Nursing 100 years of Infection

Disease is powerful.

It devastates communities, threatens global security and challenges modern health care. Florence Nightingale was the first nurse to link poor hygiene and sanitation to the spread of infectious disease. Cholera and typhoid were rife during the nineteenth century, when living conditions of the poor were overcrowded and squalid. When influenza struck in 1918, the impact on front line nurses and other clinicians was devastating.

Fever nursing

By the early twentieth century, nurses were taking an active role in caring for infectious patients. Fever nurses washed and fed the sick, applied poultices and lotions, and monitored the patient’s temperature and breathing

One of the first wards to experience the effects of Spanish Flu was St Marylebone Infirmary, London, in October 1918. The Sisters tirelessly cared for the weakened North Kensington community, as well as their own colleagues. The effect on nursing staff was devastating.

Image right: Nursing staff at Hampstead Military Hospital wear their influenza masks for a photograph, 1919

“Temporary wood partitions have been put up between each bed…on each partition is hung a sheet wrung out in Lysol and kept wet…Every nurse, doctor, ward-maid, char-woman who enters the epidemic block must wear the mask and overall.”

Nursing Times, 1918

Sanatorium at Withernsea, 1906.

In the late nineteenth and early twentieth centuries, infected patients, particularly those with tuberculosis, would be admitted to a sanatorium. Often these institutions had large open air balconies and porches, where patients could get plenty of fresh air. Nurses with experience of TB nursing would certainly have used similar skills when caring for patients with influenza. Maintaining well ventilated wards and high hygiene standards were key to the nursing role.

Mid nineteenth century, Vienna. 

Physician Ignaz Semmelweiss was noticing a trend in the death rates caused by infection among women following childbirth. The rate was much lower in clinics where midwives delivered babies than in another, where babies were delivered by medical students. Semmelweiss concluded that the students were passing “cadaverous particles” to the mothers during the birth, particles that were left on their hands from autopsies. After he introduced hand washing with a chlorine solution, death rates fell and Semmelweiss became known as the “saviour of mothers.” But who were the real saviours? Was it the midwives, already practicing good hygiene.

On display

Postcard of Crossley sanatorium huts, 1910.

For the treatment of patients with tuberculosis.

Kill that fly! 1930s

Booklet raising awareness of diseases spread by the house fly.

Mr Punch suffers with flu, 1840s

“It’s no joke being funny with the influenza”

Dr Nelson’s improved inhaler, 1861.

For treating chest infections and diseases by inhalation. On loan from British Red Cross Museum and Archives.

Illustration attributed to Temple West, 1861.

Physicians express their thanks to "Mr Influenzy" for his kind visit and bringing plenty of business.

Wrights coal tar vaporizer 1940

“Invaluable for Influenza and all infections of the Respiratory Organs” Courtesy British Red Cross Museum and Archives.
Pandemic exhibition case objects

Today’s image of infection control is quite different. 

ICNs or Infection Prevention and Control nurses provide advice in all care settings, from health protection to commissioning of services and research.

 For some practitioners working in areas impacted by outbreaks of disease, the ICN role might involve supporting staff to fit and wear protective clothing, including full body “hazmat” suits. Such images have been made all too familiar by the media in recent years, as nurses are put on the front line supporting local infrastructure in affected countries. 

In 2014, the Lassa Fever hospital in Kenema, Sierra Leone, was one of the first in the country hit by Ebola. In just a few short months, the clinic lost 15 nurses to the disease.

Image right: Melissa Kemokai, RN. Liberia 2015. Credit: Marc Campos.

On display

Influenza vaccine, 1918.

Vaccine manufactured by the Vaccine Department of the Royal Army Medical College. On loan from the Royal Pharmaceutical Society.

FFP3 mask, 2015

Used by nurses during the Ebola outbreak

Nurse with patient in iron lung, 1950s.

For treatment of polio

PPE portrait stickers. 2015.

A selection of hoods and stickers created by artist Mary Beth Heffernan.

Nursing staff at Hampstead Military Hospital, 1918

Pictured with influenza masks in Nursing Times article.

