HX64124185 RC311 .C23 Directions lor livin RECAP Thomas Spees Carrington Directions for livin?; and sleepinf; in the open air. ■RC5\\ cas intlieCitpotlfmgork CoUegE of ^J)j>s;icians; anh ^urgeong Hibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/directionsforlivOOcarr r f V rv trederic S. Lee, JJ^^;_ Oolnmbia IMvMHitj, DIRECTIONS FOR LIVING AND SLEEPING IN THE OPEN AIR THE NATIONAL ASSOCIATION FOR THE STUDY AND PREVENTION OF TUBERCULOSIS 105 EAST TWENTY-SECOND STREET, NEW YORK 1910 J DIRECTIONS FOR LIVING AND SLEEPING IN THE OPEN AIR By THOMAS SPEES CARRINGTON, M. D. Assistant Secretary of the National Association for the Study and Prevention of Tuberculosis, in charge of its Bureau of Construction, and appointed Expert on Hospital Construction in the New York State Department of Health ic -i I ' A lean-to tent shelter on the roof of an apartment house in New York City. Arranged by Mr. Frederick D. Greene. DIRECTIONS FOR LIVING AND SLEEPING IN THE OPEN AIR THOMAS SPEES CARRINGTON. M. D. Assistant Secretary of the National Association for the Study and Prevention of Tuberculosis, in charge of its Bureau of Construction, and appointed Expert on Hospital Construction in the New York State Department of Health. INTRODUCTION. Consumption, or tuberculosis, is a disease of the lungs which is taken from others and is not simply due to catch- ing cold. It is generally caused by germs, known as tubercle bacilli, which enter the body with the air breathed. The matter w^hich consumptives cough or spit up usually con- tains these germs in great numbers, and if those who have the disease spit upon the floor, walls or elsewhere, the matter will dry, become powdered, and any draught or wind will distribute the germs in it with the dust in the air. Any person may catch the disease by taking in with the air he breathes the germs spread about in this manner. He may also contract the disease by taking into his system the germs contained in the small drops of saliva expelled by a consumptive when coughing or sneezing. It should be known that it is not dangerous to live with a consumptive if the matter coughed up by him is properly disposed of. Consumption may be cured at home in many instances if it is recognized early and proper means are taken for its treatment. When a member of a family is found to have consumption and cannot be sent to a sanatorium, arrange- ments for taking the cure at home should be made as soon as the disease is discovered. The following directions are published to help persons to carry out the open-air treatment in their own homes. Many families are unable to make any great change in their mode of living and cannot afford to fit up porches and buy extra bedding or warmer clothing A number of the sugges- tions given here arc very simple and inexpensive, and will Tent shelter on a tenement house roof, partially protected from the wind by the stairway cover and nearby buildings. Work of the Bellevue Hospital Tuberculosis Clinic. A bed on the roof of a court of a tenement house, protected on the sides from the wind by the walls of upper stories. "Work of the New York Association for Improving the Condition of the Poor. 4 help those who would like to use w^hat they have at hand in making an outfit for outdoor life. IT IS IMPORTANT, IN THE TREATMENT OF TUBERCULOSIS, TO BREATHE AIR THAT IS FRESH AND PURE, TO EAT AN ABUNDANCE OF GOOD FOOD, TO STOP HEAVY WORK AND WORRY, AND TO TAKE A BODILY AND MENTAL REST BY LYING DOWN BEFORE AND AFTER THE NOON AND EVENING MEALS. To obtain the first, the patient must live out of doors. This means that as many hours of the day and night as possible should be spent in the open air, and in order to carry out this treatment some place must be provided which is not only protected from wind, but also from rain and snow, as nothing except the most severe cold weather should pre- vent the patient from living and sleeping there. The out- door shelter should be large enough for a bed, a reclining- chair and a table. It should overlook pleasant and sanitary surroundings if possible, as it is to be the home of the patient for months, and will give better results if comforta- ble and attractive. HOW TO TAKE THE OPEN-AIR TREATMENT IN A TENEMENT HOUSE. Tenement house dwellers and persons living in apart- ment houses in large cities should make every effort possible to give the open-air treatment