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sepia tone head and shoulders portraits of two women
Portraits of Elizabeth Blackwell (left) and Florence Nightingale (right), circa 1850s, around the the time that they first met in England. Box 63, Blackwell Family Papers, Manuscript Division, Library of Congress; and Prints and Photographs Division, Library of Congress.

“Nothing that you do…can fail to interest me”: Elizabeth Blackwell and Florence Nightingale Exchange Ideas on Women in Medicine

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In August 1871, Florence Nightingale wrote to Elizabeth Blackwell, stating, “Nothing that you do, independently of our being old friends, can fail to interest me. I wish you ‘God speed’ on all that you undertake.”  The letter represents a new acquisition made through the Library of Congress’s James Madison Council. This 1871 letter joins several other letters exchanged between Blackwell and Nightingale as part of the Manuscript Division’s Blackwell Family Papers. While the opening lines of the letter appear to evoke a lifelong friendship based on common interests in medical training for women, these words conceal as much as they reveal.

handwritten letter
Florence Nightingale to Elizabeth Blackwell, August 2, 1871, page 1. Box 97, Blackwell Family Papers, Manuscript Division, Library of Congress.

Elizabeth Blackwell (1821-1910) is widely known as the first woman to obtain her medical degree in the United States, while Florence Nightingale (1820-1910) is often described as the founder of modern nursing. The two women were exact contemporaries, and both made great contributions to the field of medicine; however, they took different paths to achieve their goals. When the two women met in England around 1850, they shared ideas regarding their plans and a hope to collaborate in the future. Blackwell had recently earned her medical degree from Geneva Medical College in Geneva, New York, in 1849, and then sought to deepen her medical knowledge by first studying in France and then in England. Nightingale, at this time, had not yet made a name for herself, but the Crimean War would soon make her famous for her nursing skills during the next decade. Later exchanges of letters between the two women demonstrate their continuing friendship, but their sometimes divergent ideas as to how women could succeed and intercede in the medical profession. Two of these exchanges, one in 1859, and one in 1870-1871, are documented in the Manuscript Division’s Blackwell Family Papers.

After returning to the United States, Elizabeth Blackwell spent much of the 1850s opening a private practice and founding the New York Infirmary for Women and Children in 1857. She collaborated on this latter project with her sister Emily Blackwell and Marie E. Zakrzewska, both of whom were pioneering physicians in their own right. In 1858, Elizabeth Blackwell returned to England to give a series of medical lectures related to women in the medical profession. During this lecture tour, Blackwell and Nightingale exchanged letters over the possibility of founding a women’s hospital in England, but a disagreement arose between the two women.

handwritten letter
Elizabeth Blackwell to Florence Nightingale, 1859. Box 56, Blackwell Family Papers, Manuscript Division, Library of Congress.

Blackwell desired to establish a country hospital with the assistance of the well-connected and the now famous Nightingale in order to train women as doctors. Blackwell wrote to Nightingale in early 1859,

“Your idea of a Nurse’s College, seems to me, the thing, wanted now, but it must be in connection with a great hospital, and all of our medical women, must pass through the Nurse’s College, into the medical….”

Nightingale responded to Blackwell with at least two letters (one in February and one in March 1859) trying to dispel Blackwell of some of her plans for the hospital. In her March 7, 1859, letter, Nightingale  replied,

“My dear friend I do not want to prevent you from ‘making any use’ of my ‘ideas’ you please. After they have become yours, they are no longer any more yours mine than yours. There is no copyright in ‘ideas.’ But I think the course you propose to give take…a very dangerous one….”

Nightingale’s opposition to Blackwell’s ideas primarily stemmed from the fact that she believed that women should be trained as nurses, and not necessarily as physicians. She also had a strong desire to educate as many women as possible, rather than a select few who could complete the more difficult courses for physicians. Nightingale also advocated that her nurse’s college be attached to an already established hospital, rather than Blackwell’s idea for a new institution. Blackwell, on the other hand, saw nursing as a first step in educating women in the medical profession and wanted to encourage them to become physicians, in a society that still only grudgingly accepted women into most professions.

