Nurses' Papers on Tuberculosis Part 7

Among the legislative acts should be mentioned:

(a) The Act of 1911 providing building grants for the establishment of sanatoria, dispensaries and other auxiliary inst.i.tutions.

(b) Compulsory notification of tuberculosis, etc.

Notification of tuberculosis, for instance, besides bringing to notice of the school medical officer cases of tuberculosis which might otherwise not come before him until a late period, serves in many cases to keep him informed as to "contact cases"--cases of children in contact with communicable tuberculosis.

At Burton-on-Trent a system was inst.i.tuted for periodical examination of school children who are either members of a family in which there is or has been a case of pulmonary tuberculosis, or who are attending school while residing in houses in which there is an existing case of this disease. All notified cases of tuberculosis are visited by the a.s.sistant Medical Officer of Health, who is also a.s.sistant School Medical Officer, and the names of any children living in the house, or related to the case, are ascertained, together with the school they are attending. These names are entered in a special register and when the pupils of a school, at which any of these children are attending, are examined, a special examination is made of the latter. This examination is repeated two or three times a year.

In another part of England a special letter is sent to the occupants of all houses from which the disease has been notified, calling attention to the special importance of early detection of tuberculosis in children, and asking that the children should be brought to the school clinic for examination.

In Lancashire the Medical Inspector calls on the Medical Officer of Health and obtains a list of names of persons suffering from tuberculosis, so that the children, if of school age, may be examined.

At Newcastle-on-Tyne all children exposed at any time to infection are kept under observation and re-examined. The re-examination continues even after fatal termination of the tuberculosis case with which the child was in contact.

Under the Finance Act of 1911 a sum of about $500,000 was especially appropriated for providing what are known as "Sanatorium Schools" for children suffering from pulmonary or surgical tuberculosis. These schools are known as the Residential Open Air Schools of Recovery, and the need of such schools for children requiring more continuous care than is provided at a day Open Air School is becoming widely recognized. Many children of the type already mentioned can not be satisfactorily treated unless they can be taken completely away, for a time, from their home environment.

Such treatment as is needed for many of these children is not and can not be offered in the ordinary hospital and certainly not at their homes.

The designs and arrangements of the Residential Open Air School of Recovery are very attractive. They are well equipped to fulfill their function. The children, received between the ages of seven and twelve years, are those suffering from anaemia, debility, or slight heart lesions. Cases of active tuberculosis are barred. No child is received for a shorter period than three months, and this period may be prolonged on the recommendation of the Medical Officer.

The children rise at 7 a. m. and retire at 6:30 p. m. Those who are able, make their own beds and do some of the domestic work. The diet is liberal, with abundance of milk and eggs. Careful attention is given to inculcating habits of personal and general hygiene. All children receive a daily bath.

Careful attention is paid to the teeth, tonsils and adenoids. All these conditions must be attended to before admission. Beyond this, very little treatment is given. Children are weighed once in two weeks. Instruction is chiefly practical. Instruction in gardening is given twice a week and other occupations taught are raffia work, plasticine modeling, cardboard modeling, brush work and needle work.

The number of Open Air Schools at present in England is at least thirty-five, with an attendance of at least 2,500. Forty-two other cities are listed as carrying on some form of open air education.

In the United States the Open Air School movement, from its inception, has been closely connected with the general anti-tuberculosis movement.

The credit of establishing the first Open Air School in America belongs, as previously stated, to Providence, Rhode Island, where the work was begun in January, 1908. The school was opened in a brick school house in the center of the city. A room on the second floor was chosen and remodeled by removing part of the south wall. For the wall thus removed windows were subst.i.tuted. These extended from near the floor to the ceiling, with hinges at the top and with pulleys so arranged that the lower ends could be raised to the ceiling. The desks were placed in front of the open windows in such a manner that the children received the fresh air at their backs and the light over their shoulders. Suitable clothing was provided for cold weather and, in case of necessity, soapstone foot warmers were used.

The school was started as an ungraded school and ten pupils were enrolled at the time of its opening, the number later increasing to twenty-five.

Practically all children were selected by the visiting nurse of the local League for the Suppression of Tuberculosis from infected homes under her supervision. In a few instances children with moderately advanced lesions were admitted.

The children reported at 9 a. m. and a recess was given at 10:30, when they were served soup. At noon they had a light lunch of pudding served with cream, hot chocolate or cocoa made entirely with milk. Some of the children brought additional food from home. All of the cooking was done by the teacher. Careful attention to general cleanliness and hygiene of the teeth was insisted upon. Individual drinking cups and tooth brushes were provided. The children took turns in washing dishes, setting the table and helping to serve. Children were dismissed at 2:30 p. m. They were provided with car tickets by the League for the Suppression of Tuberculosis, some for traveling both ways, some for one way only, depending upon the means of the family. During school session light gymnastic exercises were given and proper methods of breathing taught. In the spring they had a garden to work in.

The Providence school is at present a part of the general school system.

The school supplies and teacher's salary are furnished by the Board of Education. Food and carfare are supplied by the League for the Suppression of Tuberculosis. A physician is delegated by the League and one of the regular Medical Inspectors of the city schools works in co-operation with him.

Providence has at present two schools, with an attendance of forty. One more Open Air School and two roof cla.s.ses may be provided by the Board of Education in 1914. In addition, the Providence League for the Suppression of Tuberculosis conducts a Preventorium for thirty children at the Lakeside Preventorium, Rhode Island.

Boston started its first Open Air School in July, 1908. The work was carried on by the Boston a.s.sociation for the Relief and Control of Tuberculosis. The school was located at Parker Hill, Roxbury. The same regime was followed as in previously reported schools. No formal instruction, however, was attempted at first. The school was simply a day camp. The benefit derived by the children in the first open air camp for children led the a.s.sociation to ask the Boston School Board to co-operate with them in converting the camp into an outdoor school. This was agreed to, the School Board supplying teacher, desks, books, etc., the a.s.sociation furnishing the necessary clothing, food, a nurse, attendants, home instruction and medical services. The same schedule was followed here as in the other Open Air Schools. General and personal hygiene was insisted upon. The school was kept open Sat.u.r.days and during the holidays.

The children who were able paid ten cents a day to help defray the cost of food. In case they could not afford this, the money was supplied by some charity organization. While the combined public and private support had proved satisfactory, it seemed best, for many reasons, to reorganize the school so that it would be entirely under munic.i.p.al authority, and this has since been done. At the present time the school is maintained by the Boston Consumptives' Hospital and the Boston School Board. The hospital furnishes transportation, food, etc., while the School Board gives school supplies, books, desks, etc., and pays the salaries of the teachers. The children are selected by the school physicians, the type considered being the anaemic, poorly nourished, those with enlarged glands, or convalescents. Cases of active tuberculosis are not admitted.

Boston has at present fifteen Open Air Schools, with a total enrollment of about 500 children.

The first school established in New York City was started under the auspices of the Department of Education and was located on the ferryboat Southfield, which was maintained as an outdoor camp for tuberculous patients by Bellevue Hospital. It was through the special desire of the children who were patients at the camp that the school was started, for they banded together one day and informed the doctor that they wanted to have a teacher and attend school. When their action was reported to the Board of Education it was felt that such an unusual plea should be given a favorable response, and in December, 1908, the school on the ferryboat was made an annex of Public School No. 14.

This school, except for its location, does not differ from other schools of similar type. The Board of Education pays the teacher and furnishes the school supplies. Food and clothing are supplied by the hospital. The school is an ungraded one and the number of children taught by one teacher averages thirty.

Four more Open Air Schools have since been established, three on ferryboats and one on the roof of the Vanderbilt Clinic at West Sixtieth street. Officially, all these schools are considered to be annexes of the regular public schools.

In October, 1909, $6,500 was granted to the Board of Education by the Board of Estimate and Apportionment for the purpose of remodeling rooms in some of the public schools for use as Open Air Rooms. A special conference was held in December of that year by medical and school authorities to decide how best to remodel, furnish and equip these new rooms for this purpose; also how the children should be chosen for these cla.s.ses.

It was decided that the maximum number of children admitted to any one open air cla.s.sroom should not exceed twenty-five, the children to be chosen by the director of the tuberculosis clinic nearest the school and the school princ.i.p.al. No child was to be a.s.signed to the room until the parents' permission had been secured in writing. Children moving from one district to another were to be followed up and cared for in the new district. No special rule was adopted defining the physical condition ent.i.tling the child to admission. Each case was to be considered individually, and the only definite rule was that no open case of tuberculosis should be admitted. The minimum temperature of the room was 50 degrees F. The rooms, wherever possible, were to be located on the third floor. The first of these open air cla.s.ses was established in April, 1910. Such popular interest was awakened by the inauguration of these cla.s.ses that, as a direct result, a special privilege was granted by the Commissioners of Central Park permitting children of the kindergarten cla.s.ses of the public schools to pursue their studies in the open air in Central Park.

At present New York has thirty-three Open Air Schools and Open Window Rooms, with a total enrollment of at least 1,000.

Chicago's first Outdoor School for Tuberculous Children was inaugurated as a result of the joint co-operation of the Chicago Tuberculosis Inst.i.tute and the Board of Education. This school was opened during the first week of August, 1909, on the grounds of the Harvard School at Seventy-fifth street and Vincennes Road. The Board of Education a.s.signed a teacher to the school and furnished the equipment, while the Tuberculosis Inst.i.tute supplied the medical and nursing service, selected the children and provided the food.

