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Drs vs. DNs. Round two.

More on the often antagonistic relationships between Doctors and Nurses.

In the early years of the Queen’s Nursing Institute, they were at each others throats, as doctors became increasingly convinced that nurses were taking work out of their hands.

In 1908 the Penrith medical union complained that ‘by tending to cuts and bruises, nurses are depriving doctors of work.’  One doctor even went so far as to say ‘it is reversing the natural order of things that the nurse shold send for the doctor, it should always be the other way round.’  He and his fellow doctors decided not to attend cases given to them by nurses.  They were backed by the British Medical Association.

A member of the Queen’s Institute governing body commented that ‘the two bodies – the Queen’s Nursing Institute and the British Medical Association – are not on the same planet in this matter.  The whole object of the Institute is in the welfare of the sick poor, whereas the aggrieved doctors are fighting for their own hand.’

District Nurses of today, what do you think?  Do doctors behave themselves a bit better now?!

Sadly, in 1921, one nurse was well and truly caught in the act.  A member of the public complains to the editor in the May 1st edition of the Queen’s Nurses’ Magazine:

‘Since visiting a nursing conference and exhibition, I have constantly had in my mind the figure of a Queen’s Nurse I saw there.  My attention was riveted by the bonnet, the straw of which was almost indiscernable, so caked was it with dirt.  The ribbon had faded to the last possible degree and was broken and frayed.  The whole bonnet appeared to be rotting with age.  The nurse had brown hair, which was lustreless and unkempt, and very dusty.  She wore no collar and the neck of her cloak was greasy and dusty.  I saw her from behind for a few moments only, and moved on, feeling distressed that a District Nurse should so abuse her influence as to appear in such a dreadful state.  I do not see how that nurse could insist on cleanliness in her patience and their homes.’

What do you think?  Would you say this man/woman (it would be nice to blame it on a man!) is in the right?  Maybe the nurse was just having a bad day!  My hair often looks ‘lustreless’ and unkempt, I’m afraid.  But should nurses be held to a higher standard?  Remember at this point that District Nursing was as much about teaching patients about proper hygiene as it was treating illness.  Should a nurse wear her uniform with pride?

Florence Lees had some ingenious (and possibly lethal) nursing methods!

For cholera cases, she recommended that nurses ‘maintain an exceptionally high temperature in their patients rooms.’ 

In order to achieve this, they might usually use bronchitis kettles.  If a nurse hasn’t got one to hand, ‘A good substitute can be made by fitting long tin ‘pea shooters’, as children term them, one inside the other until the required length is obtained, when this extemporary tube can be fitted over the spout of an ordinary kettle, half filled with boiling water and placed on the fire.  This extemporary tin tube can be bent to any shape required, and made of any length.’

Taken from ‘A Guide to District Nurses’, 1890.

DNs cover a lot of ground today.  They did in the past too!

Let’s take for an example Nurse Jenny Wolfe, a Gloucestershire DN, from June to December in 1897.  In her donkey cart, she travelled 1294 miles – an average of 185 miles a month.  Her local organisation provided her and its other DNs with bikes in 1900, but even these were not enough to cover the ground between rural patients homes.

A report from the Queen’s Nursing Institute in 1892 states that ‘experience has shown that one nurse can efficiently nurse such a district within a radius of from three to four miles of her home, where a donkey cart is provided…Where a vehicle is provided, one nurse is sufficient for every 2500 to 3000 of the population.’

So district nurses of today, the minute you got cars, they decided to work you even harder.  It’s enough to make you long for a donkey!

When researching the history of nursing, one can’t help but hesitate at over-mentioning the ubiquitous Florence Nightingale.  Throughout the process of making this website, I’ve been trying, and mainly failing, to avoid her.  This is because I think there are other nurses, especially district nurses, who have been neglected or forgotten by history.  And Florence Nightingale had her failings.  It’s well known now that she damaged Mary Seacole’s reputation beyond measure – a woman who did as much if not more than Nightingale for soldiers in the Crimea.  She was critical, difficult to work with, and always right.

Mary Seacole

Nonetheless, Florence Nightingale is simply so famous that you can’t avoid her.  To be fair, a website about the history of district nursing wouldn’t be complete without her because she was one of its earliest and most passionate advocates.  So here’s a quick potted biography of Florence.  You might not have wanted to be her friend, but no-one could really deny that she wasn’t a damn good nurse!

Florence Nightingale was born in 1820 in Florence.  No prizes for guessing why she was named Florence then.  Feel more sorry for her sister, the real victim of Mr and Mrs Nightingale’s very literal naming system.  In 1819, she was born in Naples and was called (drumroll please…) Parthenope.  The latinized name for Naples.  Oh dear.  Poor Parthenope.  Anyway, the two girls were born abroad because their parents were on a European tour.  How Victorian of them.  When they got back, with two baby girls in tow, they settled in Embley Park, Hampshire.  Florence Nightingale’s father, William, had also inherited land in Derbyshire.  In short, they weren’t short of a bob or two.

