London, 4 June, 1914.
CONTENTS
| CHAPTER I | |
| PAGE | |
|---|---|
| Statement of the Case—Beginning the Work—Reaching the Patients—Supervision of the Work—Necessity for Experienced Nurses | [1] |
| CHAPTER II | |
| The Nurse’s Training—Health—Hours Off Duty—Afternoons Off—Character | [11] |
| CHAPTER III | |
| Salary—Increase of Salary—Carfare—Transportation—Telephone—Vacation—Sick Leave—Uniforms—Badges | [20] |
| CHAPTER IV | |
| Object of Work—Districts—Hours on Duty—Number of Daily Visits—The Nurse’s Office—Lunch and the Noon Hour—Bags—Prophylactic Supplies—Cups, Fillers, and Napkins—Disinfectant—Waterproof Pockets—Books of Instruction—Stocking the Bag and Distributing Supplies—Nursing Supplies | [33] |
| CHAPTER V | |
| Records and Reports—The Patient’s Chart—The Card Index—Nurse’s Daily Report Sheet—Weekly and Monthly Reports—Examination of Charts—Taking the Patient’s History | [48] |
| CHAPTER VI | |
| Finding Patients and Building up the Visiting List—Increasing the Visiting List—Social Workers—Dispensaries—Patients’ Families and Friends—Nurses’ Cases—Physicians | [61] |
| CHAPTER VII | |
| The General Practitioner and the Public Health—Responsibility of the Private Practitioner in Tuberculosis—Impossibility of Fulfilling this Obligation—Failure because of the Nature of Tuberculosis—Failure because of the Personal Equation | [74] |
| CHAPTER VIII | |
| The Nurse in Relation to the Physician—Municipal Control of Infectious Diseases—The Nurse’s Difficulties—A Waiting Game—Undiagnosed Cases—The Nurse’s Responsibility to the Ethical Practitioner Only | [87] |
| CHAPTER IX | |
| Obtaining a Diagnosis—The General Dispensary—Sputum Examinations—Tuberculin Tests—Registration of Cases | [105] |
| CHAPTER X | |
| Prevention of Tuberculosis—Sources through which Calls are Received—Entering the Home—Telling the Truth to the Patient—Truth for the Family—Disposal of Sputum—Danger of Expired Air—Isolation of Dishes—Linen, Household and Personal—Disinfectant and Other Supplies—Phthisiphobia | [117] |
| CHAPTER XI | |
| Inspection of the House—The Patient’s Bedroom—Porches—Gardens and Tents—Flat Roofs—Clothing and Bedclothing—Artificial Heat—Rest—Fresh Air—Food—Cooking—The Bedridden Patient | [136] |
| CHAPTER XII | |
| Care of the Family—Examination of the Family—Taking Patients to Dispensaries—Children—Tuberculosis in Children—Open-Air Schools—The Danger of Sending Patients to the Country | [154] |
| CHAPTER XIII | |
| Disinfection of Houses—Value of Fumigation—Formaldehyde—Housecleaning—Burning and Sterilizing—Boiling—Carpets, Rugs, and Mattings—Painting, Papering, and Whitewashing—Temporary Removals—Vacant Houses—Concessions—Compulsory Cleaning | [169] |
| CHAPTER XIV | |
| The Tuberculosis Dispensary—Equipment—Medicines—Hours—Consideration for 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 a Community Asset | [184] |
| CHAPTER XV | |
| The Nurse in Relation to the Institution—Reports Made to the Institution—Procuring Patients for it—The Value of the Sanatorium—Sanatorium Outfit—Return from the Sanatorium—Work for the Arrested Case—Light Work—Outdoor Work | [203] |
| CHAPTER XVI | |
| Hospitals for Advanced Cases—The Careful Consumptive—Chief Duty of the Nurse—Responsibility of the Institution—Home Care of the Advanced Case—Exceptions to Institutional Care—Compulsory Segregation | [218] |
| CHAPTER XVII | |
| The Problem of Relief-Giving—The Relief-Giver—Co-operation between Agent and Nurse—General Rules for Nurses and Agents—Conditions of Asking for Relief—Wrong Conditions of Relief-Giving—Incidental Assistance—Withdrawal of Relief—Milk and Eggs | [230] |
| 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—The Consumptive Outside the Home—Cooks—Personal Contact in the Factory—Supervision Outside the Home | [252] |
| CHAPTER XIX | |
| Municipal Control of Tuberculosis—The Danger of “Political” Control—“Politics” in Co-operating Divisions of the Health Department—Results in Baltimore—Tuberculosis and Poverty | [273] |
The Tuberculosis Nurse
CHAPTER I
Statement of the Case—Beginning the Work—Reaching the Patients—Supervision of the Work—Necessity for Experienced Nurses.
Statement of the Case. Pulmonary tuberculosis is a communicable disease, transmitted from person to person by means of the tubercle bacilli contained in the sputum of infected patients, or in the breath expired during paroxysms of coughing. The bacilli thus liberated, find their way into the system of another individual, either through the respiratory or alimentary tract, or both. The enormous prevalence of tuberculosis is due to the fact that its infectious nature was not recognized until 1882 when Koch discovered the bacilli. Since that time it has been classed as a transmissible disease, and during the past ten years a vigorous effort has been made to eradicate it. This agitation is popularly known as the anti-tuberculosis campaign, and associations for the suppression of tuberculosis have sprung up in all parts of the country. So far, no serum or vaccine has been found by which this disease may be controlled, as was the case when smallpox and diphtheria were checked. The sole way of overcoming it is to overcome the ignorance concerning its nature, its transmissibility, and the means by which it is spread.
At the beginning of the campaign it was believed that simple education along these lines was all that was needed to obtain results. These results were expected to follow as soon as the patient was informed of the nature of his disease, and how to avoid spreading it, and as soon as those in contact with him were given like information and taught how to avoid infection. Ten years ago, in the optimism of the moment, tuberculosis was freely proclaimed a “curable” disease; so that together with the campaign of prevention went a campaign of teaching the patient how to become a “cured,” or as we now call it, an arrested, case. The mechanics of cure were equally simple—rest, fresh air, and food were all that was needed, provided the disease was taken in the early stages. And all that was necessary for “cure,” just as all that was necessary for prevention, was to tell the patient what to do, and those about him what to do, and the thing was done. This is the theory upon which the work was founded, and in theory this is still a sound principle upon which to continue it. Unfortunately, a series of unlooked for conditions interposed themselves between this theory and our ability to put it into practice. At the time when the crusade was begun these conditions were not recognized, and it is only through long study of the situation, from its social, economic, and legal as well as clinical aspects that we get some idea of the difficulties and complexities of the task before us.
In the first place, tuberculosis is largely a disease of the poor—of those on or below the poverty line. We must further realize that there are two sorts of poor people—not only those financially handicapped and so unable to control their environment, but those who are mentally and morally poor, and lack intelligence, will power, and self-control. The poor, from whatever cause, form a class whose environment is difficult to alter. And we must further realize that these patients are surrounded in their homes by people of their own kind—their families and friends—who are also poor. It is this fact which makes the task so difficult, and makes the prevention and cure of a preventable and curable disease a matter of the utmost complexity.
People of this sort, however, constitute almost the entire problem—otherwise the situation would be so simple that the word problem would not apply.