The document discusses the evolution and history of medical surgical nursing from ancient times when care was provided informally to the establishment of formal nursing training programs in the 19th century. It then outlines key developments in medical surgical nursing education and practice throughout the late 19th and 20th centuries, including the merging of medical and surgical nursing education and the establishment of nursing specialties and standards. The document also examines social, economic, political, and educational trends that have influenced the development of nursing.