大象传媒

This story is entered with the help of Age Concern East Cheshire in my presence.

MY TRAINING AS A FEVER NURSE CONTINUES .
My second ward was the one for children suffering from Diphtheria. The geography, the basic cleaning routine and the basic nursing care was the same. Sister was approachable and as far as management was concerned, just as efficient. One thing I noticed at once, there were
more red and blue slips on the charts: which indicated dangerously ill and seriously ill. I also noticed most of the children were nursed without pillows. The metal frame of the bed head was protected by a padded draw sheet, secured behind by large safety pins.

One of my first instructions was that as long as the children were without pillows, everything was done for them. Absolutely no exertion. Fluids were all they were allowed, or for that matter wanted. There were china feeding cups instead of tin mugs, oh where were the bendy straws. We were allowed to sit down to feed these children. I didn't know why they were nursed flat at that time or why everything had to be done for them, but all orders were carried out without question. Would they have been any safer if we had also had the theory to accompany the practise?

Later when I asked why they were nursed flat and why had everything to be done for them? I was told that Diphtheria toxins have an affinity to the heart muscle and therefore weakening this muscle.

Sometimes a patient would be admitted and his neck would be very swollen, as in Mumps. The term used was BULL NECK and that was exactly what it looked like. THESE PATIENTS ALWAYS DIED. So, it was on this ward that I first encountered death. Some memories stay with us, and I can still recall how I felt. I wanted to scream, to run home, to beat my fists on someone鈥檚 chest. I wanted to blame someone, BUT WHO?

It was sister who carried out last offices, and like a robot I assisted her. It left me feeling weak, all power and energy ebbed away. Not until I was alone in my room did I cry. The following morning I looked towards the bed, newly made, with nothing to show the patient had been there. -- GONE FOREVER. But remembered by me, even to this day. After this, every child who was admitted, I would pray they didn't have a bull neck, or a petichial rash (haemorrhage rash) This rash in Diphtheria was also fatal. At first I couldn't help thinking "why didn't the mother go to the doctor earlier", but when a child complains of being unwell usually one of the first indications is a rise in temperature. Whilst in Scarlet Fever the temperature can be quite high, in Diphtheria it is low. It was imperative to give the Diphtheria anti toxin within four days, for any hope of recovery.

Throughout our training we were told things in a simple way, for example:-

(1) Ventilation was very important, it disperses germs and so reduces the numbers in the air. The wards were always well ventilated.

(2) Copious fluids were a rule. We were told the effect would be dilution of the toxins in the blood stream, so they became less powerful and the patients own body defences better able to fight them.

(3) Tepid sponging was necessary to keep the patient cool, as heat makes it more conducive for the bacteria to survive and multiply. Although these patients did not have high temperatures.

I began to feel so confident and clever so was bold enough to ask more questions. I wanted to know the difference between exudates as I had seen on the tonsils of the children suffering from Scarlet Fever and membrane present in Diphtheria. Learned, that exudates was whitish, soft looking and could be scraped off the tonsils. Membrane was greyish, tough looking and peels off in time from the outer edges. If you tried to loosen membrane it would bleed. Patients suffering from Diphtheria also had quite a distinctive, sweet gummy smell on their breath. Occasionally the membrane would be present in the trachea, it would become loose and block the trachea. This was an emergency.

The patient鈥檚 neck was placed over a narrow sandbag. An incision made into the trachea. Forceps were used to grasp the membrane, if successful breathing became normal and a tracheotomy tube was inserted. If unsuccessful the patient suffocated. Once in an emergency doctor actually used his penknife, the bed and patient was wheeled to the iron lung, but he died. The membrane could also extend to the full roof of the mouth, almost like another tongue.

It was on this ward that I saw an injection given for the first time. Diphtheria anti toxin was the drug given. There were no sterile packs of syringes. The syringes were constructed of metal with a glass barrel. They were kept in what looked like an oblong glass butter dish with a steel lid. A piece of white lint was placed on the bottom of the dish and a syringe was covered with spirit. After use to quickly sterilize, you cleansed the syringe with water, wrapped the glass barrel in white lint to protect it. This was placed in a stainless steel receiver. The syringe was then covered with water and boiled on a low light on the gas cooker. When cooled it was placed back in the glass container. There was no mention of the safe area to inject, no mention of the sciatica nerve, we observed and did exactly as demonstrated. In my experience there was never any complication from an injection. After witnessing my first injection I thought of my childhood, and smiled, now I know what the children at home meant about having had a prick in the bum, when they had been a patient here.

