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                  Dispensary Department Bulletin No. 1

                             NURSES' PAPERS

                                   ON

                              TUBERCULOSIS

                            PUBLISHED BY THE
                            CITY OF CHICAGO
                  MUNICIPAL TUBERCULOSIS SANITARIUM

                             SEPTEMBER 1914




             CITY OF CHICAGO MUNICIPAL TUBERCULOSIS SANITARIUM

                             STAFF OF NURSES
                               --OF THE--
                          DISPENSARY DEPARTMENT

             ROSALIND MACKAY, R. N., Superintendent of Nurses

                            ANNA G. BARRETT
                          BARBARA H. BARTLETT
                            OLIVE E. BEASON
                             ELLA M. BLAND
                          KATHRYN M. CANFIELD
                           MABEL F. CLEVELAND
                            ELRENE M. COOMBS
                          MARGARET M. COUGHLIN
                           STELLA W. COULDREY
                            EMMA W. CRAWFORD
                           FANNIE J. DAVENPORT
                             ROXIE A. DENTZ
                           C. ETHEL DICKINSON
                             ANNA M. DRAKE
                             MARY E. EGBERT
                             MAUDE F. ESS{?}
                             SARA D. FAROLL
                               MARY FRASER
                            AUGUSTA A. GOUGH
                           FRANCES M. HEINRICH
                              LAURA K. HILL
                           ISABELLA J. JENSEN
                              EMMA E. JONES
                             LETTA D. JONES
                              JEANETTE KIPP
                                ELSA LUND
                            MARY MACCONACHIE
                            JOSEPHINE V. MARK
                             ISABEL C. MCKAY
                             ANNA V. MCVADY
                             ANNIE MORRISON
                        KATHERINE M. PATTERSON
                            LAURA A. REDMOND
                            GRACE M. SAVILLE
                              BERYL SCOTT
                          FLORENCE T. SINGLETON
                              MABELLE SMITH
                           FLORENCE A. SPENCER
                             HARRIETT STAHLEY
                          GENEVIEVE E. STRATTON
                            ANNABEL B. STUBBS
                             ALICE J. TAPPING
                               OLIVE TUCKER
                            ELIZABETH M. WATTS
                              MARY C. WRIGHT
                              MARY C. YOUNG

                       KARLA STRIBRNA, Interpreter.


                           BOARD OF DIRECTORS

                  THEODORE B. SACHS, M. D.,   President
                  GEORGE B. YOUNG, M. D.,     Secretary
                             W. A. WIEBOLDT.


                             GENERAL OFFICE

                         105 West Monroe Street

                   FRANK E. WING, Executive Officer.


[Illustration: FIELD NURSES, DISPENSARY DEPARTMENT CHICAGO MUNICIPAL
TUBERCULOSIS SANITARIUM]




                  Dispensary Department Bulletin No. 1

                             NURSES' PAPERS

                                   ON

                              TUBERCULOSIS


                             READ BEFORE THE

                          NURSES' STUDY CIRCLE

                                 OF THE

                          DISPENSARY DEPARTMENT

               CHICAGO MUNICIPAL TUBERCULOSIS SANITARIUM


                            PUBLISHED BY THE
                            CITY OF CHICAGO
                   MUNICIPAL TUBERCULOSIS SANITARIUM
                         105 WEST MONROE STREET
                             SEPTEMBER 1914




                                CONTENTS


                                                                   PAGE

  Introduction--Nurses' Tuberculosis Study Circle                     5

  Historical Notes on Tuberculosis                                    7
  ROSALIND MACKAY, R. N.

  Visiting Tuberculosis Nursing in Various Cities of the United
  States                                                             11
  ANNA M. DRAKE, R. N.

  Provisions for Outdoor Sleeping                                    30
  MAY MACCONACHIE, R. N.

  Some Points in the Nursing Care of the Advanced Consumptive        37
  ELSA LUND, R. N.

  Open Air Schools in This Country and Abroad                        44
  FRANCES M. HEINRICH, R. N.

  Notes on Tuberculin for Nurses                                     56




                   NURSES' TUBERCULOSIS STUDY CIRCLE


It is well known that the gathering of facts and study of literature
essential to the preparation of a paper on a certain subject is a very
productive method of acquiring information. If the paper is to be
presented to your own group of co-workers, and the subject covered by it
represents an important phase of their work, or an analysis of some of its
underlying principles, then there is a further incentive to do your best,
as well as an opportunity for a general discussion which acts as a sieve
for the elimination of false ideas and gradual formulation of true
conceptions.

Lectures on various phases of the work being done by a particular group of
people are very important. Papers by the workers themselves are, however,
greatest incentives to study and self-advancement.

With this view in mind, I suggested the organization of a Tuberculosis
Study Circle by the Dispensary Nurses of the Municipal Tuberculosis
Sanitarium. The nurses chosen to present papers on particular phases of
tuberculosis are given access to the library of the General Office of the
Sanitarium; they are also given the assistance of the General Office in
procuring all the necessary information through correspondence with
various organizations and institutions in Chicago and other cities.

As the program stands at present, the Nurses' Study Circle meets twice a
month. At one of these meetings a lecture on some important phase of
tuberculosis is given by an outside speaker, and at the next meeting a
paper is read by one of the nurses. At all of these meetings the
presentation of the subject is followed by general discussion. The program
since January, 1914, was as follows:

January 9th, 1914--"Historical Notes on Tuberculosis," by Miss Rosalind
Mackay, Head Nurse, Stock Yards Dispensary of the Municipal Tuberculosis
Sanitarium.

