'Doctors Blackwell' Tells The Story Of 2 Pioneering Sisters Who Changed Medicine : Shots - Health News Elizabeth Blackwell was the first woman in America to earn her medical degree. Her sister Emily followed in her footsteps. Janice Nimura tells the story of the "complicated, prickly" trailblazers.
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'Doctors Blackwell' Tells The Story Of 2 Pioneering Sisters Who Changed Medicine

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'Doctors Blackwell' Tells The Story Of 2 Pioneering Sisters Who Changed Medicine

'Doctors Blackwell' Tells The Story Of 2 Pioneering Sisters Who Changed Medicine

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DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies, in today for Terry Gross. Today, more than half the students in American medical schools are women. But when Elizabeth Blackwell decided to pursue a medical degree in the 1840s, the idea was about as unthinkable in the all-male profession as a man getting pregnant. But Blackwell persisted and got her degree, and a few years later, her younger sister, Emily, joined her as a fellow physician. Their story is told in a new book by our guest, writer Janice Nimura. It's a tale with plenty of twists. Elizabeth Blackwell is fairly regarded as a feminist trailblazer, but she took a dim view of the women's suffrage movement emerging around her. After many rejections, Blackwell's admission to medical school was approved by an all-male student body, essentially as a practical joke. While Blackwell was awkward socially, her achievement made her a reluctant international celebrity, and she had encounters with Florence Nightingale and Abraham Lincoln. And the story of the nine Blackwell siblings itself is fitting material for a 19th-century period drama.

Janice Nimura's essays and book reviews have appeared in The New York Times, The Washington Post, Salon and other publications. Her first book, "Daughters Of The Samurai," was a New York Times notable book in 2015. Her new book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine." Janice Nimura joins me from her home in New York.

Janice Nimura, welcome to FRESH AIR.

JANICE NIMURA: Thanks, Dave. It's an honor to be here.

DAVIES: Before we talk about the Blackwells themselves and Elizabeth Blackwell, let's just talk about medicine in the 1840s. What was the state of the profession then? How were doctors regarded? How effective were they?

NIMURA: Well, it was really a turning point. Until right about that moment, medicine looked a lot like the way medicine had looked all the way back to antiquity. People thought about it in terms of the humors, the four humors that governed the body. There was no really good way to look inside the body. All you could do was take a temperature, feel a pulse, see what came out of various orifices. And the profession such as it was at that moment was not particularly prestigious, at least in America. And doctors tended to have sort of an arsenal of things they could do - leeches, bloodletting, mercury, laudanum, different, rather intense and harsh medications that they sort of tried one time after another until you either got better or died.

Medicine was a brutal and sort of blunt art at that point. But there were just glimmerings of the new ideas that would come to revolutionize the profession, things like antisepsis, things like germ theory, things like the importance of hygiene in combating epidemic disease. So it's an interesting choice and a peculiar choice, really, that the Blackwells made to pursue this path, which I guess we'll get into, given that it wasn't a particularly exalted path. In fact, medicine at that moment was less a profession and more of a trade.

DAVIES: Right, right. So we had doctors or people who didn't even wash their hands between patients, gave things like mercury, which was frankly poisonous. What was medical education like?

NIMURA: Basic, especially, again, in this country. There were exalted centers of medicine in Europe and Edinburgh and Vienna and Paris. But in America, medical schools were just emerging in the last, you know, half-century. More were popping up all the time. And they tended to be loose confederation of doctors who came together to teach their specialties. The basic approach was a student would study for one 16-week term in the winter, go away, get some practical instruction and then come back the following year for the identical 16-week term. That term would consist mostly of lectures, listening, writing, taking notes. If you went to a particularly well-equipped medical school, you might get to watch dissection. Maybe you might get to do a little bit yourself. But after those two consecutive identical terms of medical school, you emerged with a medical degree, probably never having touched a living patient unless you got lucky in between in apprenticing yourself somewhere that would give you some practical experience.

DAVIES: Wow. Thirty-two weeks instruction - I don't think you can get a certification to be an auto mechanic doing that.

NIMURA: Hardly.

