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District SisterBorn in Moreton, Wirral, Cheshire in 1922.
Overview: Joan Jones trained as a nurse during the Second World War. She first encountered diabetes during fever training at an isolation hospital in 1940 and then among war casualties in London. When she was midwifery sister in Dulwich in the early 1950s, mothers with diabetes had been warned to avoid pregnancy and expected their babies to be stillborn; but at Birmingham Maternity Hospital from 1955 - where a diabetic clinic was run jointly by John Malins and obstetrician Samuel Davidson - most babies lived. As a district sister in Coleshill from 1963-82, she helped many elderly patients with diabetes.
Well, my father
was a cooper - they‘re non-existent now. My mother never went out to work, and... but if she‘d have had the
opportunity, during the First World War, she always told me that she would have
been a midwife, but training wasn‘t possible, wasn‘t easy then. So, I think she ended up in a bakery, forced
to work. I went to school in a private
school. I left when I was sixteen. My parents both worked really quite hard and
had not a lot of money, but when I suggested, first, that I join the Red Cross,
my mother was very keen, as a volunteer. The war, of course, hadn‘t started then. And then I thought, when the war came, that the best thing... I didn‘t
want to go into the ATS, I couldn‘t get into the Wrens, and I was too short for
the Land Army, so I thought the only other thing left to me was nursing. My mother was very keen, but my father
wasn‘t. He didn‘t think nursing was
quite the thing for young girls, really. But I think he was gently persuaded, by one means or another, by my
mother, and I started my fever training. That was my first experience of illness: death and pain, really. And then, after I‘d done my fever training, I
went on, then, to do my general, and went on to do my part... I went down to
London to do - because my friends were all going down to London to do their
general training, and I thought that was great - so I went down to London and
did my general training and my part one midwifery.
(2) Had you come across any cases of diabetes
before you started your nursing training?
I do remember
that there was one little boy of four, whose mother was a friend of my
mother‘s. And it was a great tragedy, at
the time, because diabetes, in those days, in a child, was quite a serious
thing. And I remember them talking about
that he had to be injected, which was a terrible thing for a child. And he wasn‘t a terribly good little boy, so
they were very anxious about him; that, one, he would eat the things that he
should eat. And I remember all this
because my mother was talking to his mother. And I think, eventually, he settled down, but he wasn‘t really a
terribly good diabetic, behaviour-wise, and he died when he was about
seventeen. And that was the story, in
those days, with diabetes.
Now, coming on
to your training: What were the years of
your fever training?
I started my
fever training in 1942 (actually 1940). The war was on then, and...
What fevers were
you dealing with?
We were dealing
with everything, and, of course, in those days we had epidemics, which you
don‘t hear about now. I nursed through
epidemics of scarlet fever, diphtheria, meningitis, mumps, whooping cough; all
the childhood ailments. And the hospital
was quite near to an army camp, so we had quite a bit of meningitis in, and
dysentery, and anything else that happened to be there at the time. But to nurse the individual cases that came
in, we had a cubicle block where we did barrier nursing. On this block there were twelve rooms, and if
there was an odd infectious disease came in, from either the camp or anywhere
else, it was put into one of these rooms and it was barrier nursed. The patient had all their own implements, the
gowns were outside the room, the masks, the gloves, and if there was any question
of cross-infection, I think the whole of the hospital staff were before the
matron to find out why.
What was the
name of the hospital?
It was called
Hospital and it was in
Cheshire, near a very
pretty place called Parkgate on the River Dee. And I spent two and a quarter years there, and finally qualified.
Did you come
across any cases of diabetes?
Well, we did. Not very many, because by this time diabetes
was being researched quite a bit, and patients were beginning to be taught how
to manage their diabetes themselves. But
if they weren‘t, then the district nurse usually went in to give insulin at the
times that it was necessary. So, I
didn‘t see a great deal, but I did see one occasionally.
People who came
in with other diseases?
Well, they were
usually very ill, because of the disease complicated with the diabetes, so we
had two illnesses, really, to deal with, at that time.
Can you remember
how it was dealt with?
disease, anyway, was dealt with the usual things that we did, but the diabetes,
of course, had to have their insulin and bloods very carefully watched, because
it used to fluctuate with the disease. And
they were just managed with insulin, and diet, of course.
(3) Now, I remember the way we used to get our
patients in to the fever hospital, because, of course, the infectious diseases
were so virulent that we had to be entirely separate from any other hospital. So, we had our own ambulances, and we used to
go out for patients. The doctors - the
GPs - used to notify either the hospital or the local police station. And we used to go out for the original
patient that was notified, and then we used to call in at all the police
stations on the way to the original patient‘s address. And we used to find, very often, that if
there was an epidemic, there were two or three names and addresses at the
police stations, so we used to go out for one patient, very often, and come
back with four. And this was the way we
used to have to do it, to keep everybody isolated from everybody else.
And were these
mainly adults or children?
children, but occasionally the adult had brought the infection into the house,
so we‘d get the adult and the children, the family in. And there was one particularly poor area that
we used to go to where you could bet your bottom dollar that everybody had to
be de-loused when they came in, from the mother or the father and the children,
right down to the baby. But that was
part and parcel of it.
And if they had
happened to have diabetes, you‘d presumably have been informed.
Yes, the GP used
to leave a message to say if there was a particular child with any other
illness, including diabetes. He‘d leave
a message to say what insulin they were on and what diet they were on, and how
Can you remember
anything about the diet?
I can remember
that there used to be a line diet - a diet called a line diet - and the
diabetic had to have so many of these lines a day. That was to balance the food, and, of course,
it was without sugar and all that sort of thing. But, it‘s funny; I was talking to somebody
only the other day about this, and somebody that they knew was still on a line
diet. And I was quite amazed, after all
these years. But we used to manage the
diets much as it‘s managed now: withdraw sugar and a lot of the fattening
stuff, keep the diabetic‘s weight down, and made sure that they didn‘t eat
anything that was any sugar in.
(4) Did whatever infectious illness they have
alter their intake of insulin?
Oh yes; a great
deal, sometimes. If they were
hyperpyrexial - had raging temperatures - that used to have great bearing on
the diabetes. They were having to have a
lot more insulin, and they had to be monitored almost every hour to make sure
that the diabetes was kept as stable as it could be. If not, then they‘d go over into a coma.
Were you trained
in the advance warning signs before somebody fell into a coma?
Yes. We were... as the diabetics came in, we were
told how much insulin they were on. And
in our junior days, of course, we weren‘t allowed to give insulin - it had to
be given by a senior person, because, well, at that time, insulin was quite a
new thing. We were taught how to watch
for hypoglycaemic comas, and call for help as soon as we saw anything happening
- sweating or clamminess - and then the sister or the doctor would come along
and sort the insulin out again, take blood tests. A lot of blood tests were taken then. I don‘t say more than there are taken now,
but different, because most of it had to be intravenous. Now, of course, it‘s so advanced, the patient
takes the blood out of their own thumb, which is much better.
And what about
Well, of course,
everybody‘s urine had to be tested every day, but the diabetics‘ was tested
four times a day. And any fluctuation,
of course, had to be reported immediately, because then, again, insulin had to
be looked into. So, it was a very
complicated nursing case, really, to have a diabetic in.
Can you remember
anything about the urine testing?
For the urine
testing which was done every day, and some, for the diabetics, was done three
or four times a day, I seem to remember we used... we certainly used litmus
paper to see whether it was alkaline or acid, and, I think - I‘m not sure - I
think we used a solution called Fehling‘s. But I can‘t remember much about that now - it‘s a long time ago.
Well, after my
fever training, the war was on, and life to somebody young was a little bit
exciting, even though it was a war. And
I decided that a lot of the friends that I‘d trained with had gone down to
London to do their general
training, and I thought that was quite a good idea, I‘d go down too. I didn‘t realise just how wonderful it was
going to be, because, of course, in the middle of the war, we were right in the
and I saw far more than I ever thought I would see. But I did my training.
That was from
1943 to ‘45, ‘46. Now, because I‘d done
my fever training - that was two years and three months - instead of having to
do four years general training, they used to cut it down to two and a half
years general training, because we‘d got the extra qualification, which was
quite good. General training was a very
mixed bag. It was very good training,
because, of course, we had war casualties as well. I saw, there, quite a lot of diabetics coming
in as casualties, and also coming in with other problems, for ops and other
medical problems to be dealt with. And,
of course, their diabetes, again, had to be dealt with. Things were improving slightly then. When I say improving, I mean there was a lot
of research going on into diabetes and insulin, and it was more
manageable. Patients were getting less comatose,
because now we were managing to get the insulin better controlled. And we didn‘t have, at that time, we didn‘t
have an insulin called protamine zinc, which was a longer lasting insulin; we
only had the soluble insulin. But when
the protamine zinc came in, we were able to mix the two insulins, so that
instead of giving the patient two or three injections a day, we need only give
them two: one in the morning and one in the evening. And as long as their diet was watched very
carefully, and the patient behaved - we always had to take this into
consideration - they really did quite well, on the whole.
What do you mean
"if the patient behaved"?
Well, not all
patients are terribly good about their diets. Even
(6) now, I‘ve got several friends who are diabetics,
and if they can go off the rails a bit and make it all right for themselves,
they do. And it was even more so in
those days, because patients didn‘t... had to be taught just how serious diabetes
was. Now, I think, the patients are told
that, you know, you can live a perfectly healthy normal life and get on with
things, as long as you do the things that you should with your diet. But in those days, of course, it was still a
very serious thing that had to be coped with, as well as live as normal life as
possible. They didn‘t always behave with
their diets, and so, of course, we used to have several patients that we got,
in the end, to quite recognise as they came through the ward door, back again,
because they hadn‘t been eating the right thing, or they hadn‘t been perhaps
having their insulin at the right time.
referred to as the ‘badly behaved‘ patients?
Nobody ever said
a patient was badly behaved! But we knew
they were sometimes. And, of course, it
was difficult for them, in those days, because diabetes being treated as
successfully as it was, was in its infancy. So, patients still had the idea that if they were a diabetic, they‘d die;
and they didn‘t.
Can you remember
that, that people thought they were going to die?
When I first started
training, yes. Between the time I knew
that little boy and I went… I started my training, patients… diabetics did die,
because they only had to get a severe infection, which tipped over the diabetes,
and it was out of control. They went
into a coma and they died. I do think
that from the time that I knew this little boy, who died when he was seventeen,
things had improved with the diabetics, because when I was doing my general training in ‘43, ‘45, we were...
diabetics were living and managing to live a reasonably normal life, if they
behaved. The diabetics who were in the
greatest danger of all were the diabetics who became pregnant.
Do you remember
many of those?
Oh, yes. I didn‘t see quite so many when I was doing
my general training, when I did my part one midwifery to follow, because we did
part one midwifery for six months, so I didn‘t see a great deal of diabetics
then. But I saw a lot when I was at
Maternity Hospital, because one of our consultants had specifically a diabetic
clinic, which he ran with the diabetic physician, the Professor of Diabetes,
(7) Before we move on to your midwifery
experience, can you tell me what hospital you were in for your general
Yes, I was at St
Mary, Islington, Hospital, which was a London County Council hospital. When we were in training, the first day we
went onto the wards, we were given a large sheet of paper, which was our schedule.
It was all marked off as to all the procedures that we would learn and have to
do while we were doing our general training: things like treatment of bed
sores, catheterisations, dressing of wounds, making patients comfortable in
bed, doing the bedpans, doing the bedpan round, observation of the bedpans,
which nobody ever does nowadays. And
then, when we had done this particular job, at the end of the day we would take
our schedule to the sister of the ward, and she would sign it. And then we would keep this schedule until we
sat our exams. And this schedule went
with us to the exam, and the examiners were able to check that we had done all
these procedures that was expected of us during training. It was quite an effort, really, to remember
to get all these things in, because it depended upon the ward that you were on
as to how much experience you got. Some
wards you got a lot of... if you were on a genito-urinary ward, you got a lot
of experience with catheters and care of catheters, and care of patients, and
inserting of catheters - male and female - and observation of bladder problems,
and... So, you wouldn‘t get, perhaps, so
many injections to be given. You‘d learn
that on another ward. And so it went on. Each ward you went on, you gained more
experience. So, you had to watch your
schedule very carefully, because, at the end of the day, if there was something
you hadn‘t done and you were examined on it, you didn‘t know anything about it.
At what stage in
your training would you have injected someone with insulin?
didn‘t inject a patient with insulin until you were about a second or third
year nurse, student nurse.
Let‘s move on
now. What did you do after you completed
your general training in Islington?
Well, I stayed
on at St Mary‘s, because they were also a part one midwifery training school, and
so it was easy for me just to switch over. And it was quite a good training school - it was recognised very well as
one of the better training schools. So,
I stayed there for a further six months and did my midwifery training. But, before we were accepted, you didn‘t,
just because you‘d got your state registration, slide over to the midwifery. You had to go before the matron and the
medical officer of health and be interviewed to see if you were suitable, even
though they‘d trained you to do further training with them. Fortunately I was, so I did it!
(8) After I did my part one, not a lot of nurses
went on to do part two, but I did. And I
did it in a small hospital called The Limes in
in 1946. Part two was six months, and
there you were trained… you had three months in the hospital learning how to
deliver a baby, which you already knew about, but without assistance. Nobody of seniority was there. You were really being taught to deliver
babies on your own, ready to go out on the district. And the second part of the second part was
three months on the district, on your own, with just the doctor or the senior
midwife on call. And then, after that, I
went as a staff midwife to the
that was in 1946. I didn‘t stay there very
long - I didn‘t like it. And then I took
a post as midwifery sister and night sister at a little hospital called Crosshouses,
and I was there from ‘46 to ‘49. Didn‘t
see a lot of diabetics there, because
used to take most of them, and they were kept there. Then I went on to
and I was there from ‘49 to ‘55. And
after that, I came to... I got a post as outpatient sister in
Maternity Hospital, and I was there from 1955 to ‘63. And there I saw a lot of diabetic patients, because
until then - it was dreadful - but diabetic patients used to come in, and we
knew very well that they would invariably have a stillborn baby, because the
result for the baby in a diabetic patient was nil. But
Street, there were two consultants there who
specialised in diabetes in pregnancy, and they were very successful at getting
live babies. And these patients were
brought up to the hospital every week to be checked, and then, when the time came,
it was usually… they brought them in a little bit prematurely, and they had a Caesarean
section. They were not allowed to go
into labour. And, I should think, eight
cases out of ten, they had a living baby, which was great for everybody
Had that not
been the case when you‘d been at Dulwich previously?
(9) Until then, I‘d never seen a diabetic come
away with a living baby. And they were
always huge babies, very big babies; at least ten pounds. There was something about the diabetes and… I
don‘t know. But they were quite
successful at the maternity hospital at
Can you remember
the name of those two consultants?
Yes, I can. One was Professor Malins - he had clinics at
the other one was Dr Samuel Davidson - he was the obstetrician. And between them they ran the specialised
diabetic clinic. All the diabetics that
pregnant, all went on to the Thursday morning clinic, when they were seen by
both of these men. They were very, very
And you were at
Loveday Street from
1955 to 1963. What are your own memories
of treating mothers with diabetes during that period?
Well, of course,
things were getting better. You didn‘t
regard the mother with the same dread that you did before, because you knew
that the chances were now, with these two men, and the care that they would
receive anyway - not that they didn‘t have good care elsewhere, they did - but
the end results here were so much better that it was easier to talk to diabetic
patients and give them a lot of hope.
What did you do
when you were in Dulwich, and you, as you say, dreaded meeting a diabetic
mother? How did you talk to her?
Well, of course,
most of the mothers knew, because they‘d already been warned by the GP to try
not to become pregnant, because, if they did, the end result would be a
stillborn baby. And many of them were
advised to adopt, if they could, and, of course, adoption was easier in those
days. But we knew, and the patient knew,
when they came in, and as soon as they were delivered, we had small rooms for
them so they wouldn‘t be near the other mothers with their babies. And we sent them home as soon as possible, to
be nursed at home. We thought that was
the kindest way.
(10) And what did you do after you left
Birmingham and the
maternity hospital in
hangs a tale, really, because we knew that the maternity hospital was going to
be knocked down in redevelopment and various other things, and that the
midwifery would be going up to the Queen Elizabeth. And I felt that I would like to do something
different, rather than... and it would have meant quite a little bit of travelling
for me through the city, which I really didn‘t want to do. So, I decided that I would go onto the
district and see how I got on there. When I applied to Warwickshire County Council, they would accept me, but
all their district nurses had to be Queen‘s Nurses. Now, this didn‘t always happen in every
county council, but
County was most insistent
that we were trained as Queen‘s Nurses. So, they suggested that we went to the Queen‘s Home in
Birmingham - Summer Lane, I think it was, yes
- and they seconded us. They paid our
salary for three months, but I was on a senior sister‘s salary then, and we
were only allowed to receive a first year staff nurse‘s salary for three
months, which was quite a bit of a hardship when you had to keep a house going
and a car, and all the rest of it. However, I went and I did my three months‘ training. And at the start of it, we were given a
handbook called "Outline of District Nursing Techniques", and in it
was all the procedures that we had to use on the district. And one, in particular, was how to teach a
diabetic to give their own injections. And
in each house - we used to check up every week on them - but they used to have
a tray specially cleansed, clean towels, a holder - a glass holder or an enamel
holder with the syringe in, sitting in spirit, having been boiled before - and
their needles. And, if they were mixing
insulin, you had to teach them how to mix the insulin, and then teach them how
to give their own injection. Some
patients did this very well; some patients ran a mile, so we had to go in and
give it anyway, every day. But, all the
detailed instructions are in this handbook, so you don‘t go wrong.
was 1963. What‘s the date on that
training was 1954, so it hadn‘t changed a great deal from ‘54 to ‘63, except
that patients were then beginning to be gradually taught to give their own
insulin, which, of course, was a good thing, in a way, because it made them
freer. Because when we, as district
nurses, gave the insulins, they had to wait for us to come before they could
have their breakfast, because insulin had to be given before breakfast. And, very often, I‘ve got up at six o‘clock
in the morning when there‘s been a patient going out on a coach for a day, had
to have their insulin and their breakfast early, and the coach had been calling
for them at eight o‘clock. We‘ve had to
get out and give them their insulin before they went, which we didn‘t mind
doing. But it was so serious that they
had their insulin before their breakfast and before they had any activity,
otherwise they‘d be in a coma on the coach.
(11) Any other memories from your Queen‘s Nursing
training in 1963?
remember that our caseload was very heavy. We used to go out with... I happened to hear somebody... I read
somewhere, recently - last week, I think - in the paper what a district nurse
does now, and really I felt I could do it quite easily these days, compared to
what I did then! We used to go out with
a diary with at least twenty visits, and, of course, you had to spend time
going between one visit and the next. Even if you were a car driver, it took time. And, every week, we had to have an inspection
round, so that one of the senior people - tutors - came round with us to every
patient to see that we were doing the Queen‘s technique as it should be done,
which was following the handbook and spreading plenty of newspapers on the
floor. We always had to ask the patients
if they had newspapers - they took a daily paper - because we‘d need the newspaper
to spread on the floor to save any drips, spills or anything else, because we
were responsible if we ruined their carpets or spoilt their furniture. So, that was... we had a round done every
week. And then we had a mini-exam
towards the end of the training, and then we had the Queen‘s Nurses‘ exam, at
the Council House, at the end of our three months‘ training.
You said that
the training took place in Summer Lane, and I happen to know that that was an
area surrounded by back to back housing. Were you visiting patients in back to back houses?
Oh, yes. We had quite a few patients in back to back
houses, because Summer Lane and... oh, I‘ve forgotten the name of the roads
now, but there were...
Street was one, yes, and they were nearly all back
to back houses, and one toilet did about four houses. And it was very difficult, but we managed to
do it. And people managed to look after
themselves very well in there too, considering what they have now, compared to
what they had then.
You talked about
the very demanding caseload. How did
that fit in with the rest of your life?
Well, of course,
when I was doing my Queen‘s training, it was a daytime training. It wasn‘t the same as when I came out onto
the district - we were on call. We
started work at
When did you get
I got married in
‘55. Unfortunately my husband died in
1957, so I went... I really didn‘t stop nursing. I was nursing when I was first married, and
then, when he died, I went really back to it, so I didn‘t leave it for any
length of time.
(12) Moving on, then. After your Queen‘s Nurse training, you worked
as a district sister from 1963 to 1982, so nearly twenty years. Can you talk about your memories from the
early years as a district sister?
Well, I loved
it. I mean, I‘d loved my time in
hospital, because it was all very exciting, and there was something going on,
new, every day in hospital. But it was
the same on the district, but in a quieter way. And we really did get to know patients very well indeed, because you
took a patient on, and you never knew how long you were going to have them
for. In some instances, one patient, I
had, I thought I was going to have her when I retired, but I didn‘t - she died
a couple of years before I retired. But
we did have long-stay patients. And we
had a great deal of variation, because we covered a tremendous amount,
really. I was the practice sister. We used to call them... We were practice sisters, then, in those days,
because we... When I first came out, we
used to do areas, so that we worked... any doctor that was working in our
specific area used to send in cases to us. But then, a great change came - about 1974, I think it was - and we...
they decided - ‘they‘, the great ‘they‘ - decided that it would be rather good
if nurses were attached to the practice; the main practice of the area that
they were in. And so we were called
practice sisters. And we used to go
wherever our own doctors went, then, which was a much nicer thing, because - I
thought - because you had your patient and you knew your doctor, and you were
in constant contact with your doctor, so it was a nice little closed shop, if
But what was it
like before you were attached to a practice? Where were you based?
Well, we worked
from home. Messages were sent in by
telephone to us. We had an office that
was run by the area nursing officer and the deputy area nursing officer. They were two senior people who looked after
the whole of the area. For us it was this
side of Warwickshire - we’re
aren’t we? - North Warwickshire, but our main headquarters was in
Warwick. So, all meetings were held in
Warwick, of importance,
but our work came from... we worked from home, and had to go into our local
office for any problems, or anything that had to be sorted out. But the practice nurse covered,
(13) until 1974, she covered midwifery, general
nursing - that was very sick patients who had to be completely nursed -
diabetics, dressings, baths, observation visits, and a thing called loans
visits, which they don‘t do now, and this is why it‘s costing the health service
so much. If a patient came out of
hospital with a loan - a walking stick or a wheelchair or a Zimmer walking aid
or a monkey pole on the bed - we had to go every three months and check that
that loan was, one, still being used; two, was in good condition, and if it
wasn‘t then we used to have to give notice for it to be called in. So, the loans were very seldom lost. Now I know of people who‘ve had loans for
years, and nobody‘s ever bothered about them; anything from wheelchairs to
walking sticks. So, that was part of our
work. I hated it, because it was very
boring, but still, it had to be done. Observation visits: they were visits that you just went to see - it was
usually the over sixty-five, seventies… Anyone could stop you in the street, in those days, and say "oh,
you know Mrs So and So", "Yes", "well, she isn‘t very
well", so you would go and see her. You didn‘t have to ask permission, you didn‘t have to ask a doctor. You just went to see the old lady, because someone
had told you about her. And if you felt
that she was in need of a doctor, or he was in need of a doctor, then you
reported it to the doctor and the doctor would go. So, we didn‘t lose patients by nobody knowing
anything about them, as does happen, sometimes, these days. They were observation visits - I always found
them interesting. Weekly baths,
fortnightly baths, we used to do. But
joy of joys, about five years before I retired, they gave us a bath nurse,
which lifted a lot of work from us, at that time. And she just did baths, and left us free to
do a lot of other things that we slotted in or perhaps had to make time for, so
that was a boon. Dressings, yes,
anything from post-operation to chronic ulcers, we would do.
Did you see many
We saw a lot of
diabetic ulcers, and toes, of course. Gangrene
was one of the diabetics‘ horrors. So,
when we went into a diabetic, it wasn‘t just to give insulin. We had to check thoroughly that they were
fit. But our diabetics, in my particular
(14) extremely lucky, because, once a year, the
hospital team used to come out to our practice and bring all their stuff, and
we used to go in. And there was an
evening when all our diabetics were seen by the professor, again, and his team
of medicos and the nursing staff. And we
used to go in to report our side of it, and what had gone on in the twelve
months before. So, they were kept a very
careful eye on; they were very well looked after. And general nursing, well, they were the patients
who were usually terminal or incapacitated in some way - severe arthritics that
couldn‘t manage to wash or dress themselves - and we used to go in and do it
for them. And, of course, when I was
doing midwifery, that all had to be fitted in. And when I think about it now, the instructions were, from headquarters,
which was Warwick, that if we were up two nights doing a midwifery case, we had
to ring in the third night and we would be relieved, so that we could get a
night‘s sleep so that we would be safe on the road the next day to drive. Amazing, isn‘t it? And that was my district work, and, as I say,
I loved it. A lot of paperwork to
do. We had to fill in forms; we had the
book to fill in - two books… three books, we had. We had our dangerous drug books that we used
for… because we used pethidine and morphia, sometimes, for patients - pethidine
for patients in labour, morphia for terminal cases - which had to be written up
into the DDA book; Dangerous Drug Act book. And then we had a book where we wrote all our midwifery cases up in
detail, and a book where we wrote our general cases up. And then we had a huge form, every month, to
send off to headquarters, saying how many general nursing cases we‘d done, how
many midwifery, how many diabetics, how many dressings, in detail. And then we kept a diary, every day, with all
our visits in, and our mileage, because I owned my car, so we got an allowance,
so you had to put in how much mileage you‘d done each day.
What kind of
patients with diabetes were you seeing? What kinds of cases?
On the district,
(15) Occasionally you‘d get a child; not very
often. But they were mostly elderly
patients, who, for some reason, could no longer give their insulin. They were either going blind, or perhaps they
weren‘t strong enough, or their arthritis was so bad in their hands they
couldn‘t manage it. So, we used to go
in. I used to have about, perhaps, five,
six, seven diabetics every day, and they had to be done first, because of breakfast. And then we would go on to do the general
nursing cares, because they were ill and had to be attended to fairly early,
and then we did the dressings. And it
depended on what the dressings were as to when they were done. If they were clean dressings - post-operative
dressings - they would be done early, and then baths would be done, and then
dirty dressings would be done last. Observation
visits and the hated loans visits would be done last of all.
These six or
seven people with diabetes that you saw every morning were obviously terribly
dependent on you, so what happened if you were ill, for example?
Oh, well, of
course, if I was ill or I was off, then my relief used to go in. We were al... There was a group of three, so that there were always… the nurse on... I
was on for the district, then I had my relief, who was usually the nurse on the
next district, and then we had a second relief, so that... And this used to work very much in midwifery,
because if I was out on a case, the next one would be on call. And if she‘d gone out on a case, which
sometimes did happen, then the third one would go out. And then if a case came, called in again, and
we were all out, then we used to have to ring in to headquarters, and they
would find somebody from somewhere to get up and come over. Happened to me many times.
You were dealing
mainly with Type 2 diabetes, I guess, in the elderly. Had you had any specialist training for that?
No, we just took
it as it came.
Can you remember
receiving any training regarding changes in diet for diabetes, or changes in
care for feet or eyes?
Well, of course,
we got that in our general training, because we were taught how to care for
diabetes right from the beginning, so, you know, it was a gradual learning
streak, really. And, occasionally, there
used to be a course to update us in something new, and very often diabetics
used to come up, so we would get all the new stuff that was coming in.
(16) Tell me a bit more about this annual diabetic
evening for all your patients with diabetes.
Oh, well, this
was quite a highlight in the year, because Professor Malins used to come out
with his team, and we used to see all our diabetics in the surgery. All those that were able to come all turned
up, and they had their urine tested and their blood pressure taken, and bloods
taken, and anything that was absolutely necessary. And they were seen and advised, and told when
to go to the hospital, because in the meantime, between each of the big visits
at the surgery, they used to attend the hospital to Professor Malins‘ clinic
there. So, he knew all the diabetics extremely
well. But we had some diabetics who
couldn‘t come - they were housebound. So,
bless his cotton socks, he used to take his team out with him to all the
houses. And I remember talking to him
one night, and I said "you must find it very tiring". He said "I love village work, and so I‘m
taking my team"! And he did; he
used to visit all the diabetics that were not able to come. And then, when he‘d done that, our lady GP
used to go home and prepare a great party for us, which used to go on till
Did his team
include a dietitian or a podiatrist?
No, not in those
days, it didn‘t. The dietitian was at
the hospital, because my mother was a diabetic, and she was under his care,
actually. And she used to see the
dietitian there, but I don‘t think she ever got her feet checked. But she was a late diabetic. She was in her late sixties when she became a
diabetic, and I remember I was horrified to think that my mother had become a
diabetic, after all these years of treating them. And the district nurse had to come in; very
independent my mother was. I used to
give - because I lived near home at that time - so, at the weekend, I used to
say to her "well, tell the sister that I‘ll be home at the weekend, so she
needn‘t come in to give you your injection. I‘ll give it". Well, I don‘t
know whether it was my giving the injection or sister giving the injection, but
my mother suddenly decided that she didn‘t see why she shouldn‘t give her own,
and she did until the day she died; very good.
Can you remember
what year your mother got diabetes?
It was while I was
working on the district. I remember
diagnosing my mother, because, of course, having dealt with so many of them,
when she started to tell me how she didn‘t feel terribly well, I said to a
friend of mine, who was staying with me at the time, "I‘m sure my mother‘s
a diabetic". So, I made her go to
the doctor the next day, and sure enough... oh no, I tested her urine. I said "give me a sample of urine",
and, sure enough, it was absolutely loaded with sugar. So, how long she‘d been a diabetic for, I
really wouldn‘t know. But that was
about... I suppose it must have been about 1968, probably, ‘69, because she
died in ‘73.
(17) So, looking back on when you first
encountered patients with diabetes in 1940, and when you retired in 1982, what
were the most striking changes?
Well, of course,
first of all, the most striking change is the number of insulins that there are
now. I mean, I‘m not up to date with
insulins, as such. I have a friend who‘s
a diabetic, and I just sort of vaguely keep up to date with her. But I know that there are so many insulins
available now. And when I compare with
what we had, which was soluble insulin and protamine zinc, and that was all we
had to work on. And it wasn‘t always
easy to balance it, to get a patient, for instance, out of a coma. In that respect, life for the diabetic is
very much easier. The other thing, of
course, is diet. We had to be very
strict about the diet, in every way. During the war, the patients who were in hospital, of course, were
looked after diet-wise, because it was so much easier to do. I was trained in a thousand-bedded hospital,
which was a vast hospital in those days - not compared to what they are now,
but it was vast - and so the diabetics could have the kind of food that was
necessary for them. But now, of course,
from what I understand, they eat pretty well a normal diet, providing they take
their own blood at the right time, and adjust their insulin accordingly. And, in some instances, they‘re giving
insulin twice a day. My friend is; she
gives it to herself morning and evening. But, from what I see of her, she seems to have a pretty normal
diet. And this goes without saying, I
think, to most of the modern diabetics now, so their life is very, very much
easier. The other, of course, thing is
feet. We were trained… because we were
trained to look after diabetics right from the beginning, and feet, of course,
were one of the important things we had to deal with. If we saw any change at all, a changed colour
of toe nail or foot or toe had to be reported immediately, because, invariably,
it was a gangrenous thing. And once it
started, in those days, it just didn‘t stop. And I have seen quite a few amputations up to the ankle, then to the
knee, and then to the thigh, simply because the gangrene was creeping up, and
they didn‘t seem to be able to stop it. Now you don‘t hear very much at all. Unless a patient does not look after themselves, and does not keep an
(18) eye on their feet themselves, then you don‘t
hear of very many amputations at all. And the… all the chiropodists are geared up and trained specifically to
look after the diabetic feet, and as soon as they see anything going wrong,
immediately it‘s reported and dealt with straight away. So, the life of a diabetic, I would say,
forty years on, is almost a normal life, except the inconvenience of having to
take that little bit extra care of themselves.
talked about knowing all your patients very well. Did that continue right the way through to
when you retired in 1982?
Yes. On the district, of course, things were
different in time stay. In hospital,
patients come and go; they do. They only come in for a short time and then
they‘re out. They didn‘t come in for as
short a time as they do now - I mean, I think they‘re in and out before you
even see the patient, these days. But on
the district, the patient was coming home to whatever their problem was. It was to be looked after at home for the
rest of time. So, you had your patients
a long time - I mean, until they died, very often. So, you got to know your patients extremely
well. You got to know the family; you
got to know what their problems were, if they had any. And you were able to help in many ways that
you couldn‘t help in hospital, which is put them on to the right areas to deal
with the problem that they had, or to get in social services to help you nurse
them better, or to get in touch with the GPs if they wouldn‘t. And, particularly in diabetics, to keep a
very special eye on them, and see that they went to the hospital when they
should have done, and gave their insulin. Or, if they were giving it themselves, you went in regularly to check
that they were and they weren‘t getting the dose wrong, because you‘d make the
patient, or least ask the patient to draw up the insulin that they were giving,
and you‘d check that they were giving the right dose. So, we did see our patients longer, and we
did get to know them better than when we were in hospital. And it was a nice life; I enjoyed it.
And is it your
impression now that people with diabetes get that kind of personal care?
Well, I‘ve been
retired twenty years, so things have changed, and I only know what I hear. And it seems to me that sometimes - sometimes
- care falls rather short of what I think it should, but that‘s only my own
personal opinion as a craggy old, retired district nurse!