Chapter II: Preface

During eight successive years the writer has been engaged in special tuberculosis work, first as field nurse of the Visiting Nurse Association of Baltimore, later as organizer and director of the Tuberculosis Division of the Baltimore Health Department. Entering the field in the pioneer days of 1905, she has seen the work pass through the struggling stages of private enterprise into the well organized, almost automatic grooves of the city machinery. This continuity of service has been an experience of unique value. During this period we have walked into and backed out of many blind alleys or “No Thoroughfares,” and have acquired wisdom through the loss of infinite time, effort, and money. Although the material for the following pages was gathered in Baltimore, and is therefore, strictly speaking, of a local character, yet since practically all of the conditions indicated or dealt with are common to all towns and cities, this need not limit the application of the ideas and principles set forth.

It is also hoped that though the work of tuberculosis nursing is dealt with chiefly as done under the auspices of a Visiting Nurse Association, or as part of the work of a City Health Department, what is here presented will be of value to nurses working under private associations, and to private associations themselves. Therefore, in presenting this book to the public—to nurses, physicians, social workers, anti-tuberculosis associations, and all those engaged in public health work—the writer has two objects in view. First, to offer a working model by which any community can gain some idea as to how to organize and conduct tuberculosis work; second, to offer conclusions, gained through practical experience, as to the nurse’s part in the anti-tuberculosis campaign.

The object of the anti-tuberculosis campaign is the eradication of tuberculosis. Our experience has been to prove that the simplest and most direct method of controlling this disease is through the segregation—the voluntary segregation—of the distributor, and that to remove the patient from an environment where he is dangerous to one where he is harmless is the function of the public health nurse. This is her chief and foremost duty, and all others are subsidiary to it.

The writer wishes to express her appreciation and deep indebtedness to those friends and fellow-workers who have given her guidance and assistance during these years of service. These are: Mary E. Lent, Superintendent of the Visiting Nurse Association of Baltimore, and Susan Edmond Coyle, “lay member” of that Association; Dr. Louis Hamman, Physician-in-Charge of the Phipps Dispensary, Johns Hopkins Hospital; Dr. Samuel Wolman, First Assistant to the Phipps Tuberculosis Dispensary; Dr. Gordon Wilson, Physician-in-Charge of the Maryland University Dispensary and of the Municipal Tuberculosis Hospital; Dr. Martin F. Sloan, Superintendent of Eudowood Sanatorium; Dr. Victor F. Cullen, Superintendent of the Maryland Tuberculosis Sanatorium; and my Chief, Dr. Nathan R. Gorter, Health Commissioner of Baltimore.

ELLEN N. LA MOTTE.

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