DAVIES: The Blackwells were a fascinating family. Just tell us a little about them.

NIMURA: Sure. Eight of the nine siblings were born in their place of origin in Bristol, England, where their father was a sugar refiner, Bristol being a center of the British sugar trade. Their father was a paradox - a sugar refiner and an abolitionist - sort of think about that for a second - given that the sugar trade was based on enslaved labor. He was a dissenter and believed in education for boys as well as girls, so all nine Blackwells grew up with the same education. Being a dreamer about what could be possible within his industry, he moved them all the way to America and then all the way out to the frontier town of Cincinnati in hopes of finding a way to make sugar from sugar beets, which could grow in the north without enslaved labor rather than sugar cane. He got them all the way out to Cincinnati in 1838, and then he died broke, leaving nine children with nothing to support them.

And that sort of early trauma created in the Blackwells this tribal feeling. They really regarded each other more highly than almost anyone else in the world. And they formed sort of a clan and pulled themselves up from poverty, the girls first because the first three children were girls, immediately going to work as teachers because that's what they could do. But there was this curious inversion in the family, this orphaned family, where the women led the way initially. And that continued when Elizabeth and later Emily decided to pursue this very strange and iconoclastic career.

DAVIES: So the Blackwell kids are independent-thinking people, cared a lot about each other, and Elizabeth Blackwell would become the first woman ever to get a medical degree. Before we get to that, it's fascinating that right around the time and in the area where she went to medical school, the women's suffrage movement was really taking shape. There was the Seneca Falls Convention. She did not look favorably on this idea, did she?

NIMURA: Yeah. The medical school that she ended up in was in Geneva, N.Y., right near Seneca Falls in the Finger Lakes. She was right there. And yet she really looked sideways at those women who really wanted to recruit her to their side. She was doing something very visible and very stunning, and they really wanted her to be part of their movement. She laughed, in a way, or at least scorned what they were trying to invite her to do. She called them - I think she called the Seneca rights - the Seneca Falls Conference the Seneca Falls absurdity. She really believed that there was different work to do first. And she chose medicine because it was an unusually graphic way to prove this idea that women could do what they wanted to do by virtue of toil and talent, not anything to do with their sex.

DAVIES: So Elizabeth Blackwell decides to pursue medicine. She'd done teaching. She'd been out. She'd had employment. She goes to Philadelphia and stays with a family there and kind of spends some time with a doctor and applies to medical schools and gets rejected and rejected and rejected. What were some of the reasons that were given for excluding women from the profession by doctors?

NIMURA: Well, there was the basic idea that a woman's sphere did not include anything professional unless it was maybe teaching and maybe nursing but nothing really more than that. And then there was the - when you got down to brass tacks, there was the idea that if you let a woman go to medical school, she's going to be sitting in a lecture hall alongside men talking about the human body. And that's not proper. That's appalling, especially when you get to certain systems of the body. That's just not on. And then there was the idea that medical education increasingly included anatomy and dissection. And the idea of a woman with her hands in a corpse was impossible. No woman worthy of the title woman would want to be that person with her hands in a body. So for all those reasons, it was just impossible. It really wasn't a matter of, are you good enough? It was, you're female. This is impossible. And she was greeted with everything from, you know, rejection to hilarity. People laughed in her face when she - when they found out what she was really after.

DAVIES: And it was fascinating. At least one - I don't know. One response that you quoted was from someone who said, look; if women become physicians, a lot of people are going to prefer that, particularly women. And (laughter) they're not going to go to us. Why would we do that?

NIMURA: Right. The line, I think, was, why should we furnish you with a stick to break our heads with (laughter), which is really interesting because in the event, as it turned out, this fear that male doctors had - if we let them in, we won't have any female patients anymore - was completely unfounded, at least at first, because women who were wealthy enough to choose their medical care, even once the Blackwells were practicing, did not choose women doctors. There was no trust there. The idea of a female physician - the very phrase female physician connoted an abortionist, someone who worked in the shadows on the wrong side of the law. So if you said you were going to a lady doctor, whoa, that was a major statement of scandal. So this idea that doctors were afraid of letting women in for that reason, turned out they were more afraid of it than their women patients were, really (laughter).

