Where in the world is Florence Nightingale's medicine chest?

BACKGROUND
In the 121st anniversary year of the birth of Florence Nightingale, and during the COVID-19 pandemic, it is both interesting and salient to be reminded of the foundational work of this famous woman who began modern nursing. Her work in nursing care and nursing, health and public policy has been a continuing strong foundation to practices in societies around the world.


METHODS
In this short communication about historical research, various aspects of Florence's life and work are described, as well as the locations, memorials and museum significant to our remembrance of her.


RESULTS
A particular focus of this paper is the description of a larger but little-known medicine chest located at the College of Nursing, University of Saskatchewan, in Saskatoon, SK, Canada, and attributed as belonging to Florence.


CONCLUSION
Best known to this point in time is a smaller medicine chest at the Florence Nightingale Museum in London.


Introduction
One may reasonably assume that Florence Nightingale's medicine chest could potentially be found in a number of locations: (A) Florence, Italy, where Florence was born; (B) Istanbul, Turkey, where Florence and her nurses used this medicine chest during the Crimean War; or (C) London, England, where a Florence Nightingale Museum (FNM) was opened in 1989. These three places are the most logical options, but would you believe (D) Saskatoon, Saskatchewan (SK), Canada, at the College of Nursing, University of Saskatchewan (USask)? The correct answer is both England and Canada (Fig. 1).
Although there is a small medicine chest or box belonging to the founder of modern nursing at the FNM in London, England, there is also a larger medicine chest over 4000 miles away in Canada. Both medicine chests are claimed to have been originally owned and used by Nightingale during the Crimean War (Brown et al. 2008;FNM 2021). The two artefacts may have been a companion set at one time, as they do look to be of the same era.
This report on the medicine chest in Canada was inspired by the year 2020, named as the 'Year of the Nurse and Midwife' (World Health Organization [WHO] 2020b) in honour of the 200th birth anniversary of the founder of modern nursing -Florence Nightingale, and the year the novel coronavirus COVID-19 was declared a global pandemic (Tran 2020;WHO 2020a). These events are salient to Nightingale's foundational policies to control infection that are just as relevant today (FNM 2021). The medicine chest and exhibits of Nightingale's personal belongings remind us of how her life and work (Piszczatowska 2018) continue to have a significant influence on nursing, health care and public health throughout the world, and especially during this global pandemic of COVID-19. Specific locations where the two medicine chests are found and/or could have been found are highlighted in this report, while tracing Nightingale's historical life and legacy. The extraordinary circumstance of how the larger medicine chest arrived at its present location in Canada is briefly described. Funding: This article received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Conflicts of interest: No conflict of interest has been declared by the author.

A. Florence, Italy
Frances Parthenope Nightingale (1819-1890) Florence had one older sister who was born in Naples, Italy, on April 19, 1819 (FNM 2021), a year before her, Frances Parthenope Nightingale, who became an English writer and journalist. Although Parthenope at first disapproved of her sister becoming a nurse, she later became one of Florence's greatest advocates (Haigh 2004;McDonald 2010).
Florence Nightingale  Florence Nightingale was born on 12 May, 1820, in Florence, Italy, and she was thus named after the city of her birth (FNM 2021; Glasper 2020). Her English parents had been in Italy on an extended vacation and where both she and her sister were born (Haigh 2004). In her teenage years, in England, a flu epidemic provided Florence with the experience of caring for her family and their servants, during which she discovered a skill for nursing (Piszczatowska 2018). Born to a wealthy, well-connected family, Florence felt she had a vocation for a profession that was not well respected by her family and friends (Preston 2020).

Statue of Florence Nightingale
After Florence Nightingale's death in 1910, the city of Florence erected a statue in her honour at the Basilica of Santa Croce in 1913 (Victorian Web 2020). To date, there is not a museum with Florence's medicine chest or any of her personal belongings in Florence, Italy; however, the city is proud to be the birthplace of this famous person of the Victorian era.

