September!1!??™'  I     Sanatorium  Treatment  of  Consumption.  425 
home  treatment  have  been  visited  by  our  nurse  until  admission 
could  be  secured  to  some  hospital  or  until  transferred  to  the  District 
Nursing  Association.  We  have  placed  consumptives  in  the  Carney- 
Hospital,  the  House  of  the  Good  Samaritan,  and  the  Free  Hospital 
for  Consumptives. 
Admission  to  the  class  has  not  been  limited  to  favorable  cases. 
In  fact,  only  two  of  our  patients  were  in  the  incipient  stage  of  the 
disease. 
All  of  our  patients  have  been  poor.  None  could  afford  even 
the  $4.00  per  week  charged  at  the  State  Sanatorium.  Not  all 
the  members  are  intelligent.  Several  are  unusually  stupid.  In  the 
family  of  Zelek  P.,  a  Russian  Jew,  no  one  can  write  English,  and 
his  wife  cannot  speak  English. 
Before  admission  to  the  class  is  granted  the  applicant  must 
promise  to  give  up  all  work,  to  live  the  out-of-door  life,  and  to  obey 
all  the  rules  of  the  class.  The  truth  of  Brehmer's  motto  that 
"  The  most  profitable  work  for  a  sick  man  is  to  get  well,"  is 
impressed  upon  the  patient.  After  the  decision  to  join  the  class  has 
been  made  a  clinical  history  is  taken  and  a  complete  physical 
examination  made  and  entered  on  the  clinical  records.  Once  a 
month  the  lungs  and  sputum  are  re-examined.  The  patients  are  vis- 
ited  by  the  nurse  as  soon  as  they  enter  the  class.  Often  before  the 
decision  has  been  made  the  nurse  is  sent  to  discuss  the  question 
with  the  invalid  and  his  family,  and  to  determine  whether  it  will  be 
possible  to  carry  out  the  open-air  treatment  in  their  home.  If  there 
be  no  roof,  balcony,  piazza,  or  yard  available  for  the  rest  treatment  in 
the  open  air,  the  family  must  move  to  a  tenement  that  will  enable  the 
tuberculous  invalid  to  spend  the  entire  day  and  night  out-of-doors. 
Our  friendly  visitors  have  spent  much  time  in  seeking  satisfactory 
tenements  for  the  members.  At  the  first  visit  the  nurse  examines 
the  house  and  locality,  obtains  the  social  history  of  the  case,  ascer- 
tains the  exact  financial  condition,  and  gives  what  instruction  may 
be  necessary  to  prevent  the  spread  of  the  disease.  The  first  visit 
usually  requires  two  hours  or  more.  A  detailed  report  of  this  is  at 
once  given  to  the  physician  in  charge.  Subsequent  visits  by  the 
nurse  are  made  as  required.  Usually  the  patient  is  visited  daily  or 
at  short  intervals,  until  the  details  of  the  treatment  are  understood 
and  followed.    It  has  been  found  that  repeated  visits  are  often  neces- 