January 23rd, 1914--"Channels of Infection and the Pathology of
Tuberculosis," by Professor Ludwig Hektoen of the University of Chicago.

February 13th, 1914--"Visiting Tuberculosis Nursing in Various Cities of
the United States," by Miss Anna M. Drake, Head Nurse, Policlinic
Dispensary of the Municipal Tuberculosis Sanitarium.

March 13th, 1914--"Provisions for Outdoor Sleeping," by Miss May
MacConachie, Head Nurse, St. Elizabeth Dispensary of the Municipal
Tuberculosis Sanitarium.

March 27th, 1914--"What Should Constitute a Sufficient and Well Balanced
Diet for Tuberculous People," by Mrs. Alice P. Norton, Dietitian of Cook
County Institutions.

April 10th, 1914--"Some Points in the Nursing Care of the Advanced
Consumptive," by Miss Elsa Lund, Head Nurse of the Iroquois Memorial
Dispensary of the Municipal Tuberculosis Sanitarium.

May 15th, 1914--"Open Air Schools in This Country and Abroad," by Miss
Frances M. Heinrich, Head Nurse of the Post-Graduate Dispensary of the
Municipal Tuberculosis Sanitarium.

May 29th, 1914--"Efficient Disinfection of Premises After Tuberculosis,"
by Professor P. G. Heinemann, Department of Bacteriology, University of
Chicago.

The organization of the Tuberculosis Study Circle among the nurses of the
Dispensary Department of the Municipal Tuberculosis Sanitarium, calling
forth the best efforts of the nurses in getting information on various
phases of tuberculosis for presentation to their co-workers in an
interesting manner has, no doubt, stimulated the progress of our entire
nursing force. The first five papers presented by the nurses are given in
this series. The pamphlet is published with the idea of attracting the
attention of other organizations to this method of stimulating more
intensive study among their nurses.

                            =THEODORE B. SACHS, M. D., President=
                                Chicago Municipal Tuberculosis Sanitarium.




                    HISTORICAL NOTES ON TUBERCULOSIS

                       By ROSALIND MACKAY, R. N.

        Head Nurse, Stock Yards Dispensary of the Chicago Municipal
                       Tuberculosis Sanitarium.


So far as our information goes, pulmonary tuberculosis has always existed.
It is, as Professor Hirsch remarks, "A disease of all times, all
countries, and all races. No climate, no latitude, no occupation, forms a
safeguard against the onset of tuberculosis, however such conditions may
mitigate its ravages or <DW44> its progress. Consumption dogs the steps of
man wherever he may be found, and claims its victims among every age,
class and race."

Hippocrates, the most celebrated physician of antiquity (460-377 B. C.),
and the true father of scientific medicine, gives a description of
pulmonary tuberculosis, ascribing it to a suppuration of the lungs, which
may arise in various ways, and declares it a disease most difficult to
treat, proving fatal to the greatest number.

Isocrates, also a Greek physician and contemporary of Hippocrates, was the
first to write of tuberculosis as a disease transmissible through
contagion.

Aretaeus Cappadox (50 A. D.) describes tuberculosis as a special
pathological process. His clinical picture is considered one of the best
in literature.

Galen (131-201 A. D.) did not get much beyond Hippocrates in the study of
tuberculosis, but was very specific in his recommendation of a milk diet
and dry climate. He held it dangerous to pass an entire day in the company
of a tuberculous patient.

During the next fifteen centuries, a period known as the Dark Ages and
characterized by most intense intellectual stagnation, little was added to
the knowledge of pulmonary tuberculosis. In the seventeenth century
Franciscus Sylvius brought out the relationship between phthisis and
nodules in the lymphatic glands. This was the first step toward accurate
knowledge of the pathology of tuberculosis.

Richard Morton, an English physician, wrote, in 1689, of the wide
prevalence of pulmonary tuberculosis, and recognized the two types of
fever: the acute inflammatory at the beginning, and the hectic at the
end. He also recognized the contagious nature of the disease and
recommended fresh air treatment. He believed the disease curable in the
early stages, but warned us of its liability to recur. Morton taught that
the tubercle was the pathological evidence of the disease.

In 1690, Leeuwenhoek, a Dutch lens maker, started the making of short
range glasses which resulted later in the modern microscope, making
possible the establishment of the germ theory of disease, including the
establishment of that theory for tuberculosis.

Starck, whose observations and writings were published in 1785 (fifteen
years after his death), gave a more accurate description of tubercles than
had ever been given before, and showed how cavities were formed from them.

Leopold Auenbrugger introduced into medicine the method of recognizing
diseases of the chest by percussion, tapping directly upon the chest with
the tips of his fingers. The results of his investigations were published
in a pamphlet in 1761. This new practice was ignored at first, but after
the work of Auenbrugger was translated he attained a European reputation
and a revolution in the knowledge of diseases of the chest followed.

Boyle recognized in miliary tubercle, as it was afterwards called by him,
the anatomical basis of tuberculosis as a general disease, and, in 1810,
published the results of one of the most complete researches in pathology.
He described the stages in the development of the disease, using miliary
tubercle as its starting point. He opposed the theory that inflammation
caused tuberculosis and declared hemorrhage a result and not a cause of
consumption.

Laennec discovered one of the most important, perhaps, of all methods of
medical diagnosis--that of auscultation. By means of the stethoscope,
which he invented in 1819, he recognized the physical signs and made the
first careful study