Department is a trained nurse. She has six field nurses under her, each
handling about 100 patients. Nurses are in uniform, give bedside care when
necessary, and receive $900 per year. The dispensaries are operated
jointly by the Health Department and private charities. 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.
ST. LOUIS
The St. 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.
ATLANTA
Atlanta, Ga., has a staff of four nurses and a dispensary under the
Atlanta Anti-Tuberculosis and Visiting Nurse Association. They seem to
have a particularly well organized plan of work, very hearty co-operation
from the entire city (although the city government has appropriated
nothing for the work), and are doing much good along lines of prevention,
with dental, and nose and throat clinics, and open air schools. They have
had difficulty in obtaining nurses with social training, and have been at
some pains to arrange a social service training school, the program of
which seems very admirable.
* * * * *
According to the latest report of the National Association for the Study
and Prevention of Tuberculosis, there are 4,000 visiting tuberculosis
nurses in the United States. There are more than 400 special tuberculosis
clinics as compared with 222 in 1909. This paper deals with only a few of
the larger cities.
There are many other cities and small towns having tuberculosis nurses
doing work well worthy of mention. Several states have adopted the plan of
carrying on the work by visiting nurses in each county. These nurses have
a wide field, and are accomplishing much along educational lines, the
territory which they have to cover making any great amount of actual
nursing impossible. It is interesting to note their varied experiences. We
read of patients prepared and sent to sanatoria and hospitals, the family
and neighborhood protesting against every step; of county agents,
churches, lodges or communities called upon to assist in caring for
families; of long drives into the country to inspect and practically
reorganize some home where several members have died, or are dying with
tuberculosis; of repeated admonitions to keep windows open in rural
communities, "where the air is pure because all the bad air is kept closed
up in the homes and school houses." When the city tuberculosis nurse reads
of all this, she feels like taking off her hat to the rural tuberculosis
visiting nurse and wishing her success and fair weather.
CHICAGO
The history of the present comprehensive tuberculosis work in Chicago is
closely interwoven with the history of the Chicago Tuberculosis Institute,
which was organized in January, 1906. The Institute succeeded the
Committee on Tuberculosis of the Visiting Nurses' Association (the pioneer
Tuberculosis Committee in Chicago).
The Chicago Tuberculosis Institute gives the following as its chief aim:
"The collection and dissemination of exact knowledge in regard to the
causes, prevention and cure of tuberculosis." The progress made in the
tuberculosis situation of this city in the last seven years is directly
due to the systematic campaign of the Institute. By exhibits, lectures,
literature, stereopticon views and moving picture films, the Institute was
energetically spreading during these years the knowledge concerning
tuberculosis and its proper methods of prevention.
In the winter of 1906-07 a small and unpretentious sanatorium called "Camp
Norwood" was built on the grounds of the Cook County Institutions at
Dunning, with a total capacity of 20 beds. The Edward Sanatorium at
Naperville, made possible by the munificence of Mrs. Keith Spalding, was
under construction at the same time and was later made a department of the
Chicago Tuberculosis Institute. The Edward Sanatorium was the chief factor
in demonstrating and convincing this community that tuberculosis can be
successfully treated in our climate.
In 1907, the Chicago Tuberculosis Institute established a system of
dispensaries with a corps of attending physicians and nurses. The purpose
was given as follows:
(a) Early diagnosis of tuberculosis.
(b) Control of tuberculosis by means of personal instruction and home
visits.
(c) Education of the community in the necessity of further development
of the dispensary and nursing systems.
(d) Spread of the gospel of fresh air and "right living."
Dispensaries were opened during the latter part of 1907 as follows:
(1) Jewish Aid Society Tuberculosis Clinic in existence since 1900;
joined the Chicago Tuberculosis Institute, December 13th, 1907.
(2) Olivet Dispensary, May 15, 1907; transferred to Policlinic in
December of same year.
(3) Central Free Dispensary at Rush Medical College, November 16th.
(4) Northwestern Tuberculosis Dispensary, November 21st.
(5) Hahnemann Tuberculosis Dispensary, December 9th.
(6) Policlinic Tuberculosis Dispensary, December 13th.
(7) West Side Dispensary at the College of Physicians and Surgeons,
December 17th.
The South West Dispensary was opened in August, 1909.
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. The soundness of this policy may be seen
in the fact that the activities of the Institute, its exhibits, more
especially the success of the Edward Sanatorium, and also the work of the
dispensaries, led finally to the adoption by the City of Chicago of the
Glackin Municipal Sanitarium Law and made possible the Municipal
Tuberculosis Sanitarium now nearing completion.
The maintenance of the seven dispensaries having become a source of
considerable expense to the Institute, they were turned over to the city
and became a part of the Municipal Tuberculosis Sanitarium in September,
1910.
