“As it is not yet fully realized that the present epidemic afflicting us in these war times has caused the greatest need, and at the same time is accompanied by the greatest scarcity, of graduate nurses that has ever occurred, it is necessary to form a plan which may be adapted to any situation, as one community after another becomes involved:
“1. Graduate nurses must be used in such a way that their services be of assistance to the greatest number. This may be done by calling first upon all partially trained attendants, Red Cross workers, and then lay helpers, or any intelligent persons who are able to assist, and who will faithfully follow instructions. These latter must be instructed carefully in the essentials for treating patients, protecting themselves, and preventing the spread of infection, and be directed to make a simple record of their work each day, while the graduate nurses must move about rapidly to cover as much territory as possible if the cases are in private homes or in small groups, supervising the work of subordinates, instructing these subordinates, and following up their work. If the graduate is assigned to a hospital, the same plan should be used, i. e., nurses or lay helpers detailed to small groups of patients, with the graduate in charge. Thus an active graduate and subordinates who obey orders with military precision get actual results which cannot be obtained by attempts to furnish trained nurses to individual families or in quantity to hospitals.
“2. It is imperative that the lives and health of physicians, nurses and lay workers be conserved for service to the vast number afflicted. Accordingly in each hospital (emergency, tent-hospital or otherwise) or in each community which has been organized against the epidemic, a system should be devised to apportion the time and labor of all workers as equally as possible, according to the character of their work. All precautions against infection must be constantly observed, e. g., the wearing of gowns which cover the entire body; masks made by applying eight layers of surgical gauze, or two of butter cloth, to the convex surface of a wire tea-strainer about four inches in diameter, which is molded to fit the face from above the tip of the nose to below the point of the chin and secured to the head by tapes, (gauze changed every hour and boiled half an hour, sun dried and used over again); by the use of antiseptics, including careful cleansing of the hands after handling patients, before eating, etc., and care in destroying by burning or sterilizing infected material.
“3. Strict discipline (semi-military) is essential for saving time and insuring accuracy in receiving and executing orders. All personal differences and likes and dislikes must be absolutely subordinated to the general need. Those in charge of others should exercise judgment in issuing orders to other subordinates, being careful to avoid anything which may be unnecessary or a repetition. Subordinates will observe instructions of their superiors without hesitation or argument. Courtesy at all times on the part of every one concerned will result in reaching most quickly the goal upon which our every effort is bent—the checking, if possible, of this great public disaster and minimizing its crippling effect and death toll.
“4. Requests for aid from stricken communities should be made to the nearest representative of the Department of Health, who will refer it to the Physician in charge of the Emergency District. This includes calls for doctors, nurses, aids, materials and any other form of relief. The Department will make a supreme effort to satisfy all such needs as rapidly as possible. However, where these are at hand they should be obtained locally.
“5. The best emergency hospital is the tent hospital, where the patient may obtain fresh air for twenty-four hours and receive sunlight by being hauled out into the company streets during the day. Wooden shacks or lean-tos (like those used in T. B. treatment), the walls of which may be raised by hinges and pulleys to admit the air and sunlight, are excellent. Buildings without balconies or porches should not be used unless there is adequate room or window space. Open air schools are almost ideal; next to them are modern high schools with large grounds about them. Visitors should be excluded, except relatives of dying patients, who should wear gowns and masks during the visit.
“6. Encourage the people of the community who wish to do something for the sufferers but cannot nurse them, to make masks, gowns and other supplies, also broths or other forms of nourishing food. Traveling kitchens or food delivered from a community kitchen by motor cars are of great assistance to stricken families. A County Committee should be formed for the purpose of investigating and promptly relieving distress, financial or otherwise. This committee could enable wage earners to remain at their employment.
“7. All existing agencies (local government, organizations, societies, orders, etc.) should be co-ordinated so that there be no uncertainty or confusion as to what is needed and how to meet the need and no waste of personnel or repetition of instructions or starts upon unnecessary errands.
“8. In each district, which may include several Counties, there is a physician in full charge of the district, with permanent headquarters. There is also a supervising nurse of the district, whose headquarters should be the same as the District Chief’s, unless an emergency should make another arrangement desirable. All other Department officers are subordinates to these two representatives of the Medical and Nursing service respectively. Reports by wire or ’phone are required daily at 1 p.m. from Supervising Nurse, District Chief, and from each County Inspector at the Epidemic Headquarters, Harrisburg. These officers should arrange that all of their subordinates in the district report to them at a convenient hour prior to this time.
“9. It should be borne in mind that the District Chief and Supervising Nurse of each district are responsible for their entire district and cannot be spared too long in any one locality. Their movements will depend upon exigencies which may arise and orders from this office.