It was at this time that Elizabeth Blackwell recognized that preparation for medical practice demanded the sanction of test examinations at a respectable school; not a few months, but years of study; and above all abundant clinical experience. Rather than accept as final the indorsement of little schools established _ad hoc_, or exclusively for women, she applied to be admitted as student at twelve medical schools throughout the country, and among these found one, the school at Geneva, N. Y., to grant her request. The faculty referred the matter to the students, and they decided to invite the courageous applicant. Poor, dependent entirely upon her own exertions, and with others more or less dependent upon her, she nevertheless found means to devote five years to the study of her profession, of which two were spent in Europe, at that time a rare extravagance.[53] Uninstructed or informed by the laws and customs of the entire country that attendance on didactic lectures was sufficient to justify a medical diploma, and hospital training was superfluous,—her native common sense perceived the absurdity of this theory, and left no stone unturned to secure such fragments of hospital training as were obtainable for her in either hemisphere. During the term of study at Geneva, she utilized a vacation to seek admittance to the hospital of the Blockley almshouse at Philadelphia, and obtained it by skillful manipulation of the opposing political influences which prevailed among the managers of the institution.[54] After graduating at Geneva in 1849, the first woman in America or of modern times to receive a medical diploma, Miss Blackwell immediately went to Europe, and by exceptional favor succeeded in visiting some of the hospitals of both London[55] and Paris. In Paris, moreover, she submitted for several months to the severe imprisonment of the great school for midwives, La Maternité. Emily Blackwell was refused admission to the Hobart College at Geneva, which had graduated her sister; but was allowed, for one year, to study at the Rush College of Chicago. For this permission, however, the college was censured by the State Medical Society, and the second term was therefore refused to the solitary female student. She was, however, enabled to complete her studies at Cleveland, Ohio, and graduated thence in 1852. During one of her vacations, she obtained permission to visit in Bellevue Hospital, where Dr. James Wood was just initiating the system of regular clinical lectures. After graduation, Emily Blackwell also went to Europe, and had the good fortune to become the private pupil of the celebrated Sir James Simpson of Edinburgh. She remained with him for a year, and when she left he warmly testified to her proficiency and competence for the work she had undertaken. The testimonial is worth quoting entire: “MY DEAR MISS BLACKWELL: