"There are at present five nurses employed at Dispensary No. 21, two of whom give their whole time to following up the return cases from the State Sanatoria. As soon as the case is discharged from the sanatorium, that information, with other data regarding the condition on discharge, etc., is sent to us at once. At the end of a stated period, if that case has not been returned, the nurse looks it up, and gets it to come in. The nurses make out detailed reports on all cases discharged from the sanatoria, at periods of six months, whether our own patients or not. These will be and are valuable for statistical data. Practically all the data for reports as to subsequent results in cases discharged from the sanatoria, which have appeared in this country at least, have been made up from information gleaned by writing the discharged patient and having him fill out his own report. It does not tax the imagination unduly to conclude which is the more accurate, the answers to questioning by a trained worker (we have selected for this work the two nurses who have been with us longest) who in addition takes the temperature, pulse, etc., herself, and usually succeeds in getting the patient back to the dispensary for at least one re-examination; or such answers as a patient may see fit to make to a printed questionnaire.For the purpose of regular dispensary and inspection work, the dispensary limits itself to receiving patients from certain districts of the city, though as a state institution it is impossible for the dispensary to refuse any case, no matter where they live, if they insist upon treatment. Usually by a little persuasion, however, we can get the patients to go to the dispensary in their district, co-operating in this way with the Phipps Institute of the University of Pennsylvania, the Gray's Ferry State Dispensary, the Kensington Tuberculosis Dispensary and the Frankford State Dispensary. The section of the city from which we draw our cases is divided, for purposes of inspection and Social Service Work, into three districts with a nurse assigned to each, and this gives each of our nurses, roughly speaking, about seventy-five patients per month to take care of. These patientsmust be visited regularly every two weeks, which gives the nurse at least one hundred and fifty visits a month to pay, not including the visits to new cases.Every new case which is admitted to the dispensary must be visited within one week of the day of admission. The nurses come in from their visiting work and report daily at 12:30 o'clock, for one hour in the dispensary office, and new cases, according to the district in which they live, are assigned to the nurse having charge of that district. The advantage of having a nurse report daily to the dispensary at a time when all the doctors are there, lies in the fact that the doctor has thus the opportunity of talking over with the nurse the new cases which she is to visit and of making any suggestions which he has gleaned from the history and examination of the patient. It is thus possible for the nurses to visit the new cases in the afternoon of the same day. The advantage of this close co-operation between doctor and nurse must be at once apparent. Further, each nurse is required to report to every physician one morning a month, with the histories in hand of all the patients of that particular doctor which are on her list. This is valuable, because in no other way can the doctor get so thorough an understanding of the home conditions and social problems of a given patient as by talking the situation over directly and personally with the nurse in charge."
"There are at present five nurses employed at Dispensary No. 21, two of whom give their whole time to following up the return cases from the State Sanatoria. As soon as the case is discharged from the sanatorium, that information, with other data regarding the condition on discharge, etc., is sent to us at once. At the end of a stated period, if that case has not been returned, the nurse looks it up, and gets it to come in. The nurses make out detailed reports on all cases discharged from the sanatoria, at periods of six months, whether our own patients or not. These will be and are valuable for statistical data. Practically all the data for reports as to subsequent results in cases discharged from the sanatoria, which have appeared in this country at least, have been made up from information gleaned by writing the discharged patient and having him fill out his own report. It does not tax the imagination unduly to conclude which is the more accurate, the answers to questioning by a trained worker (we have selected for this work the two nurses who have been with us longest) who in addition takes the temperature, pulse, etc., herself, and usually succeeds in getting the patient back to the dispensary for at least one re-examination; or such answers as a patient may see fit to make to a printed questionnaire.
