Nursing Education in Early Twentieth-Century Ireland

‘The course is a very complete one, and a Nurse will have to work hard, if she wishes to get through it. If she does work hard the final examinations will present little difficulty to her, and she will enter on her profession with the confidence that is born of knowledge, and with a certificate that is a guarantee of efficiency.’

Kirkpatrick, T. P. C. ‘Registration for Nurses. A Lecture delivered in
the Dublin Metropolitan Technical School for Nurses’ (Dublin 1917).

Stella ward (from Kirkpatrick’s History)

T. P. C. Kirkpatrick was a keen advocate of nursing education, a topic which he noted in 1917 as something which was then a relatively new concern of the medical profession: ‘Fifty years ago the Trained Nurse was barely tolerated as an innovation: today she is one of the essentials of civilised life.’ His printed ‘Syllabus of a course of lectures on Medicine for Nurses’, now in the RCPI, offers us a unique view of the topics considered vital for education of nurses at Dr Steevens’ Hospital in the early twentieth century. The Syllabus outlines the topics to be covered in twelve lectures: Lecture I. Fever; Lecture II. Fever; Lecture III Enteric or Typhoid Fever; Lecture IV – Measles, Chicken Pox, Small Pox, Vaccination and Diphtheria; Lecture V. Diseases of the Heart.; Lecture VI. Diseases of the Lungs; Lecture VII. Acute Pneumoni and Phthisis (Tuberculosis); Lecture VIII.Diseases of the Kidneys; Lecture IX. Stomach and Alimentary Canal; Lecture X. The Nervous System; Lecture XI. Skin and Hair; Lecture XII. Poisonous Drugs used as Medicines.

Dr Steevens’ Hospital.
Course of Lectures on Medicine for Nurses
Dr Kirkpatrick.
SYLLABUS

Lecture I – FEVER

Clinical Thermometer, history of its introduction into Clinical Medicine. The object of its use. Difference between the temperature of the surface and that of the internal parts of the body. Different places where the temperature may be taken, the advantage and disadvantage of these compared. Necessity for the regularity in the time of taking the temperature. Time of maximum and minimum daily temperature. Meaning of the term “normal temperature”. Considerations on the normal temperature of man and how it is regulated. The heat regulating mechanism of the body. The source of heat in the body and the way this heat is lost. Warm blooded or “homoiothermal” animals compared with cold blooded or “poikilothermal” animals. Effect of pathological conditions on the heat regulating mechanism of the body. The sub-normal temperature. Temperature above normal, or fever. Examples of these conditions. Sub-normal temperature of collapse. The effect of surgical anaesthesia on body temperature. The effect of poisons, especially of those poisons called toxins, generated by the growth of bacteria in the body. Method of recording temperature, “marking charts.”

Lecture II – FEVERS.

Old classification of fevers into “primary” or “specific”, and “secondary” or “inflammatory”. Origin and meaning of this classification. Fever to be looked on as a symptom of disease and usually associated with other symptoms. The meaning of the term “fevers” as applied to a group of diseases. Characteristics of the diseases of this group. Their tendency to run a definite course and end in recovery. Explanation of this tendency. Bacterial infection as a cause of fevers. Production of “protective substances” in the body as a result of bacterial infection. Effect of these substances on the cure and prevention of fevers. Reason why a second attack of these fevers is uncommon. Artificial manufacture of these protective substances and their uses for preventive and curative purposes. Examples of this. Infectious and contagious diseases, meaning of these terms and the distinction between them. Importance of preventing the spread of these diseases from the sick to the healthy. The necessity of knowing as far as possible the way infection is carried and the channels by which it enters the body.
General considerations on the nursing of “Fever Patients”: – (1) Prevention of infection of others; (2) Helpless condition of the patient and necessity for care; (3) Prostration of patient and necessity of saving their strength to fight the disease; (4) Importance of making patient comfortable to ensure quietness and induce sleep; (5) Importance of cleanliness of patients and their surroundings; (6) Importance of regularity in feeding patients; (7) Necessity of recognising the onset of complications which may endanger the patient’s life.

Lecture III.