The Institute continued its activities as "an educational institution for
the collection and dissemination of exact knowledge in regard to the
causes, prevention and cure of tuberculosis." It concerns itself also with
keeping before the minds of the public the proper standard of care for the
tuberculous in public and private institutions. Through its Committee on
Factories, the Institute conducted during the last three years a vigorous
campaign for the adoption of the principle of medical examination of
employes. The Robert Koch Society, an organization of physicians, is the
outgrowth of the Institute. In brief, the Institute for years has led the
fight against tuberculosis in this city.
The dispensary system of the Municipal Sanitarium, organized as above
stated, has gradually developed into ten dispensaries with a
superintendent of nurses, ten head nurses and fifty field nurses. A staff
of thirty-one paid physicians are a part of the organization. The ten
dispensaries hold twenty-six clinics a week. In 1913, the attendance at
the Municipal Tuberculosis Sanitarium clinics was 43,989 patients. Nurses
made in all 39,737 visits to the homes of the tuberculous patients. The
system of visiting tuberculosis nursing in Chicago is steadily moving
toward greater efficiency in coping with the existing situation. The chief
features of the Chicago arrangement are as follows:
(1) Nurses are classified into:
=Grade II. Field Nurse=
Group C: $900.00
Group B (At least one year's service in lower group): $960.00
Group A (At least one year's service in next lower group): $1080.00
=Grade III. Head Nurse=
Group B: $1200.00
Group A (At least one year's service in lower group): $1320.00
=Supervising Nurse=
Group B: $1440.00
Group A (At least one year's service in lower group): $1560.00
=Grade IV. Superintendent of Nurses=
Group D: $1920.00
Group C (At least one year's service in lower group): $2100.00
Group B (At least one year's service in next lower group): $2280.00
Group A (At least one year's service in next lower group): $2400.00
(2) Civil Service examinations for all of the above positions render
possible the selection of the best candidates.
(3) Efficiency of the nursing force is stimulated by conferences
of various groups of nurses:
(a) Weekly conferences of junior nurses.
(b) Weekly conferences of head nurses.
(c) Conferences of the entire nursing force twice a
month.
(d) A well organized system of lectures on various
phases of tuberculosis by authorities.
(e) Bi-monthly meetings of the Nurses' Tuberculosis Study Circle,
the proceedings of which are published in this pamphlet.
(4) A centralized system of administration, with brief medical and
social records of all dispensary cases for the purpose of
clearing and information, in the office of the Superintendent
of Nurses located in the down town General Offices of the
Sanitarium.
(5) Nurses wear uniforms beginning with the middle of October of
this year (1914).
(6) Before January, 1915, all tuberculosis cases in their homes
will be cared for by the Municipal Tuberculosis Sanitarium.
This includes both far advanced and surgical cases.
The Chicago Anti-tuberculosis movement has been more fortunate in its
development than that in other cities where the dispensaries are under one
organization and the nurses under another. Here the dispensaries and their
nursing and medical staffs have steadily developed under the same
direction, the advantages of such an arrangement being clearly evident.
We look into the future with confidence. The Chicago Municipal
Tuberculosis Sanitarium, with its 900 beds and its comprehensive medical
and laboratory facilities for the study and treatment of cases, is to open
before the year 1914 expires. The County Tuberculosis Hospitals for
advanced cases are undergoing a revolutionary change in the direction of
administrative and medical efficiency. The Dispensary Department of the
Municipal Tuberculosis Sanitarium is extending sanatorium care to the
homes of tuberculous patients by building and remodelling porches and
supplying, if necessary, all equipment required for outdoor sleeping. We
have eighteen open air schools. We have an effective tuberculosis exhibit.
The principle of early detection of illness is being adopted by many
business concerns and the sanitary conditions are gradually improving. The
future is full of promise.
[Illustration]
--------------------------------------------------------------------------
CITY POPULATION PRIVATE NUMBER AVERAGE BEDSIDE UNIFORMS YEARLY
1910 CENSUS OR OF NUMBER OF CARE SALARY
PUBLIC NURSES PATIENTS
FUNDS PER NURSE
--------------------------------------------------------------------------
New York 4,767,000 Public
(city) 158 $900.00
About 125 Yes No average
Private 102
--------------------------------------------------------------------------
Chicago 2,185,000 Public
(city) 50 135 Yes Yes $900.00 to
$1,320
--------------------------------------------------------------------------
Philadelphia 1,549,000 Public
(state) 12 Varies Yes Yes $900.00
Private 4 150 No No
--------------------------------------------------------------------------
St. Louis 687,000 Private 7 100 Yes Yes $720.00 to
$900.00
--------------------------------------------------------------------------
Boston 671,000 Public 100
(city) 25 to 180 Yes No $900.00
--------------------------------------------------------------------------
Cleveland 561,000 Public
(city) 24 300 Yes Yes $720.00 to
$1,020.00
--------------------------------------------------------------------------
Baltimore 558,000 Public
(city) 16 212 Yes Yes $900.00
--------------------------------------------------------------------------
Pittsburgh 534,000 Public
(city) 4 No No $900.00
State 10 100 No No $840.00
Private 6 Yes Yes $300.00
--------------------------------------------------------------------------
Detroit 466,000 Public
(city) 10 100 Yes Yes $1,000
--------------------------------------------------------------------------
Buffalo 424,000 Public
(city) 6 125 Yes No $720.00
--------------------------------------------------------------------------
PROVISIONS FOR OUTDOOR SLEEPING
By MAY MacCONACHIE, R. N.
