The Project Gutenberg eBook of A Working Plan for Colored Anti-Tuberculosis Leagues, by C. P. Wertenbaker.

BY

C. P. WERTENBAKER
Surgeon, United States Public Health and
Marine-Hospital Service

A WORKING PLAN FOR COLORED ANTITUBERCULOSIS LEAGUES.

Reprint No. 39, from the Public Health Reports, Vol. XXIV, No. 36, September 3, 1909.

By C. P. Wertenbaker, Surgeon, United States Public Health and Marine-Hospital Service.

There was published in the Public Health Reports of May 28, 1909, Volume XXIV, No. 22, a plan for the organization of colored antituberculosis leagues, which contemplated the organization of a league in each State, with a branch in every colored church.

Experience has shown that after such leagues are formed difficulty arises in getting to work in an effective way, because the work is new in character and those engaged in it have had but little, if any, experience. It is to meet this difficulty and supply a practical guide for the work of the leagues that this is written.

ORGANIZATION OF A STATE LEAGUE.

The object of the state league is to organize the church leagues, to bind them together and render more effective their work. The caring for patients and work of a similar character are properly the function of the church leagues.

There need be but little ceremony in organizing a state league. A few leading colored men and women, preferably from different parts of the State, but not necessarily so, meet and proceed to organize the state league.

The constitution and by-laws for state leagues should be adopted, followed by the election of a president, a secretary, and a treasurer.

It is desirable that the constitution and by-laws recommended in “The Plan” be adopted in all essential particulars, so that there will be uniformity in organization and work. They have been adopted in all the States that have organized thus far, and it is believed future organizations should also adopt them.

The president then appoints a committee, the president and secretary being members of it, to select a vice-president for each county in the State. (The plan contemplates that there shall be a vice-president for each county, whose duty it is to organize a branch league in each colored church in the county.)

The selection of the county vice-presidents should be made with a good deal of care. Suitable persons who will actively carry on the work should be chosen for these positions. The vice-presidents should be authorized to appoint one or more representatives in each community to help them organize the leagues in the churches and arouse interest in the work.

It can not be impressed too strongly on the vice-presidents that the success of the church leagues in their districts will depend upon the amount of attention given the work. The organization of a branch league in a church is merely the starting point; the real work is done after the organization is completed.

The president and secretary of the state league should call for regular reports from the county vice-presidents, showing the number of church leagues in their respective counties and a statement of the work done in each.

If any of the church leagues are not prospering, the president or the secretary of the state league should visit or write to them and learn what is the trouble, and give needed advice and encouragement. Officers of the state league should consult frequently and freely with their state board of health and enlist its sympathy and aid in their work. The closer the leagues keep in touch with the health authorities the better will be the results obtained. Both the state and local health officers will be glad to give their best efforts to help along this work. They are in a position to do a great deal to assist both state and church leagues, and the leagues should work in harmony with them.

CHURCH BRANCH LEAGUES.

Organization.—In order that the members of the church in which it is proposed to organize the branch league may understand thoroughly the objects of the league, the minister or other competent person should explain clearly the purpose of the league and what it is expected to accomplish. He should inform them that relatively many more colored people die of consumption than white people; that very few colored people get well of the disease, partly because they do not know how to take care of themselves and partly because many neglect to do so; and that the object of the league is to teach the well how to preserve their health and prevent their contracting consumption and other diseases, and the sick how to regain their health. If too poor to take the necessary treatment, it is the purpose of the league to help its members to do so.

After the foregoing has been thoroughly explained, the church branch of the state league should be formed by the adoption of the constitution and by-laws given for church leagues in the plan of[5] organization published in the Public Health Reports of May 28, 1909. After this has been done, the officers required by the by-laws should be elected.

The secretary then takes the name and address of each of the members, and as soon as a member has paid his dues he is given the certificate of membership, properly filled out, and signed by the president and secretary of the church league.

The certificate of membership given to each person joining the league has printed on it information and instructions which, if followed, will tend to protect the individual from consumption.

An attempt has been made to make the certificate large and attractive, and it is expected that the members will value it to such an extent that they will frame and hang it in a prominent place in the home, where it can be frequently seen, and that the sanitary maxims that it contains will be learned and followed.

In organizing the church league it is well to have a number of the certificates on hand to supply the members as soon as they pay their dues. The form of the certificate will be found in the plan of organization for these leagues. The certificate can be printed at a local printing office, but if this is not practicable, or it is preferred to buy them, very handsome certificates printed in black and red, with a large red seal, and the name of the state and church branch league, can be bought for about 6 cents each, by the hundred.

The amount of the annual dues to be paid by each member can be changed by each league to suit the necessities of the community. The dues should be so small that no one will be kept out of the league by not being able to pay them. However, as the dues will be the chief source of revenue with which the league expects to do its work, they should not be made smaller than is actually necessary.