DAVIES: So it seemed all but hopeless. She was - Elizabeth Blackwell was rejected by medical school after medical school, finally got in at Geneva Medical College in upstate New York. Why? What happened there?

NIMURA: Well, it's a good story. If you read her memoir - a very good memoir - you really only hear the forward-facing part of it, which is that, at last, a lovely letter of acceptance arrived. And the truth was that her letter of application arrived at Geneva enclosed with a letter of endorsement from this physician that she had been studying privately with in Philadelphia who had some prestige, enough prestige that the faculty at Geneva were not quite bold enough to just dismiss this request, as crazy as it was. So the faculty, being not quite brave enough to reject it, flipped it over to the students and said, OK, students, here's this bizarre request from a woman who wants to study. We're going to let you decide if she comes. If any one of you dissents from this, it's off. It won't happen. Don't worry.

DAVIES: And what did the students do (laughter)?

NIMURA: And the students (laughter) recognizing that, A, their professors were cowards and, B, this was an opportunity to make serious mischief, had a meeting that night and basically beat any dissenters into submission and presented a unanimous front the next morning that, yes, we definitely want this lady doctor to come and study with us - or this lady medical student. The students assumed that it was a prank being played by a neighboring medical school. This was a fairly unpolished group of provincial boys. And they were seeing the opportunity for some good fun. And then they sent their response back to their faculty and forgot about it until, several weeks later, a young woman walked into the lecture hall.

DAVIES: So she enrolls in Geneva Medical College, goes to the lectures. What was her experience like? What was her reception like?

NIMURA: I think her reception was quite dual. Within the college, she quickly won the respect of everyone there. The professors recognized that their sleepy, little provincial medical college might actually win some fame by having this rather successful and brilliant woman among them, or at least some useful notoriety. The students quickly realized that she was beating them cold. She really was working harder and more skillfully than any of them. Outside of the college, within the town of Geneva, she had a difficult reception. The townspeople basically thought that any woman who wanted to study medicine was either wicked or insane. And they sort of watched her like she was some sort of sideshow freak whenever she was out and about. And so she wasn't out about much. She took lodgings very near to the medical building and walked quickly whenever she had to go to and fro.

DAVIES: We're going to take a break here. Let me reintroduce you once again. We're speaking with Janice Nimura. Her book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine." She'll be back to talk more after this break. I'm Dave Davies. And this is FRESH AIR.

(SOUNDBITE OF MATT WILSON, JEFF LEDERER, KIRK KNUFFKE AND CHRIS LIGHTCAP'S "HUG")

DAVIES: This is FRESH AIR. I'm Dave Davies, in for Terry Gross. We're speaking with writer Janice Nimura. Her new book tells the story of Elizabeth Blackwell, the first American woman to get a medical degree back in the 19th century, and Elizabeth's sister, Emily, who followed her into the profession. Nimura's book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine."

She never married and, at least as I read the story, never had, really, an intimate relationship with a man. Was that a conscious decision?

NIMURA: Yeah. I mean, it's hard, it's very hard, when you're working with 19th century letters to be definitive about those kinds of intimate, emotional moments. I got a sense after, you know, immersing myself in everything she wrote that this was a woman who didn't find human connection easy. We all know people who just don't find intimacy - that doesn't come easily to them. And I think she was somebody who wanted connection but who never quite managed it and who poured that energy and that frustration, I think, into this professional drive. She said it explicitly once in a while, you know, that this was a replacement for the sad wearing away of the heart that would come with romantic yearning. If she wasn't going to go in that direction, she was going to do this more noble quest.

And there were moments where there were men who she warmed to. For instance, when she was doing her - some practical training in Paris, she became friendly with the wonderfully named Hippolyte Blot, a doctor at a maternity hospital in Paris that she worked with. And there's definitely some suggestive writing about him in her archive, that she thought about him in certain ways. But in the end, I think, intimacy was hard. She talks about when she did finally see women patients once she was trained, when they were particularly grateful to her and they might hug her or kiss her in gratitude, she recoiled from that (laughter). She didn't know what to do with that kind of physical intimacy. So I got the sense that love, interpersonal love in any direction, was just something that remained sort of mysterious to her. And she reverted over and over again to her siblings, where it was a little bit easier and less fraught.