Florence Nightingale received a good education in classics, philosophy and classical languages.  Though she lived an active social life in childhood and in her teenage years, meeting many of the famous faces of the day through her socialite parents, she was very unhappy.  As a teenager, she became very depressed, feeling unworthy, as though her life has no purpose.  She even wrote that she could see ‘nothing in life but death.’  Aged sixteen, however, she had an epiphany.  Nightingale became convinced that God was calling her to something.  She began to study the Bible carefully and became interested in charity, poverty and the social issues of the day.

When, on a trip abroad, she came across religious nurses in Germany, Nightingale knew she’d found her calling.  Upon her return she refused her last suitor, putting herself at extreme odds with her parents.  Essentially, they booted her out, with a family physician having pretty much decided that she was toxic for the house and her family.  She became a Superintendant for a Nursing Institute for women in Harley Street and immediately immersed herself in studying the ins and outs of hospital administration.

In 1854, the Crimean war broke out and Nightingale took 38 nurses to the Scutari in the Crimea.  Here, she earned her fame, by forcing doctors to her will and fundamentally altering the way they managed hospitals.  She became more of an administrator than a nurse, although the soldiers were deeply reassured whenever she ventured onto the wards in their presence, the ‘Lady with the Lamp.’

‘Lo!  In that hour of misery, a Lady with a lamp I see, passing through the glimmering gloom, and flit from room to room.

Henry Longfellow ‘Santo Filomena’, 1857.

The war ended in 1857.  Florence Nightingale wrote that ‘I stand at the altar of murdered men, and while I live I will fight their cause.’  For her, there had been nothing valuable or honourable in such an appalling loss of life.  By now the most famous nurse in the country, she was at liberty to work for the causes she valued.  She wrote a report for the Queen and Prince Albert about how many deaths could have been prevented.  Whilst writing the report, in 1858, she became severely ill.  For the next twenty years, upon the advice of doctors, she would conduct much of her work from her bed.  This meant bossing around politicians and important people of the day, sending them flying with orders to build hospitals, to train nurses etc.

In 1860, Florence Nightingale’s nursing school was opened at St Thomas’s Hospital.  She was also deeply involved in midwifery and the development of maternity wards in hospitals in London.  But, for our purposes, her most interesting work conducted from her bed was her collaboration with William Rathbone on the development of district nursing.  They had their clashes.  In 1868, she wrote to a friend that ‘one cannot look upon Liverpool as being much of a success.  I believe the difficulties have been brought about by attempting too much and not starting on a sound basis.’  This was rich criticism, since William Rathbone pretty much followed her advice about nurse-training to the letter.  Nightingale was also deeply critical of Rathbone’s scheme of getting well-bred ladies to manage the nurses.  She believed firmly that nurses should manage themselves.

Nonetheless, knowing how terrible welfare provisions for the poor were – she wrote to Rathbone in 1867 describing the Poor Law as ‘rotten to the core’ – Nightingale believed the most good nursing could do would be in the home.  She even once said ‘never think you have done anything effective in nursing until you have nursed not only the sick poor in workhouses, but those at home.’  She was instrumental in bringing District Nursing to London and had the foresight to hand over the reins of the profession to Florence Lees. Florence Nightingale, whom Queen Victoria had prayed for when she became ill in the Crimea, was doubtless the prime-mover behind the decision to give Queen Victoria’s Diamond Jubilee money to the cause of District Nursing.

Florence Nightingale died in 1910 at the age of ninety.  This year marks her centenary, click here for details.  There can be no doubt that she trod on some people on the way up, but she did a lot for district nursing.  Let’s celebrate Florence: enigmatic, difficult to please, bossy, but wholly devoted to the cause of nursing.

DN exams, May 1957.

1) A doctor has just asked you to visit immediately a man who has just had a cerebral thrombosis.  You arrive to find the patient semi-conscious in the kitchen, fully clothed, and his wife and married son very upset.  What would you do for this patient?  What equipment would be needed?  How would you obtain this?

2) What would you do if called to the following emergencies? a) A diabetic patient in a coma.  b)  A child with a cut hand that is bleeding badly.  c) A man who has tried to commit suicide by putting his head in a gas oven.

3) Discuss the responsibilities of the district nurse with regard to dangerous drugs, care of nursing equipment, the house, furniture and car provided by the local authority for her own use and her own health.

‘To raise a heavy helpless patient: – cut three yards of coconut matting binding into three lengths, sew a firm loop at either end of each length.  Pass one length of the matting under the patient about the small of the back, gently draw it higher, then pass the second under, drawing it down lower; the third one, passed under the body in the same way, should be drawn down as low as the thighs.  When the straps are in place, pass a stick through the loops on either side (a broomstick cut in half should answer the purpose), get an assistant to come on each side of the bed and tell them to catch hold of the sticks and pull steadily against each other, with back straight, not bent.  A slight effort on their part will move the patient easily off the bed.’

If you can follow these instructions, you’re cleverer than I am.  I’m not even sure they make sense.  Can you really make a hoist out of a broomstick?  district nurses of the past were nothing if not inventive.

Taken from the September 1st issue of the Queen’s Nurses’ Magazine – only the second issue ever!