B. Istanbul, Turkey
Crimean War  Florence Nightingale came to Istanbul in 1854 to run the military hospital in € Usk€ udar (old Scudari) and care for the Turkish and allied soldiers during the Crimean War (McDonald 2019). When she arrived in the Crimea, she found horrific, unsanitary conditions in a disorganized, overcrowded, military hospital system with a high mortality of soldiers. Florence found that more soldiers were dying from typhoid, cholera and dysentery than from their war injuries (British Broadcasting Cente [BBC] 2020; McDonald 2019; Panos 2020). Nightingale believed 'epidemics could be controlled with better nutrition, ventilation and sanitation' (Panos 2020). She later introduced policies for modern nursing practices of handwashing and sanitation regimes to control infection resulting in significant reductions to the death rates of the soldiers (Monteverde & Gallagher 2020). These policies doubtless have saved millions of lives around the world since that time.

Medicine chests
Florence Nightingale brought 38 volunteer nurses with her to the Crimea. The assumption was she also brought medicine chests to use in caring for the wounded soldiers. Florence often paid for hospital supplies from her own money (Preston 2020); therefore, it is reasonable that she could have bought two or more medicine chests and brought them with her to the Crimea for her many nurses to use in caring for the soldiers. There is a museum in € Usk€ udar in Istanbul, Turkey, in the old hospital located in the Selimiye Barracks. This FNM was opened in memory of the English nurse. Exhibits include the operating theatre, as well as Florence's room and some of her personal effects. These include photographs, certificates, medallions and a bracelet presented to her by Sultan Abdulmecid (All About Turkey 2021); however, there is not a medicine chest in this museum.

Claydon House
In 1858, Florence's sister Parthenope married Harry Verney, 2nd Baronet, MP, for Birmingham. Harry Verney was one of at least three rejected suitors of her famous sister Florence (Preston 2020). Reportedly, Florence declined Sir Harry's proposal of marriage, because she was dedicated to her nursing endeavours (FNM 2021). However, Florence introduced him to her 38-year-old spinster sister, and Parthenope and Sir Harry were married within a year (FNM 2021).
After the Crimean War, Florence Nightingale was a regular and welcomed guest of her sister and brother-in-law at Claydon House (FNM 2021). Claydon House, the ancestral home of the Verney family since 1620 (FNM, 2021), is located in Buckinghamshire, England, near the village of Middle Claydon (Knox 1999). After 1860, Florence was frequently consulted about the design and administration of field hospitals (Panos 2020) and the training of nurses. Sir Harry provided Florence with a suite of rooms at Claydon House to write her numerous books on nursing and to meet influential people (National Trust 2020). Florence spent many of her later years at Claydon, especially in the summer (National Trust 2020) where she enjoyed the exceptional gardens at the estate. Miss Nightingale was early to recognize the importance of fresh air and the therapeutic effect of gardens on wellbeing.
Claydon House, now owned by the National Trust, is on the "National Heritage List for England, and its gardens are listed on the register of Historic Parks and Gardens" (Knox 1999). Florence's bed and suite of rooms at Claydon House can be seen when touring this historical site (Knox 1999; National Trust 2020).

Death of Florence Nightingale
Florence Nightingale died on 13 August, 1910, in Mayfair, England, at age 90. She was long known as the most famous woman in Victorian England, surpassed only by Queen Victoria (Piszczatowska 2018;USask 2009).

Florence Nightingale Museum London, England
In 1989, the FNM opened in London, England, on the original site of the Nightingale Training School for Nurses established in 1860 on the St. Thomas Hospital campus (FNM 2021). The FNM can be found in central London, close to the River Thames and the Westminster Bridge, and opposite the Houses of Parliament (FNM 2021). This museum celebrates the life, work and legacy of the best known figure in nursing history with a collection of over 3000 exhibits. Her many possessions on display include Florence's nursing notes, desk and a prized possession that has the following explanation for visitors: Medicine chest: Florence took this medicine chest to the Crimean War for her and her nurses to use if needed. The

Medicine Chest (box)
Approx. Size: 8"hX6"w X6"d (20cm X 15cm X 15cm) (FNM est. 1989, London, Eng). (FNM, 2021) medicine chest contained medicines such as quinine to treat malaria and carbonate of potassium for fever. The medicine chest also contained two containers of pills labelled "tonic pills" and "cough pills," a tiny set of scales and measures, and a glass beaker for measuring liquids. Much of the contents of the chest were highly toxic (FNM 2021).