For the purpose of regular dispensary and inspection work, the dispensary limits itself to receiving patients from certain districts of the city, though as a state institution it is impossible for the dispensary to refuse any case, no matter where they live, if they insist upon treatment. Usually by a little persuasion, however, we can get the patients to go to the dispensary in their district, co-operating in this way with the Phipps Institute of the University of Pennsylvania, the Gray's Ferry State Dispensary, the Kensington Tuberculosis Dispensary and the Frankford State Dispensary. The section of the city from which we draw our cases is divided, for purposes of inspection and Social Service Work, into three districts with a nurse assigned to each, and this gives each of our nurses, roughly speaking, about seventy-five patients per month to take care of. These patientsmust be visited regularly every two weeks, which gives the nurse at least one hundred and fifty visits a month to pay, not including the visits to new cases.
Every new case which is admitted to the dispensary must be visited within one week of the day of admission. The nurses come in from their visiting work and report daily at 12:30 o'clock, for one hour in the dispensary office, and new cases, according to the district in which they live, are assigned to the nurse having charge of that district. The advantage of having a nurse report daily to the dispensary at a time when all the doctors are there, lies in the fact that the doctor has thus the opportunity of talking over with the nurse the new cases which she is to visit and of making any suggestions which he has gleaned from the history and examination of the patient. It is thus possible for the nurses to visit the new cases in the afternoon of the same day. The advantage of this close co-operation between doctor and nurse must be at once apparent. Further, each nurse is required to report to every physician one morning a month, with the histories in hand of all the patients of that particular doctor which are on her list. This is valuable, because in no other way can the doctor get so thorough an understanding of the home conditions and social problems of a given patient as by talking the situation over directly and personally with the nurse in charge."
A similar plan is in operation at the other two State Department Clinics in Philadelphia.
The best known tuberculosis dispensary in Philadelphia, conducted by a private organization, is the dispensary connected with the Henry Phipps Institute. This dispensary during the eleven years of its existence has contributed greatly to the standardization of tuberculosis dispensary work, not only in Philadelphia, but throughout the entire country. Connected with a scientifically conducted hospital for advanced cases, with its laboratories and other improved medical facilities, the Dispensary of the Henry Phipps Institute occupies a high place among the similar institutions of this country. The nursing staff of the Henry Phipps Dispensary consists of three visiting tuberculosis nurses, aided by two additional nurses (both colored) assigned by other organizations to work on the Phipps Dispensary staff, one by the Whittier Centre, and the other by the Pennsylvania Society for the Prevention of Tuberculosis. Some of the important features of the work of this dispensary in its relation to nurses are as follows:
(1) An efficient training school for tuberculosis nurses, affording the opportunity of hospital and dispensary training.
(2) A course of lectures on tuberculosis given to the nursing profession at large.
(3) Intensive home work among tuberculous families.
Visiting tuberculosis work in Philadelphia is also done in connection with the Presbyterian Hospital Tuberculosis Clinic, St. Stevens Church Tuberculosis Clinic, and by the Visiting Nurse Society of Philadelphia.
PITTSBURGH
The Tuberculosis League Hospital of Pittsburgh was opened in 1907 for incipient and advanced cases, with a capacity of eighty beds. The League conducts at present a night camp, an open air school, a farm colony, a post-graduate course for nurses and tuberculosis clinics for medical students at its dispensary. There is also a post-graduate course in tuberculosis for nurses. The course requires eight months and nurses receive during that time $25 a month. Only registered nurses are accepted. The training is along the following lines: nursing advanced cases in hospital, open air school work, sanatorium care of early cases, service in dental, nose and throat clinics, and in the dispensary for ambulant cases, district nursing, service in baby clinics, educational work, and laboratory work. Patients discharged from the hospital, families of patients in the hospital, and cases reporting at various tuberculosis dispensaries, are given complete follow-up care by the nurses taking the course, thus giving them excellent training in public health work, especially that phase of public health nursing dealing with tuberculosis. At present there are nine nurses taking the course. The Dispensary of the Tuberculosis League employs six nurses.
Pittsburgh has also a State Department of Health Tuberculosis Clinic, with ten nurses, each caring for from 90 to 100 patients per month. These nurses give a small percentage of bedside care and are not in uniform, except when on duty in the dispensary. They are paid $70 per month. The plan of work is similar to that of the Philadelphia State Dispensary.
The Department of Public Health of Pittsburgh employs four visiting nurses, who investigate home conditions and instruct patients reported to the department who are not under the close supervision of a private physician, the State Department Clinic, or the Tuberculosis League Clinic. The nurses are able to correlate, in a way, the work of the two dispensaries by assigning patients to the clinic in the district in which they live. They receive $75 per month and are not in uniform.
Pittsburgh, then, has in all twenty visiting tuberculosis nurses, under three separate and distinct organizations.
CLEVELAND
In Cleveland, as in nearly every other city, the work of organizing the fight against tuberculosis was accomplished by private organizations, the Anti-Tuberculosis League and the Visiting Nurse Association. For a number of years the Health Department confineditself to keeping a card catalogue of reported cases. In 1910 sufficient funds were voted by the City Council to enable the establishment of a separate Bureau of Tuberculosis, whose duty should be the development of municipal tuberculosis work. This Bureau has taken over and gradually developed five dispensaries, with a staff of twenty-four visiting tuberculosis nurses, and paid physicians, besides the director and office force. The work in Cleveland is centralized in its Health Department.
General dispensaries are required to refer all cases of tuberculosis to the tuberculosis dispensaries, and physicians are required to report all cases to the Health Department. On report cards and sputum blanks is the statement: "All cases of tuberculosis reported to the department will be visited by a nurse from this department unless otherwise requested by the physician." With very few exceptions the physicians are glad to have a nurse call, and every effort is made to co-operate with the physicians in handling the case.
The city is divided into five districts, with a dispensary located in each district. Patients are treated only at the dispensary serving the district in which they live. "This plan prevents cases wandering from one clinic to another and enables the nursing force to do more intensive work in each district."
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 Associated 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 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. Theyseem 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." Theprogress 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 thispolicy 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 comprehensivemedical 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.
Decoration.
CITYPOPULATION 1910 CENSUSPRIVATE OR PUBLIC FUNDSNUMBER OF NURSESAVERAGE NUMBER OF PATIENTS PER NURSEBEDSIDE CAREUNIFORMSYEARLY SALARYNew York4,767,000Public (city)158About 125YesNo$900.00 averagePrivate102Chicago2,185,000Public (city)50135YesYes$900.00 to $1,320Philadelphia1,549,000Public (state)12VariesYesYes$900.00Private4150NoNo$720.00 to $900.00St. Louis687,000Private7100YesYesBoston671,000Public (city)25100 to 180YesNo$900.00Cleveland561,000Public (city)24300YesYes$720.00 to $1,020.00Baltimore558,000Public (city)16212YesYes$900.00Pittsburgh534,000Public (city)4NoNo$900.00State10100NoNo$840.00Private6YesYes$300.00Detroit466,000Public (city)10100YesYes$1,000Buffalo424,000Public (city)6125YesNo$720.00
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.
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.
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. TheAllen 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 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 ventilationthrough 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 1×4-inch tongued and grooved boards supported eight inches above the ground on 2×4-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.
One of the most important arrangements for outdoor sleeping is the sleeping porch. To be convenient, it should have an entrance from a bedroom, and, when possible, from a hall; for every outdoor sleeper should have, during cold weather, a warm apartment in connection with his open air sleeping room. The best exposure in Illinois is south, southeast or east. Sleeping out should be a permanent thing during all seasons. The sleeping porch must be kept neat and attractive. A cot placed between the oil can and the washtub on a dingy back porch is very dismal and bound to have a depressing effect on the sleeper.
It costs very little to arrange an ordinary sleeping porch provided you have the porch to begin with. If a porch is fairly deep and sheltered on two sides by an angle of the house, sufficient protection for moderately cold weather can usually be obtained by canvas curtains tacked to wooden rollers. These can be raised and lowered by means of ropes and pulleys, the bed being placed so that the wind will not blow strongly on the patient's head.