The money paid into the league as dues goes to form a fund that is disbursed by the church league collecting it to help those of its members who contract consumption. How much this help will be will depend upon the amount of money the league has at its disposal and the needs of the individual. But whether this help is much or little the having the certificate of membership and belonging to the league will give information that will teach one to protect himself and his family from disease. This means less sickness, consequently less loss of time from work, therefore more money, more comforts, and more happiness for all concerned.

The vice-presidents and organizers should see that the four standing committees required by the by-laws of the church leagues are promptly appointed and that they understand their duties.

As the work of each church league will at first consist largely of educating its members as to the cause of tuberculosis and the way[6] to live to keep from getting it, the committees, and especially the ones having charge of “sick,” “sanitation;” and “information” should be especially active. They should learn all that is possible about their respective subjects so that they can teach the other members.

In joining the church league one also becomes a member of the State Colored Antituberculosis League. Members of the state league and church branch leagues wear a button showing their connection with the leagues.

Membership.—Membership in the church leagues should not be confined to the members of the church organizing the league. As a rule it is better that the members of each church join their own church league, but if for any reason their church has no league there should be no objection to their joining the league of some other church. Those who are not members of any church should also be allowed to join the league.

Details of the work of a church league.—As soon as the church league is organized the president should appoint the four standing committees required by the by-laws to serve for one year, viz: “Finance,” “Information,” “Sick,” and “Sanitation.” The details of the work to be done may then be considered. One of the first of these is to ascertain how many of the members have or are suspected of having tuberculosis. This duty devolves upon the committee on the sick, which should get from the secretary a list of the members, giving the name and address of each. This list should be gone over and every member carefully considered. It is probable that the greater number of the members are personally known to the committee, and thus it can be told at once whether they are sick or well.

The committee is not expected to decide whether these members have tuberculosis. Their duty is to make out the list of the sick and ailing. The physician will decide the nature of the sickness.

It is desirable to find cases of consumption in the earliest stages, for these may be cured, and if all members who are not strong and healthy are examined by the physician it is possible that cases of early consumption will be found.

Each ailing member should be visited by some of the committee and more careful inquiry made as to the nature of the trouble and the member urged to go to a physician or a dispensary for examination. This is especially true if the member has been losing flesh, or has had a cough for some time, or has throat trouble, or is sickly and frail. If upon examination the physician finds that the member has consumption, the patient should get a certificate stating that fact. The physician will also tell the patient what treatment is necessary.

The certificate will be presented to the committee by the patient, and the committee will make more careful inquiry into the condition[7] of the patient, the treatment considered necessary by the physician, the patient’s means, the number of people he has depending upon him, etc., so that the facts may be presented to the executive board in accordance with the requirements of Article VII of the by-laws.

The list of the sick should be most carefully guarded and no one allowed to see it but the officers of the league and the health officers. This knowledge should be regarded as a sacred confidence that should not be divulged except to the persons mentioned above, as many might object to having it known that they have tuberculosis.

Under no circumstances should the list be allowed to fall into the hands of “patent medicine” concerns which might urge their nostrums on the patients, much to their annoyance and also to their detriment, if they become induced to take the “patent medicines.”

The measures necessary for the treatment of a patient who has tuberculosis must be determined by the physician, but it is the duty of the executive board to decide how much and what kind of help the league can give the patient in carrying out this treatment.

It is not proposed to discuss here the question of treatment in a sanatorium which is the ideal way of handling all cases of tuberculosis, for in a sanatorium the sick cease to be a menace to the community and can be under supervision and treatment all the time. Unfortunately, at present sanatoria are not available for the great mass of the people; and even if they were, many would be unable to go to them.

There is a class of patients who have to depend upon their daily labor for the support of themselves and their families. If they stop work, their support is cut off. For such as these treatment in a sanatorium is out of the question, and any treatment they can get must be given in their homes and frequently while they are working. To this class belong the great majority of the negroes; therefore the work of the church leagues must be directed to such help as can be given under these circumstances. What is necessary in each case will depend upon the condition of the patient, the stage of the disease, and the financial circumstances of the individual.

First. The patients who are in the earlier stages of the disease and are able to go about their work while taking treatment.

Second. Cases in which it is necessary to stop work and remain quiet if they are to get well.

Third. Cases in which the disease has progressed so far that it is hopeless to attempt a cure, but for which much can be done to make the patients comfortable and prevent them from scattering the germs of the disease.

As stated above, what is necessary in each case will depend upon the condition of the patient and his surroundings. Much also depends upon the means the league has at its disposal to help the individual. Most church leagues find that they have very little money; therefore the help given must be limited. However, there are certain things that can be done even by the poorest leagues.

