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An Historical Look at Nursing

Nurses of the 1900s were as important then as they are now.

The images in this article are from the book Hints and Helps Home Nursing and Hygiene, and were used with permission from the Museum of the Order of St. John.

I recently came upon a nursing textbook from the early 1900s, which allowed me to reflect on the changes we've seen in nursing in the past century. And what a better time to do that than National Nurses Week?

Reading the Saint John's Ambulance Association 1908 edition of Hints and Helps Home Nursing and Hygiene one tries to imagine the young nursing student who first opened this very same book over a century ago. It is easy to picture that British teenager, looking like a young Mary Poppins, pondering if getting the "nursing medallion" is something she would really want to do with her life.

While there certainly have been great advances in healthcare in general and nursing specifically, many of the principles remain unchanged.

"A nurse must always be modest but never prudish. Many things which would otherwise be repugnant are in serious illness done as mere matters of routine." Though verbiage may have changed, much of the book is as relevant today as it was during the days of King Edward VII.

"The nurse's duty often begins before the doctor's arrival and after his departure." Of course, it was assumed the nurse was a woman and the physician was a man, and more often than not referred to in this book as the "medical man." But the importance of teamwork between the two was paramount. "A medical man and a nurse in charge of a case should be respected and trusted in their proper spheres and should strive to assist each other and maintain each other's position. Their interests instead of being antagonistic are practically identical."

Nurses Must Know Everything
The book never sold the nurse's importance short and it seemed the best asset of a nurse of 1908 was to know everything. She usually took care of the patient at home. Houses were heated by fireplaces so the manual showed how to keep the room warm yet still fresh in winter. The nurse also served as dietician, and the book gave her guidelines for what meals would be better for which type of patient. She was taught to be a patient advocate and to know when to limit visitors. And it also gave her instructions on how to keep the patient comfortable physically as well as psychologically.

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"A picture placed opposite the bed might occupy his [the patient's] thoughts but a number of pictures might tire him," seems a little patronizing to the patient in these days of TV and the Internet, but look at a hospital room of 2013. Along with the modern comforts, there is usually one picture up on the wall for the time the patient would rather take a break from Facebook and The Price Is Right.

And one of the traits of a bad nurse, the book cautioned, is the noisy nurse. "Although they may be kind and loving they are continual sources of disturbances to the sick. They wear creaking boots or thump along on their heels. They slam doors and rattle cups [and] altogether keep the unfit patient in a state of nervous expectation wondering when the next crash will occur."

Then there is the nurse who is too quiet: "Everything is whispered, and the senses of the patient are kept at full tension, trying to find out what is going on ... it is far better to speak low than to whisper loud." There are the nurses too fussy who constantly ask the patient how he is feeling when his headache demands silence and a "continual shifting of pillows when the only desire is to be left alone, repeated visits on tip-toe to see if asleep, when all that is wanted is to be let fall asleep in quiet."

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Medical Interventions
Cleanliness was of paramount importance then as it is now, and lots of items were on the list to disinfect the room. Purchasing these today, however, looks like just the ticket to get on a Homeland Security watch-list. Sulphurous acid gas, formalin, chlorine gas, corrosive sublimate were some of the items. Burning sulphur in the house was recommended to kill off germs. There was also something called "Condy's fluid" which, whatever it is, sounds much more benign than "carbolic acid," another weapon in the arsenal against germs.

St John's that year had also put together a first aid manual which was a prerequisite to nursing: First Aid to the Sick and Injured. Many of the instructions, though basic by the standards of today's nurses, EMTs and paramedics, would work in a modern first aid course. Splinting and bandaging have changed little. But those things that have changed have been significant.

Take rescue breathing. Illustrations of restoring breath look less like CPR and more like a strong-armed robbery. It discussed "Professor Schafer's method" of downward and upward pressure on the chest to restore breaths. There was "Doctor Sylvester's method" of moving the patient's arms back and forth and "Laborde's method" where the tongue is seized and the jaw depressed.

