physician there would be no one to do this.” Thus, the physician was the link between theory and practice. Moral issues were often beside the point. The intrinsic difficulty in medicine, she wrote, was not moral, but remained “the great mass of facts which it is necessary to know” and “the variety of sciences which must be understood in order to interpret these facts.”

Where Blackwell emphasized sympathy and compassion and identified such qualities with women, Jacobi spoke rarely of exclusively feminine contributions to medical practice. Having a sympathetic nature, she argued, did not necessarily make one a good physician. He or she must be interested primarily in the facts. In the end, she wrote, unless “the interest in the disease be not habitually greater than the interest in the patient,” the patient would surely suffer. She saw women participating in the profession, not as a distinct entity unto themselves, but as separate individuals united with men by objective, demonstrable, and professional criteria in the search for truth. “Indeed,” she cautioned her students in 1883, “you are liable to be so much and so frequently reminded that you are women physicians, that you are almost liable to forget that you are, first of all, physicians.”²⁸

Jacobi did not reject entirely the notion that women had special strengths, although it is apparent that she believed such characteristics were acquired rather than innate. She admitted, for example, that “it is impossible to deny that women are intrinsically more suitable than men to take charge of insane women,” because of their “superior kindness and conscientiousness.” She quarreled little with the common wisdom that “tact, acuteness, and sympathetic insight [were] natural to women.” Indeed, while stressing the importance of first-rate training she graciously conceded that “the special capacities of women as a class for dealing with sick persons are so great, that in virtue of them alone hundreds have succeeded in medical practice, though most insufficiently endowed with intellectual or educational qualifications.”²⁹

Yet despite women’s unique skills, Jacobi insisted that they be fully integrated into the profession. She deplored the tendency of women doctors “to nestle within a little circle of personal friends and to accept their dictum as the ultimate law of things.” Their role must not be supplementary or distinctive; inevitably skilled women physicians should displace inferior men. There was nothing earth-shattering about women competing with men: “Since society is, numerically speaking, already supplied with quite enough doctors,” she wrote, “the only way in which women physicians can possibly gain any footing is by displacing a certain number of men.” In order to do so, of course, they needed to be either equal or superior, and this meant receiving a better medical education than had yet been possible.

While Blackwell urged women to specialize, Jacobi continuously cautioned women not to concentrate in obstetrics and gynecology, but to devote themselves to a “liberal study of the whole field.” Treating women and children should be used only “as a stepping-stone to general medicine.” If women “do not obtain a foothold” there, if they “content themselves with claiming this little corner,” she warned, “they will never really gain a high place even there.”³⁰

Although Jacobi remained suspicious of separatism, she also conceded that the “opposition to women students and practitioners of medicine has been so bitter, so brutal ... so multiple in its hypocrisy” that women did have common interests as an oppressed class. She repeatedly prescribed grit and hard work in the face of discrimination: “I have always advised you ... to so saturate and permeate your consciousness with the feeling for medicine,” she told the graduating class of the Woman’s Medical College of the New York Infirmary in 1883, “that you would entirely forget that public opinion continued to assign you to a special, and on the whole, inferior” position. She even urged students to forget that they “have in any way braved public opinion.” “Acclimate,” she implored, “as quickly and as thoroughly as possible” to your “new place,” and don’t “keep dawdling on the threshhold to forever remind yourselves and everyone else that you have just come in.” Medicine remained too demanding a profession for conscientious doctors to allow themselves to be concerned with problems of “social status.” If you do not find the facts of medicine more interesting than any other facts,”she cautioned, “you are not fit to be physicians”.

Yet if Jacobi lost patience with those who “dawdled on the threshold,” the “monopoly” which excluded “one half of the race [from] the advantages of education and the facilities of increased life which that confers” rankled even more. She was not naive; she knew such opposition could be removed only after “much effort, individual and collective, persistent, patient, far-sighted, indomitable.” Thus she devoted considerable time and effort to examining the practical difficulties involved in assimilating women into the male professional world. For her the most obvious problem remained what she knew was “the most delicate:” “actually raising to an equality the class which hitherto has been really inferior.”³¹

In acknowledging and working to overcome women’s short comings Jacobi and Blackwell remained of one mind. Indeed, one suspects that, however substantial were their disagreements on theoretical points, practical issues of strategy continuously drew them together. Both women deplored women’s inferior preparatory education, an education that rendered them deficient in intellectual initiative, dependent on authority, and apathetic—all qualities which Jacobi perceptively labeled characteristics of the subordination of “colonial life.” In order to rectify such disadvantages, she wrote, medical women must combine as a class to remove the obstacles that have blocked their progress. Their first task was to create among themselves a “scientific spirit,” by improving medical education for women and encouraging “free, self-sustained, self-reliant intellectual activity.” Jacobi hoped that this “gradual progress in mental culture would improve “mental initiative” in women and hopefully render them equal to men ”in every work that both undertake.“³²

