The Tuberculosis Nurse
Her Function and Her Qualifications
A Handbook for Practical Workers in the Tuberculosis Campaign
By
Ellen N. La Motte, R.N.
Graduate of Johns Hopkins Hospital; Former Nurse-in-Chief of the
Tuberculosis Division, Health Department of Baltimore
Introduction by
Louis Hamman, M.D.
Physician in Charge, Phipps Tuberculosis Dispensary, Johns Hopkins
University
G. P. Putnam’s Sons
New York and London
=The Knickerbocker Press=
1915
COPYRIGHT, 1915
BY
ELLEN N. LA MOTTE
_Second Impression_
=The Knickerbocker Press, New York=
TO
MARY E. LENT
MY FRIEND
INTRODUCTION
To tuberculosis, more than to any other infectious disease, the parable
of the seed and the soil is strictly applicable. Without the tubercle
bacillus there can be no tuberculosis, but for tuberculosis to develop,
many factors of great complexity and as yet but little understood must
facilitate the implantation of the bacillus and augment its growth. It
is true that though we may emphasize the rôle of the bacillus, still we
cannot completely ignore those personal factors that contribute to make
the infection fruitful, and likewise though we focus our attention upon
individual resistance, still we cannot keep out of sight the invader
that is being resisted. The two viewpoints meet and run together, but
are sufficiently separate to lead to different methods in our efforts to
eradicate tuberculosis.
On the one hand are those who direct their efforts toward the
annihilation of the tubercle bacillus. We are sufficiently instructed
about the life history and habits of this organism to lay our plans upon
a firm, scientific basis—a basis so firm and at first sight so simple
and so plausible that over-enthusiasm led to predictions that have been
sadly disappointed. The principles are sound indeed, but in practice
their application has met with insuperable difficulties. These
obstructions have sharpened our wits to find new avenues that now
promise a more ready approach to the goal. To put the matter briefly,
the tuberculosis campaign of the past fifteen years has taught us two
important lessons: first, that the tuberculous cannot be isolated in
their homes; second, that they cannot be cured in or out of sanatoria. I
am shocked myself to read these bald statements, particularly the
second, and still I am convinced that they are true. Some patients can
be isolated in their homes, and many patients recover from tuberculosis
and remain well. Tuberculosis is very amenable to treatment and under
proper conditions the results of treatment are very gratifying. The
difficulty is that the proper conditions are in most instances wanting,
and when they are absent sanatorium recovery is almost invariably
followed, after a brief period, by relapse. The records of cases with
tubercle bacilli in the sputum establish this fact. Concerning the value
of statistics of cases without tubercle bacilli in the sputum I
entertain the gravest doubt. While I am heartily in favour of treating
such patients, the personal equation enters too largely into the
diagnosis to give the results convincing value as evidence of the
lasting benefits of treatment. Experience has taught me that the
educational value of sanatoria has been grossly exaggerated, and that
this value is of small account in a broad plan of prevention. Our
present knowledge, fortified by the costly experience of the past
fifteen years, forces us to believe that the most direct and effective
way of dealing with the tubercle bacillus is to isolate as many advanced
consumptives as is possible. The hospital, perhaps supplemented by
colonies, is the rational method of procedure. Other factors are of
importance; all other factors are, but this is the fundamental and
essential factor in the campaign.
On the other hand are those who direct their efforts towards cultivating
the soil. Reliable studies inform us that ninety per cent. of the human
race is tuberculosis infected, and that infection occurs at a very early
age, so that at twelve years few children have escaped it. Relatively a
small number of those infected subsequently become tuberculous, so that
something more than infection is necessary for tuberculosis to develop.
What this something is we do not know. Time, manner, frequency, and
intensity of infection play an important part. Apparently too there is a
wide personal variation in susceptibility. To just what this personal
factor is due we are not in a position to say, but certain general facts
known about the distribution of tuberculosis afford us a clue to its
interpretation. Tuberculosis, like most infectious diseases, thrives
under the conditions that poverty induces. Inadequate housing
facilities, insufficient food, filth, and sordid care are a few of
these. If, as all must admit, the tubercle bacillus is more or less
ubiquitous and few escape contact with it, then an important part of our
campaign of prevention will be the raising of personal resistance so
that when infection occurs it may be successfully overcome. Here is the
field for wide social activity. Everything that makes for higher
standards of living and for improved personal hygiene is a valuable arm
against tuberculosis. Housing laws, child-labour laws, the wage
question, municipal recreation centres, the liquor question, social
service in all its departments, vacation lodges, open-air schools,
factory inspection, and so on and so on, are all indirectly valuable
anti-tuberculosis agitation.
It is not my purpose to discuss the relative merits of the various
phases of the anti-tuberculosis campaign. The death-rate from
tuberculosis is falling steadily and rapidly, and it has fallen most
rapidly in just those centres where the campaign has been vigorously
pushed on a broad basis. Which phase of the work is responsible for the
decrease or deserves the greatest credit, it is impossible to conclude
from a study of available evidence. The same statistics are interpreted
by one, for instance Cornet, as evidence of the efficiency of sputum
prophylaxis; by another, for instance Hoffman, as evidence of the
influence of improved economic conditions; by yet another, for instance
Newsholme, as evidence of the value of hospitals for advanced cases; and
finally by many, for instance Fränkel, as evidence of the undisputed
value of all three factors. Which factor one emphasizes will depend
largely upon one’s training and the field of activity in which one is
engaged.
Being a physician and by training accustomed to view problems from a
medical standpoint, it is natural that I should emphasize the attacks
upon the bacillus. As I have said, it seems to me to be firmly
established that the most efficient, the most direct, and the cheapest
way to enforce isolation and prevent infection is by hospital
segregation of cases of advanced pulmonary tuberculosis. While early
diagnosis, sanatorium treatment, and education are valuable features of
the campaign, their value will be but slight if this one essential
feature is neglected. Indeed I am inclined to see the chief value of
economic improvement in the indirect influence this improvement
exercises upon the facility for infection. With economic advance the
æsthetic value of general and personal hygiene grows apace, and the
dictates of ordinary cleanliness offer a very strong barrier to
infection. Poverty itself does not produce tuberculosis, but the
conditions that poverty fosters do, and the advantages of better living
reside not so much in an improved personal fitness as in the eradication
of the conditions that facilitate infection. This view is in accord with
what we have learned of other infections. Plague has been notoriously a
scourge to the poor. To improve living conditions lessens plague, and
this general fact was known before we learned that cleanliness produced
results indirectly by eliminating rats. Malaria has always been
particularly prevalent amongst labourers living in unprotected huts. To
improve living conditions reduces malaria, but we gain the result more
surely and directly by an intelligent campaign against mosquitoes.
Unfortunately, we are not sufficiently instructed about tuberculosis to
pick out of the whole mass of ills that poverty entails those few
essential features that control infection. Perhaps some day we will, and
then we shall be able to manage the social campaign more efficiently and
economically. For instance, we are quite at sea to know what
prophylactic use to make of the firmly grounded fact that tuberculosis
infection establishes a strong resistance to reinfection. Upon an
analogous principle rests the conquest of smallpox by vaccination. No
doubt this immunity reaction has an important influence upon the
development of tuberculosis, but as yet we know too little about it to
control it and use it to advantage in our fight with the disease.
In the anti-tuberculosis campaign the nurse must look to medical science
for the plan and inspiration of her work. Her attitude in the
tuberculosis campaign must always conform to the medical attitude,
although she may and indeed has added valuable material for building up
this attitude. It is because this intimate relation exists that I have
briefly outlined the medical impression of the tuberculosis campaign. It
is quite natural that it should represent at the same time the nurse’s
attitude. My object was to point out the numerous factors concerned in
the anti-tuberculosis crusade, their interrelation, and the quite
natural and necessary specialization that must occur. The field of the
nurse and particularly the municipal nurse is circumscribed, but it is
large enough to engage all her energy and devotion. It is not necessary
nor even desirable that she should diffuse her interest and energy over
the adjoining fields.
