THE CHILD CONTACT IN TUBERCULOSIS WORK.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 4, 1 November 1929, Page 193

THE CHILD CONTACT IN TUBERCULOSIS WORK.

The incidence of actual tuberculosis among school children m New Zealand is small and compares favourably with that found m other countries. For instance, m 1927 of 60.275 children examined by School Medical Officers, only .1 per cent. was found thus affected, of which .04 per cent, was pulmonary and .06 per cent, tuberculosis of tissue other than pulmonary. This is m accordance with the results found m New Zealand m previous

years, and with the findings reported by the London County Council authorities and by School Medical Officers m Australia. However, m view of the modern opinion that tuberculosis infection is almost universal before adolescence, it is probable that a percentage of school children now classified by School Medical Officers as of subnormal nutrition has latent tuberculosis. This group as reported m 1927 constitutes 7.14 per cent, of the children examined, and is the group under supervision.

In 1927 a special investigation was carried out m Wellington under Dr. Champtaloup, and m Canterbury under Dr. Baker-McLaglan. to enquire into the incidence of tuberculosis m Xcw Zealand school children. Schools were selected for examination m poor and well-to-do city areas, and m the country so that a fairly representative group of children was observed. The written consent of parents was first obtained. The investigation consisted of a general medical examination supplemented where indicated by special expert methods of diagnosis, e.g.. X-ray examination, examination by tuberculosis specialist. Moro's inunction test was used as an aid to diagnosis. Evidence of tubercular infection was found almost twice as often among city children as among country. Maori figures were much higher, 25 per cent, all of whom live m the country giving positive signs.

During the following year these children were regularly weighed and measured monthly, and an endeavour made to create a satisfactory conditions of environment at home and at school as possible, this work being carried out by the school nurse.

The results of this primary survey were encouraging, so it was decided m 1928 to expand this programme to include all tuberculosis contacts — that is, children whose parents suffered from tuberculosis or who had lived m contact with the disease. Naturally this is an ever-in-creasing group owing to the number of sufferers who are living m the community

and not under hospital and sanatoria conditions.

The procedure for obtaining the information regarding these cases is as follows: — Tuberculosis being a notifiable disease, all cases are known by the Medical Officer of Health. Where households m which children of pre-school or school age are known to be living m association with a tuberculosis patient, the names and addresses are forwarded to the School Medical Officer of the district. The School Medical Officer then as soon as possible carries out a thorough medical examination of the children concerned and the cases are referred to the school nurse for observation.

In Wellington at the present time over 200 children from pre-school age to secondary school age are under supervision, covering an area of 41 town and suburban schools and seven country ones. The school nurse has been detailed to carry out this work and, as can be imagined, it is of grea i t interest. Her work lies m assisting the School Medical Officer with the examination of the children and m seeing that any remedial defect, such as enlarged tonsils or defective vision, etc., is corrected. Such common defects exert a harmful influence upon their general health, thus decreasing their power of resistance to tuberculosis.

The greater part of the nurse's work lies m the homes m endeavouring to improve the environment. The fact that tuberculosis is a disease which affects those of earning capacity creates a difficult financial situation m all types of homes. If the mother is the one who is affected, the whole household suffers, additional expense is involved m running the home from a domestic point of view, or else a condition of upheaval eventuates m which all the members of the family are affected. If it is the father or an earning member of the family, much less income is brought m, the family exchequer suffers and conditions of poverty arise. This m turn affects the type of house occupied and its locality as well as the food supply and general hygienic conditions. All these are facts which

must be collected tactfully by the nurse during' her visiting* as they materially alter the programme to be undertaken for the child.

If the home conditions are fairly good and the nurse feels that the mother will follow her advice regarding diet, rest, fresh air, sleeping conditions, etc., the child is allowed to continue at school being* weighed monthly m every case, a weight chart being kept. On these charts is marked the normal line showing what this child should be for its height and age, and each month the child is weighed the chart is marked m order to observe whether the child's actual weight line is following this normal line. The normal line is checked every six months when the heights are retaken.

Should the home conditions be unsatisfactory then immediate steps are taken to try and get the child built up at the McCarthy Convalescent Home or at the seaside at Otaki, while arrangements, if possible, are made to remove the source of trouble from the home. Following this holiday the child returns to school and is kept under observation m the manner previously described.

At the time of this monthly weighing, or at any time that the nurse observes a decrease or stationary weight or any untoward symptoms among these children, arrangements are immediately made for the child to be examined by the School Medical Officer, and the parents are encouraged to bring them m to see the doctor if they are worried about them m any way. In addition, this group of children is examined by the doctor yearly at the school during routine examination. In this way the children are kept under close medical supervision.

Some personal observations m regard to these children might be made here. It has 'been noticed that while m the majority the weight line will be below the normal, m some cases the adverse is true, the child appearing to have some glandular affection with a distinctly overweight line. These cases are of great interest,

Again the child might have a stationary weight for a period and be found to suffer from enlarged tonsils and adenoids. On these being removed further loss m weight may immediately follow 7 , but it is very striking to note how the weight curve will soon rise again and continue to steadily improve.

In visiting the homes the difficulty of influencing the fixed beliefs and habits of parents, even when these are to the detriment of their children, is very evident. For instance, a mother whose child was operated upon for enlarged tonsils and adenoide at three years, and again at six years of age, and still suffers badly from nasal obstruction, persisted m the child sleeping m the parents' room with the head of its bed reaching into the wardrobe because she did not like to re-arrange the plan of the bedroom. This home was quite a comfortable one and the mother apparently of average intelligence.

Though the work is at times discouraging it gives great satisfaction to look back and see the number of children whose parents have followed our advice, even when it has involved such definite steps as building on a sleeping porch for the child, or removing from a crowded city area to the suburbs.

Great care has to be taken m handling some children as the parents are apt to become over-anxious, and their concern re-acts unfavourably on the child. For instance, one boy m Standard VI. asked about his weight most anxiously and always showed signs of dejection if there was no increase. In such cases a tone of cheerfulness and commonsense has to be adopted to overcome a tendency to worry.

The ignorant family of large numbers frequently requires much winning over before even entrance to the home can be obtained, but once the mother realises you are there to help her she will make every effort to follow your advice. Perhaps this type of case gives as much satisfaction to the nurse as any m that she has overcome any personal prejudice and ignorance.

Again, when great affection exists between patient and nurse m a family, as when a mother is cared for by a devoted daughter, the health of the daughter may be m consequence undermined. Great tact may be required m suggesting sanatorium treatment for the mother, and it may he only by being frank with the patient and appealing to her love for her child that better arrangement is obtained. In conclusion, quoting from Sir George Newman, "There is no short cut to the goal of health, no easy way of defeating disease ; we must learn and obey the laws of physiology and comply with the conditions which prevent disease. We must cultivate a sense of proportion." Take the healthy child as an example. Ft only becomes so by good nurture which necessitates the formation of sound habits, by proper use of nourishment, fresh air, exercise, warmth, rest. There is nothing magical about it, it is the daily practice of a physiological way of life and there is no other method of rearing healthy children. How much more then is this true of the particular group of children who m their own homes require protection from tubercular infection. Miss Bagley : "I will now ask Miss Mirams to read Miss Jamieson's paper on l Tuberculosis amongst Maoris/