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

The book’s concluding chapters show how Elizabeth and Emily’s work was shaped by external forces—such as the Civil War and the gradual opening of mainstream medical institutions to women—but also by their differing visions of what women’s participation in medicine should look like.

When the Civil War broke out in 1861, Elizabeth and Emily saw it as an opportunity to contribute to a larger cause aligned with their moral values. However, Elizabeth's early cynicism that the war was less about ending slavery and more about economic interests reflects her growing detachment from American society. The war also brought the growing ideological rift between the sisters into focus. Elizabeth's vision for female doctors had shifted toward a more educational and theoretical approach. She believed they should focus on hygiene and the education of others rather than practicing hands-on clinical medicine. On the other hand, Emily wanted to train women to be surgeons and clinicians. This divergence was worsened by Emily's growing doubts about whether the sacrifices she made for her career were worth it. The war offered her an opportunity to temporarily put aside her dissatisfaction, but the male-dominated medical establishment quickly undercut the Blackwells' attempts to contribute to the war effort, another example of The Struggle for Gender Equality in the 19th Century. Despite their central role in organizing the Women's Central Association for Relief and their expertise in training nurses, Elizabeth and Emily were marginalized. Their exclusion reflects the broader misogyny of the medical field at the time, which continued to block women from fully participating in the profession even in a time of national crisis. It also served to worsen Elizabeth’s detachment. Rather than seizing the moment to discuss health policy or women’s medical education, her trip to Washington, D.C., and her meeting with President Lincoln are framed through the lens of being a tourist. This episode, though minor, shows Elizabeth's growing disengagement from direct involvement in public affairs.

The Blackwells’ decision to resign from the registration committee of the Women's Central Association for Relief after a year marks a turning point for the sisters as they returned to their own projects. From the beginning, their goal was to integrate women into established, reputable medical institutions rather than confine them to what they viewed as second-rate, segregated medical colleges for women. They were vocally critical of the existing colleges in Philadelphia and Boston. Elizabeth's scathing remarks about the “half educated school girls” (235) and Emily’s frustration with the mediocre training provided to women show their belief in the inadequacy of these institutions. This frustration ultimately led them to establish their own medical college to meet their high standards, a demonstration of The Intersection of Personal Ambition and Social Change. As the college takes shape, it’s clear that Elizabeth and Emily are growing apart in their personal ambitions and roles within the medical profession. While Elizabeth saw the creation of the college as her life’s mission, describing it as “the San Greal of my life,” Emily’s role became more central to the daily operations of the infirmary and college, with Elizabeth noting that she “does grandly at the centre of this movement” (243). This pulling away is part of Elizabeth’s larger trend toward dissatisfaction and weariness of the constant battle for respect and funding.

However, Elizabeth’s return to England was again marked by disappointment compared to her idealistic image. She hoped to be embraced as a mentor by the rising generation of British women doctors. Instead, she became increasingly alienated due to her inability to accept the women who did not share her moral or educational views. Her lifelong focus on health as an ethical issue, particularly regarding sex, reaches its apex at this point. Her publication, Counsel to Parents on the Moral Education of their Children in Relation to Sex, shows off her ideals of sexual restraint and moral education, particularly for women. She thought marital sex should be virtuous rather than lustful and that sexual education was crucial for children. She also opposed contraception, seeing it as a form of degenerate behavior, and instead advocated for women to control family size through abstinence. Finally, she was critical of scientific advancements, such as vaccination and vivisection, which she viewed as violating natural laws. Elizabeth wanted to impose a strict moral framework on society, which was often out of touch with the realities of human behavior. This goal further distanced her from the medical community, which increasingly embraced scientific experimentation.

With Elizabeth gone for a final time, Emily assumed full leadership of the Woman’s Medical College. She recognized the need for the college to adapt to American culture, which she and Elizabeth had always struggled to fully embrace. She also found the personal contentment that had eluded her in the past. She adopted a child, Nannie, and formed a close relationship with Elizabeth Cushier, a former student. Her partnership with Cushier is a personal fulfillment that Elizabeth never managed to achieve. Elizabeth’s legacy is one of moral leadership and symbolic victories, but she remained largely isolated from the practical realities of the profession she helped pioneer. By contrast, Emily grew into a powerful leader who shaped not only the institutions she ran but also the women who trained under her. Her emphasis on skill and professionalism helped ensure women were taken seriously as physicians, even as Elizabeth’s influence waned. Their story is one of perseverance, vision, and the slow but steady march of progress.