the general practice of the institution, would determine the ratio of
disability annuities granted for all causes in general and for tuber-
culosis of the lungs in particular. As far as it is possible to judge,
however, the ratio of disability annuities granted on account of
tuberculosis of the lungs to the insured population has increased
during recent years, which may be due chiefly to more careful
methods of selection and to a more extended use of sanatorium
methods of treatment^
The number of male patients treated and cared for on. account of
tuberculosis of the lungs by the Invalidity Insurance Instituticm of
Bhenish Prussia during 1910 was 4,160 and of female patients 1,356.
The total number discharged during the year was 4,260. The dura-
tion of treatment is given in detail in the table below :^
1 Annual Report for 1910, p. 29.
* Idem, p. 46.
Digitized by VjOOQ IC
CABE OP TUBElUDULOUS WAGE EABKBBS IN GEBMANT.
irUMBSB AND PER CENT OF PATIENTS DISCHAROED, BY DURATION OF TREAT-
MENT ON AOCOTJNT OF TUBERCULOSIS OF THE LUNGS, PUBLIC SANATORIA,
RHENISH PRUSSIA, 1910.
Dontioa of treatment.
Domtion of treatment.
14 to 16 weeks
18 to 20 weeks
20 weeks and over
Oto 14 weeks
The bed accommodation in the public sanatoria in Rhenish Prussia
in 1910 was 916. On an average a waiting period of six weeks was
necessary previous to admission. In some of the institutions the
average waiting period was as low as 2.5 weeks, and in one as
high as 10 weeks. Institutions are provided for the observation of
more or less doubtful cases, and a considerable number of tubercu-
losis dispensaries have been established in the principal cities, and
the value of these is enhanced by traveling tuberculosis exhibits,
which, during 1910, were open to the public on 282 days and visited
by 147,612 persons. The number of public addresses on tuberculosis
during the year in connection with the traveling tuberculosis exhibits
The number of male patients receiving full treatment and care
on account of tuberculosis of the lungs during 1910 was 4,129, and
die number of days of treatment was 262,049, or an average duration
of treatment of 63 days. The expenditures on account of male
patients amounted to 1,559,595.33 marks ($371,183.69), or an average
expenditure of 377.72 marks ($89.90). Of the disbursements on
account of male patients, 27 per cent were reimbursed to the inva-
lidity insurance institution by the communal, industrial, and other'
sick funds. The amount provided for the family support of male
patients treated on account of tuberculosis of the lungs was 431,614
marks ($102,724.13), or an average support per patient per case of
104.53 marks ($24.88). Of the 4,129 male patients treated, 3,513, or
85.08 per cent, were treated successfully from an economic point of
view; that is, with regard to the required degree of restored wage-
earning capacity. ,
The number of female patients receiving full treatment on account
of tuberculosis of the lungs during the year 1910 was 1,263, and the
number of days of treatment was 90,519, or an average duration of
treatment of 72 days. The total disbursement on account of female
patients was 386,338 marks ($91,948.44), or an average expenditure
of 305.89 marks ($72.80) . Of the expenditures incurred on account
of female patients, 16 per cent was reimbursed to the invalidity
^ Annual Report for 1910, p. 4.
Digitized by VjOOQ IC
134 BULLETIN OP THE BUBEAU OP LABOB.
insurance institution by communal, industrial, and other sick funds.
The amount of family support granted to female patients was 13,746
marks ($3,271.66), or an average support of 10.88 marks ($2.69) per
case. Of the 1,263 female patients treated, 1,079, or 86.43 per cent,
were treated successfully from an economic point of view or with
regard to restored wage-earning capacity.
Of the 2,777 male patients treated in 1905, 928, or 39 per cent, had re-
tained their earning capacity to the beginning of the year 1911. Of 803
female patients treated during 1906, 286, or 41 per cent, had retained
their earning capacity to the commencement of 1911.* The results
with patients treated during subsequent years are equally favorable
and fully justify the conclusion that, from an economic point of view,
the treatment and care of tuberculous wage earners is warranted by
the facts of extended experience. It may be stated, however, that out
of 11,682 male wage. earners successfully treated and cared for on
account of tuberculosis of the lungs during the period 1905-1910, only
595, or 6.1 per cent, became subsequently entitled to disability annui-
ties. In the case of 3,506 female patients treated and cared for suc-
cessfully during the same period, 113, or 3.2 per cent, became subse-
quently entitled to disability annuities. Of the male patients, 495,
or 4.2 per cent, became subsequently incapacitated for work, without,
however, becoming entitled to disability annuities, and 200 female
patients, or 5.7 per cent, became disabled or incapacitated for work
without becoming entitled to disability annuities. The nmnber of
deaths of male patients during the period under observation was 370,
or 3.2 per cent of the number treated successfully; and the number
of deaths of female patients was 69, or 2 per cent. The nmnber of
male patients who required readmission for institutional treatment
was 1,144, or 9.8 per cent ; and of female patients, 288, or 8.2 per cent.