to a member of the family who contracts tuberculosis. First, consider the possibility of moving into the suburbs or nearby small towns. If this cannot be done, try to obtain from the landlord the use of the roof, and build a small shack there as described on page 7 of this pamphlet. If this is beyond the means of the family, use one room with a window opening on a street or large court for the patient, and then place the head of the bed beside the window and cover it with a window tent. The cost of a window tent is about $10.00, and if it cannot be obtained, take two large, heavy cotton sheets, sew them together along the edge, tack one end of the double sheet to the top of the window casing and drop the lower end over the outer side of the bed, fastening the bottom of the sheet to the bedrail with tape. There will be enough cloth hang- ing on each side of the window to form the sides of the tent, and these should be fastened to the window casings. A window tent can be made at home for about $3.00 by using Dr. S. A. Knopf's window tent raised when not in use. Dr. S. A. Knopf's window tent in position, with patient in bed looking through the celluloid window into the room, but breathing outdoor air only. 12 or 15 yards of heavy denim or light canvas. One straight piece of denim should be hung from the top of the window casingto the outer side of the bed, and the openings between this and the side window casings filled in with sides cut and fitted from the balance of the cloth. By these methods the patient gets fresh air from the window and the room is kept warm in cold weather as a place for dressing and toilet purposes. During mild and w^arm w^eather, the tent can be removed and the window kept open both at top and bottom. The flat roofs of tenement and apartment houses in large cities should, if possible, be used as a breathing place by the tenants. Shacks or cabins can be built upon them at small cost and make an economical and easily provided shelter. HOW TO BUILD A SMALL SHACK OR CABIN ON A FLAT ROOF IN THE CITY. Two by four timbers should be used for the frame and siding boards for the back and sides. The front of the shack should face slightly to the east of south and be left open, but arranged with a canvas curtain, tacked on a roller so that it can be closed in stormy weather. The shack can be built cheaply with rough boards and the roof covered with tar paper or other roofing. As the vast extent of flat roof space in all cities and in many towns should be used for outdoor living and sleeping, detailed plans for building a shelter on them and a list of material, together with the A simple wooden sliaek for a family of three which can be constructed on the roof of a tenement house or in a yard. Planned by Dr. H. E. Kirschner for the Oil City. Pa., Sanatorium. 7 approximate cost, are given. The plans and list will be understood by any carpenter, and when the shelter must be built economically it is advisable to confer with the neigh- berhood carpenter, rather than place the construction in the hands of a contractor or builder. Front view, Floor plan and Elevations of a shack for flat roofs, to go with list of lumber below. Loaned by Mr. W. H. Scopes. LIST OF MATERIAL AND ESTIMATE OF COST FOR CONSTRUCTING A SMALL OPEN-AIR SLEEPING SHACK ON A CITY ROOF OR IN A COUNTRY YARD. 328 feet of rough lumber as follows, at $30.00 per M . 4 pieces, 2 inches by 4 inches by 12 feet, sills. 5 pieces, 2 inches by 4 inches by 12 feet, floor joists. 14 pieces, 2 inches by 3 inches by 14 feet, studs. 5 pieces, 2 inches by 3 inches by 12 feet, plate. $9.84 I piece, 2 inches by 6 inches by 12 feet, plate front . 1 piece, 2 inches by 8 inches by 12 feet, rail for sliding sash. 9 pieces, 2 inches by 4 inches by 14 feet, rafters and rafter tails for front eaves. 300 feet of novelty siding for walls at $30.00 per M $g.oo 250 feet of shiplap roof boards at $26 00 per M . . . . 6.50 200 feet of 7-8 inch common flooring at $32.00 per M . 6.40 One-half roll Neponset Red Rope Roofing at $5.00 per roll 2.50 10 pieces of I -inch half round for roofing at i cent per foot 1.40 I canvas curtain on roll 5.00 4 sliding sash, 3 feet by 3 feet, at $2.00 8.00 I casement sash and frame, 2 feet by 2 feet, at $2.00 . 