Ordinary Porches.[6]A useful porch can be built for $15 to $25 with cheap or second-hand lumber, and if only large enough to receive the bed and a chair will still be effective for the outdoor treatment. The roof can be made with canvas curtain, or a few boards and some tar paper. The end most exposed to the wind and rain and the sides below the railing should be tightly boarded to prevent drafts.
Second or third story porches are supported from the ground by long 4×4-inch posts, or when small they can be held by braces set at an angle from the side of the house. When the long posts are used they are all placed six feet apart and the space between them is divided into three sections by 2×4-inch timbers. The interior is protected by canvas curtains fastened to the roof plate and arranged so as to be raised or lowered by ropes and pulleys. These curtains are made about six feet wide and fit in between the supporting posts and rest against the smaller timbers. This arrangement keeps the curtains firm during a storm, as both rollers and canvas can be securely tied to the frames. This porch would cost between $30 and $50.
Porch de Luxe.When a bed on a porch is not in use it is often unsightly and in the way, while in winter, unless well protected, the bed clothes and bedding become damp. In order to overcome this, the Porch de Luxe[7]has recently been devised. This consists of a low-built bedstead arranged to slide through an opening in the wall of the house between the porch and bedroom.
Sleeping Cabin.To lessen the disadvantages of the high roofed, windy porch, the home-made sleeping cabin is to be recommended. This cabin is built on the porch. The frame is braced against the side of the house and rests on the floor of the porch, but the top of the cabin is much lower than the roof of the porch. The frame consists of 2×4-inch timbers. The sides and roof are of canvas curtains; these can be rolled up separately. Some of these cabins have had the roof hinged so that it can be raised in warm weather. The greatest advantage of the cabin is the control of the weather situation. The cost is $15 to $20.[8]
Knopf's Star-Nook.Another arrangement is Knopf's "Star-nook."[9]This is a wall house supported by the roof of an extension, or on a bracket attached to the wall of the building. This fresh air room consists of a roof, floor and three walls and, with the exception of the roof and the floors, is built of steel frames holding movable shutters. It is nine feet long by six feet deep, the height beingeight feet at the inner side with a fall of two feet. At both ends are windows which can be opened outward. The roof can be raised entirely off the apartment by means of a crank. Also the upper sections of the front windows can be opened or closed. Sometimes new doors or windows will be needed to give access to a desired position. The "Star-nook" can be secured with safety, and when strongly supported there need be no fear in regard to its stability.
The value of roof space for outdoor treatment in cities is gradually being appreciated. They can be made splendid sites for various kinds of little buildings. The roof of an apartment house offers a choice of situations, but there are different conditions to be considered, such as the best exposure and the most protected place, one that cannot be overlooked from neighboring buildings; also security from severe storms. Tents have been erected upon the roofs of city buildings, but they are not to be recommended for such positions unless they can be placed in the shelter of a strong windbreak. When erected upon the roof of high buildings they should be protected on two sides by walls, or by other parts of the structure upon which they are to be placed.
A cabin is most desirable for the roof. In its construction it is best to use a wooden frame for the foundation. It can then be moved and its position and exposure changed easily. This frame should be made of 2×6-inch planks laid flat on the roof. The upright frame and siding boards for the back and sides should be of 2×4-inch timbers. The front of the cabin should be left open, but arranged with a canvas curtain tacked on a roller so that it can be closed in stormy weather. Tar paper is used for the roof. When completed, the framework should be braced to give firmness. If two buildings connect and one is taller than the other with no space between, a lean-to cabin is most desirable.
With the devices just described the home treatment can be secured with little cost. Patients who are afraid of outdoor sleeping should begin in moderate weather. All shelters should be as inconspicuous as possible. In choosing a suitable position for a fresh air bedroom, it should be remembered that early morning sounds and sunlight should be eliminated, if possible. This can sometimes be done by selecting a room far from the street and by shading the bed with blinds. One's neighbor should be taken into consideration, and a position decided upon which does not overlook his windows, porches or yards, and when arranging for the rest cure in the reclining chair during the day one should always bear in mind that it is much more agreeable and conducive to the well-being of the patient to have a pleasant view to look upon.