In the mid-19th century, Sophia Jex-Blake struggled against constant roadblocks as a woman trying to earn a medical degree—so she decided to establish a school of her own.

Founded in 1874, the London School of Medicine for Women was the first and only place a woman could earn a medical degree in the UK for many years. Between its opening and 1911, the number of women doctors in the country skyrocketed from two to 495. Jex-Blake was also the first woman M.D. to practice in Scotland. The hospital she established in Edinburgh provided women doctors with jobs and women patients with high-quality care for 80 years.

While Jex-Blake’s legacy as a medical pioneer is well established, one aspect of her personal biography is commonly left out—her romantic partners were women. And Jex-Blake was far from the only notable lesbian in the medical movement.

Some might argue that Jex-Blake’s sexuality was an asset in her role as a women’s rights trailblazer. Other women in the movement could be hampered by their desire not to step on men’s toes. In The Excellent Doctor Blackwell: The Life of the First Woman Physician, biographer Julia Boyd writes the first UK female doctor Elizabeth Blackwell "wished to see her sex enjoy wider opportunities ... but not at the expense of men."

Jex-Blake, on the other hand, saw no reason why women shouldn’t have it all, and have it now. Heavy-set, stubborn and hot-tempered, yet blessed with a sharp wit and eloquence, her contemporaries often cringed at her outspoken bluntness. She wrote responses to articles that objected to women doctors in medical publications and got into heated arguments with her professors at public meetings.

In her essay in the 1869 anthology Women's Work and Women's Culture, Jex-Blake demanded to know: “Who has the right to say that they [women] shall not be allowed to make their work scientific when they desire it, but shall be limited to merely the mechanical details and wearisome routine of nursing, while to men is reserved all intelligent knowledge of disease, and all study of the laws by which health may be preserved or restored.”

She may have startled some with her words, but it was hard to argue with Jex-Blake’s results. The publicity she garnered translated into significant public support for women’s right to become doctors.

Medicine was one of the first professional battlegrounds where women pushed back against the era’s norms dictating a woman’s proper place. Early Victorian vocation options left much to be desired. When it came to professions, teaching was essentially the only acceptable career. For upper class women, to work was considered an embarrassment to their family; jobs were for women who didn’t have husbands to provide for them.

Rosalie Slaughter Morton’s aristocratic father was so scandalized by the thought of his daughter earning money that it wasn't until after his death that she attended the Women’s Medical College of Pennsylvania in 1893. Since he left her no inheritance, she used money she’d been saving since childhood and eventually earned degrees to become a physician and surgeon.

Florence Nightingale’s family lodged similar objections to her nursing career aspirations. Whenever she brought up the topic with her mother and sister, they reportedly required reviving with smelling salts.

Jex-Blake’s father had only permitted her to become a math tutor—if she didn’t accept a salary. Even if a woman had a career before marriage, she was expected to quit upon tying the knot.

These stringent societal standards left some women in a special quandary. What if you weren’t planning on marrying a man? How could you support yourself financially? This challenge drove queer women to lead the way in the push to prove their gender could pursue any profession.

Nineteenth-century doctors Emily Blackwell, Marie Zakrzewska, Lucy Sewall, Harriot Hunt, Susan Dimock, Sara Josephine Baker, and Louisa Garrett Anderson all preferred women (and many of their romantic partners were also physicians). And while there may have been a stigma around women working, some argue there was less societal scorn attached to women loving women.

“Such relationships enjoyed a level of acceptance greater than what many experience today,” historian Arleen Tuchman writes in her biography of Marie Zakrzewska. Tuchman says that, in her writings, Zakrzewska “blurred the line between conventional marriage and same-sex relationships with great confidence and ease, providing further evidence that the anxieties that would surface later in the century about lesbians were not yet present.”

Tuchman also believes our modern preoccupation with whether these partnerships were sexual, “reveals more about our own understanding of companionship and intimacy than that of women in the past.”

Blackwell and Zakrzewska were among the first women in the United States to earn M.D.s, in 1854 and 1856, respectively. Together with Blackwell’s sister Elizabeth, they established a women’s hospital in New York. It was forever expanding, never quite big enough to accommodate all the women who wished to be treated there. Later, they added a women’s medical college to their offerings. Blackwell met Elizabeth Cushier when she became a student at her college. Cushier then began working alongside Blackwell at her hospital.

“I do not know what Dr. Emily would do without her. She absolutely basks in her presence; and seems as if she had been waiting for her for a lifetime,” a colleague gushed of Cushier. Blackwell and Cushier raised an adopted daughter together. By the time Blackwell closed the college in 1899, 364 women had earned M.D.s there. In 1981, Blackwell’s hospital relocated and merged with another institution. It’s now known as the New York-Presbyterian Lower Manhattan Hospital.

Soon after establishing the New York women’s hospital, Zakrzewska went to Boston to repeat the experiment. In 1862, she opened the New England Hospital for Women and Children. That same year, Julia Sprague moved into Zakrzewska’s home, and they soon began a relationship that lasted until Zakrzewska’s death 40 years later.

Women flocked to her hospital, which was one of the first in the country to institute sanitation and sterilization protocols. Boston’s top physicians were agog at its singular success in preventing the spread of disease. Before sterilization was standard, a visit to the hospital could leave patients sicker than before. Zakrzewska’s hospital remains open as the Dimock Community Health Center.

When Jex-Blake visited the Boston hospital, she met resident physician Lucy Sewall and the two started to plan a life together. Those plans were interrupted when Jex-Blake’s father died, forcing her to return to the U.K. Like Blackwell, she finally found lasting love with a former medical student-turned fellow physician: Margaret Todd.

By establishing women's medical colleges and hospitals, these 19th-century pioneers helped open the profession of medicine to women. One of the biggest hurdles for women medical students at the time was finding a place to receive practical training and internships, and then a job. Most establishments invariably turned women away. These hospitals filled that need.

By the end of the 1800s, some new terms had emerged in the English language: “new woman,” to describe educated, independent career women, “Boston marriages,” to describe two professional women sharing a home, and “sapphist,” to describe women who loved women. By pursuing careers, toppling norms and offering their personal roadmaps as examples, these women ensured others like them could flourish both in their private and professional lives.