The Tuberculosis Nurse: Her Function and Her Qualifications / A Handbook for Practical Workers in the Tuberculosis Campaign

by Ellen N. La Motte

The family also needs careful instruction as to food and rest: food, nourishing and well cooked; rest, which should at least mean that at the end of a day’s work they do not exhaust their vitality in crowded poolrooms, dance halls, and saloons. The need of recreation is one of the fundamental needs of mankind, but there is a difference between that which refreshes and that which undermines the constitution. Whether this fatigue comes from work, play, or excesses of any kind, it is usually the worn-out individual who first succumbs to exposure. In all households there is great need for instruction along these lines. There are weary, indifferent parents, and heedless boys and girls whose ignorance of personal hygiene is profound. The fact that much of this teaching falls on apparently stony ground shows the need for redoubled effort—which will in time bear fruit. Those in contact with tuberculosis must be continually on their guard against it—disease does not, as a rule, attack those who are in sound health.

In this preventive work, the nurse will be greatly aided if she knows what agencies she can call upon to reinforce her instruction. She must be familiar with all the forces of social service, and know how to reach them, and how to place her families in touch with them. Just as she must have sufficient knowledge of dietetics to suggest rice as a substitute for cabbage, bread instead of pie; so must she understand the social agencies within call, and know what substitutes they offer for the things that she condemns. A great gain will have been made if instead of the poolroom, the young boy can be given the Settlement club or gymnasium; or instead of the saloon dancehall, the young girl can be offered that of the schoolroom or the church. The aim should not be to deprive, but to substitute. Preventive work consists largely in teaching how to substitute the harmless for the harmful, the healthful for the unhealthful. In some communities, no such agencies exist; in others, they are inadequate to the needs they try to fill. But if they exist, they should be called upon.

Examination of the Family. Every person constantly exposed to tuberculosis should be examined periodically, whether or not he presents symptoms. The nurse should endeavour to get all members of the patient’s household examined. This is sound in theory, but not always feasible in practice, especially when there are a large number of patients under supervision. When one is working with small numbers, with ten, twenty, or a hundred families, it might be possible to get every member of these households examined, but when one is working with large numbers it becomes proportionately difficult. In Baltimore some 5000 consumptives are annually dealt with by the Tuberculosis Division; if every one of these patients comes in contact with five other persons—a most modest estimate—that would give us a total of 25,000 people to bring forward for physical examination. This task would swamp our dispensaries and leave no time for anything else. After all, it is the positive rather than the potential cases which are a menace to the community. Thus, however much we may advocate the need for general examination of all exposed persons, this course has its drawbacks when it comes to actual practice. The best we can do is to get the suspicious cases examined. The examination of those who have no symptoms would furnish interesting statistics, but they are hardly dangerous enough to the community to warrant the outlay of time and energy.

To induce a patient to be examined often requires weeks or months of effort and persuasion. The less the apparent necessity, the more difficult it often becomes. If a person has no symptoms he will not go, and if he has symptoms, he is afraid to go, to a physician. Therefore, whenever it is possible to get exposed persons examined, well and good; when this is not possible, the nurse may confine her efforts to those with suspicious symptoms. One of the foremost requisites in this work is the ability to distinguish between essentials and unessentials, and having made the distinction, to concentrate on the most important.

Taking Patients to Dispensaries. Unless the nurse has abundance of time and a very light district, it is not well that she should spend time in taking reluctant patients to a dispensary for examination. To do this, means to give up from one to several hours, which she can ill afford to spend in this manner. Nor is it necessary to waste her expert service in this way—it is always possible to find some one willing to take these patients, some friendly visitor, settlement worker, or even a kindly, intelligent neighbour.

Children. It is conceded nowadays that people usually become infected with tuberculosis in the first ten or twelve years of life, or during childhood. The disease itself may or may not develop in later life, according to the circumstances or environment in which the individual is placed. It may light up later, if his resistance becomes lowered, or he is reinfected, and cannot carry the extra load. For this reason, it is a vastly important thing to protect children from infection, as well as to protect those exposed in childhood from later undue strain.

The children the nurse sees are usually those in contact with a tuberculous father or mother. What is gained if we teach the parent to sleep alone, and spend part of the time away from them, yet permit him at other times to remain in close contact with the children? Intermittent contact, repeated often enough, is as bad as constant contact. If a mother nurses, feeds, cooks for, and handles her child, there are untold opportunities of infection. If the parent is intelligent and unselfish, it may be possible to bring about a relative degree of carefulness, and a minimum exposure, but there is no such thing as adequate carefulness while these conditions continue. Among the very poor, where it is impossible to regulate living conditions, there is practically no doing away with the danger of infection.

Whenever the parents are sick, selfish, or ignorant; when the children are undisciplined and uncontrolled, and where the grind of poverty has reduced ethics to the most primitive basis, one cannot expect much. When a child is in constant contact with a tuberculous individual, no matter how careful that individual may try to be, there is always some danger. By the very nature of his disease, a consumptive cannot be a hundred per cent. careful. An adult living in contact with tuberculosis may be able to resist it, a child has infinitely less chance.

The only way to ensure absolute safety for the child is to remove it from the danger, or to remove danger from it. Either the child must be removed from the house, or the patient must be removed from the house, it makes little difference which. The patient may be sent to an institution, or the child may be sent to a relative, to the country, to a neighbour, or to one of the child-saving agencies that are to be found in most communities. We are aware that in advocating this policy we are advocating what is called by the unthinking “breaking up the home,” as if tuberculosis had not long ago preceded us in this. Sending away the parent or the child is merely a belated effort to save what is left of the home.

Whenever an institution is possible, the patient should go there. In many communities, however, there are no such facilities, or else their capacity is limited. In this case, the child is the one to be removed. This often becomes a matter of extreme difficulty, since it is hard to overcome the parent’s very natural resistance. In urging this separation, we are making a choice between two lives—one already doomed, and the other which may be saved from a similar fate.