Chapter XIX

Municipal Control—The Danger of “Political” Control—“Politics” in the
Co-operating Divisions—Results in Baltimore—Tuberculosis and
Poverty.

=Municipal Control.= Tuberculosis is a communicable disease in which the patient himself must be relied upon to protect the community. We depend upon him for whatever protection he chooses to give, and whether this is much or little is determined by his circumstances, temperament, and environment. Whenever his ability or good-will breaks down, we are at his mercy. We may try to overcome his ignorance by education; to substitute ethical for unethical standards, and in a more or less unsatisfactory way to reconstruct his immediate surroundings. But the success of these efforts depends, in the last analysis, upon the patient himself. The public is exposed to a communicable disease, the control of which lies with the transmitter.

For this reason, a disease which may be contracted by a neighbour becomes as much his affair as it is that of the patient or possessor. Should the interests of the two conflict, it is obvious that we must have some impartial arbiter to decide between them. At such a point—the right of one person to transmit, of another to acquire an infectious disease—the matter becomes one of public as well as private concern. The arbiter between these two interests should be the Health Department of a community, and the control of all infectious diseases should be placed completely under the municipality.

In the first chapters of this book, we considered the special nurse as supported by a group of private individuals, in connection with some privately maintained association. Social experiments frequently begin in this way; when their value is proved, it should be the aim of the promoters to transfer this special work to the department of the municipality in which it belongs. Upon looking over the various municipal departments, we realize that much of what is now freely recognized to be municipal work, was originally carried on through private enterprise and initiative. This is the case with school nursing, playground work, juvenile court and probation work; which in many cities has passed through the stage of private enterprise and become firmly incorporated into the city machinery. In all public health nursing, the aim of the founders should be, first to prove its worth to the community, and then make the community (municipality) assume full charge of it as soon as possible. It is particularly necessary to transfer tuberculosis work from private to municipal control.

=The Danger of “Political” Control.= The question of doing this, however, is often a matter of great concern to the founders. They are usually deeply interested in the work, and have maintained it upon a basis of efficiency, in spite of many obstacles. They fear, and often rightly, that to transfer it to the municipality will be to transfer it from the basis of efficiency in its own line, to the basis of politics, and they dread that sinister condition known as “political control.” And yet the administration of public affairs is not necessarily “political” in the bad sense of the term. On the contrary, municipal control may, and in many cities does mean, that work is conducted with the force, authority, and financial backing of a great department, such as the Health Department. Under such conditions, it can attain a far greater degree of efficiency than could ever have been reached through private administration. Under municipal control, it is possible to have a large staff of nurses and pay them good salaries—which latter always means a wide choice of applicants. It is also possible to establish many and well equipped dispensaries, in charge of salaried, qualified physicians. Money will be forthcoming for all necessary expenses connected with the development and extension of the work—in short, the financial handicap will be removed, and the work can go forward with increased facilities, enlarged opportunities, and heightened dignity and authority.

On the other hand, if the administration of the Health Department is “in politics,” the reverse of this will take place. Unfortunately, in many American cities, the business of “politics” is the business of providing people with jobs at the taxpayers’ expense, regardless of the fitness of the applicant. Many of our cities are managed in this way. Moreover, in the same city, this corruptness may affect certain departments only, some being negligently and dishonestly conducted, others cleanly and efficiently. Or we may find both conditions existing in a single department, some of whose branches or divisions may be well conducted and on a high level, while other divisions may be grossly mismanaged and worthless. If a Health Department is hampered by politics, either as a whole or in certain mismanaged branches or divisions, it is useless to expect results. Placed under such a handicap, tuberculosis work would fail. Not only would the taxpayers’ money be wasted, but the community would suffer through a false sense of security, gained through its faith in, or rather its ignorance concerning, a badly conducted department. To trifle with the health of a community is a criminal act, and a Health Department which is “in politics” is the most immoral of all corrupt city departments.

Evil results of a Health Department being “in politics” may be of several sorts. For example: the Superintendent of Nurses may be an inexperienced, incapable woman, appointed by a ward politician to clear off political debts. A ward politician is hardly one whose judgment—in nursing matters at least—should be relied upon.

On the other hand, the Superintendent herself may be capable and efficient, but she may not be permitted to select the members of her staff. Instead of being able to choose them herself, according to their fitness and ability, she must accept any unqualified woman whom the ward boss may appoint. A staff of incompetent nurses, appointed without regard to character or education, is not a force from which to expect results. Moreover, nurses chosen in this manner feel that they are “protected” and can do as they like, subject to neither restraint nor discipline. This means that their work cannot be controlled, corrected, or directed in any way. Dismissal can be made only for the most flagrant offences—not for any such trifle as incompetence, laziness, or stupidity. When the Superintendent’s hands are thus tied—when she cannot select her nurses, cannot control them, and cannot dismiss the worthless as well as the unscrupulous, the result is a low grade of work. No able and self-respecting woman could hold the position of superintendent under such circumstances, thereby making herself responsible for work which she cannot control.

The acceptance of registered nurses only, and the requirement of Civil Service Examination in addition, would do much to raise the level of efficiency. These requirements, however, valuable as they are, would by no means ensure the suitability of the applicant, or guarantee the selection of nurses best adapted to public health work. Over and above this, the Superintendent should have free choice in selecting her workers, not only from the point of view of education, but also that of personal worth.

=“Politics” in the Co-operating Divisions.= Sometimes the Tuberculosis Division itself may not be on a political basis, but the various other divisions of the Health Department may be conducted in such a manner as to nullify much of the nurses’ work. For example: much depends upon the co-operation of the Fumigation Division. If the men employed to fumigate houses do their work badly or improperly—if they are too lazy to stop chinks and crevices, thus permitting the disinfectant to leak out; if too ignorant to properly measure the rooms, and unable to calculate the necessary amount of formaldehyde, this work will be valueless. Worse still if they are the kind that can be “bought off” and so shirk work entirely.

Or the trouble may be with the Sterilization Division, where the duty of the employees is to carry mattresses, etc., from the patient’s home to the city sterilizer. When there is no law compelling this sterilization, and it is an optional matter with the householder, if done, its doing is altogether the result of the nurse’s teaching and advice. If the waggon drivers are lazy and do not wish to carry the heavy mattresses, they can shirk work by means of false excuses often difficult to detect. For example: they can report that when a certain mattress was called for, the family had changed their minds about having it sterilized and refused to have it done. Upon investigation, we find that this refusal was at the instigation of the waggon driver himself—he had assured the family that sterilization was an unnecessary and stupid proceeding. To ignorant minds, one Health Department employee is as good as another, and when the advice is conflicting, they choose that which best pleases them.

Again, the fumigators or drivers may report that they cannot get into a certain house; the key could not be found; there was no one to admit them, or give them the articles to be removed. In innumerable ways they may compel the nurse to return again and again to the same house, to make arrangements which they try to frustrate by every conceivable device.

If, therefore, the employees of the various co-operating divisions are mere jobholders—if they are neither honest nor intelligent, nor interested in anything but pay-day—it is a heartbreaking task for the honest and efficient division to work with them. All of these activities interlock, and must work together to gain a common goal. If all are operated at their highest level, working in close and intelligent accord, then indeed we may expect results. But if the reverse is the case—if the co-operating divisions are a drag and a hindrance—then the task is overwhelming. The weak are corrupted and the strong discouraged.

Those responsible for placing tuberculosis work under the city’s administration—where it rightfully and logically belongs—should continue their interest still further. It is not enough to transfer it from pioneer, private control, and then drop the responsibility.

If a Health Department is clear of politics, and all its divisions work together harmoniously, magnificent results may be obtained. Power, prestige, and efficiency is a combination which results in forceful work.

=Results in Baltimore.= Results have been achieved in Baltimore by reason of a well-managed Health Department, acting in close co-operation with the institutions of both city and state. The tuberculosis machinery consists of a staff of seventeen special nurses; three special dispensaries with a physician in charge; a laboratory for sputum examinations; a fumigation corps and a steam sterilizer. With this force, we work in connection with three other tuberculosis dispensaries, and six institutions for the care of early and advanced cases. Some of these institutions are maintained by state appropriations, others by both public and private funds. The co-operation between these institutions and the Health Department is absolute; if the control was all through one, instead of a dozen different centres, it could not be more complete or harmonious. Failure in any one direction is felt down the line, consequently each is stimulated to its best effort. Thus, the nurse knows that if she fails to persuade her patient to enter the hospital, the hospital is useless, or that if the bad food of the hospital drives the patient back again to his home, the nurse’s work goes for nothing. Each reacts upon the other, and as all are working for the same end, there is constant incentive to become a strong, rather than a weak link in the chain. The results obtained cannot be measured in terms of individuals—we cannot point to so many patients improved, so many working, and so forth. Individual welfare is too shifting and too questionable a standard by which to judge. The only absolute standard is that afforded by the death-rate. A declining death-rate means also a decreasing morbidity—fewer people die of tuberculosis and fewer are infected. While our tuberculosis death-rate is still enormously high, it is nevertheless falling year by year. Thus we see:

