Nurses' Papers on Tuberculosis Part 3

Once a week the chief of the Bureau of Tuberculosis and the Superintendent of Nurses meet with each separate dispensary staff, and cases are carefully considered and work discussed. In addition, meetings of the active nursing staff are held, informal talks on tuberculosis being given, or the work of allied organizations studied, speakers coming from the a.s.sociated Charities, Department of Health, Settlement Houses, etc. Each nurse is held responsible for the handling of every individual case in her district. By thus making the nurse responsible, the interest in her work is increased and much better results are obtained. If the problem presented is one that will take more time and energy than the busy dispensary nurse can give, it is referred to a Special Case Committee.

All dispensary cases are visited in the home within twenty-four hours after the first visit to the dispensary, where a complete history of the case is taken. The patient and family are instructed and each member urged to come to the clinic for examination. Homes where a death from tuberculosis has occurred are visited immediately, with the consent of the physician. The family is carefully instructed as to disinfection, and advised to go to the physician or dispensary for examination.

Cleveland nurses wear uniforms. Each nurse carries about three hundred patients, a very small percentage being bed cases, usually not more than two patients at a time. Nurses receive $60 for each of the first three months; $65 for each of the next nine; $70 a month for the second year; the third year $80; and the fourth year $85.

DETROIT

The Detroit Board of Health maintains a staff of ten visiting tuberculosis nurses. They give a small percentage of bedside care, wear a uniform, and receive $1,000 per year. They work in connection with the Board of Health Dispensary and have the same general follow-up plan as other cities.

MILWAUKEE

The head of the Division of Tuberculosis of the Milwaukee Health 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 a.s.suming 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 a.s.sociation. 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 a.s.sociation 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 a.s.sist 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 Inst.i.tute, which was organized in January, 1906. The Inst.i.tute succeeded the Committee on Tuberculosis of the Visiting Nurses' a.s.sociation (the pioneer Tuberculosis Committee in Chicago).

The Chicago Tuberculosis Inst.i.tute 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 Inst.i.tute. By exhibits, lectures, literature, stereopticon views and moving picture films, the Inst.i.tute 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 Inst.i.tutions 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 Inst.i.tute. 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 Inst.i.tute 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 Inst.i.tute, 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 Inst.i.tute 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 Inst.i.tute, 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 Munic.i.p.al Sanitarium Law and made possible the Munic.i.p.al Tuberculosis Sanitarium now nearing completion.

The maintenance of the seven dispensaries having become a source of considerable expense to the Inst.i.tute, they were turned over to the city and became a part of the Munic.i.p.al Tuberculosis Sanitarium in September, 1910.

The Inst.i.tute continued its activities as "an educational inst.i.tution 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 inst.i.tutions. Through its Committee on Factories, the Inst.i.tute 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 Inst.i.tute. In brief, the Inst.i.tute for years has led the fight against tuberculosis in this city.

The dispensary system of the Munic.i.p.al 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 Munic.i.p.al 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 cla.s.sified 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