History of nursing in the United Kingdom matrons, whose work was largely administrative, even more so. Nursing in the Poor Law infirmaries, such as it was, was largely carried out by able-bodied paupers, who were not paid. In 1866 there were a total of 53 nurses employed in the 11 metropolitan workhouses, at an average salary of £20 18s. Florence Nightingale is regarded as the founder of modern nursing profession. There was no hospital training school for nurses until one was established in Kaiserwerth, Germany, in 1846. There, Nightingale received the training that enabled her in 1860 to establish, at St Thomas' Hospital in London, the first
Florence Nightingale Medal spirit in the areas of public health or nursing education". It was initially set up to be awarded to six nurses annually, although the first 42 awards were only made in 1920 due to the disruption of the First World War. The medal was restricted to female nurses until regulation changes in 1991. Under the new regulations it is open to both women and men, and is awarded every two years to a maximum number of fifty recipients worldwide. The vesica piscis-shaped medal is composed of gold and silver-gilt and bears a portrait of Florence Nightingale surrounded by the words