Deaths
from
Pulmonary
Tuberculosis:

1909 1400
1910 1234
1911 1165
1912 1189
1913 1129

There is nothing spectacular about this. It is heartbreakingly slow—needlessly, uselessly slow work. Yet it is progressing in the right direction.

=Tuberculosis and Poverty.= Throughout the foregoing pages we have considered the direct method of dealing with tuberculosis—the removal or segregation of the distributor. But there is also an indirect method of dealing with tuberculosis, namely the abolishment of poverty. Tuberculosis recruits full fifty per cent. of its ranks from people of a certain social level—the very poor. This class is composed of people habitually overworked, underpaid, and subject to all the deteriorating influences of unsanitary and vicious environment, and to the ignorance and degradation which follow in the wake of extreme distress. The root cause of these conditions is our present unjust economic system, which produces an excess of luxury and frivolity on the one hand, and on the other an army of people who must forego the barest necessities of life. One class is maintained at the expense of the other. Every movement which seeks to abolish this injustice, and to substitute a fairer and more equable system, is a movement which at the same time tends to raise the standard of public health. Any legislation, social or revolutionary, which makes for the improvement of industrial conditions, raises the level of public health through raising the welfare (_i.e._, resistance) of the individual. Therefore, sweeping readjustment of social and economic conditions would automatically eliminate an enormous amount of disease, by reducing the number of highly susceptible individuals. To increase the number of people with high resistance—or to decrease the number of people with low resistance, whichever way one chooses to put it—would probably diminish the amount of tuberculosis by about one half.

This indirect method—the readjustment of social conditions and the abolishment of poverty—valuable as it would be, would still leave the problem unsolved. Even diminished by one half, the amount of tuberculosis would still be formidable, and we should have to attack it as vigorously as ever, if not to the same extent. The disease would still exist, just as it now exists in well-to-do families in small towns, in rural districts, and in other circumstances attributable to neither poverty nor bad industrial conditions.

A thousand years ago, industrial conditions were as distressing as those which exist to-day—yet in those days the poor staggered under the additional burden of leprosy. A hundred and fifty years ago poverty was complicated by smallpox, the scourge of Europe. The rigid segregation of lepers in the Middle Ages relieved the situation of leprosy, while the discovery of vaccine has practically eliminated smallpox. The submerged classes, while their economic condition remained unchanged, were at least relieved of the added weight of these two great diseases. So in our present fight against tuberculosis. An aggressive campaign against this disease will not necessarily improve industrial conditions, but those who suffer most from these conditions will be relieved of one more handicap.

In our present warfare against tuberculosis we are not impelled by the blind fear that made society in the Middle Ages demand segregation, and refuse to tolerate an infectious disease at large in the community. Nor has any vaccine or similar agent been discovered by which the disease may be wiped out. Instead, we must depend upon a campaign of education—wholesale, widespread education, conducted amongst all classes of society. We know the path to be travelled, and the machinery by which we may gain our ends. If at any time we become impatient with our slow rate of progress, we can accelerate our speed by the extension and multiplication of the three fundamental agencies in the anti-tuberculosis campaign—the Hospital, the Dispensary, and the Public Health Nurse.

