The health problems of a port city and the cost of tropical diseases on trading profits forced the city to respond. In the field of public health administration, Liverpool led the way by appointing the first Medical Officer of Health, William Henry Duncan, in 1847.7 District nursing began in the early 1860s with the collaboration of Florence Nightingale and William Rathbone. In conjunction with Leeds and Manchester, Liverpool's Medical School became a leader of provincial medical education in 1884.8 The foundation of the School of Tropical Diseases and Medical Parasitology in November 1898 ensured that in a particularly relevant field of postgraduate medicine Liverpool also became a centre of world renown. The Liverpool School was the first of its kind. Plans for a school in London had predated Liverpool's opportunistic enterprise, but London opened in October, some six months after Liverpool admitted its first student in May 1899.