2.00 Hardware i.oo Strips for sliding sash i.oo Paint 5.00 $61.64 Labor 25.00 $86.64 NOTE. Canvas can be bought by the yard and a curtain made at home. A tcniporarN pnrch with i^la a^ti pr'Ucctinii. tenement hou^c. Loaned h\ the .lournal of the Outdoor Lite ^ A window tent seen from outside. The flat and extension roofs of the next house are good sites for a shacl< or tent. Two sleeping-porches, one built over the roof of a back extension and the other built in a corner of the house. 10 HOW TO ARRANGE A PORCH ON A HOUSE IN THE COUNTRY. If the family lives in a small town or in the country, it will usually be found that a porch is the most convenient way of providing open-air quarters. In selecting a site for the porch, it is well to remember that the patient should be placed out of doors in such a way that the cure can be taken with comfort at all seasons of the year. For the winter months the best place is on the south side of the house, as there will be found the greatest amount of sunshine. If this cannot be done, choose first the east, or second the west side, but not the north side except as a last resort, for it is a windy and cold position in winter. The back of the house is usually better than the front if the porch cannot be seen from the street, but what is of the most importance is to FIND A SHELTERED SPOT PROTECTED FROM THE WIND, FOR THE WIND IS MUCH HARDER TO BEAR THAN EVEN INTENSE COLD. When a house has permanent verandas and the family cannot afford the expense of providing a special porch for the patient, the permanent veranda on any floor may be used and privacy and protection obtained by putting up canvas curtains or bamboo screens. If a special porch for winter use is to be built, place it on the south side of the second story of the house, with an entrance into a room which can be used by the patient. For a passageway to the porch cut one of the windows down to the floor and put in a door 3 feet 8 inches wide, so that the bed can be rolled from the room to the porch with- out difficulty. If the room is not heated by some other means, a stove should be used and the air kept warm, so that the patient may have a comfortable place for dressing, eating and to enter when chilled. Build the porch out from the door 10 feet wide by 10 feet long and 7 feet or more in height from floor to ceiling. Place glass and sash on the side of the porch most exposed to the weather, and hang canvas curtains on rollers to enclose the open sides in stormy weather. Lay the floor with narrow spruce boards, using white lead and oil to fill in the cracks, at a grade of I inch to 5 feet, so that water will not stand during 1 1 A well-constructed porch with screens and awning protection, built on the roof of a first-floor veranda. Loaned by the State Charities Aid Association, New York. Showing a simple method of using the front veranda of a country house by protecting the sleeping quarters with canvas curtains. Loaned by the State Charities Aid Association, New York. 12 stormy weather. A porch of this kind can be built in small towns and in the country for from $50.00 to $100.00, the cost depending upon the class of material used and the way the porch is finished. HOW TO BUILD A CHEAP PORCH. A useful porch can be built for $12.00 or $15.00 with cheap or second-hand lumber, and if only large enough to receive the bed and a chair will still be effective for the out- door treatment. The roof can be made with a canvas curtain or a few boards and some tar paper. The end most exposed to the wind and rain and the sides below the railing should be tightly boarded to prevent draughts. A window can be used for the approach, but it will be more convenient if it is cut down to the floor and a small Dutch door put in below the window-sash. Second- and third-story porches are supported from the ground by long 4 by 4 posts, or, when small, they can be held by braces set at an angle from the side of the house. A cheap temporary porch protected by an awniiii^ and supported bv braces set at an angle. A good method of building a porch on the back of a cottage for country use. Loaned by the Journal of the Outdoor Life. A cheap porch protected by awnings, built on the roof of a first-story veranda. 