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                           TREASURY DEPARTMENT
     Public Health and Marine-Hospital Service of the United States

                       A WORKING PLAN FOR COLORED
                        ANTITUBERCULOSIS LEAGUES

                                   BY

                            C. P. WERTENBAKER

                _Surgeon, United States Public Health and
                        Marine-Hospital Service_

                             [Illustration]

                               WASHINGTON
                       GOVERNMENT PRINTING OFFICE
                                  1909




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 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 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 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.

For the purposes of the league, consumptives may be divided into three
classes:

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 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 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 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.