For more than ten years Miss La Motte and I have been engaged in working
at the same problems, from the same broad though different personal
viewpoint. Our work has brought us into almost daily contact. I
acknowledge, with gratitude, the many valuable suggestions that I have
borrowed from her experience, and in reading her book I note with the
greatest satisfaction what I believe to be evidence of influence from
the experience I have gained. It is a pleasure to find that after years
of arduous work we agree at least upon what is the fundamental problem
of the tuberculosis campaign, namely—institutional care of the advanced
cases of pulmonary tuberculosis. I think it is right and proper that
Miss La Motte has made this fact the guiding principle of her book, and
that she has shown the relation of nursing activity to its furtherance,
and that she has held all other phases of tuberculosis work subservient
to it. To avoid misunderstanding it may be necessary to point out that
other features of the anti-tuberculosis campaign have been merely
touched upon or entirely ignored. This apparent slight is not offered, I
am sure, as a reflection upon the value of these features; they are
omitted simply to accentuate more boldly the dominant idea of the
nurse’s work.
Another noteworthy feature of the book is the purely personal and local
character of the experience presented. It details the problems that have
offered themselves here in Baltimore, how these problems have been met,
and how an effective nursing staff has been built up, first under
private and then under municipal control. What has been accomplished
abroad and in other localities in this country is not considered. In a
way this is a disadvantage, for the book loses somewhat in breadth and
erudition. However, I am convinced that what may be lost in this respect
is more than compensated for by the gain in force and conciseness. After
all, the fundamental problems are the same everywhere, and though local
conditions will necessitate adjustment of details, still I believe the
adjustment will be stimulated and facilitated more by a spirited account
of what has been done under specific conditions than by a colourless
review of the whole field of activity.
No doubt many will find personal views expressed with which they
disagree. This is unavoidable before such a frank and radical
presentation of the situation. One is impressed by the honesty and
enthusiasm of the book, but some may wish that certain of the
statements, and particularly some strictures, had been a little
mollified. The book will be interesting and helpful and, what is more
important, stimulating to all engaged in tuberculosis work. All the
better if some parts of it cause surprise and opposition,—we will then
review more critically our own attitude.
LOUIS HAMMAN, M.D.,
Physician-in-Charge, Phipps Tuberculosis
Dispensary, Johns Hopkins Hospital.
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
CHAPTER I
Statement of the Case—Beginning the Work—Reaching the
Patients—Supervision of the Work—Necessity for Experienced Nurses.
=Statement of the Case.= Pulmonary tuberculosis is a communicable
disease, transmitted from person to person by means of the tubercle
bacilli contained in the sputum of infected patients, or in the breath
expired during paroxysms of coughing. The bacilli thus liberated, find
their way into the system of another individual, either through the
respiratory or alimentary tract, or both. The enormous prevalence of
tuberculosis is due to the fact that its infectious nature was not
recognized until 1882 when Koch discovered the bacilli. Since that time
it has been classed as a transmissible disease, and during the past ten
years a vigorous effort has been made to eradicate it. This agitation is
popularly known as the anti-tuberculosis campaign, and associations for
the suppression of tuberculosis have sprung up in all parts of the
country. So far, no serum or vaccine has been found by which this
disease may be controlled, as was the case when smallpox and diphtheria
were checked. The sole way of overcoming it is to overcome the ignorance
concerning its nature, its transmissibility, and the means by which it
is spread.