14 HOW TO PROVIDE A SHELTER FOR THE SUMMER AND FOR HOT COUNTRIES. Consumptives need a good shelter in tropical countries and protection during the summer months in northern climates. A porch should be placed on the side of the house where the direct rays of the sun will not strike it during the middle of the day, and tents or shacks placed under shade-trees or in the shadow^ of large buildings. Awnings which jut out from the roof of a porch or shack are used for shade, and Japanese drop curtains made of long strips of bamboo for privacy, as they do not stop the current of air. In places w^here the streets are not watered, a hose should be used to lay the dust in front of the house, and the floor of the porch or shack sprinkled once or tw^ice each day to cool the surrounding air. The open sides of the shelter must be screened from the floor to the roof with wire netting as a protection from flies and mosquitoes, and when this is impossible, a mos- quito-bar made of cheese-cloth, netting or scrim should be hung from the roof or laid over barrel-hoops attached to the head and foot of the bedstead. Showing a cheap method of protcoimu i slcepinn porch in hot weather with W-nctian blinds. Loaned by the .1. Ci. NX'iKon .Mff". Co., New York. IS A good method of supporting a tent by a frame, sliowing the well-built floor and ventilator in the peak. Used at the Otisville Sanatorium, N. Y. This is a good way to arrange a netting as a protection from insects. the barrel-hoops tied to the bedstead. Loaned by the Journal of the Outdoor Life. Notice 16 TENTS AND TENT HOUSES. Tents and tent houses can be used as a shelter in warm, dry climates and for the summer months in northern countries, but they are not very satisfactory for winter use in cold climates. In order to make a tent comfortable for a sick person, it should have a large fly or double roof with an air space between, a wide awning in front where the patient can sit during the day, a board floor laid a few inches above the ground and the sides boarded up two or three feet from the floor. THE BED AND BEDDING USED IN OUTDOOR SLEEPING. An ordinary iron bedstead with woven wire spring 3 feet 6 inches wide and a moderately thick mattress are all that are necessary except for very cold weather. A bedstead which can be rolled about easily is a great convenience, and should therefore be fitted with small rubber-tired wheels or casters. A good hair mattress is most desirable, but when it cannot be obtained, a cotton-felt mattress can be bought for as low as $4.00, or a wool mattress for about $10.00, In northern climates, where cold weather must be expected, two mattresses with several layers of newspaper An Emmanuel ( luirch class paiiLiit takinK the open-air treatnient in a back yard of a Boston tenement. 17 How to make a sleeping-bag with the bed-clothes. First tuck all covers except the top blanket under the bed-pad, and then tuck the top blanket under the mattress. Loaned by the Journal of the Outdoor Life. between them are often used. Over the mattress place an old blanket or a cotton bed-pad, the same width as the mat- tress, and on this the ordinary bed-sheets or blanket-sheets. BED COVERS USED IN OUTDOOR SLEEPING. Persons who like heavy bed covering may use blankets, placing as many layers over the bed as desired for warmth. Those who cannot stand heavy covering can use down comforts, as they are very warm but light. If these are too expensive, lamb's-w^ool or cotton-filled comforts can be bought, or the material for wool or cotton quilts can be 18 obtained for about $2.00 and warm, satisfactory covering made in the home. Very cheap, light, but warm covering can be made by using paper blankets placed between two thicknesses of outing flannel or bed covers. These paper blankets are sold for 50 cents each and wear for about six months. A woolen horse blanket with an outside of canvas can be used as a covering to protect the bedding in wet and stormy weather. SLEEPING-BAGS. In very severe weather a sleeping-bag may be used for patients who are very susceptible to the cold. These bags can be bought at department stores for $15.00 upward, or can be made at home by sewing blankets together around the edges, leaving the top open. In making a bag, use as many layers as may be desired, but place the same number of thicknesses on both sides of the bag. The blankets should be 7 feet long by 4 feet wide. ARRANGEMENT OF PILLOWS IN OUTDOOR SLEEPING. Two pillows should be used in preparing the bed before retiring. Place them in the form of an inverted V, with the apex at the top of the bed and the head at the point where the two pillows meet. This position allows