Information as to the way in which the disease is spread; the means to prevent it; what is necessary to get well if one has it, etc., is all printed on the certificate. When the member gets the certificate and has learned all that is printed on it, the first step has been taken in the education of the individual in regard to tuberculosis, so it should be the aim of the officers of the leagues to get the certificates in the hands of the members.

The officers of the league can see that the instructions on the certificate are understood and carried out. Many individuals are careless and must be constantly watched to see that they do not neglect important precautions. Probably the most difficult thing the league will have to do will be to induce its members to keep their windows open and let fresh air and sunlight into their rooms.

The officers and committees of the league should urge the members to keep the windows of their rooms open, especially at night, and to avoid overcrowding their sleeping rooms. Whenever a dark room or closed window which should be open is found, the danger should be pointed out, and the member urged to correct it.

The practice of sleeping with the head and face covered is so deeply rooted in the negro race that it seems almost hopeless to attempt to eradicate it in the present generation. It is a most pernicious habit. The dangers of the practice should be pointed out, and the members urged to abandon it. Children should not be allowed to contract the habit.

The careless spitting of consumptives in their homes is a practice dangerous to others. The careless at times spit on the floor, the walls, the hearth of the open fire, or on the stove if one is used. The sputum of the consumptive dries and is carried into the air as dust. This is drawn into the lungs when one breathes. The dangers of this should be emphasized, and the proper way to dispose of sputum shown. The consumptive should catch all of his sputum and burn it. There are cheap cups made of paper that can be had at small cost, and these should be used to spit in, and when they are full they should be burned. The better cups have covers to them, so that the flies can not get at the sputum. While consumption is a dangerous disease, the careful consumptive is not dangerous to live with. The careless consumptive, however, is dangerous to live with and a menace to those around him.

The minister and the officers of the leagues should consult frequently with the health officer of their community. Working together they can accomplish much more than by working alone.

The minister and officers of the league can teach their people to be careful and not produce unsanitary conditions, and the health officer can remedy conditions that the people can not correct. The leagues should urge the members to beautify their homes, no matter how humble they may be. If the home is made more attractive, interest in it will grow, and an improvement in the sanitary conditions will naturally follow. Teach the members to have grass and flowers in their yards. See that there is no dirt, trash, or litter scattered about; that the loose paling of the fence is nailed on, and the sagging gate has a new hinge. Pull the dirty rags from the broken window pane and burn them. Let them put their bed-clothing out in the sun occasionally, and sweep the dust from under the bed and furniture. Open the window and door and let air and sunlight into the rooms. All of these things tend to improve the sanitary conditions, which means health and happiness.

Members should be taught that remedies advertised as cures for consumption are not to be relied upon, and that the only known way to get well is to live in the open air as much as possible, both day and night, and to eat nourishing food at regular intervals. The consumptive when possible should go to a physician or a dispensary and follow exactly the instructions given.

Aside from the help that can be given the individual consumptive, which will be discussed later on, there is much that the leagues can do by concerted action to improve the conditions under which the negro lives. Probably one of the most important factors in the spread of tuberculosis, aside from his habits, is the manner in which the negro is housed. The negro as a rule is a renter. The houses that he can rent are usually located in the poorest and most unhealthy part of the city. They are often poorly constructed, badly lighted and ventilated, and frequently in bad repair. The rooms are usually small and dark, having but one window, and the top sash is seldom arranged to be lowered. Many houses are built on poorly drained ground, and water stands under them after each rain, making the rooms damp and cold. These houses are seldom provided with bathing arrangements or water-closets, thus necessitating the use of privies, or the back alleys, with all the dangers attendant upon such conditions. For such houses, or more frequently for one or two rooms in such a house, the negro pays proportionately more rent than the white race does for better houses in the same community, either because better accommodations are not available, or because he can not, or will not, pay for better. The family, usually[10] consisting of father, mother, and several children, and often friends or relatives, all live, eat, and sleep in these two or three rooms, frequently with the windows and doors tightly closed, and in winter a stove going at full blast.

In the negro section of the city the streets are usually either badly paved or not paved at all. The sidewalks are either in bad repair or missing. The streets are badly lighted at night, garbage cans are not emptied regularly, and the scavenger service is poor.

“There is a reason for these things,” say the landlords, the municipal authorities, and others who have dealings with the negro. The landlord says: “Negroes are destructive; they pull down, but they never improve property. A house rented to negroes will depreciate from 25 to 50 per cent in a year. If you put in plumbing they break it, they deface the walls, they tear off the shutters and the doors, they break and burn the fences. It is useless to give them good houses as they neither appreciate them nor take care of them.”