It was also on this ward that I went out in the ambulance for the first time. The patient was diagnosed with Diphtheria. We would put on a clean barrier gown. There were two ambulances, one for Scarlet Fever, the other for Diphtheria and other diseases. The Scarlet Fever ambulance had red blankets, the other ambulance had grey blankets. I wasn't prepared for the distress shown by the parent鈥檚, therefore I was not equipped to deal with it. Then in addition to that there was the attitude of the neighbours who had collected outside the house. Their arms folded across their chest, and there was such a look of hostility. It really felt wrong to take the child. However, Mr. Jones was experienced in these matters, and soon we were on our way back to the sanatorium.

It is nearing the end of my experience on this ward. Next would be night duty. It became clear to me now. The more questions you asked, the more you learned. On the wards information was not given freely, it was almost a secret.

NIGHT DUTY AS A FEVER NURSE
My first spell of night duty and apart from being apprehensive of a new experience, I was looking forward to it. The first experience of night duty was as a -RUNNER", your base was in night sister's office, which was the telephone room during the day. Night Sister
was friendly and soon made me feel relaxed. The first thing I learned was to use the telephone switchboard in case sister was on her rounds and I had to answer ca1ls. My duty was also to make her tea. When I was shown the tray, I couldn't help thinking how dainty, and how the sister's were treated like ladies. To go round each ward collecting the day reports was very pleasant. In the morning around 6 a.m. the night reports were collected for sister. Then you ran (though not literally) sometimes on one ward, sometimes between two wards, to assist the night nurse in charge. That was probably where the term runner sprang from.

There was no lengthy medicine round, no drugs, the longest procedure was in testing urine samples. I did enjoy my period of night duty, although there were long periods of feeling lonely, when sister was on her rounds. I never could get accustomed to dinner in the morning and breakfast in the evening.

There was one incident that happened during this time. Before we went to bed one morning, we had to attend a post mortem on a little boy, who had died of Meningitis. No one prepared us for the experience. I had never been in the mortuary before, it was so cold. Each slab was divided by black oil cloth curtains, the type of material used for washable tablecloths. It was the most awful experience and at that time I thought it barbaric. I didn't sleep very well that day. That night when I was collecting the night report I felt like there were little feet running behind me. I didn't look round, but made it back to base in record time. I arrived breathless and scared, sister said "what's wrong you look frightened to death".

It is approaching Halloween it is rumoured that the old house is haunted. The ghost is known as the Grey Lady. She is said to appear in the old house, which was her home. Then she wanders around a certain area in Astley, looking for her lost lover. I never saw her.

It is nearing the end of my experience on night duty. My next experience is on the cubicle block, known as C3. Again the feeling of reluctance and a fear of the unknown. There would be two diseases of which I was most fearful, Poliomyelitis and Meningitis.

Cubicle Block 3.
This was such a pleasant area in which to work. As you stepped out of the kitchen to begin your round of the patient鈥檚, you walked the full length of a glass veranda. Pleasant though it was waiting in the wings was fear, pain and death. It was not only the patients who experienced fear. When the first patient was admitted suffering from Poliomyelitis, I was frozen with fear. All I could think of was I can catch it, it can paralyse your legs and arms, or even your respiratory muscles, and you end up in the iron lung and usually die. No one else appeared to be afraid, so I concluded that I was a coward, and if I said I was afraid, sister might say I was not fit to be a nurse. However, the first time I entered the cubicle and saw how poorly and afraid the patient was, my own fear receded. There was no treatment, no vaccine to prevent contracting this disease, doctor prescribed injections of vitamin B12. Nursing care was fluids ad lib, keep the patient cool, no exertion, we dreaded the first sign of paralysis. I nursed three patients in the iron lung, two survived.

The Iron Lung
The principles were the same as the respirator of today, except it was shaped like a coffin, and encased the length of the patient from toes to chin. Everything that needed to be done for the patient had to be done through what looked like portholes. Bedpan, washing, changing all had to be done quickly.

On opening, the portholes there was a rubber disk, the hole in the disk was just large enough to put an arm through. The grip on the arm was such that bruising occurred above the elbows. One of the openings was just large enough to insert a bedpan. There was also a sort of rubber collar which enclosed the neck. These collars were in different sizes and secured by a zipper. The patients had difficulty in speaking and could only speak in the negative phase of the lung. Speech could only be described as a stilted, breathless talking. One could hear the swish, swish sound of the iron lung even before entering the ward. It was almost a welcome sound for it meant the patient was still alive.