Head Nurse, St. Elizabeth Dispensary of the Chicago Municipal
Tuberculosis Sanitarium.
In the treatment of tuberculosis, the best results have been obtained in
sanatoria. In most cities, however, sanatorium treatment is not possible
for many patients; consequently home treatment must be provided. This can
be done most successfully when we imitate as far as possible the
sanatorium method. This paper describes some of the arrangements for
outdoor sleeping which may be provided for a patient taking the "cure" at
home.
The Fresh Air Room.
Select the best lighted and best ventilated room, preferably one with
southern exposure, for the patient to sleep in. All superfluous furniture
and hangings should be removed. In doing this, however, the room need not
be made cheerless; small rugs, washable curtains and one or two cheerful
pictures may be allowed.
There should be some means of securing cross ventilation in all sleeping
rooms, as for the ideal fresh air room this is most essential. When this
cannot be arranged and when there are windows only on one side of the room
and a transom is lacking, the window should be open at both upper and
lower sash. This arrangement allows the bad air to escape through the
opening at the top, while the fresh air enters below. The "French window"
which opens from floor to ceiling by swinging inward is to be recommended
for the ideal sleeping room. In ventilating a room which is used for a
sitting room in the daytime, especially in stormy weather, it is sometimes
necessary to protect the patient from a direct draft. For this purpose a
shield may be made from an ordinary piece of hardwood board, eight inches
wide (or larger) and long enough to fit in between the side casings. It
can be covered with wire netting, cheese cloth or muslin. There are a
variety of wind shields on the market called sash ventilators, or air
deflectors.
Window Tents
In the treatment of tuberculosis the window tent was originally devised to
give fresh air to patients in their own rooms. To a poor family the window
tent has an economic advantage, especially if the room where the patient
lies serves as a living room for the rest of the family. The fact that the
well members should not shiver is of vital importance in many respects. A
simple home window tent, and one which can be made easily in the homes of
the poor, consists of a straight piece of denim or canvas hung from the
top of the window casing and attached to the outer side of the bed. The
space between this and the window casing on each side is closed with the
same material properly cut and fitted. Ten to twelve yards of cloth is
necessary. If made of denim, the price of the tent would be about $3.00;
if of canvas, about $4.50. If this cannot be obtained, take two large,
heavy cotton sheets, sew them together along the edge, tack one end to the
top of the window casing and fasten the other end to the bed rail with
tape. There will be enough cloth hanging on each side to form the sides of
the tent, and this should be tacked to the window casings. The
manufactured window tents are all constructed practically on the same
principle. The difference between them is in their shape and the manner of
their operation. There are two types: the awning variety, as illustrated
by the Knopf and the Allen tents; and those of the box order, of which the
Farlin, Walsh, Mott and Aerarium are examples.
KNOPF WINDOW TENT. The Knopf window tent[1] is constructed of four
Bessemer rods furnished with hinged terminals, the hinges operating on a
stout hinge pin at each end with circular washers so that it can be folded
easily. The frame is covered with yacht sail twill. The ends of the cover
are extended so they can be tucked in around the bedding. The tent fills
half of the window opening and can be attached to the side casings three
inches below the center of the sash, this space being for ventilation. The
patient enters the bed and then the tent is lowered over him, or he can
lower the tent himself by means of a small pulley attached to the upper
portion of the window. The bed can be placed by the window to suit the
patient's preference for sleeping on his right or left side. A piece of
transparent celluloid is inserted in the middle of the inner side so that
the patient can look into the room or can be watched.
ALLEN WINDOW TENT. The Allen window tent[2] is on the same order as
Knopf's, the difference being chiefly in size. The Allen tent covers the
entire window and has the appearance of an ordinary window awning turned
into the room, ventilation being secured from openings above the upper and
below the lower sash.