INDEX

A

Advanced cases, 46–47, 119, 145, 223, 224–227;
see _Patients_ and _Segregation_

Air, fresh, 145–147

Alcohol, 151

Ambulatory cases, 33, 34, 38, 79–80;
see _Patients_

Anti-tuberculosis campaign, 1–3;
fundamental agencies in, 286

Anti-tuberculosis Society, 5–6

Arrested cases, 2;
nursing as work for, 13–14;
see _Patients_

B

Bacilli, tubercle, articles infected by, 253;
distribution of, 169, 262–266;
presence or absence in sputum, 107–108, 111;
tenacity of, 170

Badges, 31

Bag, nurse’s, 41;
supplies carried in, 42–46, 108

Baltimore, branch offices for tuberculosis nurses, 39;
co-operation of nurses with institutions, 202, 204–205, 281–282;
dispensaries, 92, 151, 186–187, 192, 198–199, 201–202;
examination of nurses, 12;
forms used for charts, etc., 50–59;
Health Department, 42, 157, 170–171, 174, 176, 183–192, 204, 206,
250, 256, 267–268, 279–282;
milk and eggs for patients, 250;
nurse’s bag, 41;
nurses’ districts, 39 _note_;
occupations of patients, 253, 261–263;
ordinance in regard to selling milk, 255–256;
organization of tuberculosis work, 200–202;
poverty, 231–232;
registration of cases, 112;
salary of tuberculosis nurse, 21;
sick-leave, 28;
supplies for patient, 42;
Tuberculosis Division, 171, 183, 201–202, 250;
uniforms, 30–31;
vacations, 28;
Visiting Nurse Association, 8, 39, 42, 65, 201, 202

Bed, for advanced cases, 145;
placing of, 144

Bed clothing, 144

Bedding, disinfection of, 175, 176

Bedroom, patient’s, 137–140

Board of examiners for nurses, 11

Board of Health of Maryland, 42;
furnishes formaldehyde, 173

Books of instruction, 44

C

Cabot, Doctor, quoted, 70

Calls, night, 16;
sources from which received, 121

Calmette test, 111

Card index, 53–54

“Careful consumptive,” the, 220–223

Carpets, infected, 178–179

Cases, tuberculosis, see _Advanced_, _Ambulatory_, _Arrested_, and
_Discharged cases_; and _Patients_

Cases, undiagnosed, 63, 99–101

Charity Organization Society (or Federated Charities), 39, 66, 98, 108,
109, 176, 210, 236–237, 239, 241, 242, 245;
rules for agents of, 237–241

Charts, patients’, 49–54, 58–60

Children, care of tuberculous, 163;
diagnosing, 161–162;
infection of, 95, 111, 151–152, 159–164;
open-air schools for, 163–165;
sending to school, 162–163;
pre-tuberculous, 163

Classes, tuberculin, 196–197

Cleaning should be compulsory, 182–183;
see _Disinfection_

Clothing for tuberculous patients, 142–143, 211–212

Cooking, supervision of, and instruction in, by nurse, 149–151

Cooks, infection from, see under _Infection_

Co-operation, between institutions and nurse, 203, 205–208;
of newspapers in tuberculosis work, 5;
of organizations for social work and nurse, 35–36, 143, 156–157,
176–177, 182, 210;
wrong methods of, 33–34;
see also _Charity Organization Society_ and _Social Workers_

Country, the, for tuberculous patients, 165–168

Cullen, Doctor Victor F., quoted, 108

Cure of tuberculosis, 4, 125–127, 208–209

D

Daily reports, 55–57

Day sheet, 57

Death of patient, 49, 119, 120;
reporting, 53, 171

Diagnoses, erroneous, 92–97, 101;
lack of, 63;
“lay,” 68–69, 100;
necessity for formal, 115–116;
obtaining, 105–107, 184–185;
from sputum, 107–109;
value of recording, 114–115;
volunteered by physicians, 106

Diet of patients, 147–150, 249–251

Discharged cases, 204–205, 207, 209;
see also _Arrested cases_

Disinfectants, 43–44, 133, 173 _note_

Disinfection, by boiling, 131–132, 177, 178;
by burning, 175, 178, 179, 183;
by cleaning, 138, 172;
by fumigation, 170–173, 176, 179, 180, 181, 182, 183;
by painting and papering, 179;
by steam sterilization, 175–177;
effects of, on materials, 176 _note_

Dispensaries, general, 107;
tuberculosis, consideration for patients at, 189–190;
equipment of, 186–188;
establishment of, 105, 185;
hours, 188–189, 196;
importance of, 286;
necessity for, 105, 184–185;
nurses’ work in, 194–195, 197–199;
obtaining patients from, 67–68;
physicians’ work in, 191–194;
reports made to, by nurse, 202;
taking patients to, 159;
see also _Baltimore_, _Diagnosis_, _Nurse_

