Except through sterilization, there is no way in which these articles may be made safe. Carbolizing will not do this, neither will sunshine. Valuable as sunshine is, it is difficult to secure prolonged exposure, especially in tenement districts. It is possible, of course, to take a mattress apart and wash and boil the ticking; feathers or hair may be sent to an upholsterer, who has means of steaming them. Pillows may be put into a large wash-boiler, and boiled for half an hour, after which they may be washed—it will take a week or more before they become thoroughly dry and usable. All these alternatives involve a great outlay of time and energy, and we cannot but feel sceptical as to the thoroughness with which this cleaning is likely to be done. A family which objects to parting with dangerous articles, and prefers risk to inconvenience or deprivation, is hardly likely to be scrupulous as to details of this character.
In Baltimore, before the advent of the steam sterilizer, the amount of material burned was never more than a third of the amount which should have been burned. Still, under the circumstances, we were thankful to have achieved this third. Since the establishment of the sterilizer, we now succeed in getting over two thirds (70 per cent.) of the infective material sterilized. This is a triumph for the nurse’s teaching, since there is no law making sterilization compulsory.
Boiling. Everything which can be boiled will of course be made safe, whether these articles be of wool, linen, china, rubber, etc. Even blankets may be boiled, although the family will object to this on the ground that it shrinks them. The nurse must explain that not to boil them may have consequences even more disastrous. The nurse must never permit her patients to make indiscriminate bonfires, and wantonly destroy harmless articles, or those which may readily be made so. We know one family which destroyed a whole set of dishes, not from painful association, but from a misdirected desire to do the right thing. For this reason, the nurse must look over all articles carefully, giving thoughtful counsel as to the proper disposition of each.
Carpets, Rugs, and Mattings. As the sterilizer cannot be used for carpets, rugs, and mattings, there is nothing to do but advise that these articles be burned. As a rule, this destruction is agreed to with more readiness than in the case of pillows and mattresses.
Painting, Papering, and Whitewashing. Whenever possible, the rooms used by a consumptive should be repapered, painted, or whitewashed as the case may be. The more thorough and complete the measures taken to eliminate tuberculosis, the greater the chances of success. It is a costly disease, and costly measures, both as to money, energy, and time, are required to get rid of it. Half-way methods are poor economy.
Temporary Removals. The foregoing directions apply mainly to those cases in which the patient has either died, or has been permanently removed elsewhere. If his return is not expected (as when an advanced case enters the hospital), the amount of cleaning, burning, repapering, etc., would naturally be as great as that required after death.
On the other hand, when his removal is but temporary and the patient expects to return home after a few months, the amount of disinfection would be considerably modified. When he enters a sanatorium, his house must be fumigated and cleaned, so that for a few months at least the family may be relieved of danger. Under such circumstances, it would not be necessary to counsel the destruction of the mattress and bedding that he is to use upon his return. Meanwhile, no other member of the family should use these things, although in certain instances it is almost impossible to prevent their doing so. For such cases the municipal sterilizer is needed—indeed no community can make much headway against tuberculosis until it provides a means of removing the danger without causing loss to the individual.
Vacant Houses. When a family’s removal leaves a vacant house, there is naturally no one left to do the cleaning. The Health Department will do the fumigation, but the more essential house-cleaning remains undone. These houses often stand idle for weeks or months before finding a new tenant. Even if it were possible to discover the landlord or owners (a task which in itself would require a staff of employees), it is doubtful whether they would clean these houses themselves, or notify their new tenants of the need for extra vigilance. Legislation compelling house-cleaning would be difficult to put through. The landlord feels relieved of all responsibility when once the fumigation is accomplished, and that this fumigation is not a hundred per cent. effective is no concern of his. He, together with the general public, has been misled as to its true value. Nor is thorough cleaning, painting, and papering an expense that he would willingly incur. The question of the fumigated but not necessarily safe house is one that causes considerable anxiety. We feel that the only way to deal with it, is that the nurse keep these vacant houses on her visiting list, so to speak, and watch for the time when they are re-let. This entails considerable loss of time, which she can ill afford to spare from her patients, but the information she can give the new tenant will have distinct preventive value. She must tell the newcomer that he has moved into a house in which there has been tuberculosis, and that only by the most exact and painstaking efforts can it be made safe.
Concessions. In carrying out this important work, the nurse sometimes becomes so enthusiastic that her common-sense gives way under the strain. She wishes to carry her point, without fully realizing the prejudices, ignorances, sometimes even the comfort, of the family she is dealing with. After a death, she comes upon a household in a most upset, distressed, and often irresponsible condition, and she must be very gentle and patient in her relations with them. She must accomplish what is necessary, without undue disturbance of their prejudices and feelings. For example: Orthodox Jewish people observe a mourning period of several days following death, during which time they wish to remain undisturbed. Fumigation should be postponed until this time is past. A few days’ delay will not injure the health of a family which has been exposed to infection for months. By thus respecting their religious customs, it will be possible to gain better co-operation as to cleaning and so forth; co-operation which would have been jeopardized by riding roughshod over their feelings and beliefs.
Sometimes people raise objections because they have nowhere to go for the six hours required for fumigation, during which time they must leave the house. If there is no kindly neighbour to take them in, the nurse may arrange with a Settlement or other social agency, to give them shelter. We have often asked for hospitality in this way, and have always met a ready response. Sometimes, if a house is a large one, it is possible to have it fumigated in sections, a few rooms being done one day, a few the next.