the shoulders to nestle between the pillows and protects them from the cold wind which will otherwise find its way under the bed- clothes when the patient lies on his side or turns over. HOW TO PREPARE THE PATIENT FOR THE NIGHT. In cold weather the outdoor sleeper should get into the bed in a warm room and have some one roll him out of doors. When this cannot be done, use a warm dressing- gown in going back and forth from the dressing-room to the porch, and warm the bed by placing in it for a few minutes before retiring, a hot-water bag, hot bncks, soap- stones or bottles filled with hot water. In some instances it is well to leave a hot stone or bottle wrapped in flannel at one corner of the bed. where it will throw ofi" heat slowly during the night. In tucking in the patient at night, all covers except the top blanket or comfort should be tucked in under the bed- pad which lies on the mattress. The topmost cover is then tucked under the mattress to keep the under covers from I ' A method of screening beds in hot countries. Loaned by the Journal of the Outdoor Life. sliding off when the sleeper is restless. This method of tucking-in forms a sort of sleeping-bag with the bed-clothes, known as the Klondyke bed, and prevents the cold air from reaching the body. CLOTHING WORN AT NIGHT. The night clothes worn by the outdoor sleeper during the winter depends largely upon the strength of the patient. Some persons need much more than others, but even the weakest can usually keep warm if they have blanket-sheets and hot bottles. A woolen undershirt, a sweater and a long outing flannel nightgown or bathrobe are usually worn, but in very cold weather some patients wear a pair of A knitted helmet for protecting the head, neck and shoulders. Loaned by the Journal of the Outdoor Life. 20 drawers made of flannel, a pair of bed-socks or knitted slippers and a woolen abdominal bandage. HO^A^TO PROTECT THE HEAD FROM DRAUGHTS. The head of the bed should be shielded from the wind or a strong draught by placing it close to the protected end of the porch, or by covering it with a canvas hood supported on a barrel-hoop attached to the bedstead or hung by a rope from the ceiling. The patient can wear a knitted skull-cap long enough to be pulled down to the end of the nose and over the ears, or a knitted helmet which covers the whole of the head, face and neck, with the exception of a small opening for the nose and mouth. A hood shaped like an old-fashioned sunbonnet is very comfortable, and can be made at home from eiderdown or outing flannel by using as many thicknesses as may be needed. NEVER COVER THE HEAD WITH THE BED-CLOTHES. If the nose grows cold, use a small piece of flannel, held by elastic bands from the ears, to cover the top, or a piece of cotton held in place by a strip of adhesive plaster. Care should be taken not to interfere with the inhaling of fresh air or to allow the breath as it is expelled from the nose or mouth to come in contact with the cloth and form icicles. Chap- ping of the face during the night can be prevented by using cold cream or vaseline about the nose and lips. CLOTHING FOR DAY USE. The clothing for use during the day when the patient is up or sitting in a reclining-chair should be of light weight but warm. Underclothes of half cotton and wool or linen mesh, and a sweater which buttons in front, with the ordinary outer clothes, are usually worn. The over- coat for men, women and children should be of fur if possible, as even the cheapest of skins are warmer than any other kind of garment. If a new coat cannot be bought, a heavy cloth overcoat will give good protection, and be much warmer if it has a high, soft collar. Leather leggins and woolen tights are used as extra garments, and are a great comfort when taking exercise on cold days. HOW TO PROTECT THE HANDS. Patients who wish to use their hands while sitting out of doors in cold weather can wear thin, well-fitting cotton gloves. These are used by army men, and can bo 1. How to wrap a patient in a chair. The reclining-chair is first overlaid with a rug or a comfortable, and double blankets extended their full length, leaving the free ends on the floor. Loaned by the Journal of the Outdoor Life. bought for thirty cents a pair. Over them should be drawn a knitted woolen glove with the ends of the fingers and thumb cut off and bound to prevent unraveling. For