How nursing has changed since first killer pandemic
Melbourne was the Australian epicentre of the Spanish flu outbreak in 1919, and a small band of district nurses were forced to change their methods to help our city's poorest people survive the pandemic.
Some of those changes stuck and remain today as Victoria's nurses battle COVID-19.
A matron and up to 12 nurses from the Melbourne District Nursing Society (MDNS) cared for
thousands of Spanish flu patients and their families in 1919, stepping into the unknown amid a
global pandemic that killed up to 15,000 Australians and 20 million people worldwide.
The MDNS was a charity that was later renamed the Royal District Nursing Service and is now known as not-for-profit organisation Bolton Clarke.
Deidre McGill, Bolton Clarke's executive general manager of at-home support, said MDNS nurses cared for the poor in inner city areas when the first Australian case of the Spanish flu was identified in Melbourne in January 1919.
"There were a lot of slum areas at that time, and the district nurses visited people in their homes after they may have gone to hospital. The families were poor. They didn't have any equipment, no food, no running water or blankets," she said.
"Our focus is still on people who are sick and marginalised."
The deadly Spanish flu influenza strain first emerged in the northern spring of 1918. It flourished in the damp trenches in war-torn Europe thanks to mass troop movements and quickly went global.
Its symptoms included a severe pneumonia that caused haemorrhaging on the patient's cheeks and, in the worst cases, a bloody mucus that filled patients' lungs.
Unlike other strains, it hit otherwise healthy people aged 15 to 35 the hardest.
NURSES HIT THE ROAD
One of the biggest changes to the MDNS, one that has shaped the way modern district nurses work, was the introduction of cars.
Before the Spanish flu, none of the nurses could drive.
They either walked or cycled to their in-home appointments but the huge caseload caused by the pandemic forced the nurses to mechanise.
They had driving lessons and, in April 1919, began to drive cars loaned to the charity by wealthy benefactors, businesses and the Women's Automobile Club.
Soon, they took delivery of cars owned by the MDNS.
"We increased our visits substantially because of Spanish flu. There were a lot of people who died in Victoria and we visited people in their homes and supported them with medical care, food and blankets," Ms McGill said.
Nurses were able to move between appointments much faster and treat more patients per day. The district nurses never looked back to the days of pedal and pedestrian power.
The MDNS made more than 46,000 home visits in the year to June 30, 1919 - about four times the number of visits they made the previous year.
HELPING PATIENTS GET HOME SAFELY
Melbourne hospital became overwhelmed quickly.
In a letter to The Argus on March 10, 1919, just six weeks after the first case, MDNS chairman CM Tathum called for the government to establish a convalescent home for patients. MDNS nurses had already visited 300 flu patients, he said.
"Many of these have been sent to hospitals, and whilst doing their rounds in various suburbs the nurses have found several of our former patients sitting on curb (sic) stones - discharged from hospital and too weak to reach their homes, the trams refuse to carry them and rightly so," he wrote.
Ms McGill said hospital staff were forced to discharge Spanish flu patients as soon as they passed the acute phase but had not recovered fully.
"In 1919, people would be discharged, they would walk out and they'd be left to their own devices. It was just the sign of the times," she said.
"Unfortunately, sometimes there wasn't a home to go or they didn't have the ways and means to get home.
"That's still the case today, and that's where services like ours step in to make sure that there is a safe environment and food, that they will be warm."
MDNS nurses worked to bridge the gap between hospital care and home recovery in 1919 - a role modern district nurses still fulfil, Ms McGill said.
"We have nurses in all the hospitals now, so that when someone is discharged, they are referred to our district nurse liaison, who makes sure they can get home and links them with nurses on the road to make sure they get home and that there's a good environment," she said.
DELIVERING THE BASICS
Ms McGill said that before the Spanish flu, MDNS nurses were delivering food and blankets and offering advice on hygiene to the poor, in part to guard against the possibility of a flu epidemic.
"Then it hit and there was a greater need, and it went through some of the areas (served by the MDNS) pretty significantly because it was so contagious," she said.
Mr Tathum told The Argus on February 15, 1919, that nurses performed what might today be called "deep cleaning" in patients' homes.
"They are willing to go to the poorest homes, scrub and disinfect the houses, and have, I consider, been of inestimable value during this epidemic," he said.
Households received food deliveries three times a day along with blankets and other necessities.
The nurses distributed up to 100 litres of soup to needy families each morning alone, cooked in the Red Cross kitchens.
"They (nurses) were trying to manage not just the influenza outbreak but many people weren't leaving their homes because of the flu. They didn't have food. We were delivering food and essential items to them, and we still do that now," Ms McGill said.
Ms McGill said MDNS nurses were well educated and understood the importance of handwashing, and the use of protective equipment such as masks, gowns and gloves.
"When people were discharged from hospital through Spanish flu, our nurses educated the patient and their broader family so if anyone had coughs or any illness on discharge, the family did not become infected. Handwashing, cleaning, airing out the house to get fresh air in. And all of that has not changed today.
"We're putting in place the actions we put in place then. It's amazing."
Despite their efforts, Spanish flu cases ballooned across Melbourne.
On April 24, 1919, 1380 people were in hospital with Spanish flu in Victoria, and there had been 13 deaths in hospitals and 19 in other locations that day.
By early May, MDNS nurses were making 1500 home visits a week, many because of the flu outbreak, and the service was down to nine nurses, two of whom had become ill themselves.
On May 21, The Argus reported that in the previous two weeks, MDNS nurses made 1475 and 1548 house calls respectively, compared to 450 and 375 visits at the same time in 1918.
The nurses treated 1212 individual Spanish flu patients alone in the previous three months.
In the same period in 1918, compared to 1100 total patients for all of 1918.
Overall, it's estimated that between 10,000 and 15,000 people died from the Spanish flu in Australia.
Ms McGill lauded the district nurses of 1919 for their bravery in the face of the deadly pandemic.
"I am so incredibly humbled by the strength of those people in that time, and I'm incredibly proud of our people now. All of my team who are out there every day in the unknown," she said.
Ms McGill said her team today were community leaders by ensuring their patients understood hygiene, physical distancing, social isolation and maintaining mental health.
"And that mirrors what happened 100 years ago. They were incredibly strong and well educated.
"They understood infection and the principles of infection control, and they put it into practice.
"I'm incredibly proud of what we did then and we're doing now."
Originally published as How nursing has changed since first killer pandemic