DUNEDIN HOSPITAL—THE TUBERCULOSIS PATIENT AND CONTACT, AS SEEN IN THE TUBERCULOSIS DISPENSARY.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 4, 1 November 1929, Page 191

DUNEDIN HOSPITAL— THE TUBERCULOSIS PATIENT AND CONTACT, AS SEEN IN THE TUBERCULOSIS DISPENSARY.

The Tuberculosis Dispensary is established for : —

1 (a) The examination and diagnosis of cases sent by the Medical Practitioner.

(b) The arranging of appropriate treatment for -those found to be tuberculous, to be sent to the sanatorium, hospital, or the patient's own home.

2. The examination of "contacts/ the arranging of treatment for those found to be tuberculous, and the supervision for preventive purposes of those not already affected.

3. The scope of the Dispensary exceeds that of the ordinary Outpatient Department, as it is a clearing 'house for tuberculosis, and through the "contacts" a place for searching out early cases.

4. The Dispensary fails m a greater or less degree if it does not co-operate with the medical profession. Public Health Department, School Medical Service, Plunket Society and all social workers.

Tuberculosis is a disease of all ages. It occurs at every period of life from infancy to old age.

The 'tuberculosis patient visiting the Dispensary differs considerably m age, stage of disease, and temperament, each patient requiring treatment from his own individual standpoint.

When a patient visits the Dispensary for the first time, a full history of the case is taken, including temperature, pulse, and weight. The patient is then examined by the Tuberculosis Medical Director, and on leaving the Dispensary is given a sputum outfit, and instructions how this is to be used. The specimen should be brought to the Dispensary the following morning for bacteriological examination.

All cases have an X-ray photograph taken of the chest at the earliest opportunity, and continue to be X-rayed at regular intervals to report progress.

It is frequently decided on the patient's first visit whether he shall be admitted to hospital, sanatorium, or shall remain m his own home. If in-patient treatment is determined on the patient is advised accordingly.

Should the patient be an infectious case, after he leaves his own home his room is disinfected, and the remaining members of the family who have been m contact with the patient are asked to come to the Dispensary to be examined, emphasising the fact that "Prevention is better than Cure." It is only m isolated cases that one meets with any opposition — contacts of all ages being only too willing to be examined.

If suspicion rests on one or more members of the family they are advised to visit the Dispensary at regular intervals and kept under close observation. Temperature and weight is recorded on each visit, and they are examined regularly by the doctor.

Such patients are taught through the Dispensary how to manage themselves m respect to fresh air, proper food, amount of exercise and rest, by more careful and systematic ways of living.

If a case should prove negative, the patient is told to return to the Dispensary m three months, unless during the interim any symptoms arise which arouse suspicion. Under such conditions he is advised to report immediately to the Dispensary.

When a patient decides on domiciliary treatment and promises to carry out instructions, 'he is visited the day following his visit to the Dispensary. Advice is given as to suitability or room, balcony or sleeping porch.

Dishes used by patient to be kept separate and sterilised regularly. All articles of clothing should be disinfected before going to the laundry.

If the patient has any sputum a flask should be used. All sputum is burnt and the flask disinfected twice daily.

The patient's temperature is of the utmost importance, and very minute instructions are given re the taking of this three times a day. If the temperature is raised or the pulse abnormal, the patient remains m bed until both return to normal conditions.

The food should be nourishing. Three meals a day are advised, with a glass of milk to be taken at each meal.

As the patient improves under treatment, graduated exercises are commenced. Everything depends on the patient's resistance to the disease to bring about a steady recovery. When a patient does not respond to "Rest" treatment, artificial Pneumo-thorax is frequently commenced with a view to checking the disease. Patients have done remarkably well under this treatment, many of whom would have spent a much longer period m bed if the treatment had not been given.

Artificial Pneumo-thorax is begun either m hospital or sanatoria, and when the treatment is well established patients ma}' be permitted to go home and return to the Dispensary for their refills. A patient usually remains m bed for an hour after treatment. He or she, as the case might be. is then considered quite equal to dressing and going home.

Some cases are treated with vaccines. Children frequently with tuberculin inunction. All such treatments are only given under medical supervision.

School children who are contacts or under suspicion may be recommended to the School Doctor for the open air school, where they are seen and examined regularly by the School Medical Officer.

When a patient is discharged from the hospital or sanatoria he revisits the Dispensary, which continues to supervise him and seeks to prevent a relapse. The doctor gives such a patient advice with reference to suitable employment, and encourages him to maintain at home the life he has been taught m the sanatorium.

Although tuberculosis is an infectious disease, it is said to be infectious to a very limited degree. If ordinary precautions are taken when attending or nursing a tuberculosis patient, those m attendance need have no fear of contracting the disease. In conclusion, the Dispensary aims m every possible way to ascertain all information pertaining to patient or contact, with a view to assisting m any way when the necessity arises. It endeavours to guide, advise and help m realising its responsibilities to patients, and co-oper-ating with all the activities interested m Public Health and Social Welfare. Miss Bagley next introduced Miss Smaile, who spoke on nursing a case of tuberculosis m 'the home. Miss Smaile : " This is not a prepared paper. There are certain standardised methods for nurses visiting the home. First the nurse must be able to enter the house. It is no use visiting the house unless you can go m and be sociable. If they have no confidence m you they will not take any notice of what you say. The nurse has her bag with her and it is usually necessary to do something with that bag. This the nurse must be very particular about. If nurse does one thing and says another, then it does not go down very well. Secondly, she must take every opportunity to teach. Observe and detect all problems whether they are physical or social. Social problems play a very important part. " Then there is the ambulatory case — this is an economic problem. Very few people can finance tuberculosis. Then there is the attitude of the people towards T.B. People are afraid of it. They do not understand tuberculosis is quite safe m public if it is treated m the right way. " Next there are the causes. Remove the cause of the predisposing cause. Then there is the true value of diagnosis. Nurses should know something about getting an early diagnosis. You must know all the methods of treatment, An-

other important thing is to know all the institutions. The patient does not know the institutions or how to get into them. The nurse has to be very familiar with all these. " Then there is the housekeeping problem. You can have a poor house but need not have poor housekeeping. The nurse cannot alter a poor house, but she can train a poor housekeeper. The poorest houses can be ventilated. Circulatory air is necessary. It does not need to be outside. Just merely a window open is not sufficient, if everything else is shut. Then there is cleanliness. It does not matter how dirty or how hopeless a place is, we can usually do something. Then there is the accurate decision. The case that is most likely to get well should try and get into the sanatorium, rather than the one that is less hopeful. " Now we come to her methods of teaching. We know the Public Health Nurse must demonstrate. Only by getting people to do things under her supervision, can she teach them. She must keep on with one thing until it is understood. Tuberculosis is a very long disease. Nurse must teach care of the room and care of the patient; disposal of sputum ; care of dishes and the transmission of disease." Miss Bagley : " The next paper is the ' Child Contact.' written by Miss Bulkley, of Wellington, to be read by Miss Cherry."