Of these fifty-five removals, it is safe to assume that fifty-five centres of infection were established in consequence. The families where they were quartered were doubtless unaware of the nature of the disease, or how to protect themselves in any way. Nor is it likely that any of these fifty-five farm-houses were afterwards properly cleaned or disinfected. It was of course impossible to follow the results in these scattered centres of infection—remote counties of Maryland and Virginia—but we succeeded in doing so in one instance out of the fifty-five. In this case, the patient had gone to a farm in Virginia; as a result of his visit, three members of a hitherto healthy family became infected, all of whom have since died, as well as the original patient, the “city boarder” who carried infection among them.
Of course, if patients insist upon going to the country, nothing can prevent them, although the nurse must do her best to dissuade them. One patient who had a large airy room in town, decided that she would be better off on a farm. She was questioned as to conditions at the farm, and it transpired that she was to occupy an attic room, with one window, and that this room was to be shared with three other people. It then became an easy matter to dissuade her from going. It is not always thus easy to deflect them. Should they insist, they should be given plentiful supplies, and if the nurse can obtain the address of the family where they are to stay, she should send full information as to the patient’s condition. It is a regrettable fact, but when a patient is removed from surroundings where his condition is known, he is apt to discard his sputum cup and all other precautions by which he is rendered conspicuous.
We cannot be too emphatic in refusing to send consumptives to the country. If a sanatorium or day camp is not available, they would better remain in the city. If the patient has money, he cannot of course be prevented from going. If he has no money, no appeal should be made for funds to send him away. To ask for money for such use is a wrong the public health nurse should have no hand in. Her business is to prevent scattering infection, not to aid in it.
CHAPTER XIII
Disinfection of Houses—Value of Fumigation—Formaldehyde—House-Cleaning—Burning and Sterilizing—Boiling—Carpets, Rugs, and Mattings—Painting, Papering, and Whitewashing—Temporary Removals—Vacant Houses—Compulsory Cleaning.
Disinfection of Houses. One of the most important of the nurse’s duties is her arrangement for the fumigation and cleaning of premises that have been vacated by a consumptive. This takes place after death, or upon the patient’s removal to an institution, to another house, or to another room in the same house.
Since tubercle bacilli are not confined to the sputum, but are discharged in great numbers during coughing attacks, and to a less extent during sneezing, speaking, and so forth, a patient not confined to one room, but who wanders freely about the house, scatters bacilli everywhere. No matter how careful he may be about the sputum, the nature of the disease makes it practically impossible to be equally careful about the expired air. Moreover, these organisms do not die of themselves, at the end of a few weeks. They are singularly tenacious and persist for months, virulent and active. A case is recorded in which they were found in a room six months after the patient’s removal, alive and virulent enough to cause tuberculosis in guinea-pigs inoculated with them. For this reason it takes drastic measures to rid a house of these tenacious germs.
In indicating the rooms to be fumigated, it is necessary to include all those that have been occupied by the patient within the past six months. If he dies in his bedroom, it is not enough to do merely that one room. It is equally necessary to fumigate the kitchen, in which he sat until two months ago; the parlour, where he spent a few hours a day, and the second bedroom, to which he was now and then removed. All are infected, and all need the utmost care to free them from germs. The family must be taught why these rooms are dangerous, and made to understand the necessity for full and complete disinfection. It is better to err on the side of too much, rather than of too little care.
In Baltimore, the actual fumigation is not done by the nurses, but by the employees of the Fumigation Division of the Health Department. The nurse indicates the rooms, instructs the family, and makes all the preliminary arrangements, after which she reports the premises to the fumigator, who disinfects them next day. It would be well if this fumigation could be done by the nurses or by a special corps of nurses; this would probably ensure more intelligent and conscientious work than that which the average city employee bestows upon this important task.
As a matter of routine, every death from pulmonary tuberculosis is reported to the Tuberculosis Division; the nurse in whose district this death has occurred then inspects the house and arranges for the fumigation. Four times out of five the patient is already known to us and already under supervision, which makes the duty easier than if he were unknown. In either case, however, the nurse visits the home and arranges all the details.