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

by Ellen N. La Motte

There are certain ways, however, in which danger from the home threatens people who live outside, people in no wise connected with the patient, and unaware of his existence. This occurs when the patient leaves his home to seek employment in the community, or when he makes or handles certain articles which go forth into the community as carriers of bacilli. Infections of this sort may be termed accidental. They are infrequent as compared to house infections, but infrequent as they are, they should be prevented.

In Baltimore, nearly fifty per cent. of the patients under supervision are able to work. They seek a livelihood in office, factory, shop, hotel, and private home. We also find that nineteen per cent. of the families under supervision carry on some sort of gainful occupation within the confines of their own homes. As a rule, the patients who conduct these little home industries or occupations are more advanced cases than those able to find employment in shops and factories. In some instances, this home industry was carried on before the patient became ill; in others, by far the greater number, it is the direct result of an illness which has modified his earning power and compelled him to eke out a scanty income by this means. In many cases the actual work is not done by the patient himself but by some other member of the household. Sometimes these industries are not dangerous to other people, or the risk is so slight as to be negligible. At other times, the menace is grave. Each case must be considered upon its individual merits—one must not generalize and condemn in wholesale fashion.

Sewing and Sweatshop Work. A number of our patients are dressmakers, or do factory sewing at home. Much has been written about the danger of clothing made under such conditions, either by the patient himself or by other members of his family. This output is not as dangerous as many people suppose, although such an admission would deprive the campaign of much picturesque photography. Much of this clothing is of washable material, such as cotton shirts, blouses, overalls, and the like, therefore any germs they might carry would be removed in the first washing. The danger has also been exaggerated in the case of woollen materials, such as coats, trousers, etc. Any organisms contained in these articles would soon die, or their virulence become so attenuated that little harm would result. This also applies to artificial flowers. It is not the occasional dose of bacilli, conveyed in this or any other manner, but the large and repeated implantations which do the damage.

Infected clothing doubtless plays considerable part in the spread of the acute contagious diseases, such as measles, diphtheria, and scarlet fever, but in tuberculosis the risk is so slight that it may almost be called non-existent. Under such conditions, the danger is not to the wearers, or probable buyers, but to workers who make this clothing while in contact with the consumptive himself.

Food. There are other home occupations about whose danger to the public there can be little doubt. Many patients keep small grocery stores, confectionery shops, and lunch rooms, and prepare and handle foodstuffs of all kinds. Again we must discriminate. The consumptive who sells tinned foods (which he does not handle), or meat, fish, or vegetables which are cooked before they are eaten, is not necessarily spreading disease among his customers. On the other hand, he who sells and handles milk, cream, ice-cream, bread, cake, candy, and so forth, is a decided danger to all who buy his wares. The alimentary tract is one of the main portals of entry for the tubercle bacilli, and every precaution must be taken to prevent the contamination of food. The patrons of these little shops are the people of the neighbourhood, who are regular customers, and their health is endangered not by occasional but by repeated doses of germ-laden food.

Milk and Cream. There is an ordinance in Baltimore forbidding the sale of milk and cream in a house where there is an infectious disease; this includes tuberculosis. In order to sell milk, it is first necessary to obtain a permit from the Health Department, but this permit may be revoked whenever occasion demands. If the nurse finds that one of her patients is selling milk (as is often done in connection with a small grocery business), she reports this fact to the Health Department. It may be that the patient himself never comes near the shop, and is out at work or away all day. This sometimes happens, but not often. Usually he waits upon the customers himself, selling milk in penny amounts, with a dirty finger inside the measuring cup. Or he may be too ill to attend the shop, but sits or lies in an adjoining room, so that his wife may wait upon him and upon the customers alternately. Under such conditions, the danger may be almost as great as if he himself handled the milk, since she does not take time for proper cleanliness.

To revoke a permit usually occasions considerable hardship, and the reduction of an already pitiful income. Yet summary measures must be taken unless the milk is sold without risk to the purchasers. The patient should be removed to a hospital, and the family must choose between letting him go and giving up the permit. When there are no hospital facilities and the permit must be withdrawn, leaving the family under financial stress, the nurse should ask assistance of the Federated Charities. This assistance, however, should never be offered as an alternative to removing the patient to a hospital.

There are other foods besides milk and cream liable to contamination, the sale of which is not controlled in any way. Thus as we have seen, while a consumptive may be prohibited from selling milk, he may sell ice-cream without let or hindrance. And furthermore, an ice-cream cone or “snow-ball,” handled by dirty, germ-laden fingers, is most often sold to the most susceptible of all customers—the child.

Lunch Rooms and Eating-Houses. Many patients earn their living by keeping eating-houses, oyster-parlours, ice-cream saloons, and so forth. There is danger to the customer whenever the cooking and serving of food are done by a consumptive, or by those in contact with a consumptive. A community to be well protected should enact comprehensive legislation controlling every aspect of the food supply, and special emphasis should be laid upon the handling of food by those with a transmissible disease.

Laundry Work. Another home occupation is laundry work—unskilled labour requiring no capital and largely resorted to, especially among negroes. This is heavy work, hence not always done by the patient, but often by some other member of the household. Whether the patient irons the clean clothes or sits coughing in the same room where this is done (we have often seen newly ironed clothes spread upon the bed of a last-stage case), the result is much the same. Under such circumstances clothes become contaminated. Since this sort of laundry work is usually done for regular customers, they week after week wear clothing that has come from an infected house. It is dangerous to sleep constantly on pillow cases that have been coughed on by a consumptive, and to use towels and napkins that have been subjected to a like infection.