These patients must have been terrified, if they ever thought what would happen to them if the machine ever broke down. As these patients improved weaning them from the iron lung was not easy. At first the lung was switched off for a short period, to give them confidence. The bed which initially had been removed from the cubicle to make room for the iron lung was returned. At first no attempt was made to put the patient in bed, then the patient was persuaded to leave the iron lung for short periods at first. Then for longer intervals, this was perhaps a test of trust and care which had developed between nurse and patient. The use of the iron lung became more and more redundant, due to the advancement in preventative medicine. For example the Salk vaccine.

One very strange incident occurred with regards to Poliomyelitis at this time. I was on night duty and learned there had been an admission that day. A young R.A.F. pilot had been admitted suffering from Poliomyelitis. Apparently doctor was puzzled as apart from the fact that his legs were paralysed there was nothing else to indicate Poliomyelitis, his legs were clinically without feeling there was no reaction to either pricks or the plantar reflex response. He was very handsome but one could sense the apprehension. A week later as I was writing my ward report, his bell rung, I rushed down to his cubicle, he was so excited, he requested me to loosen the bottom of the bedclothes and look at his feet. He moved his big toe, from then on very quickly all movement was restored. The night after this occurred doctor came to see him. Confidentially the doctor informed me of his conclusion. This patient who was a pilot in the R.A.F. flying a fighter bomber had endured much trauma. He had been home on leave and was subconsciously terrified to go back. He said this young man was quite unaware of this and doctor concluded by saying that the mind was a powerful thing. That was the first time I had ever associated the mind influencing the body, actually it seemed so bizarre and I doubt I believed doctor, even though I had a great respect for him. Now of course after many years of experience I do agree that the mind does have a powerful influence on the body.

The theatre was used fairly often. Patients suffering from meningitis were taken to the theatre. Cerebral spinal fluid was withdrawn not by lumbar puncture but by cisternal puncture. The hair was shaved in a semi-circle at the base of the skull. It was not uncommon to see babies suffering from meningitis, with bulging fontanelle, arched back, sunken eyes in dark sockets, and that awful piercing scream. In babies the cerebral spinal fluid was withdrawn from the fontanelle.

The ladies suffering from Puerperal fever were taken to the theatre. The uterus was irrigated with glycerine and iodine. This was a procedure which filled me with acute embarrassment, and I would have much preferred to stand at the head of the patient instead of at doctor's elbow. Feelings like this were never aired.
It was on this ward that I learned of the back street abortionist and their crude methods. The use of a knitting needle to procure an abortion would sometimes cause Septicaemia and death. In my immaturity I could never see any justification for making the decision to get rid of a baby. To be eighteen years of age in those days was not like today, with all the freedom and knowledge available. I was horrified. It was doctor who was observant enough to notice my attitude. After eliciting how I felt and following some discussion he ended by saying you are here to nurse, not to judge, if you cannot do that, perhaps you shouldn't be nursing. I HAVE ALWAYS REMEMBERED THAT PROFOUNDLY HURTFUL STATEMENT. I learned from that not to make emotional judgments. Experience has taught me that they are not as sound as those based on knowledge
It was also on this ward on night duty, my first experience of a babies death, which occurred from meningitis. Everything I did following the death was done in a dream. It seemed impossible that nothing more could have been done to save the patient. So unfair. I kept control by making the little one a bonnet out of white lint. Now, just what use was that?. To the baby none. To me it helped sooth the ache.

Also during a spell of night duty on this ward, two patients were admitted suffering from Erysipelas (E.R.Y). The treatment was local and consisted of a magnesium sulphate mask, cut out of white lint. The masks were placed in a fomentation ringer, then immersed in a
solution of magnesium sulphate, wrung out and placed over the face. At night this looked menacing and before going on my rounds I had to talk to my, saying over and over again 鈥淚t鈥檚 only a mask, it鈥檚 only a mask鈥�.
The war was in its second year, at night we were enveloped in darkness, every window was either covered with black curtains, or painted black. Even then we were not allowed to use torches. Of course in the moonlight we felt very exposed. The fear evoked by the sirens and and the drone of the enemy bombers never dimished.
One Embarrassing Moment That Occurred On This Ward.
Hot fomentations were prescribed for inflammation, usually boracic lint, this was pink lint impregnated with boracic. Two enamel bowls were placed on an enamel tray, the bottom one contained boiling water. The foment was placed in a foment ringer, this ringer was made from old sheeting and quilted by the ladies in the sewing room. It was rolled like a sausage, and then placed in the boiling water. This was taken to the bedside on the tray, with one bowl placed on top of the other. The ends of the ringer were grasped and twisted in opposite directions, to wring out the solution. The foment picked up by one corner then shook a little to cool, tested on the back of the hand, and applied.