BOX WINDOW TENT. The box variety of window tent consists of a light steel
frame covered with canvas or cloth. The frame fits between the window
casing like a wire screen frame. The bottom, through which the head is
passed, can be made of flannel and can be drawn closely around the neck.
AERARIUM. Dr. Bull's aerarium[3] is another device similar to a window
tent. This arrangement consists of a double awning supported on a wooden
or steel frame and attached to the outside of the window with a special
ventilating arrangement. The head of a cot bed is put through the window
and the patient's head rests out of doors. The lower window sash must be
raised about two feet and a heavy cloth or curtain hung from its lower
edge so that it will drop across the body and shut off the room from the
outside air.
Window tents have a few advantages. The patient's prolonged rest in bed
will be more endurable when he is permitted to look out on the street and
watch life than when obliged to gaze at the four walls of his room. Also
patients, who can be persuaded only with difficulty to sleep with the
window wide open, will not hesitate when they have this tent as an
inducement. Draft which the patient usually dreads, particularly in cold
weather and when he perspires, need not be feared when sleeping in a
window tent. Further, this limits the possible infection to the interior
of the window tent, which is obviously an advantage. While, as a matter of
course, the patient will have been taught to always hold his napkin before
his mouth when he coughs or sneezes, this is not always done, and cannot
be done when coughing in sleep. The constant exposure to air and light of
the bacilli, which may have been expelled with the saliva and remain
adhered to the canvas, will soon destroy them. Also the canvas of the tent
is attached to the frame by simple bands and its removal from the frame
for thorough cleansing, washing and disinfection is thus made easy.
Tents
Tents are frequently used for open air living. However, they are not to be
recommended for those who can afford to construct open buildings of more
durable material. 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 through 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. Many modifications of the ordinary tent have
been made for the purpose of obtaining a well ventilated canvas shelter.
GARDNER TENT. The Gardner tent[4] is conical in shape with octagonal floor
area, with an opening in the center of the roof and one at the bottom
between the floor and the sides. These openings act like a fireplace and
produce a constant upward current of air through the interior. "The floor
is in six sections and can be bolted together. It is made of 1x4-inch
tongued and grooved boards supported eight inches above the ground on
2x4-inch joists. Around the edge of the floor is a wainscoting of narrow
floor boards four feet in height. There is no center pole, as the tent is
supported by an eight-sided wooden frame. The roof and sides are of khaki
colored duck. The lower edge of the canvas walls are fastened several
inches below the floor and one inch out from the wainscoting on all sides.
This leaves an opening through which a gradual inflow of air is obtained
without causing a draft. The opening in the center of the roof is one foot
in diameter and is covered with a zinc cap." The cap is raised or lowered
by a pulley attachment.
TUCKER TENT. The Tucker tent is similar to the Gardner in that it is
supplied with ventilation in the wainscoting near the floor and in the
center of the roof. It is rectangular rather than octagonal in shape and
is made in two sizes--one, eight feet wide by ten feet long, and the
other, twelve feet wide by fourteen feet long. It has a wooden floor,
wooden base and canvas side, with window openings on each side. "The
canvas above the base in the front is attached to awning frames so that it
can be raised or removed altogether for the free entrance of air and
light." The roof and fly are made of 12-ounce army duck.
LA POINTE TENT. The La Pointe tent is similar to the Tucker tent. It is a
canvas cottage with doors, windows and floor. The top is made of canvas,
with a fly which projects two inches on all sides. The windows have a wire
netting and canvas shutters, the canvas being so arranged that it can be
pulled up as a curtain, or extended as an awning. Its cost is $85 to $100.
ARMY TENT. A simple ordinary tent is the United States Army tent. There
are two different styles, one with closed corners and one with open
corners. It is made of army duck with poles, stakes and guys, and costs
according to size. A small tent eight feet four inches long and six feet
eleven inches wide would cost $7.50, and lumber for floor about $2.00
extra. This tent is easily put up, care being taken to select a dry soil,
places where the water stands in hollows after a rain should be avoided. A
small trench about one foot deep around the tent will help in keeping the
soil dry.
TENT COT. For experimenting in outdoor sleeping a tent cot is a very
simple arrangement. It consists of a plain canvas cot with a frame
supporting a small tent. Ventilation is secured by openings at both ends;
also at the side where the patient enters. These openings are covered with
flaps which can be opened or closed. It is light, weighing from twenty to
fifty pounds, and its position and exposure can be conveniently changed.
The cost is $9.
KNOPF'S HALF TENT. Another simple arrangement is Knopf's half tent.[5] It
consists of a frame of steel tubing covered with sail duck and secured
with snap buttons on the inside. It is used for patients sitting out of
doors. The reclining chair is placed in the tent with its back to the
interior. Its weight helps to hold down the floor bracing attached to the
frame.
Sleeping Porches