DAVIES: You know, I asked about intimate relationships with men. Was there any evidence of an intimate relationship or a closer relationship with a woman in her life?

NIMURA: Not any kind of conjugal one that might look like the one her own sister Emily had in the latter decades of her life with a female partner. There were definitely meetings of the minds. I mean, Elizabeth became very close to Florence Nightingale briefly and also had a wonderful correspondence with Lady Byron, the wife of the poet. So she had meetings of the minds with other women. She, I think, was very wary of attraction in general. There are places where she's writing about what she describes as love passages with women in a way that sounds a little bit doth protest too much. I wondered sometimes whether she was disdaining them because she was drawn by them. But again, when you're dealing with 19th century letters, all you can do is wonder a lot of the time and let your subjects keep their privacy because there's really nothing else to do.

DAVIES: So Elizabeth Blackwell becomes the first woman to get a medical degree in, what, 1851, right? Is that when she finished?

NIMURA: 1849 it was.

DAVIES: But she didn't have a lot of practical experience. She had spent some time at a place in Philadelphia. And so she heads to Europe to really get much more hands-on experience. And she goes to this place in Paris, which is sort of the - a very well-known obstetric hospital. Tell us about what she experienced there.

NIMURA: Well, it was an interesting move. The hospital was called La Maternite. And it was housed in an ancient convent in the middle of Paris. It was a state-run hospital, training hospital, where young women from all the departments of France would come to become midwives and then return to their provinces. French medical education was really quite progressive and very much more oriented toward the practical (laughter) than American medical education was. The thing was Elizabeth already had an M.D. She wasn't, you know, an untried, young - sweet, young thing from the provinces looking to become a midwife anymore. But she recognized that by becoming a student at La Maternite, she would have access to hundreds and hundreds of obstetric cases in the course of the months that she would spend there.

So she took the difficult move of sequestering herself there, because once you became a student there, you couldn't leave. You were, you know, a young woman under the care of the state in a way. So she became a student among students in a dormitory for months and learned a tremendous amount about not just labor and delivery, but also the connection between poverty and disease, because if you were delivering a baby in a public maternity hospital in 1850, you were indigent. You had no other choice. Maybe you were a prostitute. You were definitely impoverished. And you were often suffering from venereal disease. So she, Elizabeth, really got a tremendous amount of experience very quickly in that connection. The prevailing wisdom in the early 19th century was often that illness had to do with sin. But she was becoming aware that illness often had to do much more with poverty than moral behavior.

DAVIES: And while she was at La Maternite, she had an injury, a very serious one. Tell us about this.

NIMURA: Right. So a lot of the women delivering would have been suffering from gonorrhea. When an infant is born to a mother suffering from gonorrhea and passes through the birth canal, they often contract something called gonorrheal conjunctivitis, which is an eye inflammation - today, in the age of antibiotics, treated easily. It's still serious but treated easily with antibiotics. Then, it was a very serious problem. So Elizabeth, in the wee hours of the morning, was tending to an infant, an affected infant, in the labor and delivery ward, was syringing out its infected eye. And some of the washing liquid splashed into her face.

And she contracted gonorrheal conjunctivitis and lost one eye after a protracted illness of several weeks, where she was confined to a bed in the same hospital, in agony and also in fear that she was going to lose her sight entirely. I went to visit the convent - it still stands - that La Maternite was housed in. It's still part of a larger hospital complex in the middle of Paris. And it's a beautiful place. But it's a cold, drafty, austere stone place. And my admiration for Elizabeth's determination in enduring what she endured in that setting just - (laughter) my admiration rose to the level of awe in that moment.

DAVIES: And she lived the rest of her life with a glass prosthetic for an eye, right?

NIMURA: Yep, a glass eye.

DAVIES: We're going to take a break. Let me reintroduce you again. We are speaking with Janice Nimura. Her new book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine." We'll continue our conversation in just a moment. This is FRESH AIR.

