tuberculosis became a model for other health advocates and reformers throughout the state of Virginia. Valentine urged IVNA's board to make its nurses available to any Virginia locality that wanted to found its own branch of the Instructive Visiting Nurses Association. Women's suffrage Valentine's demanding schedule took its toll on her health, forcing her to step down from her leadership positions with the REA and IVNA in 1904. In 1905, she and her husband relocated to England where she became aware of the issue of women's suffrage. Valentine's time abroad allowed her to witness the work of radical suffragists in England while also observing the problems back in America with a wider lens. Seeing little legislative urgency to solve the ongoing challenges of education, public health, and child labor, Valentine concluded that giving women the right to vote would facilitate reform in these arenas. Equal Suffrage League of Virginia Early days and growing numbers In November 1909, Valentine co-founded the Equal Suffrage League of Virginia and was elected president. Fellow league co-founders included artists Adele Goodman Clark and Nora Houston; physician Kate Waller Barrett; and writers Ellen Glasgow, Kate Langley Bosher, and Mary Johnston. Months later, under Valentine's direction, the league joined forces with the National American Woman Suffrage Association (NAWSA). At the time NAWSA was using "practical politics" to make the argument for suffrage; they organized by electoral districts to orchestrate major publicity campaigns and put pressure on politicians. The approach proved difficult for the Virginia suffragists as they faced intense public apathy; as a result, they switched tactics, believing that education would be the only way to make suffrage a viable political issue in their state. The league began its public campaign to educate Virginia's citizens and legislators about equal suffrage by canvassing house to house, distributing leaflets, renting booths at fairs, making speeches, and holding street meetings in Richmond's Capitol Square. In 1912, Valentine met with several of Richmond's most prominent businessmen and convinced them to found the Men's Equal Suffrage League of Virginia. The Equal Suffrage League of Virginia saw its membership increase to nearly 120 in the first year. By 1911 the league opened an office at 802 East Broad Street; Richmond became the home of the league's state headquarters. By 1914 there were 45 local chapters; by 1915 there were 115; and by 1919, the Equal Suffrage League of Virginia had become the largest