In telling the story of the Blackwell sisters, Nimura explores what it means to be a women’s rights activist, and whether intention matters when examining the legacy of an historical figure. While Elizabeth Blackwell was steadfast in her belief that women are inherently as intelligent and capable as men, she continually disparaged the character of most women she met. Rather than examining the male-run and -propagated institutions that enforced female subjugation, Elizabeth blamed other women for being silly and frivolous and thereby making their own advancement an impossibility. She placed the blame squarely on her female counterparts and not on men, even rejecting the burgeoning women’s rights movement as “anti-man.” In working to succeed within existing institutions rather than striving to dismantle the foundations of sexism from the ground up, Elizabeth presents an example of a visionary who remained blinded by the confines of society’s existing power structures. And she presents a quandary for readers—should we revere someone who demonstrated heroic levels of courage and perseverance in the face of gargantuan obstacles to success, but who nonetheless subscribed to the archaic ideas that raised those obstacles in the first place? Ultimately, Nimura presents a nuanced picture of a woman who was by no means perfect, but whose ideas were the catalyst for enormous positive change.              

Nimura also touches on several issues that remain relevant for today’s medical students who identify as underrepresented in medicine. As a student at Geneva College Elizabeth was extraordinarily isolated. She recruited her sister Emily to follow in her footsteps partly because she simply longed for the companionship of another woman who shared her aspirations and interests. Elizabeth’s struggles highlight the need not only for support and mentorship for women and underrepresented minorities in fields that are traditionally dominated by white men, but also for the comfort that comes with recognition of a shared identity. Additionally, both sisters strove for perfection because they knew that in order to succeed there was no alternative. Nimura writes that Elizabeth’s “strategy for acceptance was to leave no opening for criticism” (Nimura 123). And when Elizabeth and Emily founded their women’s medical college, they pioneered a curriculum that that was far more rigorous than that of any male medical school in existence, knowing that was the only way for their graduates to have any hope of legitimacy. The constant stress of isolation and of having to prove themselves was exceptionally taxing for the Blackwell sisters, and demonstrates the disproportionate toll that is placed on all minorities in the medical field. The fact that nearly 200 years later these issues remain salient for a growing number of medical students is indicative of work that remains to be done.            

Nimura also examines the ways in which the image of the female physician was sanitized so as to be acceptable to men and to the general public. Elizabeth and her supporters made the argument that women were ideally suited to be physicians because of their naturally compassionate nature and because women would be more comfortable presenting obstetrical and gynecologic complaints to other women. Additionally, as female physicians were expected not to marry, the field of obstetrics was a way in which they could maintain their respectability by remaining identified with motherhood. Yet as soon as Elizabeth and Emily are introduced, Nimura makes it clear that the sisters are interested in medicine as an intellectual exercise, not out of an abundance of empathy towards the ill. They inwardly stood in almost complete opposition to the societal ideal of a female physician, but outwardly conformed in order to gain financial backing. Again, the parallels that can be drawn between the experience of female physicians today and that of the Blackwell sisters is dishearteningly striking. Women remain overrepresented in the fields of pediatrics and obstetrics and gynecology and underrepresented in fields such as surgery. It remains disproportionately difficult for female physicians to both have families and practice medicine. And many women find themselves in a work environment that prioritizes a traditionally male standard to which they must conform.            

The Doctors Blackwell is a tale of enormous progress that also serves to highlight the boundaries that remain to be broken. While certainly not the ideal feminists that many have painted them to be, the Blackwell sisters’ audacious pursuit of a better life for themselves and for all women is a moving testament to the powers of persistence and resolve. They withstood enormous pressure in order to continue on the path that they knew was right. In this respect, every physician would do well to emulate them as we push medicine towards a more just and equitable future.