The Tuberculosis League Hospital of Pittsburgh was opened in 1907 for incipient and advanced cases, with a capacity of eighty beds. The League conducts at present a night camp, an open air school, a farm colony, a post-graduate course for nurses and tuberculosis clinics for medical students at its dispensary. There is also a post-graduate course in tuberculosis for nurses. The course requires eight months and nurses receive during that time $25 a month. Only registered nurses are accepted. The training is along the following lines: nursing advanced cases in hospital, open air school work, sanatorium care of early cases, service in dental, nose and throat clinics, and in the dispensary for ambulant cases, district nursing, service in baby clinics, educational work, and laboratory work. Patients discharged from the hospital, families of patients in the hospital, and cases reporting at various tuberculosis dispensaries, are given complete follow-up care by the nurses taking the course, thus giving them excellent training in public health work, especially that phase of public health nursing dealing with tuberculosis. At present there are nine nurses taking the course. The Dispensary of the Tuberculosis League employs six nurses.
Pittsburgh has also a State Department of Health Tuberculosis Clinic, with ten nurses, each caring for from 90 to 100 patients per month. These nurses give a small percentage of bedside care and are not in uniform, except when on duty in the dispensary. They are paid $70 per month. The plan of work is similar to that of the Philadelphia State Dispensary.
The Department of Public Health of Pittsburgh employs four visiting nurses, who investigate home conditions and instruct patients reported to the department who are not under the close supervision of a private physician, the State Department Clinic, or the Tuberculosis League Clinic. The nurses are able to correlate, in a way, the work of the two dispensaries by assigning patients to the clinic in the district in which they live. They receive $75 per month and are not in uniform.
Pittsburgh, then, has in all twenty visiting tuberculosis nurses, under three separate and distinct organizations.
CLEVELAND
In Cleveland, as in nearly every other city, the work of organizing the fight against tuberculosis was accomplished by private organizations, the Anti-Tuberculosis League and the Visiting Nurse Association. For a number of years the Health Department confined
itself to keeping a card catalogue of reported cases. In 1910 sufficient funds were voted by the City Council to enable the establishment of a separate Bureau of Tuberculosis, whose duty should be the development of municipal tuberculosis work. This Bureau has taken over and gradually developed five dispensaries, with a staff of twenty-four visiting tuberculosis nurses, and paid physicians, besides the director and office force. The work in Cleveland is centralized in its Health Department.
General dispensaries are required to refer all cases of tuberculosis to the tuberculosis dispensaries, and physicians are required to report all cases to the Health Department. On report cards and sputum blanks is the statement: "All cases of tuberculosis reported to the department will be visited by a nurse from this department unless otherwise requested by the physician." With very few exceptions the physicians are glad to have a nurse call, and every effort is made to co-operate with the physicians in handling the case.
The city is divided into five districts, with a dispensary located in each district. Patients are treated only at the dispensary serving the district in which they live. "This plan prevents cases wandering from one clinic to another and enables the nursing force to do more intensive work in each district."
Once a week the chief of the Bureau of Tuberculosis and the Superintendent of Nurses meet with each separate dispensary staff, and cases are carefully considered and work discussed. In addition, meetings of the active nursing staff are held, informal talks on tuberculosis being given, or the work of allied organizations studied, speakers coming from the Associated Charities, Department of Health, Settlement Houses, etc. Each nurse is held responsible for the handling of every individual case in her district. By thus making the nurse responsible, the interest in her work is increased and much better results are obtained. If the problem presented is one that will take more time and energy than the busy dispensary nurse can give, it is referred to a Special Case Committee.