At the beginning of the campaign it was believed that simple education
along these lines was all that was needed to obtain results. These
results were expected to follow as soon as the patient was informed of
the nature of his disease, and how to avoid spreading it, and as soon as
those in contact with him were given like information and taught how to
avoid infection. Ten years ago, in the optimism of the moment,
tuberculosis was freely proclaimed a “curable” disease; so that together
with the campaign of prevention went a campaign of teaching the patient
how to become a “cured,” or as we now call it, an arrested, case. The
mechanics of cure were equally simple—rest, fresh air, and food were all
that was needed, provided the disease was taken in the early stages. And
all that was necessary for “cure,” just as all that was necessary for
prevention, was to tell the patient what to do, and those about him what
to do, and the thing was done. This is the theory upon which the work
was founded, and in theory this is still a sound principle upon which to
continue it. Unfortunately, a series of unlooked for conditions
interposed themselves between this theory and our ability to put it into
practice. At the time when the crusade was begun these conditions were
not recognized, and it is only through long study of the situation, from
its social, economic, and legal as well as clinical aspects that we get
some idea of the difficulties and complexities of the task before us.
In the first place, tuberculosis is largely a disease of the poor—of
those on or below the poverty line. We must further realize that there
are two sorts of poor people—not only those financially handicapped and
so unable to control their environment, but those who are mentally and
morally poor, and lack intelligence, will power, and self-control. The
poor, from whatever cause, form a class whose environment is difficult
to alter. And we must further realize that these patients are surrounded
in their homes by people of their own kind—their families and
friends—who are also poor. It is this fact which makes the task so
difficult, and makes the prevention and cure of a preventable and
curable disease a matter of the utmost complexity.
People of this sort, however, constitute almost the entire
problem—otherwise the situation would be so simple that the word problem
would not apply.
This is why “cure” is not the solution of the matter. Too few people are
cured, in comparison to the numbers annually infected, to make any
impression on a disease of such wide prevalence. The sanatorium,
valuable as it may be for certain cases, is of little use to those who
relapse upon return to an environment they will not or cannot control.
This is also why mere instruction in preventive measures, unaccompanied
by effective isolation, is barren of results.
Experience has taught us the unsatisfactory nature of so-called cures,
and the futility of that prevention which allows the distributor of
tuberculosis to remain at large in the community and heedless of his
obligations. Hence we must look to segregation as the only reasonable
course to pursue. If segregation can be obtained in the home, well and
good. If not, then we must look to the institution to provide the proper
care. This segregation, most of it voluntary, some of it enforced, is
the only way to do preventive work on a scale large enough to count. To
this end, we need dispensaries where the disease may be recognized and
diagnosed, nurses to visit the patients in their homes, and hospitals
for advanced cases, the function of the nurse being to teach patients
and their families the necessity for segregating the former in
hospitals.
=Beginning the Work.= Let us suppose that a certain community, town or
country, suddenly becomes aware of tuberculosis in its midst, and in
consequence wishes to get rid of it. It is but a fraction of the
community which is enlightened enough for this, but from this nucleus
must come all that awakening of public sentiment needed to facilitate
the campaign. To estimate the number of tuberculous persons in any
locality, multiply the yearly tuberculosis death-rate by five or
ten—authorities differ as to the exact figures. The result will be the
approximate number of those afflicted. The public press will help in
disseminating this information, which is the basis from which we must
work. Since the beginning of the campaign, newspapers have been
wonderfully helpful allies in giving wide publicity to facts concerning
tuberculosis. As a result of this newly aroused interest, an
Anti-Tuberculosis Society may be created, and into its fold are gathered
all those willing to help in the work, each with his dollar. Lectures,
exhibits, open-air speaking, lantern-slide exhibitions, meetings in
churches and others held before various societies are given in various
parts of the town, and in this way information about tuberculosis is
spread far and wide.
There are two classes of the community, however, that must be
reached—those who have tuberculosis and those who have not. The people
who go to lectures and exhibits belong chiefly to the latter class.
Frequently, of course, the sick ones find their way in, in an endeavour
to learn something which may be helpful to them; unfortunately, they are
able to take away but little, and the little they do get they often
misapply. We recall the case of a man who went to a tuberculosis
exhibit, and learned that fresh air was good. As a result, he walked
several miles a day in order to get it, and nearly killed himself. He
had succeeded in learning one important fact—that fresh air was
valuable—but another, of equal importance, that exercise was harmful,
had escaped him.