(SOUNDBITE OF BRAD MEHLDAU TRIO'S "GREAT DAY")

DAVIES: This is FRESH AIR, and we're speaking with writer and historian Janice Nimura. Her new book is about Elizabeth Blackwell, the first woman to get an American medical degree in the mid-19th-century, and her sister Emily, who followed her into the profession. The book is called "The Doctors Blackwell."

So while Elizabeth was getting her medical degree and learning in Europe and dealing with this eye affliction, she always hoped that her younger sister, Emily, would follow in her footsteps and get a medical degree and join her in a practice someday. You know, after Elizabeth had broken the barrier and gotten this degree from Geneva Medical College and did so quite publicly - I mean, it was quite well known - did things get easier or harder for other women inspired to pursue the profession?

NIMURA: Well, initially, harder and easier. It depends who you were and what you wanted. Elizabeth sort of anointed Emily to follow her because she knew that medicine was going to be a lonely road to travel and she knew that she esteemed her Blackwell siblings above all others. So let's choose the smartest Blackwell sister. And Emily, who had three rather domineering older sisters, sort of took a look at her options and said, sure, I'll come along. Geneva College itself, having, you know, given Elizabeth a degree at the top of the class, politely but firmly said, Emily, we are not interested in having you here as a student. We've had enough with women medical students.

The issue was that just at the time that Elizabeth was receiving her medical degree, women's medical colleges were beginning to open because there were more than just these two women who were interested in receiving medical degrees. But the world was so horrified at the idea of men and women studying medicine together that in Philadelphia and in Boston, women's medical colleges had opened. So if you were a woman who wanted to pursue medicine, that was the obvious thing to do. It was much easier for the male medical colleges to reject you because they could say, why do you need to come here? Go there. That's for you.

Emily, though, and Elizabeth did not esteem these women's medical colleges highly at all. They just concluded that any women's medical college is going to be, by definition, inferior, mediocre, that a truly impressive degree would only be earned from a men's medical college. So Emily was not going to be bested by her sister and take a degree from a women's medical college. So she struggled and received, I would say, more rejections than Elizabeth because the Blackwell name was now a thing (laughter).

But she insisted and eventually found her way to a place at Rush Medical College in Chicago, which was wonderful. And she had a wonderful year there. And she found a wonderful patron among the faculty and was doing great until he decided to take a sabbatical. And the trustees of Rush said, could you please not come back for the second term? Thanks. And so she was left high and dry and being just as determined as Elizabeth, managed to get herself to a place at Cleveland Medical College, which is now Case Western, to finish her second term and receive her diploma. She was just as much of a force.

DAVIES: You know, Elizabeth had long wanted her younger sister Emily to come and practice with her. They did. And they would both have long professional careers but mostly not together. Why?

NIMURA: Right. So, you know, they had this intense partnership, but they also had some intense disagreements. And partly it was innate to them and partly it was circumstance. Elizabeth really moved more and more throughout her career toward public health and less toward medical practitioner, partly that was that she only had one eye, so she couldn't practice surgery. Even reading could be difficult for her. So she did a lot more as a writer and as a speaker, as what she thought of as a teacher armed with science, someone who could really inform the populace about hygiene, about prevention. Whereas Emily saw the role of a woman in medicine as to be a woman in medicine, as skilled as any man in all of the techniques. So she was a surgeon. She was an obstetrician. She was a medical professor. And she wasn't as much of a public figure in any way as her sister was.

And they - at a certain point, Emily really began to chafe against this sister who was always going to be the first woman doctor, always going to be the Blackwell that people thought of. And she got tired of being the sort of - I think she described it as gleaning on the outskirts of her sister's career. So in 1869, the sisters opened a women's medical college as an offshoot of the infirmary they had founded. And in 1870, Elizabeth, having achieved the institutional triumphs that she had set out to achieve in America, went back to her native England, where she had always yearned to return, leaving Emily in charge in New York.

