Sexism Sinks Friendships and Stifles Progress: The Case of Elizabeth Blackwell and Florence Nightingale

“The mission of the lady-doctors is—what is it? We lament to record our conviction that it is one of arrogance and self-glorification.”

—a 1859 British Medical Journal article.

Sexism Sinks Friendships and Stifles Progress: The Case of Elizabeth Blackwell and Florence Nightingale
Elizabeth Blackwell (left) and Florence Nightingale. (Picryl + Boston Public Library)

When Elizabeth Blackwell met Florence Nightingale in London in 1850, they became fast friends. Blackwell had just become the first woman in America to earn an M.D., and was now seeking additional training at hospitals in France and England. Nightingale was feeling stifled by the expectation that she live idly in her parents’ home while waiting around for a husband.

Blackwell called Nightingale one of her most valued acquaintances, and described her as a young lady trapped at home, “chafing against the restrictions that crippled her active energies.”

Blackwell recalled one beautiful April day when the women strolled the grounds of Embley Park, the Nightingale family’s large winter estate.

“Do you know what I always think when I look at that row of windows?” Nightingale asked Blackwell as they walked outside the large drawing room, the scent of laurels encompassing them. “I think how I should turn it into a hospital ward and just how I should place the beds! I should be perfectly happy working with you; I should want no other husband!”

Dreams Take Shape

Nightingale had experienced a “Christian calling” to become a nurse as a young woman. She spent a few months training as a nurse at Kaiserswerth hospital in Germany, and longed to put her skills to use. Her family were not happy about this. At the time, the idea of any well-off woman working was distasteful.

For Blackwell, it was at the urging of a dying neighbor that she came to understand the need for women doctors. When applying to medical school, several people told her she should choose the path of least resistance and become a nurse. But Blackwell’s greatest goal was to effect social change, to expand women’s professional sphere, and nursing would not achieve this purpose. Blackwell graduated from Geneva College in New York in 1849.

Now, the pair spent many evenings chatting by the fireside in Thavies Inn. Blackwell also accompanied Nightingale on a visit to a 12-bed hospital that served the 30,000 German immigrants living in London’s East End. They continued to exchange many letters after Blackwell returned to New York.

There were a lot of similarities between the two women. “They were within a few months of the same age; they both had the same sense of vocation, the strong religious feeling as the base and root of all their work, the same feeling that they had got to do, what each eventually did do, in the way of raising the standard of women’s work; the same intense joy and satisfaction in her appointed task,” a mutual friend once observed.

Florence Nightingale Becomes Famous

During the Crimean war, Nightingale finally got her chance to shine. In November 1854, she led a team of nurses to the Selimiye Barracks in Scutari, Istanbul. Military hospitals had been entirely overwhelmed by the volume of wounded soldiers, and the contagious diseases proved more deadly than the injuries. Contaminated water, rats, stretchers lining hallways, soldiers laying in their own filth: The cramped, filthy conditions ensured illness spread quickly.

Nightingale nursed British soldiers through cholera and typhus outbreaks while doing her best to clean up the place. She returned from the war a national heroine. A fund was set up in her name for use in opening a nursing school. Before long, her adoring public had raised £44,000.

But Nightingale had contracted “Crimean fever,” a bacterial illness that left her with chronic symptoms. She complained of intermittent fevers, extreme fatigue and sciatica. Solace came in the form of frequent trips to the spa town of Great Malvern, three hours outside London. More than anything, she preferred to be left alone. Perhaps her celebrity was too much for her.

If you found this article helpful, please consider supporting our independent reporting and truth-telling for as little as $5 per month.

A Reunion Plagued with Disagreement

When Blackwell returned to London to give a lecture tour in 1859, she reached out to Nightingale again. Having such a famous friend proved incredibly advantageous. Nightingale’s letter of recommendation ensured Blackwell secured a spot on the British medical register—the first woman, no less.

