Chicago . Municipal Tuberculosis Sanitarium. Dispensary Department

“ Great care should be taken in instructing and demonstrating to the family how to properly care for the room. Special attention must be given to the bed, its comforts and its cleanliness. Every nurse is familiar with what is known as the "Klondike" bed, and it is unnecessary to discuss it here in detail. Since both patient and family derive such direct benefit from a constant supply of fresh air, too much attention can not be given to proper ways of securing it, and at the same time keeping the patient warm. ”

“ Realizing this, the nurse must kindly but firmly impress upon the patient the necessity of co-operation and the danger of infecting others and of reinfecting himself. She should at once create a more cheerful atmosphere by repeated suggestions that if he will only do his duty as a hopeful patient, he will not be considered a menace by those who come in contact with him, and his family will gladly associate with him. ”

“ Head Nurse, Stock Yards Dispensary of the Chicago Municipal Tuberculosis Sanitarium.
So far as our information goes, pulmonary tuberculosis has always existed. It is, as Professor Hirsch remarks, "A disease of all times, all countries, and all races. No climate, no latitude, no occupation, forms a safeguard against the onset of tuberculosis, however such conditions may mitigate its ravages or retard its progress. Consumption dogs the steps of man wherever he may be found, and claims its victims among every age, class and race." ”

“ Occurrence, then, of a subcutaneous tuberculin reaction does not indicate necessarily sanatorium or institutional treatment; neither does it absolutely indicate the necessity of tuberculin treatment. The decision rests on the consideration of all the clinical features of the case.
In the absence of any symptoms or physical signs of disease, a reaction should call for regulation of every day life, tending to increase the state of general resistance (improvement of nutrition, etc.) frequently without discontinuance of work. ”

“ Dr. Philip of Edinburgh was the first to systematically and completely organize the anti-tuberculosis campaign. In 1887 he inaugurated that new institution, the anti-tuberculosis dispensary, which has since rendered such inestimable service. The fundamental principle of the Edinburgh system is that the disease should be sought out in its haunts.
The first dispensary in the United States was opened in New York in 1904, modeled after the Edinburgh system. About the same time came the Open Air Schools—Charlottenburg establishing one in 1904 and Providence, R. I., following in 1908. ”

“ A thorough study of the history, thorough physical examination, examination of sputum (if any) give sufficient data for a reliable diagnosis in the vast majority of cases.
2. Cases, with uncertain symptoms or inconclusive physical signs, pointing to possible existence of tuberculous infection, may be treated as "suspicious" cases (without resorting to subcutaneous tuberculin test) , the treatment consisting of rearrangement of mode of life, diet, work, etc., that would tend to increase of general resistance of the patient. This can and should be done in the vast majority of suspicious cases. ”

“ Three or four nurses are on duty in the clinic each morning, taking histories, attending nose and throat room and preparing patients for examination. At the dispensary only a medical history of new patients is taken, the social history being obtained by the nurse on her first visit to the home. Pulse, temperature and weight are also taken at the dispensary, after which the patient waits his turn for examination. Each new patient is given an examination in the nose and throat room; old patients also, if necessary. After examination or treatment, all patients return to the general waiting room. ”

“ It does not tax the imagination unduly to conclude which is the more accurate, the answers to questioning by a trained worker (we have selected for this work the two nurses who have been with us longest) who in addition takes the temperature, pulse, etc., herself, and usually succeeds in getting the patient back to the dispensary for at least one re-examination; or such answers as a patient may see fit to make to a printed questionnaire. ”

“ Each case of tuberculosis reported to the Department is turned over to a nurse, who visits the physician to see whether or not he wishes the help of the Department. If he does, the nurse instructs the patient and family, arranges for the patient's removal to a sanatorium upon the physician's advice, attends to disinfection of premises and examination of remaining members of family. If the family is in need of material relief she arranges for a pension. All returned sanatorium cases are kept under the supervision of this staff. ”

“ In hemorrhage, a cold diet should be given, such as milk, eggs, gelatin and custard. The nurse must insist in absolute rest and the patient should not be permitted to move until the danger of bleeding is over. Nervousness always accompanies hemorrhage, and the nurse can do much to allay this by assuring the patient that few people die from hemorrhage. ”

“ Flowers always add to the attractiveness of a room, and when the bed is placed near the window the patient is given the opportunity of enjoying, to some extent, at least, the pleasures of out-of-doors. The mattress should be provided with a washable cover. Strips of muslin sewed across the tops of the blankets will protect them from sputum, in case the sheets happen to slip. Soiled bed linen must be handled as little as possible, soaked in water, washed separately and boiled. If sputum-covered, it should be soaked in a five per cent solution of carbolic acid or a solution of chloride of lime. ”

“ The organization of the Tuberculosis Study Circle among the nurses of the Dispensary Department of the Municipal Tuberculosis Sanitarium, calling forth the best efforts of the nurses in getting information on various phases of tuberculosis for presentation to their co-workers in an interesting manner has, no doubt, stimulated the progress of our entire nursing force. ”

“ In addition, meetings of the active nursing staff are held, informal talks on tuberculosis being given, or the work of allied organizations studied, speakers coming from the Associated Charities, Department of Health, Settlement Houses, etc. Each nurse is held responsible for the handling of every individual case in her district. By thus making the nurse responsible, the interest in her work is increased and much better results are obtained. If the problem presented is one that will take more time and energy than the busy dispensary nurse can give, it is referred to a Special Case Committee. ”