Enteric or Typhoid Fever. – Definition of the disease. Cause, the Bacillus Typhosus. The method of infection. Infectiousness of. Typhoid carriers. Pathological lesions found in the disease. Common age of those attacked. The immunity against subsequent attacks. Course of the disease. Incubation period. Invasion. First week. Fastigium of disease. Second week symptoms. The rash and its characteristic mode of appearance. The third week. The termination of the disease by “lysis”. Convalescence. Complications, especially tympanites, haemorrhage, and perforation. Symptoms of their onset, and immediate treatment. General treatment of disease. Food. Bowels. Baths and sponging. Care of the patient. Disinfection of excreta. Period of infectivity.
Typhus Fever. – Definition of the disease. Probable nature of the cause. Infectiousness of. Common age of those attacked and its importance in prognosis. Protection against subsequent attacks. Incubation period. Invasion. First week symptoms. Rash. Second week symptoms. Importance of nervous symptoms. The delirium of. Termination by crisis. Complications unimportant. Duration of infection. Importance of fresh air in disinfection.
Scarlatina. – Definition of. Probable nature of the cause. Method of infection and infectious of. Usual age of those attacked. Immunity against subsequent attacks. Commonness of slight attacks and their danger. Course of the disease. Incubation period. Invasion. Symptoms of. The rash. Time of appearance and its characters. The fastigium and its symptoms. Termination. Convalescence in. Complications, especially as they affect the heart and kidneys. Desquamation. Treatment of the disease. Period of infectiousness. Disinfection. Doubtful nature of prognosis.

Lecture IV

Measles. – Definition of. Probable nature of cause. Method of infection and infectiousness of. Common age of those attacked in these countries. Protection against subsequent attacks. Course of the disease. Incubation period. Invasion and symptoms of. Fastigium. Appearance of rash and its characters. Importance of examining the mouth for early appearance of the raskh. Distinguishing characteristics of the rash from that of Scarlet Fever. Duration of the fever. Termination. Convalescence. Importance of attention to. Complications, especially those affecting the lungs. Effect of disease on tubercular infection. General treatment. Importance of attention to the eyes. Disinfection. Period of infectivity.
Rotheln, or German Measles. – Slight nature of this disease, but the importance of distinguishing it from Measles and from Scarlatina. Characteristics of rash. Duration of infection.
Varicella or Chicken Pox. – Definition of. Cause of the disease unknown. Infectiousness of. Common age of those attacked. Immunity against subsequent attacks. Course of disease. Incubation period. Invasion. Characters of eruption. Termination. Convalescence. Unimportance of complications. General treatment. Disinfection. Period of infectivity.
Small Pox, Variola. – Definition of. Probable cause of the disease. Infectiousness of, and the great importance of strict isolation. Persons of all ages liable to the disease, but more common in young people. Course of the disease. Incubation period. Sudden invasion. Symptoms of. Prodromal rashes in. Stage of eruption. Character of eruption in different stages. Variation in the course of the disease with the extent of the eruption. Modified, discrete, confluent, and haemorrhagic small pox. Stage of suppuration and secondary fever. Termination. Convalescence. Complications. Deformities produced by the disease. Prognosis and death-rate. Disinfection, importance of. Period of infectivity.
Vaccinia, or Vaccination. Short history of the discovery by Jenner, 1798. Method of preparing the vaccine lymph and of vaccinating patients. The effects of vaccination. Nature of protection afforded by vaccination against Small Pox. Duration of this protection. Necessity of re-vaccination. Importance of knowing the general facts about vaccination.
Diphtheria. – Definition of. Cause of the disease the bacillus of Diphtheria. Method of infection. Pathological lesions associated with. Age incidence of the disease. Slight immunity against subsequent attacks. Course of the disease. Incubation period. Invasion. Fastigium. Condition of the throat it. Dangers of extension of the membrane to the larynx. Termination. Convalescence. Complications, especially those connected with extension of the membrane, or with the heart or kidneys. Treatment. Local treatment of the throat. Danger to nurse in. Anti-toxin treatment. Dose of anti-toxin, and meaning of the term “anti-toxin unit”. Description of the preparation of anti-toxin. Disinfection. Importance of. Period of infectivity. Importance of bacteriological examination of patients before they are considered free from infection. Infectious nature of mild cases, especially when the disease attacks the nasal passages.

Lecture V.

Diseases of the Heart. – Review of the anatomy of the heart. The pericardium. The chambers of the heart and the vessels leading to and from the heart. The valves of the heart. Review of the circulation of the blood. The contractions of the heart muscle. The cardiac cycle. The systole and diastole of the heart. Function of the valves of the heart. The pulse. Importance of accurately counting the pulse, and the information we obtain from it. Effect of disease of the heart on the circulation. Increased work of the heart as the result of disease. The result of this increase on the heart. Compensation in heart disease. Hypertrophy of the heart. Its advantages and significance. Various forms of heart disease. Pericarditis. Myocarditis. Endocarditis. Chronic valvular disease of the heart. Different forms of valvular disease. Regurgitation and stenosis of the aortic and mitral vales. Symptoms of heart disease – Failure of the circulation, dropsy, breathlessness and cyanosis, failure of kidney secretion. Physical signs of cardiac disease. Cardiac murmurs. Diagnosis in heart disease and what it depends on. Importance of physical examination of the heart in order to arrive at a diagnosis. Prognosis in heart disease and what it depends on. Sudden death in heart disease and the conditions under which it may occur. Treatment. The importance of rest. Value of exercise. Resisted movements and massage. The use of drugs. Digitalis. General treatment of patients with heart disease.