Blackwell also wanted Nightingale’s help with another venture: the establishment of a large country hospital outside London, run by women, for women. It would be akin to the one she and her sister, Dr. Emily Blackwell, had founded in New York two years prior. With this second establishment, Blackwell hoped to achieve her dream of opening a medical college and nursing school for women.

But Florence Nightingale had ideas of her own. She wanted to open a nursing school in connection with an already-established city hospital. Blackwell went to see Nightingale in Great Malvern to talk it over.

“[W]e conversed very earnestly about the nursing plan in which she wished to interest me,” Elizabeth wrote to her sister Emily. “She thinks her own health will never permit her to carry out her plan herself, and I much fear she is right in this belief. My old friend’s health is fading.”

Nightingale pressed Elizabeth Blackwell to be the superintendent of her nursing school, but Blackwell wanted to train women to be nurses and doctors. Nightingale scoffed at Elizabeth’s plans. They didn’t have enough money to open a brand new hospital, she argued, and if they announced their intention to train women as doctors, the doors of every London hospital would be shut to them. Neither woman would concede her dream to the other, so Blackwell headed back to New York again. 

“On Different Roads”

What a groundbreaking establishment the pair might have created to train women as doctors and nurses. What an incredible boon it would have been for women’s educational and professional advancement. Alas their personal and professional relationships became yet another victim of patriarchy and internalized sexism.

They were “on different roads,” Florence Nightingale told Blackwell. And Florence’s road was not paved with women physicians.

The “American World” of female M.D.s “talks a ‘jargon,’ and a very mischievous one,” Florence Nightingale asserted in a letter to politician John Stuart Mill. “The women have made no improvement—they have only tried to be ‘men,’ and they have only succeeded in being third-rate men. … These women have, in my opinion, failed.”

In her book Notes on Nursing, she reiterated these thoughts: “I would earnestly ask my sisters to keep clear of … the jargon, namely, about the ‘rights’ of women, which urges women to do all that men do, [in] the medical and other professions.”

Blackwell called the book, “ill tempered, dogmatic, exaggerated,” adding, “I see how difficult it would have been for me to do her work, the character of our minds is so different.”

Blackwell was likely perturbed that Florence chose not to use her fund to help her establish a women’s hospital and college in the U.K. She also may have been jealous of the fame and acclaim Nightingale enjoyed after the Crimean War. For their work in establishing the Women’s Central Relief Agency during the American Civil War—which grew into the United States Sanitary Commission—Elizabeth and Emily Blackwell had received no credit whatsoever.

Society loved to celebrate Florence Nightingale’s work. She’d elevated the field of nursing to near-mythological status: Nurses were now angels of mercy. Blackwell, on the other hand, endured both professional and personal ostracism, as well as malicious gossip. Women were lauded as assistants to male doctors, but to strive to become the doctors themselves was seen as an abomination. 

“Does anyone hint that there is no greater incompatibility with feminine attributes in the proceedings of Dr. Elizabeth Blackwell than in those of Florence Nightingale? There is, we fear, a wide difference between the two cases,” a 1859 British Medical Journal article declared. “The mission of Florence Nightingale was one of mercy and benevolence: She went, that she might afford to the sick and wounded the treatment which woman alone could give them. The mission of the lady-doctors is—what is it? We lament to record our conviction that it is one of arrogance and self-glorification.”

Despite all they held in common, Florence Nightingale’s acceptance of the patriarchal status quo that women should be content to be nurses and not force their way into medical schools to become doctors drove a wedge between the two women. They exchanged a few more letters, but their principles proved stronger than their friendship.

Elizabeth Blackwell and Florence Nightingale both independently saw their schools take shape. In 1860, Florence used the Nightingale Fund to found a nursing school at St. Thomas’ Hospital in London. In New York, Elizabeth and Emily Blackwell opened a women’s medical college attached to their women’s hospital in 1868. They modeled the nursing program on Florence’s plans.

Up next:


Olivia Campbell's work has appeared in The Guardian, The Cut, Washington Post, and Smithsonian Magazine, among others. Her first book, Women in White Coats: How the First Women Doctors Changed the World of Medicine , will be published March 2, 2021.