Blackwell had no quarrel with these points. She agreed that the barriers to women’s equal access to quality medical education must be removed as quickly as possible, and she understood that only thorough scientific training would promote women’s success. Both women hoped that the unique opportunities offered by the Woman’s Medical College of the New York Infirmary would begin to alleviate some of these difficulties. The two stood united as well in the battle to widen women’s opportunities for clinical experience and professional association, and both, for different reasons, nthusiastically welcomed the advance of medical coeducation. But where Jacobi’s brand of feminism strived to minimize the differences between men and women and to integrate female physicians into the profession as rapidly as possible, Blackwell adhered to the very end to a vision of the woman doctor’s unique contribution. This was true at least in part because her concept of disease was linked to her notions of morality and her belief that authentic moral understanding depended on female intuition. Such assumptions allowed her to equate bacteriology with male science and its triumph with the victory of the male principle over the female. That such a victory would lead inevitably to the denigration of inuition and morality in medicine was deplorable enough, but the final and most egregious consequence would be that women would be deprived of their power, purpose, and unique advantage in the profession—and this at the very moment when civilized society was beginning at long last to afford them a role appropriate to their highest capacities.

Blackwell’s suspicions of “ignorant male domination” caused her to worry that women physicians accepted male models uncritically. “The only disappointment which comes to me now, as I draw towards the close of a life full of joy and gratitude,” she mused in 1889, “is the surprise with which I recognize that our women physicians do not all and always see the glorious moral mission, which as women physicians they are called on to fulfill. It is not by simply following the lead of male physicians, and imitating their practices, that any new and vitalizing force will be brought into the profession.³³

Indeed, a central theme in the story of women in medicine has been the tension between “femininity,” “feminism” and “morality,” on the one hand; and “masculinity,” “professionalism” and “science,” on the other. In a society that continually emphasized woman’s primary maternal role, the stepping out of prescribed avenues of endeavor inevitably involved for its participants some explanation of purpose. Did women have the right to pursue professional goals, usually considered masculine, with the same vigor as their male colleagues and for similar reasons of self-interest and personal fulfillment? Was the goal of equality a legitimate one for women, or need they contribute as well to some higher female mission? What obligations did women professionals have to other women, or to “female values” in general? Must women emulate the professionalism of men, or seek to temper dominant male values by asserting their uniquely feminine characteristics? Women physicians were the first female professionals to grapple with such questions in the nineteenth century, and we shall see that their contemporary descendants in the profession still do. Nor have other women professionals in the twentieth century escaped such conflicts.

Jacobi and Blackwell, as first-generation women physicians, struggled to formulate answers that would ease women physicians’ transition into the public and professional world. They shared similar goals as well as the common experience of being pioneers. In retrospect, their differences on the issue of women appear less pronounced than their broad areas of agreement. Each struggled defiantly in her own way with the humiliating effects of discrimination while holding fast to her objective of broadening the sphere of constructive activity for all women. Both saw the role of women in medicine idealistically, in the sense that they rejected its pursuit on the grounds of self-interest and emphasized instead the physician’s larger social responsibilities. Jacobi, for example, once declared to her mother that “I look upon a rich physician with as much suspicion as a rich priest.” In 1889 Blackwell wrote in the same vein, “I say emphatically that anyone who makes pecuniary gain the chief motive for entering upon a medical career is an unworthy student: he is not fit to become a doctor.” Both women believed that the success of women in the profession had immense importance for the general success of women “in every other department of society.”³⁴ On questions of strategy, too, they were usually of one mind: both hoped to widen the access of medical women to superior scientific training and to increase their professional and clinical opportunities. Nevertheless, the two women represented distinct approaches to the problem of women in medicine, and their differences were passed on to succeeding generations of professional women.

Although the fact of their womanhood was central to them both, we must not forget that Jacobi and Blackwell differed in the final analysis on medical issues as well—medical issues that went well beyond questions of gender. The achievements of the bacteriologists and the introduction of the concept of specific etiology unleashed in the late nineteenth century constructive forces that would dominate developments in scientific medicine for the next century. Yet the scientific medicine that would flourish after 1900 would do so increasingly at the expense of a holistic approach to the problem of illness. In many respects the worst fears of Elizabeth Blackwell concerning the neglect of psychological, environmental, social, and personal factors would come to pass. Doctors would begin gradually to overlook treatment of the whole patient, concentrating instead merely on the disease. The nurturing aspects of nineteenth-century practice, with its heavy emphasis on intuition, sympathy, and art, would gradually give way to a medical science becoming aggressively more “masculine.” From the perspective of the nineteenth century, Jacobi’s enthusiasm for laboratory science, her identification with the most revolutionary and dramatic achievements of her profession were progressive and refreshing. Blackwell’s ideas, heavy with religious overtones and convoluted personal idiosyncrasies appeared to many to be reactionary, uninformed, and annoyingly short-sighted. But the passage of time would gradually reveal the shocking limitations of laboratory science. Once again researchers would begin to see the value in studying factors in disease causation that cannot be measured, recorded, or recreated in an experimental setting.

To be sure, our contemporary interest in holistic approaches to disease is something very different from the kind of position Elizabeth Blackwell occupied a century ago, and could have come about, in fact, only after scientific reductionism became institutionalized in medicine. However, in the midst of such an about-face, Blackwell’s vision seems almost prophetic as she mused to a friend in 1853: