A nurse contracts tuberculosis on the job, 1944-45.

In our post-HIV/AIDS era, health care professionals know well the risks of infection and the need to practice universal precautions with all patients. Awareness of the dangers of infection grew in the late nineteenth century, although it had long been clear that caring for the sick entailed the risk of becoming ill. Moreover, prior to the development of antibiotics, nurses and others ministering to the sick contracted fatal and/or debilitating illnesses that had few or no effective treatments. Historians know little of these experiences. Constance Mally (pseudonym), a nurse working in the Sydenham Hospital, Baltimore, Maryland, in the 1940s was one such professional: she contracted tuberculosis when caring for patients. Letters about one part of Mally's experiences in the History of Medicine Division of the National Library of Medicine allow historians to explore a small part of the risks facing nurses working with patients suffering from contagious illnesses. They can also provide an important teaching tool to help students explore the complicated and complex historical dimensions of one particular experience. Baltimore's Health Department ran Sydenham Hospital for the isolation and treatment of communicable diseases. From 1909 until it closed in 1949-in large part because of the widespread use of antibiotics-the hospital had an average daily population of sixty patients, many of them children, with scarlet fever, smallpox, poliomyelitis, diphtheria, pneumonia, whooping cough, meningitis, syphilis, measles, chickenpox, and other contagious diseases. Patients stayed for weeks and sometimes months, nursed back to health with rest, a careful diet, and any available medical treatments. Hospital policy called for chest X-rays of new employees, and when Mally arrived at the hospital in September 1942 her lungs were clear. As the following letters reveal, within a few months she likely contracted tuberculosis from caring for a patient with fulminating infection and a tracheotomy tube. The patient died. A few years later, X-rays revealed a cavity in Mally's lung. Sent to a sanatorium in 1944, she underwent several operations and seemed to improve. Parts of Mally's experience are revealed in a set of letters exchanged between the hospital's medical director, the director of the city's Bureau of Tuberculosis, and the superintendent of the Maryland Tuberculosis Sanatoria. The letters do not make clear whether Mally fully recovered, left the sanatorium, and resumed her nursing career, although they suggest that such stren uous work after discharge would have been hazardous. They do reveal, however, how the hospital negotiated Mally's sick pay. Then, as now, hospitals kept a careful watch over their expenditures, balancing their need to support the workers who put their lives on the line with the interests of those paying the bills, in this case the taxpayers of Baltimore, who, through their elected officials, kept a tight rein over the budget. These letters also offer a window into other themes and issues in health care when analyzed within a broader context. Readers of these letters as well as those teaching history might want to use them to consider what has changed in hospitals, patient care, and medicine since the 1940s-and what has stayed the same. Here we would need more about the institution, about the work of nurses caring for contagious patients, and about the medical treatment of specific illnesses. Materials are available. The records of the Sydenham Hospital itself, including the correspondence regarding Mally, are located in the History of Medicine Division of the National Library of Medicine (for an online finding aid, see http://www.nlm.nih.gov/hmd/manuscripts/ead/sydenham.html). A brief history of the Sydenham hospital can be found in "Baltimore's Sydenham Service for Hospital Care of Communicable Diseases 1909-1924-1949," Baltimore Health News, July 1949, 147-57; and an analysis of tuberculosis nursing can be found in Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia: University of Pennsylvania Press, 1992). …