Dr. Elizabeth Blackwell, Library of Congress

Journey started in Asheville for 1st US woman to earn medical degree


“If I could have been treated by a lady doctor, my worst sufferings would have been spared me,” a friend told Elizabeth Blackwell in early 1845.

English-born Blackwell was interested in history and metaphysics and had never before expressed any interest in curing illness or caring for the sick. She recalled, “I hated everything connected with the body, and could not bear the sight of a medical book.” Still, less than four years later, Blackwell became the first woman to receive a medical degree in the United States.

Notably, Blackwell’s journey to achieve this goal began in Asheville.

It was a difficult time to choose to pursue medicine as an occupation, even for a man. Unlike in England, where a medical license indicated some level of education and position in society, medicine as a career in the United States was still considered a trade, and not a lucrative one. American women had certainly been healers, well-versed in first aid, nursing, and midwifery, but those referred to as “female physicians” at the time were operating clandestinely as the only abortion providers available; a practice that Elizabeth abhorred. And because medical science was in its infancy, most licensed male doctors – armed with only purgatives, laudanum, and lancets – did more harm to their patients than good.

Human health was also generally poor at the time. The growth of cities alongside contaminated water, lack of garbage disposal facilities, and an abundance of vermin fueled a parallel increase in disease transmission. Influenza, cholera, typhoid fever, and tuberculosis spread quickly with little understanding of why. (Louis Pasteur had not yet proposed the germ theory of disease.)

So then why would Blackwell, a woman from a middle-class family, a woman who had no interest in curing illness, studying medicine, or having “intimate contact” with patients, choose to break this particular glass ceiling?

For Blackwell, it was the allure of proving that women were just as qualified as any man to study and practice medicine – and the fame that came along with doing so. In her autobiography, she wrote, “The idea of winning a doctor’s degree gradually assumed the aspect of a great moral struggle, and the moral fight possessed immense attraction for me.”

It also came with an added bonus – a purpose beyond marriage; and an explanation of why she had chosen not to marry. She wrote in her journal, “I felt more determined than ever to become a physician, and thus place a strong barrier between me and all ordinary marriage. I must have something to engross my thoughts, some object in life which will fill this vacuum and prevent this sad wearing away of the heart.”

Now with a goal, Blackwell began to make contact with schools and physicians, trying to find someone or some entity that would take a chance on educating a woman in medical science.

She wrote to a number of family friends who were physicians and received the same reply from every one. She recalled in her autobiography, “They all replied to the effect that the idea was a good one, but that it was impossible to accomplish it; that there was no way of obtaining such an education for a woman; that the education required was long and expensive; that there were innumerable obstacles in the way of such a course; and that, in short, the idea, though a valuable one, was impossible of execution.”

Even her friend, the famed abolitionist, Harriett Beecher Stowe, told her, “that (the) idea was impracticable, though (Harriett) confessed, after some talk, that if carried out it might be highly useful. (Harriett) also spoke of the strong prejudice which would exist, which (Elizabeth) must either crush or be crushed by.”

Pursuing a medical degree was made all the more difficult because the Blackwell family’s financial position was precarious. Blackwell had been raised in England and then New York on money made from her father’s sugar refinery. But shortly after her father moved the family to Cincinnati in 1838, he died, leaving his wife and nine children with $20 in the bank and no income.

Unable to pay outright for an education, Blackwell accepted a position teaching music at Asheville Female Seminary, which had been located at the corner of Church Street and Patton Avenue (the current location of the Drhumor Building), to save money for medical school. This teaching position would serve a dual purpose. Its principal, Rev. Dr. John Dickson, had been a physician and had a medical library, which he would make available for Blackwell to embark on a “trial medical study.”


Asheville Citizen, Sunday, Nov. 8, 1931

On June 16, 1845, Blackwell left Cincinnati to begin the 11-day carriage journey to Asheville. Her first night in the Dickson household was life-changing. She remembered, “I was overwhelmed with sudden terror of what I was undertaking. In an agony of mental despair I cried out, ‘Oh God, help me, support me! Lord Jesus, guide, enlighten me!’ … A glorious presence, as of brilliant light, flooded my soul. … All doubt as to the future, all hesitation as to the rightfulness of my purpose, left me, and never in after-life returned. I knew that, however insignificant my individual effort might be, it was in a right direction.”