Going back to the embarrassing moment I shall always remember, it was later during a further spell of night duty on the Scarlet Fever ward. In the side ward was a gentleman who after progressing favourably, developed a high temperature for no apparent reason. Earlier when settling him for the night, he tried to tell me something about his PRIVATES! With difficulty I tried not to show my embarrassment, because I thought he was rude, and I made my exit, pretty quickly. Doctor must have been concerned about the patients rise in temperature, because this particular night, he paid a visit, to see this patient. When doctor began to question him, he told him about his privates. Doctor, of course asked him why he had not complained of this before. He said he had tried to do so, earlier to me. On examining him, Doctor found his scrotum was swollen and inflamed. Needless to say, back in the office, Doctor was angry, especially when I had said, I thought the man was rude. He ordered hot fomentations, he must have observed my panic, and said, "You know how to do this procedure!" I didn't, well I could prepare the hot fomentation, but how could a fomentation stay in place THERE! He then asked me for lint and a needle and cotton, and proceeded to cut out a circle of lint, and with a needle and thread laboriously sewed with big tacking stitches around the edge. He explained I was to pull the thread to secure it in place. I breathed a sigh of relief. Then as he was going, he turned and said, you must wear gloves, I replied, why. He then replied, HELLS BLOODY BELLS, HOW OLD ARE YOU. How naive I was, but I learned fast.

Pneumonia was treated with kaolin poultices. The tin of kaolin would be placed in a saucepan of boiling water. A suitable size of old linen selected the corners of which would be mitred. Then the kaolin spread evenly, a thin piece of Gauze was placed over the kaolin to prevent it from sticking to the skin. The edges of the linen would then be folded over. The poultice would be taken to the patient between two warm dinner plates. Sometimes it was very difficult to keep the poultice in place, especially if the patient was restless. Kaolin poultice is still used today but is now already prepared in tin foil packs. It still gives relief.

I will now relate one story which almost put an end to my nursing career. It involves a kaolin poultice and a senior nurse who was on night duty. This senior nurse was a very good and very experienced nurse. It was common knowledge that the sister on this ward and this particular nurse did not get on with each other. These days it would be termed a conflict of personalities.

Sister reported nurse as being negligent, having found a kaolin poultice which should have been on the patient鈥檚 chest, in the bed. This really was not unusual if the patient was restless, however, sister reported nurse to matron, and she was sacked. Sisters鈥� word was law. Most of us considered this unfair. We proceeded to make a statement to this effect, and quite a number of the nurses signed this. It was submitted to matron, this was a brave, or was it a foolish thing to do. Matron and assistant matron tried to persuade us to change our minds, but to no avail. It was a traumatic time but we just felt that nurse was being unjustly dealt with. One time during class sister tutor again tried to persuade us to retract our statement, all but myself did so. Sister was angry and suggested they do what was successfully carried out previously, in a similar situation. Put me in Coventry. I still didn't change my mind, and it wasn't really carried out by my colleagues. The situation came to the attention of the board. I was called before the board, a thing unheard of then, or since. The waiting was very traumatic, and very unpleasant. I was so agitated but also very angry as I waited to go before the board. I remember (childish now when I think of it). There was just one woman on the board, she asked the first question. "Are you in the habit of criticizing sister?鈥� I answered truthfully, "No". At that time I didn't realise the implication of that question. When the chairman of the board asked me to sit down, I was so angry and frightened, I said. "No what I have to say I will say standing". Also I am not asking you to believe me, I expect you to believe me because I am telling the truth". I must have impressed them because the nurse in question was reinstated. There was no union for nurses in training, the Royal College of Nursing was for trained staff only.

Occasionally children would be admitted suffering from severe Laryngitis. They were nursed in a steam tent. The tent would be constructed from screens, with sheets thrown over the screens to form the structure. An electric copper kettle with a log spout, the spout covered with Gauze, would be placed through an opening between the sheets. Boiling water with tincture of benzoin, would provide medicated steam. It was successful.

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