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

by Ellen N. La Motte

Suppose there are no hospital facilities, and it is necessary to keep the patient at home. In this case, the most susceptible members of the household, namely, the children, should be removed. To place out children is a difficult matter, since it is hard to get the parents’ consent; this can be done, however, with time.

If this turns out to be impossible, relief may be given on condition that the strictest precautions are observed. This assistance may be given as long as both patient and family follow rigidly all directions given by the nurse; failure to do so should be a signal for the withdrawal of all aid. To assist the patient who has no choice but to remain at home, means to give relief under the least favourable conditions, but it must answer when there are no hospital facilities. When such facilities exist, no alternative should be permitted. When a family reaches the point where outside interference—social interference—is needed, we think it not unreasonable that this assistance should be given upon terms which tend to promote, rather than diminish the welfare of its members.

Wrong Conditions of Relief-Giving. Relief is sometimes given in a way that makes it defeat preventive work, and tends to create new sources of infection. For example: we recall a case in which the father of a family was in the last stages of consumption. His wife took in washing, and was general drudge for the patient and five small children. This man refused to go to a hospital, and also refused to use his sputum cup, or take any other precautions. Most of his time was spent in bed, and beside him in the bed were his two small children, whose presence gave him pleasure. Neither doctor, nurse, nor agent could bring about a better state of things, yet the family was desperately poor and in great need of help. In consequence, assistance was given upon the patient’s own terms of being allowed to carry out his right to infect his family. Groceries were given in large amounts, and the patient himself was supplied with abundant milk and eggs, which kept him alive for weeks beyond the point where his own manner of living would have ended the matter. Soon after his death, one of the children died of tubercular meningitis, while his wife developed a pulmonary lesion. All the family are now public charges.

We recall another case: The family consisted of the patient, his wife, and eight children. The patient was grossly careless, declining to observe the slightest precautions, and flatly refused to enter a hospital. After his death, his wife and five of the eight children were found to have tuberculosis. During the last six months of his life, a certain agency had poured in unceasing relief, thereby subsidizing a centre of infection.

Still a third case is that of a widow, with two small children. She would not part from these children, and refused to go to a hospital, or to let them go to the country. A separate bed was provided, so that for part of the time at least the children might be away from her, but she declined to let them occupy it. She kept them in bed with her. Neither would she use a sputum cup nor follow advice in any way. All this time, some benevolent old ladies kept her well supplied with groceries, milk, eggs, coal, rent, and so forth, by means of which assistance she was able to drag out a moribund existence for eight or ten months. Pitiful as this case was, the utter selfishness and immorality of this sort of “mother love” is something which should repel rather than attract the sympathies of thinking people.

These are perhaps extreme instances, yet in a lesser degree this is what usually happens unless relief is made conditional upon removal of the danger. Charitable associations should be careful not to act as accessories in the spread of tuberculosis, and should not prolong conditions under which this is practically inevitable. If centres of infection are thus perpetuated, through sources over which the associations in question have no control, nurse and agent, at least, should not countenance such “benevolence.”

Incidental Assistance. There are many occasions when the nurse should ask for relief, and when this should be freely and generously given. When a patient enters an institution, it may be necessary to pension his family during his absence; assurance of their welfare will enable him to leave with an easy mind. Unless such provision is made, we are threatened with the alternative of seeing him sit at home, unable to work, but engaged in the minor though highly dangerous occupation of caring for the children while his wife goes out to service.

Relief may also be of a temporary nature. While a patient waits for admission to a hospital he may be too sick to remain alone at home. This may mean that his wife, the breadwinner, is forced to give up work in order to care for him. Assistance should be given during this waiting period, after which time the wife will return to her employment and the family affairs readjust themselves.

Again, we may have a family in which the patient himself is the only one who needs help, the income sufficing for all ordinary demands, but not for the extraordinary demands of illness. While awaiting admission to an institution, it may be necessary to give him extra food, extra clothing or bed clothing, an overcoat, railway fare, or something of like nature, either to make him comfortable, or to facilitate his removal when the time comes. The patient must not be allowed to suffer during this enforced wait, but this assistance must not be interpreted as encouragement to remain at home.

In the foregoing instances, relief has been conditional upon removal. We must sometimes give assistance under other circumstances. If there are no hospital facilities, or if he will not avail himself of them, we are doing good preventive work if we give the patient an extra bed, since this may result in his partial separation from the children or other members of the household. Extra clothing may also be given under like conditions. On the other hand, if we gave milk and eggs to the patient, we should be supplying food which would maintain indefinitely a centre of infection. (Good preventive work may be accomplished by ample feeding of the other members of the household, thus increasing their resistance. In this case we should be sure that this food is taken by the children, or by those for whom it was intended, since otherwise it would be wasted.) Let us put the matter very frankly: it is wrong to prolong a patient’s life, unless at the same time we can make him harmless to those about him. If the two are coincident, well and good. If not, then the shorter the exposure, the better for all those who must submit to it. We repeat what was said at the beginning of the chapter: the patient on the poverty line is surrounded by a group of individuals whose vitality is at a very low ebb. Our first duty is to protect these individuals.