Compulsory Cleaning. In most communities, fumigation is compulsory. But there is no regulation whatever concerning the after-care of the premises—the cleaning, sterilization, and destruction of infective material. The relatively unimportant part is obligatory, while the essential part is optional. And that this essential part is done, and well done, depends almost entirely upon the teachings of the public health nurse.
If, however, the family remains obdurate, refusing to clean and disinfect, nothing can be done. Since it is now generally acknowledged that fumigation falls far short of what it was once expected to do, we need laws making adequate disinfection compulsory; until such laws are enacted, we can only rely on the ability of the nurse to teach the necessity for cleaning and disinfecting. How valuable is this teaching may be gathered from these figures (Report, 1913, Tuberculosis Division of the Baltimore Health Department): “After death: houses cleaned, 80 per cent.; bedding, etc., either burned or sterilized, 70 per cent.” With adequate laws, the nurses would make even a better showing.
CHAPTER XIV
The Tuberculosis Dispensary—Equipment—Medicines—Hours—Consideration of Patients—Function of the Dispensary—The Physician’s Service—The Physician’s Qualifications—The Physician and the Patient—Duties of the Nurse—Tuberculin Classes—The Nurse in Home and Dispensary—The Nurse as an Asset to the Community.
The Tuberculosis Dispensary. No community can make definite progress against tuberculosis until it establishes a place where suspicious patients may be sent for examination and diagnosis. Unless this disease be promptly and definitely recognized, it is impossible to give advice, or take authoritative action concerning the treatment of the patient and his family. If in connection with the dispensary there was also a corps of municipal physicians, who could visit the patients in their homes, and examine all suspects called to their attention, diagnoses could be obtained even more promptly. As it is now, considerable interval often elapses between the time when the patient is advised to go to a dispensary and the time when he follows this advice. The existence of a corps of visiting physicians would prevent such delays. The patient would be allowed a reasonable time in which to present himself, at the expiration of which period he would be sought out by the officer of the municipality. This prompt recognition of tuberculosis would save the community from an enormous amount of exposure. The time may yet come when Departments of Health will see the wisdom of such measures.
Until that time, the special dispensary represents the only means of obtaining a diagnosis; it is the only place where patients may freely be sent, and where an expert and frank opinion may be had. Such a dispensary may be established in connection with the general dispensary of a hospital, or by the local Health Department, or it may be supported by the same group of people or association which supports the special nurse. In Baltimore, we have had dispensaries of all three kinds, and the nurses have worked in connection with each one, on exactly the same terms.
Equipment. The great tuberculosis dispensaries run in connection with the large hospitals and medical schools are usually very completely and elaborately equipped. They contain large waiting rooms, examining rooms, special rooms for the giving of tuberculin, for X-ray examinations, for throat examinations, for laboratory work, and so forth. All these are needed in teaching centres, where it is necessary to collect certain scientific data. But for the purpose of making an ordinary physical examination a simpler equipment will do equally well.
In Baltimore there are several small municipal dispensaries, all under the control of, and managed by, the Department of Health. They are situated in different parts of the city, readily accessible to the patients of different localities. Each dispensary consists of two or three rooms, which are in the same building which houses the Federated Charities, and other social agencies. This arrangement has several advantages, from the point of view of both economy and co-operation. To have rented similar rooms in another building or in a private house would have meant a much greater outlay of money, to say nothing of the opposition encountered in obtaining the use of these rooms for dispensary purposes.
The furnishings of these little municipal dispensaries are extremely simple, but they lack nothing of comfort and convenience. The outer or waiting room contains two or three dozen chairs, or benches to accommodate an equal number of people. A corner of this room is screened off for the nurse’s table, where she keeps her charts and records, and writes the patients’ histories. A couple of filing cabinets, a medicine closet, and a pair of scales complete the outfit.