Districts, 35–36, 39 _note_

Duplication of work, 33–34

E

Education unsuccessful as preventive measure, 2–3

Examination of patients, nurses, etc., see _Diagnosis_, _Dispensary_,
_Families_, _Health Department_, _Nurse_, _Patients_, _Physician_,
_Sputum_

Expenses of nurse, 24–26

Eye test, 111

F

Factories, spreading of tuberculosis in, 266–267, 271 _note_;
supervision of patients in, 267;
see also _Patients, occupations of_

Families of patients, co-operation with nurse, 127, 174;
examination of, 157–158;
hygiene of, 155;
infection of, 68–69, 97;
relations with nurse, 152;
recreations of, 155–156;
respect for customs of, 181–182;
see also under _Children_ and _Nurse_

Food, importance to patient of proper, 147–150;
see also under _Diet_, _Infection_, _Nurse, instruction by_

Formaldehyde, formula for, 173–174 _note_

Forms, see _Charts_, _Records_, _Reports_

Fumigation, see under _Baltimore_, _Disinfection_

H

Hamman, Doctor Louis, quoted, 111

Health Department, badges, 31–32;
co-operation with institutions, 205–207;
dispensaries, 185;
examination of sputum by, 187;
laws in regard to tuberculosis, 76–77, 112;
notifying employers of tuberculosis patients, 269;
physicians of, 89;
politics in, 275–278;
registration of cases with, 112, of deaths, 171;
reports from institutions to, 206;
supervision of discharged patients through, 207;
supplies provided by, 42;
visiting physicians needed by, 184–185;
see also under _Baltimore_, _Disinfection_

Heat, artificial, in outdoor treatment, 143, 147

Histories, see under _Patients_

Home, “breaking up the,” 161;
care of advanced patients at, 225–227;
conditions in patients’, 139, 148, 160, 163;
entering patients’, 31, 118, 122;
see _Infection_

Hospitals, for advanced cases, 207–208, 218–219;
importance of, in tuberculosis, 223, 271, 286;
opposition to building of tuberculosis hospitals, 219–221;
sending patients to, 207–208;
special wards for tuberculosis, 218–219

Houses, inspection of, by nurse, 136–137;
vacant, watched by nurse, 181

I

Infection, of children, 159–160;
sources of, 140, 159–160, 165–168, 252, 255–268;
see also under _Advanced cases_, _Ambulatory cases_, _Bacilli_,
_Children_, _Factories_, _Families_, _Patients_

Institutions, see _Hospitals_ and _Sanatoria_

Instruction, books of, 44;
of patients and families, 127–133, 142–148;
see also under _Nurse_

L

Landlord, irresponsibility of, 180–181

Laws, for proper disinfection, 183;
for protection from infection, 264;
for registration and reporting of tuberculosis cases, 7, 111–112;
State, in regard to tuberculosis, 76, 77

“Light work” for tuberculosis patients, 215–216

Lyman, Doctor David R., quoted, 213

M

Maryland, State Board of Health, quoted, 213;
neglect of law for registration of tuberculosis cases, 113;
Tuberculosis Association, 8 _note_

Milk, infection through, 255

Milk and eggs, see _Diet_

Minor, Doctor Charles L., quoted, 126

Municipal control of tuberculosis work, 77–86, 89–91, 274–275;
see also _Baltimore_

N

Napkins, paper, use of, 130–131

Newspapers as agents in tuberculosis work, 5

Nurse, the tuberculosis, “asset to community,” 199;
access to cases, 121–122;
calls, 121–122;
character, 16–19;
co-operation with physician, 88, 103, 109;
discovering cases, 67;
dispensary work, 194–199;
district, 35–36;
duties of, 46, 48–49, 52, 53–56, 58–59, 62–70, 100–101, 105, 106,
108–109, 122, 128–137, 149–153, 154–157, 169–170, 181–183,
204–205, 207–208, 211–212, 213, 216–217, 224, 258–259;
establishment of, 7–10, 89;
expenses, 24–26;
function, 117–118, 224, 247–248;
giving relief, 232–233, 237, 241–242, 245–248;
health, 12–15;
hours on duty, 14, 36;
instruction of patients and families, 127–131, 133–148, 155–156, 172,
174, 178, 183;
lunches, 40–41;
noon hour, 40–41;
office, 38–40;
physical examinations, 12–13;
relations with patients and families, 18, 123, 133, 152–153, 181–182;
relations with physicians, 71–73, 87–89, 92–94, 99–104, 123;
responsibility to community, to patient and family, 118;
to organization, 89;
salary, 20–23;
sick-leave, 27–28;
social worker as nurse, 233–234;
time off, 14–16;
training of, 10–12, 62;
uniforms, 28–31;
vacation, 26–27;
visits, 36–38;
visiting list, 63–70;
see also under _Baltimore_, _Charts_, _Children_, _Co-operation_,
_Diagnosis_, _Diet_, _Disinfection_, _Dispensaries_, _Families_,
_Health Department_, _Home_, _Registration_, _Reports_, _Visiting
Nurse Association_

