[2]. Baltimore is divided into sixteen nursing districts, with eight branch offices or sub-stations, for the use of the sixteen nurses.
The nurse’s office should be simply but comfortably furnished. It is used for several purposes—as a store room for supplies, and as a rest room, where she takes her lunch and spends an hour off duty in the middle of the day. The furniture should consist of a large writing table, which may also be used for a dining table; chairs, a lounge or couch, and a small gas stove or Bunsen burner for cooking simple meals. If there is no available closet, there will have to be a commodious cupboard for storing the prophylactic supplies. A large stock of these must always be kept on hand, so that the nurse may refill her bag before starting out again on her afternoon rounds. A telephone in the office, or at least in the same building, is of course necessary.
Lunch and the Noon Hour. It is not within the province of a superintendent to dictate to her nurses as to what they shall eat. The association, be it private or municipal, furnishes the office and the hour, but the nurse must provide her own lunch and select it according to her fancy. A word, however, in regard to this lunch. It should be as nourishing as possible, and should consist of such wholesome food as eggs, milk, cocoa, and so forth. If a nurse substitutes a pint of milk for a cup of tea or coffee, she is wise.
In addition to nourishing, wholesome food (in contradistinction to unprofitable pie and buns from the neighbouring bakeshop), a short period of relaxation on the lounge or couch is a wise way in which to spend a portion of the noon hour. In dealing with tuberculosis, food and rest are necessary to keep one strong and well, and no nurse can afford to trifle with her health when engaged in this serious work. On no account should the noon hour be cut short, no matter how little tired she may be. Better work can be done if one is well fed and rested.
Bags. The association which employs the nurse should also provide her with the bag for carrying the supplies. The kind of bag needed is a much discussed question. It should be strong, even though this necessitates its being heavy. There is no other way out of it—for unless the bag has the first qualification, strength, the weight of the supplies will soon wear it out. Very light bags are not practical.
The bags used in Baltimore are made somewhat like the ordinary Boston bag, about fourteen inches long, and of good black leather. They weigh a few more ounces than those used by other associations, but they last longer. It must also be remembered that the bag used by the tuberculosis nurse, no matter how heavy it is when she starts forth on her rounds, grows lighter and lighter as she goes from house to house, leaving the supplies. Thus, at the end of the day, when she is most tired, it is practically empty.
Prophylactic Supplies. The prophylactic supplies used for the patients consist of tin sputum cups, cardboard fillers, paper napkins, waterproof pockets, disinfectant, and books of instruction. The first three are of primary importance. The Health Department of a community usually provides these supplies, even when the nursing work is carried on by a private association. Thus, in Baltimore, where for six years the tuberculosis work was done by the Visiting Nurse Association, an arrangement was entered into between this Association and the State Board of Health, according to which, the latter paid for and provided the supplies which the nurses distributed. The only condition imposed was that each case should be reported to the Health Department, and that the Health Department should be constantly advised as to the number of cases under supervision. If no such arrangement is possible, then the private association supporting the nurse must be put to the additional expense of buying the supplies.
It is impossible to make the patients themselves pay for them. Naturally, they consider them a nuisance and a bother, and it is difficult enough to persuade them to use them, even when given free. The cost is not great, however.
| Tin sputum cups, (in lots of 5000) | 7 cents apiece. |
| Fillers, (in lots of 1,000,000) | $3.50 per thousand. |
| Paper napkins, (in lots of 5,000,000) | $.55 per thousand. |
| Disinfectant, | 10 cents a bottle. |
| Waterproof pockets | 4 cents apiece. |
| Books of instruction | 2 or 3 cents apiece. |
Disinfectant. The most expensive of the supplies is the disinfectant, which is also probably the least valuable. That used in Baltimore is a special preparation, consisting largely of creolin; it is put up in pint bottles by one of the large wholesale drug houses. For use, it is diluted in water, a tablespoonful to a pint, and used in wiping up floors, furniture, and so forth. It is of necessity too dilute to have much germicidal action, and the patients place far too much reliance upon its odor—which, to the ignorant mind, is of prime importance. Although we use this disinfectant, we prefer to teach our patients that better results may be obtained by the lavish use of hot water, brown soap, and a scrubbing brush, and that thorough cleaning of this kind is of more value than the most malodorous drug ever dispensed. Disinfectant to be of real use must be strong and powerful, and it is dangerous to distribute such powerful drugs promiscuously. Several of our patients have tried to commit suicide by drinking even the weak preparation that we gave them. On the whole, we believe that an anti-tuberculosis society would lose nothing by omitting disinfectant from its list of prophylactic supplies, and better results could be obtained by substituting a thorough grounding as to the value of soap and water.