Lecture VI

Diseases of the Lungs. – Review of the anatomy of the air passages and the lungs. Imporance of the air sinuses of the head. The larynx, the trachea, the bronchi and the lungs. The pleura. General physiology of respiration. The way the air enters and leaves the lungs. The changes effected in the blood during its passage from the lungs. The close connection between the circulation and respiration and their dependence on one another. The absorption of oxygen by the blood in the lungs and the elimination of cardon dioxide from the blood. The necessity of the respiratory function to life. The using up of oxygen and the formation of carbon dioxide by the tissues. Methods of physical examination of the air passages and lungs. The laryngoscope. Inspection, palpitation, percussion, auscultation and mensuration of the chest. The way of a diagnosis is arrived at as a result of physical examination. Forms of disease. Pleurisy with or without effusion. Symptoms, prognosis, and treatment. Tapping the chest. Necessity for surgical cleanliness in. Treatment of purulent effusions. Bronchitis. Varieties of, their symptoms, signs, treatment, and prognosis. Danger of, in the very young and very old. Catarrhal pneumonia. The nature of the condition. Liability of patients to this condition in many forms of disease and after operations. Symptoms, signs, treatment, and prognosis in. General treatment of these diseases of the lungs. Importance of careful nursing.

Lecture VII

Acute Pneumonia – Definition of, cause of. The Pneumococcus. The method of infection. How far the disease is infectious. Importance of the susceptibleness of the person attacked. The pathological changes induced in the lungs. The importance of the age of the patient, and of the patient’s general condition when attacked. The slight immunity afforded by one attack of the disease. The course of the disease. The incubation period. The sudden invasion and the symptoms of it. The fastigium and its symptoms. The termination by crisis. Complications and sequelae. Treatment. Importance of saving the patient’s strength. Danger of heart failure. The use of stimulants, when they should be given. Importance of sleep.
Phthisis – Defintion of the disease. Its frequency. The cause of it. The tubercule bacillus. Essential identity of all forms of tubercular disease. The infectious nature of the disease. Channels of infection. Importance of infection through the alimentary canal. Necessity of prevention of infection of food. Infected animals. Course of the disease. Difficulty in recognising the onset. Importance of family history, and of exposure to infection in doubtful cases. Changes in the lungs caused by the disease. General symptoms of patient. Loss of weight, cough, sweating, fever, and haemorrhage from the lungs. Treatment. General, open air life, importance of fresh air, good food, and cleanliness. Phthisis can be cured in this country and in patients own homes. Advantages of sanatorium treatment. Special treatment of haemorrhage and fever. Importance of proper rest, exercise, breathing and attention to personal hygiene. Tubervulin in diagnosis and treatment. Prevention of infection. Importance of watching “contacts” for early signs of the disease. Hopefulness of the preventive treatment of tuberculosis. Importance of the part played by Nurses in the fight against consumption.

Lecture VIII

Diseases of the Kidneys. – The functions of the kidneys. The liability to disease on account of their duty of getting rid of poisonous substances from the body. The necessity of examination of the urine in kidney disease. Quantity and characters of normal urine. Method of estimating the quantity of urine excreted. The specific gravity of the urine and the information we get from it. The reaction of the urine. The importance of using clean vessels for specimens of urine. Albumen in the urine and its significance. Simple tests for albumen. The importance of the presence of blood, pus, and tube casts in the urine. Deposits of lithates and their significance. Three great types of kidney disease: (1) Acute nephritis. Causes of. Importance of, in specific fevers, especially in scarlatina. Symptoms. Sudden onset. Changes in the urine in. Changes in the pulse. Fever. Dropsy. Termination. Uraemia and its symptoms. Treatment. Importance of proper diet, rest, and warmth. Wet packs. (2) Sub-acute nephritis. Difficulty in recognising its onset. Changes in the urine in. The course of the disease. Dropsy. The termination of the disease. Treatment. (3) Chronic nephritis. The great difference between this and other forms of kidney disease. The urinary changes in. Liability to eye trouble, to uraemia, and to apoplexy. Treatment.

Lecture IX.

