At a graduation ceremony at a church in Geneva, New York on January 23, 1849, Geneva Medical College in New York bestowed a medical degree upon Elizabeth Blackwell.

A rather ordinary ceremony. A rather ordinary happenstance.

Except it wasn’t. For Blackwell was the first woman in the United States to receive a medical degree.

And she had fought tooth and nail to make it happen.

Born near Bristol, England on February 3, 1821, Blackwell was the third of nine children of Hannah Lane and Samuel Blackwell, a sugar refiner, Quaker, and anti-slavery activist. In 1832, the Blackwell family moved to America, settling in Cincinnati, Ohio. Only six years later, however, Samuel Blackwell died, leaving the family penniless. To make ends meet, Elizabeth, her mother, and two older sisters worked in the predominantly female profession of teaching.

But God–and Elizabeth–soon had other plans.

While attempting to comfort a dying friend, Blackwell was frustrated to learn that her friend’s ordeal had been made worse by her team of all male doctors, who did not understand her unique physicality or needs. She bemoaned to Elizabeth her wish for a female physician.

The only problem? There were practically none. Most physicians trained as apprentices to experienced doctors; though a few women also apprenticed and became unlicensed physicians, most of those experienced doctors refused to take on female students. Medical colleges were few at the time, and none accepted women.

Inspired by her friend, Elizabeth decided she was going to change all that.

While still maintaining her post as a teacher, she boarded with the families of two brother physicians who agreed to mentor her, Reverend John Dickson and Samuel Henry Dickson. Wanting to take her training even further, she returned to Philadelphia in 1847, hoping for admittance into the Philadelphia Medical School. As she waited for a response, she studied anatomy with another physician, Jonathan M. Allen .

She was rejected.

Not one to be discouraged, Elizabeth applied again, this time to twelve other medical schools.

She was rejected from them, too.

Elizabeth’s family approved of her ambition, but the rest of society did not. Most physicians she consulted recommended that she either go to Paris to study or take up a disguise as a man to study medicine. The main reasons offered for her rejections were that (1) she was a woman and therefore intellectually inferior, and (2) she might actually prove equal to the task, prove to be competition, and that she could not expect them to “furnish [her] with a stick to break our heads with.” Still others found the idea of a female doctors laughable. It was, quite literally, a joke even to the men who eventually accepted her to Geneva Medical College—the question of whether or not to accept a woman was put up to a vote of the 150 male students, who voted in favor as a practical joke.

It is unknown whether or not Blackwell knew of this when she received her acceptance letter and started school in 1847. But, even if she didn’t, she learned of her fellow students’–and professors’–attitudes about her presence right away.

On campus, she was shunned. Professors forced her to sit separately at lectures and often excluded her from labs. They often 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.

The situation in town wasn’t much better. The local townspeople of Geneva ostracized her, labeling her as a “bad” woman for defying her gender role.

Nevertheless, as they say, she persisted.

Eventually, by pure doggedness and intellect, Elizabeth won over some of her professors and fellow students. When she graduated–first in her class–the dean of her school congratulated her in his speech…but added 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.”

Blackwell didn’t let it get her down. Degree in hand, she published her inaugural thesis on typhoid fever in the Buffalo Medical Journal and Monthly Review in 1849. Afterward, she traveled to London and Paris, where she continued her training, though doctors there relegated her to midwifery or nursing. She began to emphasize preventative care and personal hygiene, recognizing that male doctors often caused epidemics by failing to wash their hands between patients.

In 1851, Dr. Blackwell returned to New York City, where discrimination against female physicians meant few patients and difficulty practicing in hospitals and clinics. With help from Quaker friends, Blackwell opened a small clinic to treat poor women; in 1857, she opened the New York Infirmary for Women and Children. Its mission included providing positions for women physicians. During the Civil War, the Blackwell sisters trained nurses for Union hospitals.

In 1868, Blackwell opened a medical college in New York City. A year later, she placed her sister in charge and returned permanently to London, where in 1875, she became a professor of gynecology at the new London School of Medicine for Women. She also helped found the National Health Society and published several books, including an autobiography, Pioneer Work in Opening the Medical Profession to Women in 1895.

Elizabeth faced discrimination at every turn, and she remained committed to her quest not only for herself but for those who would follow in her footsteps.

And follow they would.

In 2017, for the first time ever, a majority of medical students in the United States were women.