I think there was a certain relief for both of them that Elizabeth could go back to England, where she preferred to be, and pursue moral reform, hygiene, prevention, speaking and lecturing, writing a ton where Emily could stay and run the infirmary, be a professor at the medical college without her sister's interference. They never - they did not live on the same continent for the last 40 years of their lives. And the irony to me is that in running these institutions in New York so competently, Emily Blackwell, in a sense, sustained her sister's legacy here almost to her own detriment because if you've heard of them, you've heard of Elizabeth Blackwell, not Emily. She almost sustained her sister's legacy to the eclipse of her own.

DAVIES: She's the one who really had the drive to keep it going. Yeah.

NIMURA: Right. It's interesting. They died within months of each other in 1910. And there was a huge gathering at the New York Academy of Medicine to honor their lives. And the speakers honored both of them, of course, honored Elizabeth's pioneering achievement. But none of the speakers had known Elizabeth in the last 40 years because she'd been gone. And all of them had a deeper professional connection to Emily as this major figure in the New York medical scene. And so when you read the eulogies that happened that day, the eulogies for Elizabeth were rather more formal, talking about her as if she was sort of an idea more than a person. But the eulogies for Emily were really warm and deeply respectful and admiring.

DAVIES: We're going to take a break here. Let me reintroduce you. We're speaking with Janice Nimura. Her new book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine." We'll continue our conversation after a short break. This is FRESH AIR.

(SOUNDBITE OF KEVIN EUBANKS' "POET")

DAVIES: This is FRESH AIR, and we're speaking with writer and historian Janice Nimura. Her new book is about Elizabeth Blackwell, the first woman to get an American medical degree in the mid-19th century, and her sister, Emily. You know, Elizabeth Blackwell spent the last - what? - 40 years of her life also in England where she was born. And she wrote a lot. And one of the things that she wrote about was sex education and the role of sex in marriages, she, of course, having no direct experience with this. What was her message to couples of the day?

NIMURA: When it came to things like controlling family size, she very much believed that family size should be controlled for the health of the mother. And to that end, she believed that women should marry a little bit later so that they could make a more careful choice of husband. And then she truly believed - and this is interesting - that a woman should be able to control when sex happened and control family size basically by the rhythm method. She firmly believed that knowing that a too large family would be detrimental to everyone's health, that a woman could be able - would be able to tell her husband when it was OK to have sex so as to limit her family size. This was wildly impractical, but she never admitted it. It was one of the ways in which her level of ideology exceeded reality in a way.

DAVIES: As far as you were able to determine, Elizabeth Blackwell had never had another intimate relationship either with a man or a woman. What about her sister Emily?

NIMURA: So her sister - Emily was a much, I think, more emotionally balanced person and much easier in the world than Elizabeth. She had much less trouble connecting to other human beings. And just after Elizabeth left for London and Emily found herself at the helm of their institutions and alone in New York leading things for the first time, it's interesting to see. It was just also at this time that the Blackwell matriarch, their mother, died. And you can see Emily rebuilding her own idea of an ideal family.

She - there was a student at the medical college who was becoming a promising surgeon, a woman named Elizabeth Cushier. And Emily became very close to her as a friend, and then Elizabeth Cushier moved in with Emily. And they spent the last three or four decades of their lives as partners. Everyone recognized that they had an intimate partnership. I don't know the details or the degree of their intimacy, but there was real warmth and real love between them. This was a kind of connection with a peer that Elizabeth never managed.

Both of the sisters also, interestingly, adopted daughters and had very different kinds of relationships with those girls. Elizabeth had more of a high-to-low, mistress-to-acolyte relationship with her daughter, where Emily, you know, had a girl who called her Mama, signed her letters with kisses and ended up marrying and giving her many grandchildren. So they had very different ways of connecting to other people.

DAVIES: Yeah, I wanted to focus a bit more on this fascinating part of Elizabeth, the older sister Blackwell's life, which is that, you know, you said she kind of had trouble connecting with people and she adopted a daughter, Kitty. Tell us about the adoption and the relationship.

NIMURA: Yeah, it is kind of fascinating. So in 1854, this is Elizabeth alone in New York, Emily not quite finished with medical school, Elizabeth struggling to find patients who don't come. She hasn't yet opened her institutions, and she's lonely. She's devastatingly lonely. And so what does she do? She goes to the public nursery on what is now Randall's Island in New York, and she picks out an Irish orphan who's about 6 or 7 named Kitty Berry, and she takes her home.