Now more determined than ever, she vowed to make the most of her time in Asheville. She found Asheville “decidedly pleasant” and her employer “a well-educated, intelligent man, beloved by all, and regarded quite as a father by all his pupils.” However, there was one aspect of life in Asheville that Blackwell particularly disliked – the institution of slavery. Her father, despite making a career of refining sugar that had been harvested using slave labor, had been an ardent abolitionist and passed his ideals to his children.

Blackwell was indignant at the prevalence of slavery in Asheville and uncomfortable associating peacefully with slaveholders. (Dickson enslaved at least two people.) She wrote her mother, “When I first came here I determined to teach all the slaves I could to read and write, and elevate them in every way in my power, as the only way I could reconcile it to my conscience to live amongst them; but to my consternation I found that the laws forbade it, and that Dr. Dickson was not willing to evade them.”

Instead, she organized a Sunday school to teach scripture to some of Asheville’s enslaved population. “As I looked round the little room and saw those ladies holding forth to their slaves, fancying that now they were fulfilling every duty and were quite model mistresses, I longed to jump up, and, taking the chains from those injured, unmanned men, fasten them on their tyrants till they learned in dismal wretchedness the bitterness of that bondage they inflict on their brethren,” she wrote to her mother. “But one person can do nothing. I sat quietly teaching, and reserved my indignation to vent on this inoffensive white paper.”

And so she kept her head down and concentrated on individually effecting change for women. Soon she was very pleased to report to her family, “I have just performed my first professional cure, and am already dubbed Dr. Blackwell by the household. I went into (the maid’s) room last night, and found her suffering from an intense throbbing headache. I offered to relieve her, half doubting my own powers, never having attempted anything of the kind; but in a quarter or half an hour she was entirely relieved, and declared some good angel had sent me to her aid.”

When Asheville Female Seminary closed at the end of 1845, Blackwell left Asheville to pursue her studies with Dickson’s brother, also a physician, in Charleston, South Carolina. By the summer of 1847, Blackwell felt academically and financially prepared to seek entrance to medical school.

She sailed to Philadelphia, “then considered the chief seat of medical learning in America,” and began submitting applications. She received rejections across the board. Not to be discouraged, she sent applications to smaller “country” medical schools in the Northeast.

Finally, on Oct. 20, 1847, the medical school at Geneva University in New York notified Blackwell that she had been accepted into their medical program.

The acceptance, however, was not as forward-thinking as Blackwell might have hoped. When the faculty declined to render a decision, they punted the question to the student body. Unlike the more prestigious medical schools in Philadelphia, Geneva’s student body was notably less refined. According to the Blackwell family’s biographer, around the time of Blackwell’s admittance, “several overeager anatomy pupils, unsatisfied with the college’s supply of unclaimed bodies from nearby Auburn State Prison, tried to rob the grave of a recently interred Irishman. The dead man’s compatriots had driven them off with gunfire.”

The medical students, eager for the ridiculous entertainment that would be provided by the presence of a lady doctor, voted unanimously to accept Blackwell. Once she arrived, she found herself isolated from not only the student body, but the community at large, who thought she was either wicked or insane.

So she dedicated herself to her studies – learning the value of expelling illness from the body using “modern” techniques such as adhering leeches, prescribing mercury laxatives, using mustard plaster to burn and blister the skin, and administering opium to dull the pain from the aforementioned procedures.

After two terms of study and a summer residency at the Blockley Almshouse – a poorhouse, hospital, orphanage, and insane asylum, Blackwell took her final examinations at the end of 1848. She finished at the top of her class and received her diploma on Jan. 23, 1849.

Reactions were mixed; even the professor who had been among her most ardent supporters, when he wrote of her success did so with the caveat, “that the inconveniences attending the admission of females to all lectures in a medical school, are so great, that (I) will feel compelled, on all future occasions, to oppose such a practice.”

Blackwell went on to study and practice medicine both in England and the United States, but primarily used her medical degree – and the fame and power it had granted her – to influence social and moral reform.

Remarkably, by the time Dr. Blackwell died in 1910, approximately 6% of American doctors were women. By 2021, 35% of physicians in the U.S. were women as were more than half of all medical students.

Anne Chesky Smith is the executive director of the Western North Carolina Historical Association and the author of the 2021 book “Murder at Asheville’s Battery Park Hotel: The Search for Helen Clevenger’s Killer.”


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