"Hysterical Fits" are listed in the first aid manual. Today they are called panic attacks. How to deal with them? 1) Avoid sympathy with the patient and speak firmly to her. 2) Threaten with a cold water douche and if she persists in her "fits" sprinkle her with cold water. 3) Apply a mustard leaf at the back of the neck.

Beyond mustard leaves, the nurse of 1908 was familiar with cod liver oil and a great way to administer it was to "serve with salt or sardines at breakfast." Castor oil was another common treatment and the patient "generally takes castor oil well when it is shaken in a bottle with warm milk sweetened and flavored." And spirits, too, were used, but caution was advised. "Far too frequent use of spirits is made to restore a patient after an accident, often with serious results. The safest rule therefore is to defer administration of alcohol until after arrival of the doctor," said the first aid manual.

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The early century nurses had access to tools other than medications. "Leeches are used for the removal of blood. Their effect is local and not constitutional. They can be used in cases of acute inflammation," the manual said about the doctor's little helpers who, like the caring nurse, could become very attached to their patient. "Before putting on the leeches the part is to be washed with warm milk and water and dried. It is better not to use soap, as it may prevent the leeches from biting."

The nurse had to be aware of people whose mind did not mesh with reality. "Patients in delirium must be humored and not actively opposed. Their delusions should be listened to and not contradicted. If a curtain appears to the fevered intellect to be some personal enemy it is no good to say 'it is only a curtain' but if the curtain be shaken and its folds rearranged and the patient be told that there is no enemy there then the idea will probably pass from his mind."

Attributes of a Good Nurse
A good nurse should be able to talk firmly, but never unkindly. She should be able to win her patient's confidence. Dress emphasized the practical: "dresses should be made quite plain with the skirt not long enough to be trodden on. Unbleached linen or brown Holland should be used for infectious cases also for summer wear in general" and as for individuality, "ornaments are out of place though a white ribbon bow may be worn on the throat to give variety." And, as today, the nurse was reminded to take care of herself as well as the patient. "Regular exercise in the open air is necessary. A walk of an hour's duration in the open air is minimum allowance." She should brush her teeth twice a day and as for alcohol, "a nurse need not be a teetotaler. (but) Of spirits she ought scarcely to know the taste."

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A nurse of 2013 transported to that time would be faced with typhoid, scarlet fever, measles, rotheln (German measles), small pox and diphtheria. And the nurse of 2013 would also be in for a culture shock too big to imagine, going from a high-tech society to a place where castor oil and leeches were commonplace.

But the overall idea of the nurse seems to have remained the same. The patient is paramount. The nurse must take the lead in assuring the patient's comfort and well-being. The nurse is the indispensable resource of the physician regarding the changing condition of the patient and the administration of what the doctor needs to have done to assure recovery.

And as for that young nurse who first read this manual more than 100 years ago, had she made a career of nursing she probably cared for countless patients through the Spanish flu epidemic and both World Wars. She saw babies born, people die, and got to know those whose lives she saved. In her career she would have seen her profession go from a medallion from the St. John Ambulance Association to a college major and a license, and then might have retired sometime in the 1950s. It's likely she would have missed seeing the last exciting decades of her changing field: male nurses and female doctors, scrubs replacing white dresses and helicopters transporting patients, patient information being transported into space and back again. And throughout her career through the present day she would have seen many of the diseases that struck fear in 1908 become rare with new ones taking their place. But who knows? She may have lived longer than average life expectancy and had she made it to 1985 she just might have gotten the news that Joseph Upton of Harvard had positive results with his groundbreaking research into the medical use of leeches.

Devin Greaney is an EMT and a freelance writer.

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Much of the material in the book referred to was directly lifted from the classic "Notes on Nursing" by Florence Nightingale. I graduated with a BSN in 1977 but sadly did not read this book until I was in graduate school as it was not 'required' and so many other things were. "Flo" SHOULD be required reading for all nursing students (both LPN and RN) sometime during their schooling. Knowing our history helps us to understand our present as well as our future.

Laura ,  BSN, MS, RN-BCJuly 03, 2013
St. Louis, MO

Very interesting, our nursing history needs to be more visible.

Dolores  Heinzmann May 09, 2013
Jersey City , NJ


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