Withdrawal of Relief. When relief is given with the understanding that certain conditions be complied with, it should be withdrawn if this compact be violated. The nurse is in a position to know of any breach of faith, and should notify the agent accordingly. The objection is sometimes raised that assistance given in this way is a bribe, or a threat, or a means of coercion, and is therefore wrong. This rather overstates the case. Let us say, rather, that under these circumstances we have in our hands a powerful lever, by which mountains of ignorance and prejudice may be removed. By the use of this lever, we can work quickly and well for the best interests of the family and the community. We constantly see families who are not on the poverty line, and over whom we have no control, yet who are equally obstinate, ignorant, and dangerous, and regret infinitely that we have no such lever as in the case of patients who are below the poverty line.
When asking for relief, the nurse must be sure that her patients will take advantage of it, and that she is not sending the agent on wild-goose chases. Patients have sometimes been supplied with cots, window-tents, reclining chairs, and other similar and expensive articles, which they subsequently declined to use. An indifferent, careless patient, unwilling to co-operate in any way, is not one for whom to demand such an outlay.
Milk and Eggs. Ten years ago, milk and eggs for consumptives was an integral part of the tuberculosis campaign. In those early days, they were considered as necessary as was fresh air itself. They were prescribed as a matter of routine, and if the patient could not afford to buy them, they were at once supplied by some charitable association. We have come a long way since then.
Attention has already been called to the fact that, in the past few years, medical opinion has undergone a great change as to the value of milk and eggs. This rich and highly concentrated food is considered far less advantageous than was at first supposed. By reason of their fat content (especially the case with eggs), they tend to cause indigestion, always a serious complication in pulmonary tuberculosis. For this reason, the old idea of living on enormous quantities of milk and eggs has been largely abandoned. Some sanatoriums do not give them at all—other food is substituted, equally nourishing but less apt to upset the stomach. Yet the idea that they are necessary for consumptives dies hard.
In Baltimore, there is now no question of providing them. During the past year, nearly five thousand consumptives passed under the supervision of the Tuberculosis Division; we asked that milk and eggs be given to only thirty-eight of this number. Of these thirty-eight cases, thirteen were advanced, waiting admission to a hospital; two were early cases, waiting admission to a sanatorium; nine were suspects, and extra nourishment was needed in order to facilitate diagnosis; and fourteen were chronic cases, to whom this diet was given as a valuable tonic.
Quite apart from their value, the real reason that we have ceased to give milk and eggs is because of our policy of removing the patient to an institution. The furnishing of this diet, or of anything else which tends to keep him at home, is something we do not endorse. We do not wish to place any premium upon the home, or to offer any inducements to remain in it. If our patient wants milk and eggs, we can send him where they may be had.
If there is no hospital for the tuberculous patient in a community which is able to furnish one, the maintenance of the patient by charity as a centre of infection, makes little difference, one way or the other. In this case, the absence of a hospital means that the community is merely sentimentalizing and pottering over the tuberculosis problem.
CHAPTER XVIII
Home Occupations of Consumptives—Sewing and Sweatshop Work—Food—Milk and Cream—Lunch Rooms and Eating-Houses—Laundry Work—Boarding- and Lodging-Houses—Miscellaneous Occupations—Summary—The Consumptive Outside the Home—Cooks—Personal Contact in the Factory—Supervision Outside the Home.
Home Occupations of Consumptives. Up to this point we have considered the patient solely in relation to his own family, or to those with whom he comes in immediate, constant contact. The people surrounding him are in their turn infected, transmitting the disease to others who in like manner are intimately exposed. Roughly speaking, all of this infection takes place within the four walls of the home. The home, therefore, is the centre of infection,—the focus from which tuberculosis radiates into the community. The further one is removed from this focus, the less the danger.