The person that cared for and supported the patient though the ‘rest cure’ was the tuberculosis nurse. “In tuberculosis, the nurse has to be the close ally of both the physician and the surgeon, who themselves work together probably more closely that in any other branch of medicine. The nurse’s contribution to the control of tuberculosis is, therefore, an all important one.” These are the opening lines of a nursing textbook written in 1945, putting the nurse centre stage in the care of the tuberculous. 1945 was on the cusp of the antibiotic era. The introduction of a cocktail of antibiotics over the next few years would change the face of this disease. In the UK the drugs would mop up the declining tail of a huge epidemic, which had been smoldering since the industrial revolution, though tuberculosis had been ever-present for thousands of years. We know this from the tell-tall marks and ancient DNA preserved on long buried bones.
Before the advent of successful drug therapies in the 1950s, nursing was particularly important in patients’ experiences of tuberculosis care. After the infectious nature of tuberculosis was appreciated in the 1880s the disease became a problem of public health, not just a private family drama. Special institutions - sanatoria, dispensaries, outdoor schools - were established to treat patients. The rest-cure of the sanatoria demanded that patients do nothing for themselves. Rest meant rest and everything else fell to the lot of the nurse, who had to attend to the patient’s needs on a constant basis. The sanatorium became the patient’s entire world. In such circumstances it wasn’t just the body, but also the spirit that needed nursing. Patients worried about their families left behind. Children pined for their parents.
A chronic shortage of sanatorium beds meant that patient education was vital. Nurses were also there to instill a hygienic way of living into the patients’ lives. Before the NHS social class and ability to pay affected how and where and for how long they were treated. Acute episodes might bring the patients into a charitable voluntary hospital where they would be patched up. If declared beyond medical help and destitute, the poor law infirmary provided a place to die. Some patients were also cared for at home and dispensary nurses would find themselves winding down dark alleys and though bleak courts to bring care and advice into the homes of the desperately poor. A public health film from about 1910 shows what was involved in this sort of work. It required dedication and toughness, tact and diplomacy. It fell to the lot of these dispensary nurses to undertake the arduous work of contact tracing - finding out who might have become infected by the patient.
There were never enough beds but the number of sanatoria expanded in the interwar period in Britain and there was often a nagging shortage of nurses. There was a school of thought that suggested that former patients made the best nurses, after all they knew what it all meant. Some nurses were certainly inspired to help others by their own experiences and those of their families. So many households had family members who suffered. Dedication to the less fortunate was also a religious calling and nursing sisters of the Daughters of the Cross ran sanatoria for adults and children. The rise in surgery for tuberculosis in the 1930s placed new demands on nurses. As did the care of children whose immobilised diseased joints brought a whole new meaning to the word dependency. But what about the risks to nurses? Tuberculosis is of course an infectious disease and nurses were constantly exposed to potential infection. How did they cope? The risks they undertook and their worth were often under-appreciated.
This talk takes the nursing-eye view of tuberculosis care from the end of the 19th century through the classic sanatorium and dispensary era in the first half of the 20th century.
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