ordinary protection, w^hen not at w^ork, a heavy fur or woolen mitten should be worn w^ith long, w^oolen w^ristlets. Never use tight gloves of any kind in cold weather, as they restrict the circulation of the blood and cause the hands to grow^ cold. HOW TO PROTECT THE FEET. Use woolen stockings, and if they cause irritation, wear a cotton stocking next to the skin. Sometimes tw^o or more pairs of woolen stockings are necessary in very cold weather, but they must alw^ays be large enough to fit loosely. Felt shoes are warm and light, and are much used. Soft leather shoes covered by large fur-lined leather shoes are very w^arm and comfortable, but are expensive, as they must be made in a set, to order. Foot-muffs should be used in sitting out during a cold day. They are made of fur or of cotton quilts sewed up like a bag, into which the feet can be placed. On very cold days the muff can be placed in a wooden soap-box with hot bricks beside it, and new^spapers wrapped about the muff to fill in the empty space. CHAIRS FOR DAY USE. An easy-chair is a great comfort to the patient during the day. A steamer chair is easily obtained and gives good service, and the canvas chair with a wooden frame can be bought for $i.oo, or the cane-seat extension-chair for $2.50 up. A more durable chair is made for this purpose with an iron frame, costing about $25.00, which can be transported and used in a rough manner without danger of breakage. To prevent the cold currents of air reaching the patient from below, the chair must be covered with some thick, closely w^oven, warm material. A fur rug is the best for this purpose, but several layers of blankets and newspaper will ansv/er and are more economical. TABLE FOR WORK AND AMUSEMENT PURPOSES. The patient should have a table handy on which to keep books and other things used for amusement or work. An adjustable table, the top of which the patient can swing before him or away, is a great convenience, and can be used as a book-rest when the hands are under cover. 2 How to wrap a patient in a chair. After seatinc yourself, draw up the free ends of the blanket and tuck in at the sides. A steamer rug is placed over all. loaned by the .fournal of the Outdoor Life. GENERAL DIRECTIONS FOR THE CARE OF THE PATIENT. The directions for the care of the patient are not intended in any way to take the place of a physician's orders. Every consumptive should consult a doctor, and these suggestions are given to help the patient carry out his directions. Rest is a most important part of the open- air treatment, and exercise must be regulated by the doctor. Always have at hand an extra wrap, and never remain out if chilled. Cold weather should have a bracing effect, and when it does not, go into a warm room and get a hot drink, preferably milk, remaining indoors until com.fortably warm. "When going out again use more wraps, and keep behind a shield or screen that breaks the force of the wind. Always be cheerful and hopeful; never waste your strength in anger or by being cross. Lead a temperate life, go to bed early and get up late; do not use alcohol in any form except when prescribed by your doctor. Do away with tobacco if possi- ble, and use only weak tea and coffee in small quantities. Never sw^allow^ the matter coughed up, but always destroy every particle by spitting in a paper or cloth which can be burned. Never allow the hands, face or clothing to be soiled by sputum, and if this happens by accident, wash the place soiled with soap and hot water. Men who have consumption should not wear a moustache or beard unless it is trimmed close. Particular care must be taken, \vhen sneezing and coughing, to hold in the hands before the face a cloth which can be burned. Soiled bed-clothes, night- dresses, other washable garments and personal linen should be handled as little as possible until they are boiled prior to their being washed. The dishes used by the patient must be boiled after each meal. All the above means care and work, but must be done both as a protection to the household and in order to bring about a speedy cure for the patient. 24 COLUMBIA UNIVERSITY LIBRARIES is book is due on the date )nr This expirst- >- r- « 'definite p' DATE DUE , ! — . .1 If. .-u Hi l(}llfi •m ] iim ^ ,pO >\sf^ ^©' M^ 'li ^\^^ \ ^ n i.j ^a/ n May t T u " ^ ms k DEMCO 38-296 COLUMBIA UNIVERSITY LIBRARIES 0043068510 n