292 NURSING PRACTICE Sex Transm Infect: first published as 10.1136/sti.78.4.292 on 1 August 2002. Downloaded from The historical role and education of nurses for the care and management of sexually transmitted infections in the United Kingdom: 1 Role K Miles ............................................................................................................................. Sex Transm Infect 2002;78:292–297 Nurses have been involved in the management of earliest references to the term “nurse” is cited in sexually transmitted infections (STIs) well before the era the context of venereal disease transmission, rather than actual “nursing” involvement in the of Florence Nightingale. Their role has varied from that treatment and management of venereal disease. of the technician, almoner, counsellor, and doctor’s Mahon (1808) reviewed writings of venereal dis- assistant, to one in which they are able to provide first ease transmission from the beginning of the 15th century until the middle of the 18th century.10 He line management of STIs in nurse led clinics. However, quoted a number of authors who claimed they changes to the role of the nurse have not been entirely had evidence that the transmission of venereal through choice. It appears that nurses have often been disease occurred from the newborn to the nurse following breast feeding, and vice versa. called upon in times of crisis and need—their role often None the less, there is evidence of nursing evolving only through demand for services and involvement, as we now know it, in venereal dis- personnel. Barriers to developing the role of the nurse ease management before the era of Nightingale. continue to exist as we move into the 21st century. From The women (patients) had a more permanent Lock hospitals to specialised genitourinary medicine contact with the matron who was responsible for the day to day management of the clinics, this historical review looks at how the role of the [Manchester and Salford Lock] hospital. At nurse has evolved over the past 150 years and suggests first the hospital committee experienced diffi- how past lessons can help enhance the contribution culty in finding a trustworthy woman and in nurses will make to the future of STI management and 1827 the matron had to be dismissed after it was discovered that “women of notoriously control. bad character had been found drinking in the http://sti.bmj.com/ .......................................................................... kitchen” and the matron had been “seen in a house of ill fame, singing in the company with he history of sexually transmitted infections very dissolute characters.”11 (STIs) and their associated control efforts in Also before Nightingale, evidence of a nurse the United Kingdom during the 19th and administering treatment for venereal diseases T 1–8 20th centuries have been well documented. was cited in 1848 when a nurse was dismissed for However, the involvement of nurses is less clear. overenthusiastic use of mercurial ointment (to on September 24, 2021 by guest. Protected copyright. This is the first of two papers presenting the his- treat syphilis), causing damage to the life of a torical role and education of nurses in the field of patient.3 genitourinary medicine (GUM) over the past 150 In central London, records of nurses being years. employed at St Peters Hospital for Stone (1860– The review was conducted using journal and 1960) date from 1864, followed by the employ- textbook publications and source documents ment of a matron in 1876.12 At this time, the hos- from the Wellcome Institute for the History of pital was reported to have trouble retaining Medicine Contemporary Medical Archives Centre and the Public Record Office in Kew, London. The nurses because of poor wages and lack of findings are presented in chronological order of educated women. events and/or publication. The London Lock Hospital in Soho (1746– 1952) also employed a matron and two nurses.13 Series editor: Vanessa Male nurses supplied the needs of the few male Griffiths WET NURSES AND LOCK HOSPITALS: inpatients from the 1890s, while male orderlies ....................... 19th CENTURY looked after the outpatients department. In the Early references to the term “nurse” in conjunc- Correspondence to: early 1900s, the huge number of outpatients Kevin Miles, nurse tion with “venereal disease” are not identified consultant, Mortimer immediately with the nursing profession, as we (20 000–30 000 per annum) overwhelmed the Market Centre, off Capper system, but the rebuilding of Dean Street in 1912 Street, London now know it. The word “nurse” originates from WC1E 6AU, UK; the Latin word nutrire, to nourish, or suckle. brought the departments up to date and allowed [email protected] Nursing was not publicly recognised as a profes- much of the treatment to be undertaken by sion until 1860 when Florence Nightingale nurses and orderlies. In general, the passage