The San Francisco call., 1909-08-22

The clinic has consistently adhered
to this plan since it's inception, which
it. is hoped the following facts will
demonstrates
The detail work in the construction
of the clinic is considerable and several
weeks were spent previous to the open
ing of the tuberculosis clinic in prepa-
ration for it. 1t was necessary to plan
system of records which would be
comprehensive enough to include in
every detail the structural plan of the
clinic. The social history chart was
made to correspond to the Associated
Charities record, for the obvious rea-
sons that it would simplify the relief
work of that and other organizations
to forward the patients history, and 1t
would save the patient the fatigue and
annoyance of a second interview. The
daily journal sheets were printed in or
der to form a permanent record of
the daily attendance at the clinic. The
system of card filing shows the per-
centage of daily attendance at the clinic,
for, besides the regular card index, a
second file is kept which classifes the
patients names. according to their
clinic day. 1t is a simple matter by
referring to the file. to lay out the
patients histories for the days record
ing.
The medical chart has an indicated
space for recording the temperature,
pulse, respiration ana weight of the
patients on the days they visit the
clinic. This also serves 20 record on
the chart the dates of each patients
visits. The medical chart has an indi-
Gated space for the throat examina-
tion which makes the absence of sucls
an examination directly obvious.
A sheet with ruled lines to record
the nurses visits to the patients, re-
lief given and general remarks, IS at
tached to each record. Under general
remarks" are recorded reports to the
board Of health of all cases of tuber-
culosis, insanitary premises and the
removal of patients so that the prem
ises may be disinfected.
Cards of recommendation for treat
ment. with a designated space for di-
agnosis, are filled out and signed by
the physicians and attached to the
cases. Duplicate copies are made out
by the nurses for relief societies to
which the patients are referred. The
cards are of positive value to these
societies, as they give definite informaG
tion regarding the relief needed and
the patients physical condition. They
are of value also to the nurses, IS they
have the physicians instructions rela-
tive to the treatment necessary for the
patient.
large map of the city has been
mounted and numbered pins which
correspond to the numbers on the his
tory charts, have been placed in the
blocks where the patients live. This is
a graphic method of showing the num-
ber and location of the tuberculosis
patients and also simplifes the dis
tricting of the nurses visits.
This system seems elaborate, but no
part of 1t in it's execution has proved
to be dispense BILE. The system means
a large amount of clerical work for
the nurses, which it does not seem
practicable to delegate to any one else.
The hours spent by the nurses at the
clinic include many other duties be-
sides the clerical work. The tempera-
ture, pulse. respiration and weight OF
each patient are taken and the new
patients given paper napkins, paper
bags and pocket sputum boxes and are
carefully instructed in their use. The
don't spit cards are also given them
to supplement the nurses teaching
This instruction of the patients by the
nurses in principles of protecting
themselves, their families and the
community from the infection of
tuberculosis is the ground work of
the clinics activities and is a powerful
sociological factor, as it will inevita-
bly, react upon the health of the entire
community.
But without the visits to the homes
of the patients the nurses instructions
are about as fruitless as the seed of
the sower that fell upon the rocks and
among the thorns. She must see the
home conditions under which the pa
tient is living and give the family the
benefit of her social training in the re-
organization of the home. so that the
patients recovery and the protection
Of the other members of the family
may be made possible.
With but few exceptions the families
visited by the nurses from the tuber-
culosis clinic have found the nurse to
be an important asset in their recov-
cry, because she has shown them the
necessity and the way properly to re-
organize the home. But without a re-
lief fund back of the nurses this pro-
cess can only be partly effected. For
tunately this handicap has not been
put upon the clinic work, as the Asso-
ciated Charities and the Hebrew board
Of relief have been able and willing to
respond to the constant demand made
by the doctors and nurses for relief for
their patients and the patients fami-
lies.
The following histories demonstrate
the process of the reorganization of
the home and the amount of money
necessary in these instances to eff
feet IT,
The first history shows forcibly the
necessity OF the reorganization of
home conditions in order to make the
patients recovery possible. The pa
tient is 2 young and extremely pretty
married Spanish woman with hus-
had received a small amount of as