‘People are curiously incredulous of a danger they cannot see’.

Sarah Rogers PhD student, University of Huddersfield

Recently I read this quote written by Eva Lückes, matron of The London Hospital, 1880-1919. It seems to me, as relevant today, as when she wrote it nearly 140 years ago:

‘The most inconvenient and most dreaded of all illness is the occurrence of any infectious disorder; and with good reason, for, unless due caution is taken, there is scarcely a limit to the mischief that may be done…. Lose no opportunity of impressing upon those whom it may concern, the paramount importance, the absolute necessity, of isolation in all cases of infectious disease. People are curiously incredulous of a danger they cannot see. Only those who have had to deal with such matters can understand the extraordinary difficulty of making people realise the risks they run themselves and for others by carelessness in this respect.’

In the light of current protests around the world against mask wearing, social distancing, vaccinations, and ‘lockdowns’, which are all measures aimed at reducing infection and ultimately preserving life, this nineteenth century commentary by Lückes about the hidden dangers of airborne disease resonates today.  Today, medical staff despair that ‘widespread denial of the pathogen and the crisis still persists’ (Doctor Wijesuriya, The Guardian 1 January 2021). Such is the opposition to preventative measures that the Pope was moved to write that protestors were trapped in ‘their own little world of interests’ (The Guardian 23 November 2020).

Some thirty-five years after Lückes spoke about the dangers of ‘hidden illnesses’ she was still matron of The London during the 1918 Spanish Flu pandemic. In significant parallels with the current Covid pandemic, which are being played out in hospitals around the world, as well as at The Royal London today, a doctor at the London Hospital in 1918 reported that:

‘The number of medical beds are quite insufficient to cope with the difficulty which was increased by the fact that about 80 nurses were off duty with influenza. The death rate was very high as it was practically impossible to admit any but cases already in extremis. It was decided that the beds in Operation Ward should be allotted to nurses who were suffering from this disease.’

[Gauze face mask, England, 1901-1940. Credit: Science Museum, London.  Creative Commons  Attribution 4.0 International (CC BY 4.0)]

Although the hospital committee acknowledged that the chief risks to staff were from a patient’s breath and mouth secretions, they refused to allow nurses to wear a gauze mask sprinkled with antiseptic because they ‘felt that [masks] would cause alarm to patients and also to the nurses…’. Unlike today, when volunteers deliver food parcels, meals and snacks to hospital staff, in 1918 the committee granted ‘extra rations, for both doctors and nurses who are treating or nursing these cases’ as it was felt that they should ‘not go on wards with an empty stomach!’ Before they ate, all staff caring for Influenza patients were advised to rinse their mouth and wash their hands, as well as ‘have at least two hours fresh air daily’

As today, the pandemic had a significant impact on the nursing staff; lectures and classes for probationer [student] nurses were halted. Lückes also reported to the hospital’s management committee ‘the great strain on the wards’ because of the influenza epidemic, and ‘drew attention to the large number of our own staff who were ill’. Sadly, the deaths of several nurses are documented in the hospital minutes between November 1918 – February 1919.

However, as today, hospital staff placed hope in vaccination, and in 1918 physicians working at The London Hospital recommended to the management committee that: ‘in the present state of our knowledge prophylactic inoculation appears advisable’. Whilst small pox, diphtheria and typhoid vaccines had been successfully used since the nineteenth century, those being developed for the Spanish Flu in 1918 were virtually useless because ‘the causative organism of the current influenza was still unknown…’ and were being developed to protect against bacterial infection, rather than, the as then yet unidentified, viral causes of influenza (Editorial Committee of the American Journal of Public Health, 1919). Today, whilst governments contend with misinformation surrounding the Covid pandemic, we are fortunate to already have a series of vaccines which offer some prevention against this latest highly contagious illness.

Sources:

Eva C. E. Lückes, Home Nursing Sick and Room Appliances (1883), modern reprint (London, Kegan Paul, Trench and Co., 1883), p.15 -A lecture delivered for the National Health Society, 12 June 1883

Editorial Committee of the American Journal of Public Health, 1919

House Committee minutes, 1918-1920; RLHLH/A/5/56; Barts Health NHS Trust Archives and Museums

Doctor Wijesuriya, The Guardian, 1 January 2021 and

The Pope, The Guardian 23 November 2020