DAVIES: A one-day transaction, right?

NIMURA: Basically. She sort of looked them over and took one home - and then talks about her in a strange, kind of liminal space between servant and daughter fan (laughter). She needed this young woman as an emotional - a source of emotional support. But she never wanted - interestingly, for a woman who had insisted on a career for herself, she never wanted Kitty to marry or pursue a career herself.

Kitty's role was as sort of servant-acolyte to Elizabeth. And Kitty, bless her heart, really moved into that role. So one person described her as being like an eiderdown quilt. She accommodated herself to all of Elizabeth's sharp edges and just held her close. Throughout life, she remained single and at Elizabeth's side as her person. It's very - it was a very unusual and hard to define relationship.

DAVIES: Right. I mean, there was a point when Elizabeth took a trip to Europe for many months, did not bring Kitty, the adopted daughter, along. And then later in life, when members of some of Elizabeth's siblings needed, you know, help, Kitty would help out with housework, et cetera. It certainly was kind of a subservient relationship, so it seemed. What did Kitty, the adopted daughter, call Elizabeth Blackwell?

NIMURA: (Laughter) Dr. Elizabeth.

DAVIES: Doctor - that's what I thought, yeah.

NIMURA: Yeah. She was always my dear doctor, whereas Emily's adopted daughter called her Mama. So, you know, this is - that to me, those kinds of details are very telling about the kind of prickliness that was central to Elizabeth's personality.

DAVIES: In reading the book, you can tell you had the advantage of an awful lot of correspondence among the Blackwell children, which, you know, there's a lot of rich detail here. On the other hand, you know, you're talking - you write about two women whose voices you never heard, of whom there are no surviving photographs for most of their working life, it seems. And I'm just wondering, as you did this research, is there a point at which these women come alive to you, you really see them as people?

NIMURA: Certainly. You know, I think anybody who's tried to do biographical writing knows that unless you are drowning in material, you probably don't have enough. And I was certainly drowning in material because the nine Blackwell siblings were such a clan and they all also sort of drove each other nuts. So they were always leaving each other and writing to each other, which gave me not just Elizabeth and Emily's voices but the voices of the seven other siblings writing about them. So it was possible at certain critical moments when something exciting was happening to sort of "Rashomon" style see many different perspectives on the same event, see two siblings gossiping about a third. And that gave you sort of a 3D view - and then diving deeply into Elizabeth and Emily's writing and getting to know them intimately, you know, down to the level of handwriting.

You could tell when they were particularly emotional because their writing would shift. Knowing that so intimately, it's really a privilege. When you spend that much time with two women on the page, you start to feel lucky that you have been kind of admitted to their thinking. At the same time, you're acutely aware that you don't know these women and you need to make sure that you leave room for the idea that you may not be getting it right, that what you're doing is your best to understand and that there's - there are going to be areas that remain unclear.

DAVIES: After spending so much time looking at these two trailblazing women, is there one sort of enduring message you think that their story brings us?

NIMURA: Yeah. I feel like the mission of this book is to tell a story of two women who were undeniably heroines but who also weren't always adorable or attractive. They were complicated, prickly, sometimes self-contradictory people, just like most of the people we know - right? - today. And to me, that taught me that it's really important in this moment to kind of relearn how to admire women, in a way, especially now as we are about to inaugurate our first female vice president, to understand that a heroine doesn't always have to be a Disney princess but can be a woman with all sorts of rough edges and complications and that we can admire them profoundly anyway.

DAVIES: Well, Janice Nimura, thank you so much for speaking with us.

NIMURA: It was a great pleasure to be with you.

DAVIES: Janice Nimura's new book is "The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine To Women And Women To Medicine." Coming up, Ken Tucker reviews folk musician Peter Stampfel's new collection of songs, one from each year of the 20th century. This is FRESH AIR.

(SOUNDBITE OF BOB DYLAN SONG, "WIGWAM")

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