Elizabeth Blackwell

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Stateside, Blackwell was faced with adversity, but did manage to get some media support from entities such as the New-York Tribune. Her practice floundered at first, a situation some attribute to false accusations that all women doctors were abortion care providers. In 1852, she began delivering lectures and published The Laws of Life with Special Reference to the Physical Education of Girls, her first work, a volume about the physical and mental development of girls that concerned itself with the preparation of young women for motherhood.

In 1853, Blackwell established a small dispensary near Tompkins Square. She also took Marie Zakrzewska, a Polish woman pursuing a medical education, under her wing, serving as her preceptor in her pre-medical studies. In 1857, Dr. Marie Zakrzewska, along with Blackwell and her sister Emily, who had also obtained a medical degree, expanded Blackwell's original dispensary into the New York Infirmary for Indigent Women and Children. Women served on the board of trustees, on the executive committee and as attending physicians. The institution accepted both in- and outpatients and served as a nurse's training facility. The patient load doubled in the second year.

When the American Civil War broke out, the Blackwell sisters aided in nursing efforts. Blackwell sympathized heavily with the North due to her abolitionist roots, and even went so far as to say she would have left the country if the North had compromised on the subject of slavery. However, Blackwell did meet with some resistance on the part of the male-dominated United States Sanitary Commission (USSC). The male physicians refused to help with the nurse education plan if it involved the Blackwells. In response to the USSC, Blackwell organized with the Woman's Central Relief Association (WCRA). The WCRA worked against the problem of uncoordinated benevolence, but ultimately was absorbed by the USSC. Still, the New York Infirmary managed to work with Dorothea Dix to train nurses for the Union effort.

Blackwell made several trips back to Britain to raise funds and to try to establish a parallel infirmary project there. In 1858, under a clause in the Medical Act of 1858 that recognised doctors with foreign degrees practicing in Britain before 1858, she was able to become the first woman to have her name entered on the General Medical Council's medical register (1 January 1859). She also became a mentor to Elizabeth Garrett Anderson during this time. By 1866, nearly 7,000 patients were being treated per year at the New York Infirmary, and Blackwell was needed back in the United States. The parallel project fell through, but in 1868, a medical college for women adjunct to the infirmary was established. It incorporated Blackwell's innovative ideas about medical education – a four-year training period with much more extensive clinical training than previously required.

At this point, a rift occurred between Emily and Elizabeth Blackwell. Both were extremely headstrong, and a power struggle over the management of the infirmary and medical college ensued. Elizabeth, feeling slightly alienated by the United States women's medical movement, left for Britain to try to establish medical education for women there. In July 1869, she sailed for Britain.

In 1874, Blackwell established a women's medical school in London with Sophia Jex-Blake, who had been a student at the New York Infirmary years earlier. Blackwell had doubts about Jex-Blake and thought that she was dangerous, belligerent, and tactless. Nonetheless, Blackwell became deeply involved with the school, and it opened in 1874 as the London School of Medicine for Women, with the primary goal of preparing women for the licensing exam of Apothecaries Hall. Blackwell vehemently opposed the use of vivisections in the laboratory of the school.

After the establishment of the school, Blackwell lost much of her authority to Jex-Blake and was elected as a lecturer in midwifery. She resigned this position in 1877, officially retiring from her medical career.

While Blackwell viewed medicine as a means for social and moral reform, her student Mary Putnam Jacobi focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties.

After leaving for Britain in 1869, Blackwell diversified her interests, and was active both in social reform and authorship. She co-founded the National Health Society in 1871. She perceived herself as a wealthy gentlewoman who had the leisure to dabble in reform and in intellectual activities – the income from her American investments supported her. She was rather occupied with her social status, and her friend, Barbara Bodichon helped introduce Blackwell into her circles. She traveled across Europe many times during these years, in England, France, Wales, Switzerland and Italy.

Her greatest period of reform activity was after her retirement from the medical profession, from 1880 to 1895. Blackwell was interested in a great number of reform movements – mainly moral reform, sexual purity, hygiene and medical education, but also preventive medicine, sanitation, eugenics, family planning, women's rights, associationism, Christian socialism, medical ethics and antivivisection – none of which ever came to real fruition. She switched back and forth between many different reform organisations, trying to maintain a position of power in each. Blackwell had a lofty, elusive and ultimately unattainable goal: evangelical moral perfection. All of her reform work was along this thread. She even contributed heavily to the founding of two utopian communities: Starnthwaite and Hadleigh in the 1880s.

She believed that the Christian morality ought to play as large a role as scientific inquiry in medicine and that medical schools ought to instruct students in this basic truth. She also was antimaterialist and did not believe in vivisections. She did not see the value of inoculation and thought it dangerous. She believed that bacteria were not the only important cause of disease and felt their importance was being exaggerated.

She campaigned heavily against licentiousness, prostitution and contraceptives, arguing instead for the rhythm method. She campaigned against the Contagious Diseases Acts, arguing that it was a pseudo-legalisation of prostitution. Her 1878 Counsel to Parents on the Moral Education of their Children was an essay on prostitution and marriage arguing against the Contagious Diseases Acts. She was conservative in all senses except that she believed women to have sexual passions equal to those of men, and that men and women were equally responsible for controlling those passions. Others of her time believed women to have little if any sexual passion, and placed the responsibility of moral policing squarely on the shoulders of the woman.

The book was controversial, being rejected by 12 publishers, before being printed by Hatchard and Company. The proofs for the original edition were destroyed by a member of the publisher's board and a change of title was required for a new edition to be printed.

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