Disease is powerful.

It devastates communities 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.

Just over 100 years since the so called ‘Spanish flu’, every one of us living through 2020 has felt that impact for ourselves. The world we live in and the technology we use now looks very different. But throughout centuries of disease, it is the front line staff, the nurses and support workers, who stand in the face of it.

With the help of vaccines many diseases are now rare. Smallpox, once rife, is now a fear of the past. Yet microbes that cause disease are adaptable, constantly modifying to be one step ahead of us. The more we fight them the stronger they become. Influenza has been visiting our homes for centuries, each time a different strain to the last. Nursing skills in this unpredictable environment become ever more vital, keeping infections at bay in our homes, clinics and hospitals.

Black and white postcard image of the interior of a diptheria ward at Leeds City Hospital, Seacroft. The portrait contains nurses, doctors and two child patients.

Image: Interior of a diptheria ward at Leeds City Hospital, Seacroft. RCN Archive.

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


Text saying: 'On the frontline' in blue on a white background with a patterned blue border

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.

Around this time nurses began 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.

Nurses with experience of TB nursing would have used similar skills when caring for patients with influenza. Maintaining well ventilated wards and high hygiene standards were key to the nursing role, as they are today.

One of the first wards to experience the effects of the so-called Spanish Flu was St Marylebone Infirmary, London, in October 1918. The Sisters tirelessly cared for the weakened North Kensington community, as well as for their own colleagues. The effect on nursing staff was devastating. Through history, when a new disease strikes, it is often the nursing staff who are hit by it first.

"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 shows patients and nurses sitting outside on porches and balconies.

 

Image: Sanatorium at Withernsea, 1906. RCN Archive. 

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

Artistic intervention

In 2015, artist Mary Beth Heffernan created an art intervention to humanise the alienating appearance of the Ebola “hazmat” suits. By taking headshot portraits of the health care workers and securing them to the outside of the suits, Mary Beth gave a face to the staff behind the masks. She says:

“The otherworldly appearance of the personal protective equipment (PPE) exacerbates patients’ isolation and fear of Ebola Virus Disease (EVD). The frightening effect diminishes clinicians’ ability to establish trust and emotionally connect with patients.”

Her PPE portraits are were used in Liberia at the ELWA II Ebola Treatment Unit in Paynesville, and the Tubmanburg Ebola Treatment Unit in Bomi County.


Image right: Melissa Kemokai, RN. Liberia 2015. Photo 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

Title saying: 'Preventative measures' in blue with a mottled blue background artwork

Personal Protective equipment, or PPE, has become a household term in 2020. Images of masked medics and robed nurses have been made all too familiar by the media in recent years. News reporting on the Ebola outbreak in 2014 is a key example of this. The Lassa Fever hospital in Kenema, Sierra Leone, was one of the first in the country hit by the Ebola virus. In just a few short months, the clinic lost 15 nurses to the disease. 

To those outside Ebola affected countries, the current climate makes it easy to forget that Ebola outbreaks are still happening. More recent cases in the Democratic Republic of Congo’s Equateur province continue to be a concern. Responding to Ebola within the COVID-19 context is a huge challenge. UK nurses and health care teams continue to support local communities in Ebola prevention and healthcare maintenance.  

"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

 

Image right: Ebola Survivors and Champions campaign poster, 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


Title text saying: 'Breaking down myths' on a white background and with a blue stylised border

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. 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!


The exhibition 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.