When Elizabeth Blackwell applied to upstate New York's Geneva Medical College in 1847, the faculty put her admission to a student vote.

The administration hoped the students would reject the idea of a woman studying medicine.

They voted unanimously to accept her, with some of the young men thinking it was a hoax.

Blackwell soon proved it was neither a hoax nor a stunt, and graduated as the first accredited female physician in the U.S.

Entering the school was tough enough. Then came life in Geneva, a town between Rochester and Syracuse. "She was sneered at and subject to accusations she was perverted," said Ellen More, professor of psychiatry at the University of Massachusetts Medical School. "She was accused of an 'unwomanly' interest in the human body. It was a highly personal struggle."

Blackwell was born in 1821 in Bristol, England, to a family of reform-minded people. Her father, despite being in the sugar business, was an abolitionist and took the family to the U.S. in 1832.

Blackwell became acquainted with another reform-minded family, that of Harriet Beecher Stowe. Stowe was an abolitionist who would write the anti-slavery book "Uncle Tom's Cabin," and she was an early proponents of women's rights. Blackwell and her siblings were also close friends of a group of Transcendentalists, who also pushed for social change.

Being an abolitionist wasn't easy in Cincinnati, where her family lived for a time. Right across the river was Kentucky, a slave state.

Ugly View

When she took a job in Henderson, Ky., as a teacher, her hatred of slavery grew as she saw firsthand the difference between the lives of slaves and their owners. Her time there was lonely, but it solidified her commitment to social reform.

She was sure that in order to change the world, women had to be in professional jobs, and medicine was one. She wasn't a natural scientist. Nor was she initially interested in medicine. But changing society was too important to let something like that get in the way.

"She schooled herself to be passionate about medicine," More said.

Between academic sessions, Blackwell went to Philadelphia to be an observer at Blockley Almshouse, a combination hospital and poorhouse. She found the staff hostile. The young male doctors said that only after they completed their rounds could she see patients.

Still, Blackwell did her best to gain experience. While at Blockley she learned the value of hygiene to cure the sick — when the germ theory of disease was in its infancy. From that, she wrote her thesis on typhus treatment and got her degree.

After Blackwell graduated from medical school in 1849, she faced more hurdles. Letters flowed to the Boston Medical and Surgical Journal, calling the practice of medicine degrading to women and against divine law.

That resistance kept her from finding a physician's job in the U.S. She knew she had to get practical, clinical experience somewhere. So she went to Paris, where such attitudes were less pronounced — she hoped.

As it turned out, she couldn't get a position at a hospital there either.

But after an introduction to Pierre Louis — whose statistical methods would underpin clinical trials — she landed an internship at La Maternite, the state-run maternity ward.

Blackwell's trials weren't over. While working there, she contracted an eye infection from an infant and nearly lost her sight. For the rest of her life she wore a glass eye. The loss of half her vision precluded a career as a surgeon.

Even so, Blackwell returned to America in 1851 and went to New York City determined to start her medical practice. Even though other women were entering the medical profession, she had a difficult time drumming up business. Many — even other women — didn't trust a female doctor.

Blackwell didn't let that get to her. She pushed to boost her practice, even if it didn't make much money. Her first patients were mostly Quakers, who were often at the forefront of the women's rights movement.

By 1853, Elizabeth's younger sister Emily had also graduated with a medical degree. Both knew not many women could get jobs at local hospitals. So they acted — opening the New York Infirmary for Women and Children in 1857.

The hospital was female-staffed. On top of that, it served poor immigrants whom Elizabeth saw as desperately needing health care.

Blackwell's mission was to provide cures — plus to emphasize prevention of disease.

She thought instruction in hygiene would go a long way toward improving the health of the populace. Whenever she treated patients, she would give instructions on hygiene and prevention — a new concept in medical practice. Blackwell's major innovation was treating the patient as a whole, rather than looking at the illness in isolation.

Even though she established a medical practice in New York and started a hospital, Blackwell was never truly satisfied with her accomplishments, says Julia Boyd, author of "The Excellent Doctor Blackwell."

"The pioneering phase of her initiatives always appealed to her more than their mundane maintenance, and . . . after years of grindingly hard work in New York she was ready for a change," Boyd wrote.

One reason was her upbringing. Her family raised her to agitate for reform. Mix in her strong personality, and Blackwell wanted more than running a hospital.

She wanted to change society — such as that of England, which made it tougher than America for women to enter the medical profession. Blackwell was one of two women on the British Medical Register for 20 years. The other was Elizabeth Garrett Anderson.

In 1858, Blackwell sailed for England. Upon landing, she faced a British Medical Council that wanted to keep women out for good — as it made clear by specifying that women could not be registered as doctors in Britain. The council did this after Blackwell managed to get her name in the British Medical Register, a requirement for anyone wanting to practice there.

Blackwell thought reform should be achieved within the system. She sought help in forming a lobbying group to change the law, thus allowing — not forcing — universities to accept women.

Blackwell won the day. By approaching her friend Russel Gurney, a member of Parliament, such legislation was passed in 1876.

Her London School

Law was one thing, reality another. Just like America, England made women go through a maze to find clinical training.

Blackwell wanted to make the process easier. So she signed on with Anderson and Sophia Jex-Blake, a former Blackwell student, to form the London School of Medicine for Women. Blackwell became a professor and remained with the school for decades.

Even late in life she pushed for better treatment of women and attention to women's health.

Blackwell was at the forefront of the movement to repeal Britain's Contagious Disease Acts, which said that any woman suspected of prostitution could be forced to undergo an internal exam for syphilis. Women who refused to be examined could be imprisoned. Knowingly spreading syphilis was a criminal offense — but only for women. The law was repealed in 1886.

She died in 1910. By then, many medical schools that rejected her had opened their doors to women.

BY JESSE EMSPAK