Before the 1870's, trained nurses were virtually unknown in the United States. Hospital nursing was an unskilled occupation, taken up by women of the lower classes, some of whom were conscripted from the penitentiary or the almshouse. The movement for reform. originated not with doctors, but among upped-class women, who had taken on the role of guardians of a new hygienic order. Though some doctors approved of the women's desire to establish a nurse training school, which would attract the daughters of the middle class, other medical men were opposed. Plainly threatened by the prospect, they objected that educated nurses would not do as they were told -- a remarkable comment on the status anxieties of nineteenth-century physicians. But the women reformers did not depend on the physicians' approval. When resisted, as they were at Bellevue in efforts to install trained nurses on the maternity wards, they went over the heads of the doctors to men of their own class of greater power and authority. (Florence Nightingale, who had friends high in the English government, had followed exactly the same course in reforming her country's military hospitals.) Professional nursing, in short, emerged neither from medical discoveries nor from a program of hospital reform. initiated by physicians, outsiders saw the need first. Which of the following is the best title for the passage?