Though gender inequality remains an issue for women in medicine, great strides have been made over the past century. Women now make up almost half of medical students in the United States and a third of physicians - an accomplishment that can be largely attributed to Dr. Elizabeth Blackwell.
In 1849, British-born Dr. Blackwell graduated from Geneva Medical College in New York, becoming the first woman in the U.S. to receive a medical degree.
"The significance [of this] cannot be overestimated, as this was a time when a woman being a physician was not the social norm," Dr. Shelley Ross, secretary general of the the Medical Women's International Association (MWIA), told Medical News Today.
Until her death in 1910, Dr. Blackwell was a strong advocate for women in medicine, spending much of her time campaigning for women's rights and establishing institutions dedicated to training female medical students in both the U.S. and the United Kingdom.
Although Dr. Blackwell was widely slandered for these actions at the time, she emerged as a role model who led the way for women in medicine.
"Because Blackwell altered her role as a woman in pursuing a career as a physician, some viewed her as abnormal and unnecessarily rebellious, while others admired her strength and courage and saw what her accomplishments could lead to in the future," says researcher Alyssa Turose.
"Blackwell inspired those of the latter viewpoint, and many of them began to take risks themselves in order to cross the social barriers."
In the fourth of a series of articles celebrating female role models in medicine, we look at the struggles that Dr. Blackwell faced to become America's first female doctor.
How has her life and career helped to set the stage for today's female medical students? What challenges remain for women in the medical profession?
Embarking on 'a moral crusade'
"Elizabeth, it is of no use trying. Thee cannot gain admission to these schools. Thee must go to Paris and don masculine attire to gain the necessary knowledge," physician Joseph Warrington told Blackwell, after she enquired about attending medical college in the U.S.
Never before had a woman been accepted to a medical college in America, but Dr. Blackwell was not deterred by the widespread discouragement.
"[...] neither the advice to go to Paris nor the suggestion of disguise tempted me for a moment," Blackwell wrote in a letter to Baroness Anne Isabella Milbanke Byron in 1851. "It was to my mind a moral crusade on which I had entered, a course of justice and common sense, and it must be pursued in the light of day, and with public sanction, in order to accomplish its end."
In 1847, after numerous rejections from medical colleges in the U.S., Dr. Blackwell applied to Geneva Medical College. The college's faculty allowed the all-male student body to vote on Blackwell's admission, assuming they would never let a woman into their ranks.
In jest, the student body unanimously voted "yes." She was finally accepted as a medical student, making her the first female medical student in the U.S.
The talk of the town
Dr. Blackwell's gender was initially a sore point at Geneva. Professors told her that she had to sit apart from the other students, and she was often excluded from the laboratory.
She was also asked by a professor to avoid attending reproductive anatomy classes out of fear of "embarrassing" male students. Dr. Blackwell refused this request, stating that she wanted to be treated no differently to other students.
This attitude earned her much respect and support from her fellow students and, academically, Dr. Blackwell thrived during her 2 years at Geneva.
However, being the only female medical student at the institution made her the talk of the town; she was frowned upon by other women for opposing gender roles.
"I had not the slightest idea of the commotion created by my appearance as a medical student in the little town," Blackwell wrote in her journal.
"Very slowly I perceived that a doctor's wife at the table avoided any communication with me, and that as I walked backwards and forwards to college the ladies stopped to stare at me, as at a curious animal.
I afterwards found that I had so shocked Geneva propriety that the theory was fully established either that I was a bad woman, whose designs would gradually become evident, or that, being insane, an outbreak of insanity would soon be apparent [...]"
Dr. Elizabeth Blackwell
Dr. Blackwell was undaunted by the negative attitudes toward her and maintained focus on her goal: becoming a doctor. In fact, she was driven by the gender discrimination she received.
"The idea of winning a doctor's degree gradually assumed the aspect of a great moral struggle," she wrote in her journal, "and the moral fight possessed an immense attraction for me."
A 'truly remarkable' achievement
In 1849, at the age of 28, Dr. Blackwell graduated top of her class, becoming the first woman in America to achieve a medical degree.
