Nurses' Papers on Tuberculosis Part 4

=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 Munic.i.p.al 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 Munic.i.p.al 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 Munic.i.p.al 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.

[Ill.u.s.tration]

-------------------------------------------------------------------------- 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 Munic.i.p.al 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 s.p.a.ce 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 ill.u.s.trated 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 s.p.a.ce 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 pa.s.sed, 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 s.p.a.ce 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 14-inch tongued and grooved boards supported eight inches above the ground on 24-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 b.u.t.tons 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.