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District nursing associations have co-operated with the Council in the experimental use
of disposable syringes and incontinence pads. It is not possible to estimate from small
scale experiments how much staff time and work could be saved by the introduction of
disposable equipment on a large scale, but it is evident that over a long period some
saving is to be expected.
The introduction of sulphonamide therapy and antibiotics have replaced the long
treatments for abscesses, whitlows or excision of carbuncles which were once the daily
task of the home nurse—and puerperal fever, then the commonest cause of maternal
death, is now almost unknown on the district. In 1961, of 1,566,730 home visits paid by
home nurses in the county, 546,959 (35 per cent.) were for injections only; a further six per
cent, were for injections and other treatment. These included injections of mersalyl which
have banished the water-bed which had to be refilled every two weeks, the treatments
by paracentesis and the care of pressure points to prevent the bed-sores, to which
the oedematous patient with chronic nephritis or cardiac failure was so prone. Pneumonia
in 1931 meant poultices, steam kettles and the anxiety of the 'crisis'. The treatment of
diabetes, too, is becoming less exacting of the nurse's time. Many new patients, including
children, now learn to give their own injections and some older patients can be satisfactorily
maintained on oral treatments, so that the nurse in these cases takes on a supervisory role.
The most striking change, however, in the day-to-day work of the home nurse has been
the shift in the age range of her patients.
Age distribution of patients nursed at home
1931 1961
% %
0- 5 years 19.5 5
5-14 years 20 39
15-65 years 42
Over 65 years 18.5 56
The general improvement in the hygiene and health of children brought about by the
maternity and child welfare and school health services is reflected in the marked decline in
1961 in the number of children who have needed nursing care at home. One reads, almost
with incredulity, that in 1931 home nurses gave many rubbing treatments to children with
rickets, having received special training in this technique at Guy's hospital. Modern drug
therapy for worms has replaced the enemata of infusions of quassia. The infectious diseases
of childhood have been largely brought under control by immunisation programmes, so
that the severe complications which were then treated by inhalations, steam kettles and
poultices have almost disappeared from district practice. There were, too, babies suffering
from ophthalmic infections or pemphigus referred from the domiciliary midwifery service.
Otorrhoea was commonplace and home nurses in London attended school treatment
centres each morning to treat these cases, a daily attendance of 70 children at one centre—
mostly with otorrhoea and some eye affections and sores—having been recorded. The
London County Council in 1931 maintained centres throughout the county for the operative
treatment of tonsils and adenoids, where children were retained for two nights before
being sent home for nursing care by the district nursing associations. In addition, many
children had operative treatment in hospitals outside the Council's scheme and these
children were sent home the same day for nursing care at home.
In 1961 these centres for tonsillectomy, like the special hospitals for severe cases of
ophthalmia neonatorum or bone tuberculosis, had long since disappeared. The 2,236
children under five years of age treated by the home nursing service in 1961 represent
only 5.4 per cent. of the total case load.
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