Thermometer given to Nurse Gillian Mckay by the Public Health Agency of Canada, 2015.

For self-monitoring during the 21-day post Ebola contact period on her return from Sierra Leone.
Pandemic exhibition case

Wash your hands!

Today, hospital infections such as MRSA continue to be a threat combatted by the daily practices of frontline health care staff.

Nurses use alcohol-based sanitisers to clean their hands up to 50 times a day and chlorine remains a common disinfectant. For nurses working in Ebola struck countries, how to correctly wash hands with chlorine is part of the training. This could be even more important than correctly putting on, or taking off, the hazmat suit.

The importance of effective and regular hand washing is increasingly essential as a barrier to infection. This is taught from day one of a nurse’s career. But viruses are spread in so many different ways. Ways that are still being understood today.

Images right: Ebola Survivors and Champions campaign posters, Social Mobilisation Action Consortium, 2015.

Today I woke up with a cold, a surprising thing given how many hundreds of times a day I wash my hands with chlorine to kill Ebola. Chlorine is the bullet that kills the enemy we can’t see.

Nurse Gillian Mckay

Different viruses are spread in many different ways

In the early 1980s, hundreds of men were becoming sick and dying from an unknown illness spreading through the gay communities in America and London. Misunderstandings about how the disease spread led to fear, stigma and public anxiety. In 1983, Human Immunodeficiency Virus (HIV) was discovered and recognised as the virus that causes Acquired Immune Deficiency Syndrome (AIDS).

The face of HIV changed overnight when Princess Diana visited the Middlesex Hospital, in 1987. She sat and held the hands of men dying from AIDS without wearing gloves. That same year, the world’s first government sponsored national AIDS Awareness campaign was launched: Don’t Die of Ignorance.

At the start of the epidemic nurses were at the forefront of breaking down myths about how HIV was transmitted and developing standards of care. Today we still have no cure for HIV. But a person living with HIV who is accessing care and treatment now has a normal life expectancy. 

On display

AIDS awareness trading cards 1993

Educational cards produced by comic book publisher Eclipse Enterprises. The cards feature information about HIV and AIDS, as well as personalities who lived with AIDS, died from the disease or were key in promoting AIDS awareness. 

British Red Cross Anti-AIDS medical kit, 1988. 

Loaned from the British Red Cross Museum and Archive.

Items from sexual health education kit, 1980s.

This kit was created as a tool to promote safe sex in schools and raise awareness of HIV and AIDS.

Like a Prayer by Madonna cassette tape, 1989.

This release of Madonna's single included a fact sheet about AIDS.

Nursing and AIDS video teaching tool, 1992

Produced for community nursing staff.

RCN HIV nursing society newsletter, 1997.

The death of Princess Diana features on the front page. She was instrumental in raising awareness and breaking stigma around HIV and AIDS. 

Sunday Times supplement, 1987.

"This issue is about AIDS. It is also about you."
Pandemic case 3 hotspot

We now face new challenges.

We travel more frequently and further than we ever have. Modern warfare fractures populations and compromises access to basic sanitation. And with each class of antibiotics we develop, microbes evolve to resist and survive. History shows us how challenges go full circle. Pre antibiotics, we feared infection. Upon the discovery of antibiotics and the revolutionary results of vaccines, society entered a period of optimism. Cures had seemingly been found and people were surviving diseases that previously would have killed them. This led us into complacency and a false sense of security. We now find ourselves at the start of the cycle once more. Fear is rising again, as microbes develop resistance to our methods of keeping safe and healthy. Hygiene standards, especially hand-washing, still remain the most important action to prevent the spread of disease. Throughout history the nursing role has been at the forefront of infection control.

Don't let the bugs win!

You can visit the exhibition at RCN Scotland, Edinburgh from 1 November until March 2019.

It was curated by the RCN Public Health Forum, RCN History of Nursing Society and the RCN Library and Archive Service. Special thanks go to our lenders: the British Red Cross Museum and Archives, the Alexander Fleming Laboratory Museum, the Royal Pharmaceutical Society, David Elliman, Mary Beth Heffernan and Gillian Mckay.