To make the undertaking succeed, it is necessary to reach both the sick
and the well, since that strong, intelligent public opinion, which is
the motive force behind all new movements, must be aroused among the
sick as well as among the healthy. But as we have seen, the former are
not those who go largely to lectures, so they must be reached through
some other means. The most effective way of reaching them is through the
employment of a special nurse, who shall give eight hours a day, week in
and week out, to visiting in the homes where tuberculosis exists, and
giving instruction adapted to each individual case. By this means the
people most in need of assistance are reached without loss of time and
effort, and case after case is uncovered. This is shooting straight for
the bull’s-eye—namely, the infected home from which tuberculosis is
spread.
There may be laws on the statute books compelling doctors to notify the
local health authorities of their tuberculosis cases, but these laws are
not lived up to. Nor will the establishment of a hospital for advanced
cases bring these patients to light; neither will the sanatorium, nor
even the special tuberculosis dispensary. The surest and most effective
way of unearthing them is through the visiting nurse. Therefore the
nebulous plans of the newly formed anti-tuberculosis association may
well crystallize themselves into a decision to put such an effective
agent into the field.
=Supervision of Work.= After this decision has been made, the question
arises, by whom is the nurse to be directed? Is she to be placed under
the local health department, under a dispensary, under the charity
organization society, or under the visiting nurse association, if such
an organization exists in the town? If supported by a church or special
association of some sort, should not the governing board of such
organization direct her work? Or is she to be a free lance and manage
herself?
Unless taken over by the local health department (which in that case
becomes responsible for her salary and expenses incurred in the work),
the nurse should be affiliated with the Visiting Nurse Association,
rather than with any lay organization. Better results will be obtained
if her work is directed by a superintendent of nurses who is accustomed
to dealing with and judging nurses, and familiar with their duties along
technical lines. The credit of supporting the nurse would still rest
where it belonged—with the church, with the anti-tuberculosis
association, or whatever group of people might be responsible for her
maintenance,[1] but this arrangement would relieve the lay organization
of much responsibility, for no matter how good their intentions, such a
group cannot direct nursing work as well as this can be done by one
qualified for the purpose. Another advantage gained by placing the new
nurse with the Visiting Nurse Association is that it keeps together the
various branches of public health service, and the tuberculosis nurse
realizes more fully than she otherwise might, how completely her own
specialty is interlocked with and dependent upon other forms of social
activity.
Footnote 1:
For five years the Maryland Tuberculosis Association supported five
nurses, which it placed under the management of the Superintendent of
the Visiting Nurse Association of Baltimore.
There is still another advantage in placing the new nurse with the
established organization, for then a nurse may be selected with regard
to her ability alone, leaving it to the Superintendent of Nurses to give
her the necessary careful training in social work, and the proper
supervision.
If there is no Visiting Nurse Association in the community, under whose
auspices the new special nurse may be placed, the lay organization will
have to do the best it can. In this event, it will be absolutely
necessary to select a nurse thoroughly trained in social work, and since
the number of women with this equipment falls far short of the demand, a
delay of some duration may take place. This delay is always borne with
great impatience by the newly formed group of people, anxious in their
enthusiasm to attack the tuberculosis problem at once. Yet policy would
counsel postponing the undertaking until a suitable person can be found,
for it is usually a fatal mistake to begin new work with an
inexperienced worker. Moreover, a situation which has existed for years
may be tolerated a few months longer without undue alarm as to
consequences.
If it is impossible to obtain a nurse fully trained in public health
work, the community may select a good nurse and send her for a few
months’ experience to some well recognized centre of public health work,
such as New York, Chicago, Boston, Baltimore, etc. The money thus spent
will prove a valuable investment to a community thus far-seeing, and an
ample return will be manifest in the efficiency of the nurse’s work.
A wrong start in choosing a nurse has driven many an enthusiastic
organization into deep waters, and caused trouble and misunderstanding
of a most grievous sort. In several instances, the local campaign
against tuberculosis has come to a disappointed end; in others, public
interest has been so antagonized and repelled that the movement received
a check from which it did not recover for several years.