O

Occupations of patients, see under _Infection_

Office of tuberculosis nurse, 38–40

Open-air, schools, 163;
treatment, 140–143

Organizations, see under _Charity Organization Society_, and
_Co-operation_

Outdoor work for tuberculosis patients, 216

P

Patients, bed-ridden, 151–152;
carelessness of, 97, 214–222, 266–268;
changing physicians, 80–81, 92–96, 98–100;
charts, 48–53;
co-operation with nurse, 248–249;
discharged, 204–207, 212–215;
employment of, 262;
examination of, 158, 190;
histories, 123–124;
home occupations, 261–262;
isolation of, in homes, 151–152;
limitation of, 33, 200;
objection of, to institutions, 210–211;
outdoor treatment, 144;
rest for, 143–144;
sending to country, 165–168;
supervision outside the home, 267–272;
supplies for, 42–43, 45;
telling the truth to, 124–127;
see also _Advanced_, _Ambulatory_, and _Arrested cases_, _Baltimore_,
_Children_, _Diet_, _Dispensaries_, _Families_, _Health
Department_, _Home_, _Injection_, _Instruction_, _Nurse_,
_Segregation_, _Relief_

Phipps Dispensary, see _Dispensaries_ under _Baltimore_

Phthisiphobia, 14, 134–135, 270–272

Physicians, incompetent, 93–97, 101–104;
municipal, 90;
standards of, 83;
reporting tuberculosis cases, 113;
State requirements of, 75–76;
“unethical practitioner,” the, 72, 84, 85;
see also under _Diagnosis_, _Dispensaries_, _Nurse_, _Patients_

Pockets, waterproof, 44

Poverty, relation to tuberculosis, 3–4, 61, 80–81, 230–232, 265,
283–285

Prevention of tuberculosis, 4, 120, 155–156, 159–161, 247–248;
see also under _Disinfection_, _Nurse_, etc.

R

Records and reports, 48–58

Registration of cases, cards for, 116;
laws for, 76, 111–113;
value of, 114–115

Relief, conditional, 231;
not to be given by nurse, 234;
obtained by nurse, 143, 210, 245–246, 257;
proper use of, 248–249;
rules for agents and nurses, 237–241;
withdrawal of, 248;
see also _Nurse_, _Co-operation_, _Patient_

Reporting cases to the Health Department, 7, 56–59, 171, 205–207

S

Salary of tuberculosis nurse, 20–22, 24

Sanatorium, outfit for, 211–212;
value of, 208–209, 213

Segregation, 4–5, 218–220, 223–229

Sick leave, 26–28

Skin test, 110

Social agents and workers, 35–36, 62, 66–67, 165, 234–239

Sputum, cups, 42–43;
disposal of, 128–130;
examination of, 9, 40, 107–108;
see also under _Infection_ and _Instruction_

Sterilization, see under _Disinfection_

Superintendent of nurses, 13, 15, 24, 59–60, 116

Supplies, nursing, 46;
prophylactic, 42–45, 76–77, 133

T

Tests, tuberculin, 110–111

Tuberculin classes, 196–197

Tuberculosis, abolition of, 223, 283–284;
arrest of, 125–126;
campaign against, 1–6, 285–286;
character of, 79;
cure, 2–4, 125, 208–209;
deaths from, 283;
difficulties in dealing with, 79–82, 85–86;
municipal control of, 85–86;
number of cases in given community, estimate of, 63;
see also _Bacilli_, _Infection_, _Prevention_, _Poverty_