FNM Exhibit: 1918 (Spanish) influenza pandemic
In 2017/2018, the FNM showcased a series of exhibits on the 1918 (Spanish) Influenza pandemic to mark 100 years since the 1918 global pandemic that in four successive waves infected 500 million people, about a third of the world's population at the time, killing more than 50 million people (Rosenwald 2020;Spreeuwenberg et al. 2018). The infection control skills Florence Nightingale tested during the Crimea proved to be critical lessons on how infections spread and how to design military or field hospitals that became policy in combatting the 1918 Flu pandemic.

Uncertain future of FNM in London
In May 2020, the FNM was set to celebrate the 200th anniversary of Florence's birth with a special 200 objects display (FNM 2021). However, in early 2020, due to the necessary restrictions put in place with COVID-19 seizing control as a 'global pandemic' (Tran 2020;WHO 2020a), the celebrations had to be put on hold. The FNM in London 'faces an uncertain future' (Thompson 2020, p. 1) and like many businesses has struggled due to the coronavirus lockdown.

D. Saskatoon, SK, Canada
About Saskatoon, SK An unlikely location for a Florence Nightingale possession to appear is Saskatoon, SK, Canada. The city of Saskatoon was established in 1906 and now has a population of over 300,000. Saskatoon is known as the city of bridges, whose main employer is USask, followed by the production of potash mining. Saskatchewan, in the centre of Canada, is one of the three Prairie Provinces (City of Saskatoon 2021). The University of Saskatchewan was established in 1907 and the School of Nursing in 1938 (USask 2019) and today. USask is a member of Canada's top U15 research universities.

Florence Nightingale medicine chest in Canada
Today, this medicine chest is in a display case in the College of Nursing. The information card with the exhibit provides only a brief notation tracing how this historical relic was twice gifted to friends before ending up at USask as an intriguing artefact among the University Archives and Special Collections (Fig. 3): History of the medicine chest in Canada:  1961, 1974, 1980: Brown et al. 2008.

Future research of the Florence Nightingale medicine chest in Canada
The two global events of 2020 (as previously described) not only inspired this report but also future research. Although the medicine chest has been in Canada for over 100 years and at USask for over 60 years, it had never been thought about as a potential research project! The years go by and sometimes we forget we even have this historic relic, 'our best kept secret'! (USask 2020 to examine the artefact itself, expose its secrets, and explore the connections and relationships between the custodians of the medicine chest in its journey before and after arriving in Canada. Preliminary research of the medicine chest revealed that Mr. Isaac Milsom had been the head gardener at Claydon House, and he and his wife Mary Ellen were intimate friends of the Nightingale sisters (Saskatoon Daily Star 1917). After Florence's death in 1910, Mr. and Mrs. Milsom and family immigrated to Canada in 1912 (Census & Immigration of Canada 1912;Census of England 1911) bringing the medicine chest with them.
When the pandemic is over, should our medicine chest be shared with others? Perhaps our medicine chest was meant to keep travelling around the world as a travelling exhibit on loan to museums so that more nurses and the public can see and appreciate this historical relic of nursing's most famous member-Florence Nightingale.

Implications for nursing policy and practice
Florence Nightingale's foundational policies for modern nursing practice are just as relevant today during this global pandemic when once again nurses serve as frontline practitioners. Handwashing, social environment and sanitation regimes for infection control are critical lessons from the past, so crucial to nursing, health care and public health policy today.