At a graduation ceremony at a church in Geneva, New York on January 23, 1849, Geneva Medical College bestows a medical degree upon Elizabeth Blackwell, the first woman in the United States to receive one. Despite the near-uniform opposition of her fellow students and medical professionals, Blackwell pursued her calling with an iron will and dedicated her life to treating the sick and furthering the cause of women in medicine.

Blackwell’s family was remarkable by any standard. Her father was a staunch abolitionist and both her brother and his wife were active in the women’s suffrage movement. Another sister-in-law was the first female minister to be ordained in a mainstream Protestant denomination, and Elizabeth’s younger sister Emily also studied medicine.

A gifted student, Elizabeth felt compelled to become a doctor after a conversation with a dying friend, who told her that her ordeal had been that much worse because her physicians were all men. Elizabeth’s family approved of her ambition, but the rest of society still found the idea of female doctors laughable. It was, quite literally, a joke even to the men who accepted her to Geneva Medical College—the question of whether or not to accept a woman was put up to a vote of the students, who voted in favor as a practical joke. Nevertheless, Blackwell received her acceptance letter and started school in 1847.

Blackwell’s fellow students shunned her. So did the townspeople of Geneva. Her professors complained that teaching her was an inconvenience, and one even tried to stop her from attending a lesson on anatomy, fearing it would be immodest for her to be present. When Blackwell graduated, the dean of her school congratulated her in his speech but went as far as adding a note to the program stating that he hoped no more women would attend his school. The sentiment was echoed by the rest of the American medical community—a letter to the Boston Medical and Surgical Journal described her graduation as a “farce.” Again, Blackwell succeeded in the face of indignities, not only graduating but publishing her thesis in the Buffalo Medical Journal.

Blackwell set up a clinic for the poor of New York City, where she met what she described as “a blank wall of social and professional antagonism,” but remained determined to treat as many patients as possible. She founded a hospital, the New York Infirmary for Women and Children, in 1857 with the help of her sister and another protégé, both women who had followed in her footsteps and received medical degrees. She and her sister trained nurses during the Civil War and opened their own medical college in 1868. She eventually moved to London, becoming a professor of gynecology at the School of Medicine for Women.

Faced with sexist discrimination at every turn, Blackwell not only received her degree and practiced medicine but contributed greatly to the education of the first generation of female doctors in America. The profession remained notoriously male for many, many years, but the progress that started with Blackwell continues. In 2017, for the first time ever, a majority of medical students in the United States were women.