Stomach and Alimentary Canal – Functions of the alimentary canal. General review of the physiology of digestion. Importance of the proper performance of each function. Dangers of improper mastication of food, bad teeth, and oral sepsis. Dangers of improper digestion in the stomach. The necessity of regular feeding for the stomach to get the necessary rest. Dangers of improper elimination of the bowels. The importance of accurate diagnosis in stomach disease. Indigestion and dyspepsia, often the sign of serious illness, such as gastric ulcer or cancer. Methods of examination of the stomach by stomach tube. Test meals, when given and what they contain. Importance of haemorrhage from stomach to bowels. The distinction between “haemoptysis” and “haematemesis”. Examination of the vomit. The importance of pain. Its sudden onset; its situation; its relation to the taking of food; its association with tenderness on pressure. Jaundice as a symptom of gastro-intestinal disease. Bile in the urine. Distention of the abdomen, tympanites, and meteorism. Diarrhoea. The frequency of the motions. The association of, with pain or straining; tenesmus. The examination of the stools; the presence of blood; undigested food; mucous or parasites in the stools. Melaena. The stools in the obstructive jaundice. Importance of diarrhoea, especially in young children. Constipation. Importance of intestinal obstruction, its symptoms and signs. Intussusception in children. Danger of purgative in intestinal obstruction. The use of enemata. Perforation of the stomack or intestines.

Lecture X.

The Nervous System. General review of the anatomy and physiology of the Nervous System. The cerebro-spinal axis and the peripheral nerves. Variety and complexity of the diseases of the nervous system. Psychical and Physical disturbance compared and contrasted. The reality of psychical disturbance and the inability of the patient to control them. Importance of the recognition of this in the treatment of some patients with hysteria. Capacity of the patient to appreciate mental impressions even when mentally diseased. The importance of this in treatment. Importance of the proper treatment of persons affected with all forms of mental or psyschical disease. Importance of the care of patients with nervous disease. The special liability of some of these patients to the development of bed-sores. The necessity of care for the prevention of deformities in many paralytic patients. The care of the bladder and rectum in patients with either retention or incontinence. Difficulties in the management of such patients. Necessity of regular feeding in helpless patients. Dangers of forcible restraint. Necessity for care to prevent patients injuring themselves or others. The use and abuse of massage and electricity in the treatments of nervous diseases.

Lecture XI.

The Skin. – General anatomy of the skin. Functions of the skin for protection, elimination and regulation of heat. Importance of recognising these functions of the skin in the treatment of patients. Liability of the skin to damage by external irritants. Danger of injuring the skin in cases of loss of sensation from any cause. Importance of this when using hot bottles, poultices or strong chemicals. Liability of the skin to parasitic infection. Various parasitic diseases. Contagiousness of parasitic diseases of the skin. Bacterial infection of the skin. General rules for the management of patients with skin disease. Importance of cleanliness, of avoiding irritation, of protection from infection from without.
The Hair – Its histological anatomy. The care of the hair. Advantages and disadvantages of cutting the hair in certain cases. Diseases of the scalp. Pediculi capitis and their treatment. Itchiness of the skin as a symptom of diease.
Care of the hands. Chapped hands. Chilblains. Treatment of. Prevention of bed-sores. Some common skin diseases.

Lecture XII.

Poisonous action of Drugs used as Medicines:-

Arsenic – Symptoms of acute poisoning. Treatment of.
Chronic poisoning. Early symptoms. Importance of their recognition. Later symptoms. Treatment.
Iodine. Iodide of Potassium and Iodoform. Symptoms of “iodism”. Mental symptoms after the use of Iodoform. The erythema of Iodoform poisoning.
Carbolic Acid. Effect of pure Carbolic Acid on the tissues. Use of alcohol as an antidote. Symptoms of poisoning from the use of Carbolic lotions. Importance of examination of the urine in. Danger of Carbolic dressings in young children. Treatment. Use of magnesium sulphate and alcohol.
Opium. Symptoms of. Treatment. Use of Liquor Potassium Permanganate.
Mercury. The symptoms of chronic mercurial poisoning. Importance of recognising the earliest symptoms. Importance of the care of the mouth while taking mercury. Danger of mercury in kidney disease.
Belladonna and Atropine. Condition of the pupils in. The effect on vision.
Strychnia and Nux Vomica. Symptoms of, and treatment.
Digitalis. The cumulative action of. Sudden onset of symptoms. Importance of watching the quantity of urine.
Salicylate of Soda. Symptoms of poisoning.
Turpentine. Danger of use of in kidney disease. Blood in the urine.
Ergot. Thyroid extract.
Sources

Kirkpatrick, T. P. C. (1917), ‘Registration for Nurses. A Lecture delivered in the Dublin Metropolitan Technical School for Nurses’ (Dublin).
Kirkpatrick, T. P. C. (1924; reprinted 2008) The History of Doctor Steevens’ Hospital Dublin, 1720-1920 (Dublin).
Syllabus of a course of lectures on Medicine for Nurses: RCPI TPCK/2/6/4.