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

by Ellen N. La Motte

Tuberculosis in Children. Although children become infected at an early age, it is often most difficult to obtain a diagnosis for them. The most competent specialist hesitates to pronounce a child tuberculous until he has repeatedly examined it, and kept it under constant observation—and even then he may prefer to call it “suspicious only.” By the aid of the eye test and the skin test he may finally arrive at a positive diagnosis, but even then, he may not be sure of the location of the lesion. The child, therefore, though diagnostically a positive case, is not necessarily an infectious one.

All these doubts and difficulties in connection with the diagnosis of tuberculosis in children serve to show that in a way this question may be called a negligible one, negligible, that is to say, as a menace to public health. It is important for the individual that a diagnosis be made, in order to do intensive work in upbuilding his resistance, but he is negligible as a distributor of infection. About ten per cent. of the visiting list is made up of children. On entering a home where there are two children, one tuberculous and one not, the nurse’s efforts should be concentrated on separating the two—the emphasis being placed on the care of the one as yet uninfected.

The question frequently arises, Should these tuberculous children be sent to school? Is it well for them as individuals, from the standpoint of their own health, and is it well for those who are thrown in contact with them? This decision rests solely with the physician, and can be made by him alone. As far as danger to others is concerned, it must be remembered that while a person may be tuberculous, he is not necessarily infectious, and it is upon the infectiousness of a case that the danger depends.

It is difficult to care for these tuberculous children. Most nurses become deeply distressed because of this. The children are frequently undisciplined, and their parents often weak and lacking in self-control. The nurse becomes discouraged and annoyed when she sees her directions unheeded or disobeyed. But, after all, these cases constitute but a minor part of the problem, and they are not patients who do much harm. It is sad to stand by and see the individual throw away his chances, or to see them thrown away for him—but this standing by is part of the work.

Open-Air Schools. During the past five or six years, open-air schools or classrooms have been established in several of our large cities. This is an excellent affirmative answer as to whether a tuberculous child should attend school. At these places, careful, systematic attention is given the child for several hours a day. Non-tuberculous children are also admitted—they may be called pre-tuberculous, since they are anæmic, run-down, undernourished children, who come from homes where tuberculosis exists in active form. For such cases, the open-air school does excellent preventive work, in raising the child’s resistance to a point where it can cope with the exposure at home. These open-air classes are always in charge of a physician and a nurse; their management does not come within the range of this discussion, any more than does that of the hospital or the sanatorium.

The public health nurse must always take advantage of these schools, if they exist, and must see that her children are sent there. She must avail herself of every agency and of every opportunity which will improve or secure the welfare of those under her charge.

Schools of this kind are extremely valuable, but are not the solution of the tuberculosis problem, any more than the sanatorium for the early case is its solution. Both of these institutions deal with results, not causes. To fight tuberculosis, we must strike deep at the cause—the advanced case who scatters the disease. Open-air schools always make a strong appeal to people—it is easy to obtain money to support them, and easy for public sentiment to exaggerate their value in the anti-tuberculosis campaign. Since the public mind generally grasps but one idea at a time, it is not well to dissipate its facile interest on side issues. When a community has established on adequate scale the machinery for combating tuberculosis, it may then establish such effective allies as the open-air school. But to bring them on first, before the fundamentals, is to misdirect public sentiment, and to place the cart before the horse.

The Danger of Sending Patients to the Country. Sooner or later, the nurse will be called upon to decide whether the tuberculous patient shall be sent to the country. This will be urged by earnest, well-meaning people—and sometimes by social workers who should know better. Needless to say, this policy calls for strong condemnation. Whatever good the patient himself might gain from going to the country, must be offset by the fact that the disease is spread elsewhere. To create new centres of infection is not the result at which the tuberculosis campaign is aimed.

In his own home, under immediate and constant supervision, it is difficult to obtain from the patient anything better than relative carefulness. To get even that requires unceasing vigilance and continual training, both of the patient and of his family. Therefore, to free him of this restraint by sending him to a distant farm, would mean his immediate relapse into carelessness, and a danger to those among whom he is quartered. To send a consumptive into another household is to send him where he may infect other people. Pity for the patient should not obscure our interest in his possible victims.

Moreover, the welfare of the patient himself is not as a rule secured by this method. These journeys to the “country” are usually to out-of-the-way little farm-houses, with various shortcomings both as to food and accommodation. They are often anything but satisfactory places for a sick man; or, if they happen to possess advantages, the patient may not know enough to use them. In making these statements, we are not speaking entirely at random, or from general surmises as to probabilities. A few years ago, we had on our visiting list some fifty-five patients who went to the country for the summer. They were in all stages of the disease, and it is well to note, in this connexion, that it is usually the advanced case who is most anxious to get away. Of the fifty-five cases, two were really benefited by their sojourn; thirteen were temporarily improved, but lost it all within a few weeks after their return; thirty-two came back to town worse than when they went away, and eight died while in the country.