The municipal authorities say that negroes make no effort to keep their surroundings clean and sanitary. They throw things into the street, choke the plumbing, drains, and sewers with old rags, trash, and dirt, and make no effort to help the authorities keep things in order; therefore it is useless to try to help them until they learn to help themselves. They say that there are exceptions to these statements, but that they are true so far as the great mass of the negroes is concerned. Reference is made to the subject here to draw attention to the fact that the leagues can do much to change these conditions, thereby bettering the condition of the race.

If the things that are said about the negro by the landlords, the municipal authorities, and others are true, then it is necessary for the negro to change these conditions before there can be hope for much betterment. If they are not true, steps should be taken to convince the landlords, municipal authorities, and others that they are false.

It is in this way that the leagues, though aimed at tuberculosis, may be the means of bettering the conditions along many lines. If the negro can demonstrate that he is not destructive, and that he can and does take care of the house in which he lives; if he will keep his surroundings neat and clean; if he shows that he is clean and sanitary in his practices, and that he feels his responsibility as a citizen by trying to keep up the sanitary conditions and the appearances of his home and his city, he will find that many of his troubles will disappear. If a landlord finds that his property is being cared for by his negro tenant, the yard, fences, etc., being kept in order, the rent promptly paid, and tenant is desirable, he will be only too glad to keep him, and to make such alterations in his house as he may desire. If it is demonstrated to the municipal authorities that the[11] negro is as careful of his section of the city as the whites, his wants will receive consideration. The educated negroes succeed in getting surroundings that are far better than those of the average because they have learned to appreciate the above facts, and have put them into practice.

When the leagues have taught their members that it is not healthy to live in dark, damp rooms, with bad sanitary surroundings, and have educated them to the point where they will refuse to live under such conditions, then the landlords will build proper houses for them. The leagues working in conjunction with the health officer can get the city authorities to so frame the building ordinances that only sanitary dwellings will be erected in the city.

What a church league can do for the individual consumptive.—In addition to supplying the members of the league with information in regard to tuberculosis and sanitation, which is the work of the committees, and trying to induce the members to follow the instructions given them, there are other things that the league can do for the individual consumptive.

The chief difficulty that will be encountered by the leagues is the lack of money to help their sick members. It is hoped, however, that as the league demonstrates its value to the community more money will be available, and the work of helping the sick members can be extended. This work contemplates the “class method” of treating patients at their homes, the establishment of dispensaries, and ultimately sanatoria and “tuberculosis farms,” where a patient can earn a living by working on the farm and at the same time be under medical supervision. It is realized that these things are for the future, but it is well to keep them in mind as one of the ultimate aims of the leagues.

Now let us consider what can be done for the members who have consumption. The league should buy a number of the paper spit cups mentioned above, and distribute them to their consumptive members, and urge their use. These cups are cheap and therefore can be burned after being used. If every consumptive can be induced to use these cups and then burn them much will be done toward stopping the spread of consumption.

Whenever a case of consumption is discovered the officers of the league should apply to the health officer to disinfect the rooms occupied by the consumptive, in order to protect the other people in the house from the disease. Then if the consumptive is careful he is not likely to reinfect them. Also when a consumptive dies the health officer should be asked to disinfect the rooms.

Consumptives should spend most of their time out of doors, and if possible should sleep on a porch, or in a shed, or tent. All one needs is something to protect against the weather and keep off the[12] rain and snow, but let in a great deal of fresh air. Patients live out of doors all winter in the north, with the thermometer below zero, and many have been cured of consumption in this way, including negroes. The league may help to provide the shack, shed, or tent, or it may furnish sleeping bags, blankets, etc., and in this way help the patient.

If the patient is very poor it may be that the league can see that he gets proper food which he might not otherwise have. The committees of the league will doubtless find many other means for helping the patient at small expense. The minister in making his pastoral calls can be of the greatest help both to the patient and to the community by seeing that the patient is properly carrying out his instructions, and that he has the proper facilities for doing so.

Dispensary.—As soon as the church league is formed, some physician should be designated who will examine all members referred to him, to decide if they have consumption. Usually there will be found one or more physicians who are members of the league, who will probably act in this capacity. If practicable a tuberculosis dispensary might be established at some convenient point, possibly in one of the rooms in the church, where the physicians could be found on certain days at stated hours, say, twice a week. Here they could see the consumptives, and examine and advise them as to the treatment necessary. They could also examine other members referred to them to decide whether they had consumption or not. Records of the dispensary work should be kept.

It is not practicable at this time to go more minutely into the details of the work of these leagues, which are now in their formative stage.

The writer will be glad to lend any aid in his power to any state or church league that may desire it, and all persons who are interested in this movement are invited to write to him, expressing any views they may have for the advancement of the work. He will be glad to have any aid, advice, or criticisms that may be offered.

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