of Accepted for publication 17 May 2002 opened the first school of nursing at St Thomas’s sounds and prostatic massage were left in the ....................... Hospital, London.9 Possibly this is why one of the hands of the male nurses.14 www.sextransinf.com Historical role and education of nurses in STIs in the UK: 1 293 MORALISING AGAINST THE SEXUALLY doctors, but that it might well be supplemented by trained Sex Transm Infect: first published as 10.1136/sti.78.4.292 on 1 August 2002. Downloaded from PROMISCUOUS: EARLY 1900s social workers . .” (point 24: p 8). Although the mere sugges- Following a presentation to the International Congress of tion of another professional giving advice had moved on from Nurses in 1909, Dock, an American nurse, wrote a manual for the 1917 VD act23 preventing anyone other than a duly quali- nurses with the chief purpose being “to reiterate the social fied medical practitioner being allowed “to offer to give or give significance of the venereal diseases and the crusade upon any advice in connection with the treatment thereof,” nurses which women should enter in regard to them.”15 This text, as did not feature in this report. with the vast majority of medical texts of the time, was obsessed with the notion of prostitution and its control. RECOGNISING NURSES’ CONTRIBUTION TO VD CONTROL: 1920s POST ROYAL COMMISSION: 1916 In a 1928 text for nurses24 and others engaged in the treatment On the 12 July 1916, the local government board produced of venereal diseases, it was acknowledged that: regulations on the organisation of medical measures against By its influence on family life the nursing profession could 16 venereal diseases. Although this document discussed the role be of much more assistance in the fight against venereal and responsibilities of the medical officer of the clinic, the role diseases that it has been in the past (preface) . the study of the nurse was not made explicit. of venereal disease still received little attention in a doctor’s The early 1900s also saw an abundance of medical texts training, and even less in a nurse’s. (p 6) describing the venereal diseases. The vast ranges of remedies The potential of the nurse to provide public health were presented and many authors wrote numerous editions. information—warning patients of cleanliness with regard to One text written by a doctor “more especially for nurses and baths and WC seats, was recognised. However, it was also midwives” also duplicated the medical texts of the time.17 stressed that: Although the book intended to provide “suitable instruction” to nurses, of the total of 54 pages, the term “nurse” was only or must she [the nurse] take to herself the task of telling a used in the preface and conclusion where the education of patient that he has venereal disease, even if the patient sus- nurses was discussed. pects the condition and has asked her opinion ...If,how- ever, he has no medical adviser, she may be able to help fur- NATIONAL COUNCIL FOR COMBATING VENEREAL ther by suggesting one with experience in the diagnostic DISEASE: POST FIRST WORLD WAR and treatment of VD or by referring him to a venereal clinic. In February 1919, the Medical Committee of the National (p 28) Council for Combating Venereal Disease (NCCVD) considered Other roles of the nurse were explored, one with reference providing facilities for the early preventative treatment of VD. to the medicolegal issues and role of consent in the context of Such early treatment facilities were to be attached to public the nurse acting as an impartial witness: conveniences, in large towns, or clinics and the staff would A mistress cannot demand the examination of a servant. consist of trained orderlies and nurses who would administer This request is occasionally made in cases of suspected early treatment [urethral/vaginal irrigation] as “first aid,” pregnancy by the worried mistress, the doctor being asked passing on all necessary cases to the medical officer.18 to examine the breast during real or pretend examination However, at the same time, although sympathetic to the of the chest ...ifthenurseplaysthepartoftheimpartial initiative of the nurse, the nursing role was scrutinised in so witness . her position is a very insecure one legally. (p 31) far as providing advice to patients: http://sti.bmj.com/ The same text also presented the nurse’s role in the The Honorary Adviser of the National Union of Trained intravenous treatment of syphilis with arsenic. “The nurse Nurses had written reporting to the National Council must see that the injection needles are kept in order. They [NCCVD] the case of a member of their union, a health must be sharp . the surgeon inserts the needle into the vein, visitor, who, when in attendance on an infant suffering and when satisfied that it is correctly placed in the lumen, he from some form of venereal disease had advised the father may ask the nurse to release the tourniquet” (p 73–4).