When she graduated from medical school in 1849, Elizabeth Blackwell earned more than an M.D.: she also earned the distinction of becoming America’s first woman doctor.

It wasn’t an easy road. Rejected by all but one college and regularly shunned by her peers, Blackwell still managed to build an impressive and varied career. Her tenacity and trailblazing achievements helped expand women’s access to the medical field in the United States and beyond.

1. Elizabeth Blackwell was born into a family of reformers and activists.

Blackwell was steeped in examples of progressive courage from an early age. Despite being in the sugar business (an industry that, in the early 1800s, relied heavily on enslaved people for labor), Blackwell’s father was staunchly anti-slavery. When the family moved from England to the United States in 1835, they became active in the American abolitionist movement.

According to Nancy Kline’s biography, Elizabeth Blackwell, First Women M.D., the family sheltered the outspoken abolitionist pastor Samuel Cox and, on at least two occasions, hid runaway enslaved people in their home. Blackwell regularly attended abolitionist meetings and later befriended Uncle Tom’s Cabin author Harriet Beecher Stowe.

2. A dying friend first encouraged Elizabeth Blackwell to pursue medicine.

After making medical history, Elizabeth Blackwell was honored with a special U.S. postage stamp.Wikimedia Commons // Public Domain

In 1845, Blackwell sat at the bedside of a friend who was dying from ovarian cancer. During their conversation, Blackwell’s friend remarked regretfully that, “If I could have been treated by a lady doctor, my worst sufferings would have been spared me.” It was a statement with an agenda. She went on to ask Blackwell, “Why not study medicine?”

Initially, Blackwell resisted the bold proposition, writing, according to Kline, that she was “shocked” by the idea. At the time, Blackwell was working as a teacher in Kentucky and recalled that she “couldn’t bear the sight of a medical book.” She was, she said, much more “interested in the moral and spiritual side of life, not the body.”

Within a couple of years of that provocative conversation, however, she began to explore the possibility of pursuing a medical degree.

3. The only medical school to admit Elizabeth Blackwell did so as a joke.

When she applied to medical schools in 1847, Blackwell received rejections across the board. Luckily, there was one (accidental) exception. When she applied to Geneva Medical College (now Hobart and William Smith Colleges), a small rural school in western New York, the faculty decided to let their students make the call. Assuming the measure could not possibly pass, administrators informed the approximately 150 students that a single “no” vote would end her bid. Some students thought her application was a prank from a rival school, while others simply found the proposition amusing. Unanimously, they voted yes.

Blackwell was in.

Though she’d passed her first hurdle, her time at Geneva was anything but easy. Professors made her sit separately during lectures and often excluded her from labs. The locals who lived in town refused to engage with a woman so improper. Nevertheless, graduation found Blackwell at the top of—and respected by—her class.

4. Elizabeth Blackwell’s sister also became a doctor.

Inspired by her sister, Emily Blackwell decided to follow Elizabeth into medicine. After being rejected by a number of schools (including Elizabeth’s alma mater) she was finally admitted to Western Reserve University (now Case Western Reserve) and graduated as America’s third woman doctor in 1854.

The two sisters teamed up on multiple occasions over the course of their careers. Just three years after Emily’s graduation, they founded the New York Infirmary for Women and Children. And when the Civil War broke out in 1861, Emily and Elizabeth trained women nurses for the Union Army, despite meeting resistance from male army doctors.

Though Elizabeth left the infirmary just two years after its establishment, Emily stayed on to manage the institution. She oversaw the infirmary for the next 40 years, staffing it with women and growing it to treat more than 7000 patients per year.

5. Elizabeth Blackwell founded a college for women and taught as a professor.

Initially, Blackwell planned to become a surgeon. But after a medical accident left her blind in one eye not long after graduating from medical school, she was forced to take a different path. After working for years both in private practice and, later, in her infirmary, she launched a women-only medical college in 1868. The Women’s Medical College of the New York Infirmary quickly gained a reputation for its rigorous standards and was eventually absorbed by Cornell.

Five years after returning to her native England, she helped establish the London School of Medicine for Women in 1874–5. She taught there as a professor of gynecology until an injury forced her to retire in 1907.

6. Elizabeth Blackwell never married.

An elderly Elizabeth Blackwell with her adopted daughter, Kitty.Wikimedia Commons // Public Domain

Being single seemed to run in the family: not one of the five Blackwell sisters were wed. (Blackwell’s brother Henry made the most notable match of the nine siblings when he married famed women’s rights activist Lucy Stone.)

Blackwell did adopt a daughter, an Irish orphan named Kitty Barry, in 1856. Though Blackwell seems to have regarded Kitty as a domestic helper as much as a member of her family, she ensured she was educated, and Kitty stayed by her adopted mother’s side for the remainder of her life. When Kitty died, she asked that her ashes be buried with Elizabeth’s, whom she called her “true love.”