Ametrotome sounds like a more pleasant device than it is. A switchblade of sorts, it was once used to treat fertility issues. A doctor would push the metrotome into a woman’s uterus, press the handle, and release the blade; when he pulled it out, it cut through one side of her cervix. After that, the doctor reinserted the tool and repeated the procedure on the other side. Eventually a version of the metrotome was made with a double blade that could cut both sides of the cervix at once—a supposed improvement on the original design.

Elizabeth Blackwell did not approve of metrotomes, or much of anything else that male doctors recommended for female patients in the nineteenth century. When one of her relatives faced the prospect of being treated with one, she argued for less invasive interventions and cautioned that the scarring resulting from the procedure might make pregnancy even less likely. Blackwell, who was born in England in 1821, and immigrated to the United States with her family as a child, was America’s first female doctor. Her younger sister Emily was the third. Although neither sibling was especially interested in women’s health, the lack of opportunities available to them in the field of medicine meant that they mostly treated female patients and were often limited to obstetric and gynecological care. In order to expand their practice, they opened the New York Infirmary for Indigent Women and Children, the first hospital staffed entirely by women, which went on to treat more than a million patients in its first hundred years.

The Blackwells were medical pioneers, but, except for a few professional awards named in their honor and a plaque commemorating the location of their infirmary, they have largely been forgotten. A new biography by the writer Janice P. Nimura, “The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine” (Norton), attempts to redress that situation by considering their lives in the broader history of medicine and social reform. It is an admirable project, even though, as the story of the Blackwells makes clear, context is not always flattering.

Elizabeth Blackwell was admitted to Geneva Medical College as a joke. She was twenty-six years old and had already apprenticed herself to two physicians, but she was rejected by more than a dozen schools. The only acceptance letter came from the students of Geneva Medical College, an Episcopal school in upstate New York. Dated October 20, 1847, it contained the following resolutions: “That one of the radical principles of a Republican Government is the universal education of both sexes; that to every branch of scientific education the door should be open equally to all; that the application of Elizabeth Blackwell to become a member of our class, meets our entire approbation; and in extending our unanimous invitation, we pledge ourselves that no conduct of ours shall cause her to regret her attendance at this institution.”

Although this promising letter purported to reflect the deliberations “of the entire Medical Class of Geneva Medical College,” it failed to explain why Blackwell’s admission had been relegated to the student body. The answer was that the faculty had opposed it but did not wish to offend one of her recommenders, and so punted the issue to the students. Nor did the letter explain how those students had come to unanimously support her application: aware of the faculty’s opposition, delighted by the prospect of pranking them, and knowing that their decision had to be unanimous, they menaced the only dissenter until he relented. In the end, the motives of Blackwell’s fellow-students did not matter; she set off right away, starting the fall term a few weeks behind the men in her class.

It was a return of sorts for Blackwell, since her family had initially settled in Manhattan. Her father, Samuel, worked in the sugar trade, running highly combustible refineries that processed raw sugar from the Caribbean, first in Bristol, England, until that facility was destroyed by fire, and then on New York’s Duane Street, until that one burned down, too. The British had already outlawed the slave trade, but plenty of industries still depended on the labor of the enslaved elsewhere; though Samuel was an advocate of abolition, and his children gave up sugar in their tea to protest slavery, he never gave up his career.

The elder Blackwells were English Dissenters, and their religious ideals manifested not only in their abolitionism but also in domestic thrift, moral zealotry, and a commitment to their children’s education—for their five girls as well as for their four boys. The family got to know William Lloyd Garrison in New York, and when they later moved to the Midwest they worshipped in Lyman Beecher’s church and befriended his children, Henry Ward Beecher and Harriet Beecher Stowe. When transcendentalism arrived in Ohio, some of the Blackwells began attending William Henry Channing’s church, the Unitarian Society.

All nine of the Blackwell children inherited the reformist energies, moral seriousness, and social daring of their parents. Some of the girls attended the feminist lectures of Lucretia Mott and the Grimké sisters, one went on to translate the novels of George Sand and the philosophical works of Charles Fourier, and one was welcomed into the parlors of Lord Byron’s widow and George Eliot. Although none of the Blackwell daughters ever wed, one of the sons married Antoinette Brown, the first female ordained minister in the United States, and another married the suffragist Lucy Stone, one of the first American women to earn a college degree and the first one on record to keep her maiden name. These relationships and much else are thoroughly chronicled in the more than two hundred thousand pages of letters, diaries, speeches, and other family writings that survive. Yet those copious documents contain a maddening elision: nothing in them adequately explains why two of the sisters went into medicine.

Neither of the Blackwells showed any early interest in the subject. “I hated everything connected with the body, and could not bear the sight of a medical book,” Elizabeth writes in an autobiography that she published in 1895. “I had been always foolishly ashamed of any form of illness.” She did, however, watch steadfastly as her father died of complications from what was likely malaria a few years after immigrating, tracking his pulse and breathing as both weakened and noting those measurements in her journal, along with the amount of brandy, broth, and laudanum he was spoon-fed in his final days. Many accounts have suggested that this was formative for her career, but Elizabeth did not cite her father’s death as contributing to her decision to become a doctor. Instead, she describes how a female friend encouraged her to consider medicine: “If I could have been treated by a lady doctor,” Blackwell remembers her saying, “my worst sufferings would have been spared me.”

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That remark does not go very far in explaining the persistence with which Elizabeth pursued her medical education and encouraged one of her sisters to do the same, or the perseverance both showed in trying to put their degrees to use. When Elizabeth started medical school, in 1847, the American Medical Association had only just been founded, in part to standardize education, and an M.D. could be earned in two years. While she was at Geneva, townspeople came to gape at her during classes, fellow-students disparaged her, and medical journals covered her enrollment as if it were some new disease that needed to be observed and possibly cured. Even the British humor magazine Punch took notice, initially, if facetiously, applauding the first female doctor for “qualifying herself for that very important duty of a good wife—tending a husband in sickness,” later belittling her with a mocking poem called “An M.D. in a Gown,” and eventually publishing a caricature of her sister treating a dog.