Except during inclement weather, the children occupied a large shelter tent in which thirty reclining chairs were placed. Meals were served in the bas.e.m.e.nt of the school building, where a gas range, cooking utensils and tables were installed for this special purpose.

The nurse, who was a.s.signed by the Tuberculosis Inst.i.tute on half-time attendance, visited the school each afternoon, took daily afternoon temperatures, pulse and respiration, looked after the general physical condition of the children, made weekly records of their gain or loss in weight and did instructive work in the home of each pupil.

Of the thirty children selected, seventeen had pulmonary tuberculosis, two had tubercular glands, and eleven were designated as "pre-tuberculous."

None of the children had pa.s.sed to the "open" or infectious stage. On admission two-thirds of the children showed a temperature of from 99 to 100.2 degrees.

The daily program was similar to that already described for the Providence and Boston Schools. The school was kept open for a period of only one month, with excellent results. During this time the thirty children made a net gain of 115 pounds in weight, and at the close of the period practically all of them showed a normal temperature, with their general condition greatly improved.

It is needless to say that the experiment created a great deal of local interest in the problem of better school ventilation. Those who had the success of the movement most intimately at heart realized, however, that the undertaking lacked the element of permanency and that the results accomplished by it lacked that degree of conclusiveness which would attend the same results if secured through the operation of an all-the-year-round school.

The opportunity to demonstrate the effectiveness of such an all-the-year-round school was realized in the Fall of 1909 by a grant from the Elizabeth McCormick Memorial Fund to the United Charities for the purpose of conducting such a school on the roof of the Mary Crane Nursery at Hull House. This school was opened by the United Charities in October with twenty-five carefully selected children, and was conducted throughout the following winter and spring with the co-operation of the Board of Education and the Chicago Tuberculosis Inst.i.tute. During the same winter the Public School Extension Committee of the Chicago Women's Club, co-operating with the Board of Education, established two cla.s.ses for anaemic children in open window rooms--one in the Moseley and one in the Hamline School. Here the regular regime was broken by a rest period, and lunches of bread and milk were served twice each day. "Fresh Air Rooms,"

in which the windows were thrown wide open and the heat cut off, were also established for normal children in several rooms in the Graham School. No attempt was made here to furnish lunches and no rest period was provided.

There were, then, during the school year of 1909 and 1910, three distinct cla.s.ses of children cared for by three distinct agencies--the cla.s.ses for normal children in the low temperature rooms at the Graham School; anaemic children, with rest period and two lunches, in the Moseley and Hamline Open Window Rooms, and the Roof School for Tuberculous Children, with specially provided clothing, sleeping outfits, three meals a day and medical and nursing attendance, at the Mary Crane Nursery.

The same condition existed throughout the following year--1910-11--with the addition of one Open Air School on the roof of the munic.i.p.al bath building on Gault Court, given rent free by the City Health Department, and two Open Window Rooms for anaemic children in the Franklin School, all maintained by the Elizabeth McCormick Memorial Fund.

In 1911 the Elizabeth McCormick Memorial Fund a.s.sumed the responsibility for all the open air school work carried on in the Chicago Public Schools, and began the standardization of methods which should be employed in the conduct of such schools.

Through the initiative of the Elizabeth McCormick Memorial Fund the Chicago Open Air School work has been rapidly developed during 1912 and 1913, the program being along the line of additional roof schools for tuberculous children and an increasing number of open window rooms for anaemic children and children exposed to tuberculosis. In all this work the Elizabeth McCormick Memorial Fund has had the co-operation of the Board of Education, the Chicago Tuberculosis Inst.i.tute and the Munic.i.p.al Tuberculosis Sanitarium. The Board of Education has supplied teachers and furnished rooms wherever there has been a distinct demand for such a provision. During the past two years the Munic.i.p.al Sanitarium has made appropriations aggregating $12,000 to pay the cost of food for these schools, in addition to furnishing the necessary nursing service.

At the present time four Roof Schools and sixteen Open Window Rooms, with an enrollment of 500 pupils, are being maintained.

For full information concerning the Chicago Open Air School movement, see "Open Air Crusaders," January, 1913, edition, published by the Elizabeth McCormick Memorial Fund, 315 Plymouth Court, Chicago; or write Mr. Sherman C. Kingsley, Director, Elizabeth McCormick Memorial Fund, for more recent developments.

s.p.a.ce will not permit a statement of the development of the Open Air Schools in other cities in the United States since this movement was started in 1908. It is, however, encouraging to note what has been accomplished and the comprehensive plans which are being made to further this great movement for the good of the future citizens of America.

[Ill.u.s.tration]