Tuberculosis Division, see under _Baltimore, Health Department of_

U

Uniforms, 28–29

V

Vacations for tuberculosis nurses, 26

Visiting list, 63–66

Visiting Nurse Association, 8, 9;
see also under _Baltimore_ and _Co-operation_

Visits by tuberculosis nurse, 36–38

W

Wards, special, for tuberculosis patients, 218–220

Windows in patient’s room, 137, 144

Work done by tuberculous patients: “light work,” 215;
outdoor, 216,
see also under _Infection_ and _Patients_

------------------------------------------------------------------------

A

Medical Dictionary

for Nurses

Giving the Definition, Pronunciation, and Derivation of the principal
terms used in medicine, together with supplementary tables of weights,
measures, chemical symbols, etc. arranged with special reference to use
by the nursing profession

By Amy E. Pope

Formerly Instructor in the Presbyterian Hospital School of Nursing
Author of “Anatomy and Physiology for Nurses,” etc.

_12^o. Illustrated. 288 pages. $1.00_

_In full flexible Morocco, Thumb Index. $1.60_

No one could be better fitted to produce this book, filling a long-felt want, than Miss Pope, because of her large practical experience as a nurse, instructor, and author. Without question this volume must quickly be recognized as indispensable to the students of her great profession.

_All Booksellers_

NEW YORK LONDON
2–4–6 =G. P. Putnam’s Sons= 24 Bedford St.
W. 45th St. Strand

Text-Book

of

Anatomy and Physiology

For Nurses

by
Amy E. Pope

Author, with Anna Caroline Maxwell, of “Practical Nursing,” and Former
Instructor in Practical Nursing and Dietetics in the Presbyterian
Hospital School of Nursing.

_Crown 8^o. With 135 Illustrations, many in color
$1.75 net. Postage extra_

The object of this work is to provide a text-book containing more physiology than the books on anatomy and physiology hitherto provided for nurses. The book is very fully illustrated and contains a number of questions for each chapter; also an extensive glossary, which includes a detailed explanation of all the chemical and physical terms used.

Practical Nursing

A Text-Book for Nurses

By Anna Caroline Maxwell

Superintendent of the Presbyterian Hospital School of Nursing

and

Amy Elizabeth Pope

Formerly Instructor in the Presbyterian Hospital School of Nursing;
Instructor in School of Nursing, St. Luke’s Hospital, San
Francisco, Cal.

_Third Edition, Revised. Crown 8^o. About 900 pages. With 91
Illustrations. $2.00.
Postage extra_

Over 50,000 copies of _Practical Nursing_ had been sold up to January 1st, 1914. This new edition has been entirely reset, revised, and enlarged, and contains over 50 per cent. more material than the previous editions. An important feature of the new edition is, that the authors have not confined themselves to one method of treatment where experience has shown that other methods may be more effective in certain cases. Detailed instructions have been given, thus bringing the book in line with the latest developments in practical nursing.

A Text-Book of Materia Medica for Nurses

Compiled by

Lavinia L. Dock

Graduate of Bellevue Training School for Nurses, Secretary of the
American Federation of Nurses and of the International Council of
Nurses, etc.

_Fourth edition, revised and enlarged. 12^o. net, $1.50_

“The work is interesting, valuable, and worthy of a position in any library.”—_N. Y. Medical Record._

“It is written very concisely, and little can be found in it to criticize unfavorably, except the inevitable danger that the student will imagine after reading it that the whole subject has been mastered. The subject of therapeutics has been omitted as not a part of a nurse’s study, and this omission is highly to be commended. It will prove a valuable book for the purpose for which it is intended.”—_N. Y. Medical Journal._

* * * * *

G. P. Putnam’s Sons
New York London

------------------------------------------------------------------------

TRANSCRIBER’S NOTES

1. P. 173, the portions listed in “Potassium permanganate, oz. 111.; liquid formaldehyde, pint 1.” are unlikely to be correct. Did not alter the passage. 2. Silently corrected obvious typographical errors and variations in spelling. 3. Retained archaic, non-standard, and uncertain spellings as printed. 4. Re-indexed footnotes using numbers. 5. Enclosed italics font in _underscores_. 6. Enclosed bold font in =equals=. 7. Denoted superscripts by a caret before a single superscript character or a series of superscripted characters enclosed in curly braces, e.g. M^r. or M^{ister}.