handwritten notes
Elizabeth Blackwell, Notes: “Clough and F. N. Opposing Hospital,” 1859 [first page misdated 1851]. Box 61, Blackwell Family Papers, Manuscript Division, Library of Congress.
Nightingale felt so strongly about her opinions that she returned Blackwell’s early 1859 letter, noting that Blackwell should reconsider her ideas for the hospital: “P.S. I return your note, in order that you may look at Point 5 again. It is this which makes me so anxious about you.” “Point 5” concerned Blackwell’s desire to have students take “a complete medical course” to train them as full-fledged doctors. Nightingale’s decision to return the letter to Blackwell allows researchers to view one example of Blackwell’s side of the correspondence. Another instance demonstrating Blackwell’s frustration with Nightingale’s opposition to her ideas appears in some of Blackwell’s 1859 notes on the new hospital, where she mentions her struggles and lists some of her main arguments: “I hope soon to hear of renewed strength, I am much grieved at these failures of physical power. F. N. is trying to break down the hospital scheme….”

Without Nightingale’s support, Blackwell was unable to establish a hospital in England, as she had done in the United States with the New York Infirmary for Women, and she eventually departed. However, Blackwell later returned to in England in 1869 and lived out the rest of her life there. Although the two women disagreed on how to accomplish their shared goal of educating women in medicine, they continued to correspond and encouraged each other’s endeavors. In 1870 and 1871, Blackwell and Nightingale again exchanged letters, this time on the topic of the Contagious Diseases Acts, passed by the British Parliament in the 1860s in an attempt to control venereal diseases in the military. The Library’s collection contains only Nightingale’s side of the correspondence (letters from Nightingale that Blackwell received and retained in her papers). However, both Blackwell and Nightingale likely agreed that the acts were, as Nightingale put it, the “most dreadful crisis ever known in the history of civilized mankind.” The laws threatened women’s reputations, freedom of movement, and control of their bodies by regulating prostitution with harsh penalties falling inequitably on women, especially working-class women, and not on men. The acts granted police the power to detain at their discretion any woman suspected of being a prostitute, allowed magistrates to compel the woman to undergo an invasive medical examination, and required confinement in “lock hospitals” until signs of infection cleared, while male clients went unscathed, a double standard that mobilized Nightingale and other women to organize repeal campaigns.

two pages of a handwritten letter
Florence Nightingale to Elizabeth Blackwell, August 2, 1871, pages 2-3. Box 97, Blackwell Family Papers, Manuscript Division, Library of Congress.

The latest fascinating addition to these notable exchanges of ideas is Nightingale’s August 1871 letter mentioned at the beginning of this post. This letter confirms a return to a cordial friendship between Blackwell and Nightingale and a continued common interest in health education. Nightingale, especially, was focused on public health, making the important point that:

“Sanitary work of this kind can only be done by going personal grappling with the evils – by going personally among those for whom it is to be done – going, for instance, into all the back slums of London & other towns – practically learning & teaching there what constitutes the health of dwellings, the health of children, the health of populations, of occupations, &c.”

Blackwell’s earlier 1850s vision for a hospital and for training of women as doctors was eventually taken up by another generation of women physicians in England, including Sophia Jex-Blake and Elizabeth Garrett Anderson in the 1870s. Elizabeth Blackwell served in an advisory capacity and delivered lectures as a professor at the London School of Medicine for Women. Nightingale, even while suffering from a debilitating illness that confined her to bed, published significant works on nursing and influenced many public health reforms. Though they did not always agree, both Elizabeth Blackwell and Florence Nightingale shared their ideas and influenced significant debates on women’s health and women’s place in the medical profession.

Discover more about women in health and medicine in the Manuscript Division’s collections during Women in Medicine Month.

Sources Cited

“When the two women met…” It is uncertain exactly when the two women may have first met, but they encountered each other several times during Elizabeth Blackwell’s visit to France and England in 1849-1850. Mark Bostridge, Florence Nightingale: The Making of an Icon (Farrar, Straus, and Grioux: New York, 2008): 152-153.

“their sometimes divergent ideas…” Lois A. Monteiro, “On Separate Roads: Florence Nightingale and Elizabeth Blackwell,” Signs 9, no. 3 (Spring 1984), 520-533.

“Blackwell, on the other hand…” Monteiro, 524-525.

“with harsh penalties falling inequitably on women…” Julia Boyd, “The Art of Medicine: Florence Nightingale and Elizabeth Blackwell,” The Lancet 9674, vol. 373 (May 2, 2009), 1517.

“Elizabeth Blackwell served in an advisory capacity…” Janice P. Nimura, The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine (New York: W.W. Norton & Company, 2021), 251.

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