“ Each nurse keeps a complete index of all cases of pulmonary tuberculosis in her district, which is at all times accessible to nurses and physicians at the clinic.
In the Department of Health clinics, the plan is as follows: a supervising nurse who does no district work, and several field nurses, each assigned to special duties on clinic days, such as registration room, throat room, examining rooms, etc. Field nurses are also responsible for the care of patients in their sub-districts, each nurse carrying an average of about 125 patients on her visiting list at one time. ”

“ Painted walls are inexpensive, and they have the further advantage that they can be washed frequently. The floor should be bare and likewise frequently washed. Simple furniture is commendable, and old pieces can be made very attractive by having them enameled. Proper furnishings include a comfortable bed (one made of iron and raised on wooden blocks makes nursing care easier) , a bedside table, chairs, a rocking chair, a washstand, and even a couch on which the patient could be placed occasionally to relieve the monotony. ”

“ Ordinary tents hold odors. They are often very hard to ventilate; for a strong draft is produced when the flaps are open. There is no ventilation 33through the canvas, as it is impenetrable by currents of air. In order to make a tent comfortable for a sick person it should have a large fly forming a double roof with an air space between, a wide awning in front where the patient can sit during the day, a board floor laid at least a few inches above the ground, and the sides boarded up two or three feet from the floor. ”

“ Usually by a little persuasion, however, we can get the patients to go to the dispensary in their district, co-operating in this way with the Phipps Institute of the University of Pennsylvania, the Gray's Ferry State Dispensary, the Kensington Tuberculosis Dispensary and the Frankford State Dispensary. The section of the city from which we draw our cases is divided, for purposes of inspection and Social Service Work, into three districts with a nurse assigned to each, and this gives each of our nurses, roughly speaking, about seventy-five patients per month to take care of. ”

“ The nursing staff consists of a supervising nurse and six field nurses, the latter receiving $720 per year. They wear no uniform. They give a limited amount of bedside care, some member of the family being taught to properly care for the patient, if he cannot be sent to a hospital. Recently an additional nurse was engaged by the Association to follow up cases on whom no diagnosis has been made and who have not returned to the dispensary for re-examination. ”

“ Where it is necessary that the family should move, the nurse should assist in the selection of a new home. If possible, a detached house should be chosen, affording plenty 38of light and sunshine, away from dusty streets and roads. Offensive drains and other insanitary conditions should be avoided. The water supply should be abundant and the plumbing in good repair.
The room of the patient should be well lighted and well ventilated, and preferably have a southern exposure. Cross ventilation is very desirable. ”

“ Louis Society for the Relief and Prevention of Tuberculosis has a staff of seven nurses, a social service department, a relief department, and an employment bureau. Conferences of nurses and workers are held three times a week, the social workers assuming the various problems met by the nurses in their daily work. St. Louis nurses carry on an average 100 patients each, about 25% being bed cases. Nurses are in uniform, and receive from $60 to $75 per month. Patients report to the City Dispensary or to the Washington University Dispensary, and the usual plan of home supervision is in force. ”

“ The Providence school is at present a part of the general school system. The school supplies and teacher's salary are furnished by the Board of Education. Food and carfare are supplied by the League for the Suppression of Tuberculosis. A physician is delegated by the League and one of the regular Medical Inspectors of the city schools works in co-operation with him.
Providence has at present two schools, with an attendance of forty. One more Open Air School and two roof classes may be provided by the Board of Education in 1914. ”

“ The nurses of the Tuberculosis Division are graduate nurses and are registered. They are paid $75 a month, with car fare and telephone expenses, and are allowed two weeks' vacation with pay. They are not required to take a Civil Service examination, but are carefully selected with a view to obtaining women of a high grade of efficiency. They wear uniforms of blue denim with simple hats and coats, but not of uniform design. Each nurse wears under the lapel of her coat a badge reading "Nurse—Baltimore Health Department," which she uses on occasions. ”

“ The underlying and controlling belief of the Chicago Tuberculosis Institute has always been that no great progress can be made in the campaign against tuberculosis, or in any other reform movement, until the soil is sufficiently prepared. ”

“ Next comes the concrete problems which the nurse must solve. That of proper housing of the patient is one of the most important, and especially so in the case of the advanced consumptive, because of the greater danger of spreading the infection if the conditions are unfavorable. ”

“ Probably the best argument for maintaining such schools was not only the physical benefit derived, but the actual advance made by the children in their studies, although they spent less than half as much time on school work as did their companions in the regular schools, not only fully maintaining their standing, but ever surpassing their companions in the regular classes. ”

“ A cabin is most desirable for the roof. In its construction it is best to use a wooden frame for the foundation. It can then be moved and its position and exposure changed easily. This frame should be made of 2×6-inch planks laid flat on the roof. The upright frame and siding boards for the back and sides should be of 2×4-inch timbers. The front of the cabin should be left open, but arranged with a canvas curtain tacked on a roller so that it can be closed in stormy weather. Tar paper is used for the roof. When completed, the framework should be braced to give firmness. ”

“ It is needless to say that the experiment created a great deal of local interest in the problem of better school ventilation. Those who had the success of the movement most intimately at heart realized, however, that the undertaking lacked the element of permanency and that the results accomplished by it lacked that degree of conclusiveness which would attend the same results if secured through the operation of an all-the-year-round school. ”