At her graduation ceremony, the dean of Geneva Medical College, Dr. Charles Lee, publicly congratulated Dr. Blackwell on her achievement and said that he held "admiration at the heroism displayed, and sympathy for the sufferings voluntarily assumed."
"In 1849 women still did not have the right to vote in America. For a woman to hold a degree and pursue a career that was seemingly intended for men only was truly remarkable," Dr. Kelly Thibert, National President of the American Medical Student Association, told MNT.
"It was acts like this one that were imperative to the women's movement, aiming to achieve equality in all aspects of life, including in the field of science and healthcare," she added.
The news of her medical degree became widespread, and it achieved a mostly positive response. However, this favorable reaction did not guarantee Dr. Blackwell a medical career; the medical community in the U.S. remained reluctant to accept women into its ranks, and Dr. Blackwell was unable to find a hospital that would allow her to gain medical experience.
Furthermore, despite Dr. Blackwell's success at medical college, negative attitudes toward female medical students remained.
On a printed edition of the speech he made at Dr. Blackwell's graduation, Dr. Lee added a footnote stating that the "inconveniences attending the admission of females to all the lectures in a medical school, are so great, that he will feel compelled on all future occasions to oppose such a practice [...]."
Soon after, the State Medical Association of New York declared that "no more women" were to be accepted to medical schools.
In the years to come, Dr. Blackwell would tackle gender inequality for female medical students head on, providing them with opportunity to train and practice.
Providing women with a 'safe environment to study'
Inspired by the challenges she faced as a minority in the field of medicine, Dr. Blackwell established the New York Infirmary for Women and Children in 1858.
Now known as the New York University Downtown Hospital, the aim of this institution was not only to provide medical care for the poor, but to provide medical training for female students and positions for female physicians.
"Having an environment where women could study without the stigma of being female or the harassment from male physicians would have provided a safe environment for study," Dr. Ross told MNT.
Today, women account for around 47 percent of medical students in the U.S. - an achievement that may not have been possible without Dr. Blackwell's determination to defeat gender inequality in medicine.
"[...] the onset of various medical schools for women only showed the world that women were not going to be deterred from becoming doctors just because men thought they should not do so. If they could not be accepted into medical schools in existence, they would start their own.
It takes one person with an idea, a second person to make it a movement and then it becomes O.K. to join, and this would be the way of acceptance for women in medicine."
Dr. Shelley Ross
Even after she stopped practicing medicine in the late 1870s due to health problems, Dr. Blackwell continued to campaign for women's rights, as well as reform in preventive medicine, hygiene, and family planning.
Ongoing challenges for women in medicine
According to Dr. Ross, when it comes to women being accepted into medical schools, the "battle has been won." However, a number of challenges remain for female medical students.
Talking to MNT, Dr. Thibert said that women in medicine are often "pigeonholed" to certain roles, such as nursing.
"Don't get me wrong, I have learned a lot from nurses and there is absolutely nothing wrong with the nursing profession or being mistaken for a nurse at all," she told us. "However, when society perceives that the only medical role a female could pursue is nursing, then there's an issue, as we are limiting women to nursing just because our views of women's careers in medicine is a narrow one."
Additionally, Dr. Thibert noted that women who wish to pursue medical specialties that are male-dominated often have problems finding mentors in these areas.
Dr. Ross told MNT that having more women in leadership roles within the medical profession could help to overcome such challenges; at present, women make up just 15 percent of department chairs and 16 percent of deans.
"There need to be enough women physicians in senior leadership roles that the tipping point is reached so that it is now the norm rather than the exception," said Dr. Ross. "Often women in more senior roles do not bring younger women along the way with them. Often it is because the young women can not be persuaded to follow, so we need to mentor them and give them the fire in their belly to want to lead."
"Organizations such as MWIA provide that networking for female physicians that give[s] them the skills to succeed in a safe environment - similar to the all-female teaching hospital established by Elizabeth Blackwell," Dr. Ross added.
The fight for gender equality in medicine is far from over, but it is clear that without the work of Dr. Blackwell, the outlook for female medical students and physicians may not be so bright.
As researcher Tairmae Kangarloo says:
"She was certainly ahead of her time and paved the way for other women. Even now, 160 years later, we are still admiring her work and the ways in which she helped to revolutionize the role of women."