The number of male cases which could not be ascertained or made
subject to control was 875 ; and of female cases, 362.*
The experience data of the public sanatorium at Ronsdorf conform
to those of similar institutions and do not require extended considera-
tion. Out of 662 patients discharged during 1910, 140 were from 12
to 13 weeks in the institution, and only a relatively small number
received treatment for more extended periods of time. Of the
patients discharged during the first six weeks of treatment, 25 were
dismissed on account of the fact that the disease was too far advanced,
46 on account of nostalgia, personal reasons, etc, and 13 because they
were not tuberculous.
In probably no other part of the German Empire has the tuber-
culosis campaign been more effectively organized than in Bh^sh
Prussia. Throughout the entire territory tuberculosis dispensaries
^Annual Beport for 1910, pp. 56, 57.
Digitized by VjOOQ IC
OABB OP TUBEBCULOUS WAGE EABNEBS IN QEBMAKY. 135
ha?e been established, including rural communities, and efforts are
being made to extend the campaign to all of the rural communities.
For illustration, at Essen and vicinity,* tuberculosis dispensaries were
established, in 1910, in five communities, with a total population of
245,000. The total number of persons making application for treat-
ment and advice was 1,577, of which one-third were ascertained to be
tuberculous. That the importance of early treatment is clearly recog-
nized is made evident by the fact that of 545 persons provided for
with treatment and care, 35^, or 65,5 per cent, were in the first stage
of the disease. The number of nurses employed is only five, and these
during 1910 made 2,340 visits to the patients' homes. The expendi-
tures during 1909 amounted to 11,500 marks * ($2,737), and the num-
ber of cases considered during that year was 866, including 220
bacteriological examinations of the sputum. The expenditures dur-
ing 1910 and 1911 were larger, but full information is not availaWe.
The medical results have been much the same as in other sections of
Sh^iish Prussia, and a consideration of details would involve need-
Unusual attention has been given to the treatment and care of
tuberculous invalids; that is, persons in receipt of disability an-
nuities on account of tuberculosis, but in too advanced a stage of
the disease to warrant treatment and care on economic grounds.*
The number of far-advanced cases cared for in return for the sur-
render of the annuity has rapidly increased from 167 in 1907 to
222 m 1908, 293 in 1909, and 411 in 1910. The treatment is in hospi-
tals or homes for incurables, and the social importance of such treat-
ment is made evident by the fact that during 1910 there were 67
patients who had been treated for more than two years, 75 for more
than one year, and 111 for more than six months. In 10 cases the
patients were discharged as successfully treated, with restored earn-
ing capacity for a reasonable period of time. Most of the patients
undertake voluntarily the performance of suitable duties, chiefly
domestic or farm labor. Many of the patients have agreed to re-
main permanently in the institutions providing for their care, which,
of course, secures the best possible results from a sanatorium point of
view. The 411 persons treated during 1910 received 73,652 days of
treatment, or an average duration of treatment per person of 179.2
daya The total expenditure amounted to 132,805 marks ($31,607.59),
and of this amount 34,367 marks ($8,179.35) was reimbursed by the
surrender of disability annuities. The number of patients under
treatment at the end of the year increased from 44 in 1906 to 128 in
1909 and 221 in 1911. The provision is chiefly in small hospitals
^Annaal Report for 1910, p. 94.
'IdGiQ, p. 48.
•Idem, p. 106.
Digitized by VjOOQ IC
136 BULLETIN OP THE BUREAU OF LABOB.
widely distributed throughout the territory of the Invalidity Insur-
ance Institution of Rhenish Prussia, but also in special ho^itals f oir
tuberculosis and homes for incurables. It is held that the average
expenditure per patient per day should not exceed 2 marks (48
cents) , and that provision for treatment and care should be in com-
paratively small rooms, containing not more than from four to six
The Invalidity Insurance Institution of Rhenish Prussia has been
especially active in fostering the movement for housing reform
throughout the congested industrial districts of its territory, and up
to the end of 1910 the sum of 54,234,795 marks ($12,907,881) had
been provided for this purpose, and of this amount, 42,482,509 marks
($10,110,837.14) was still outstanding .in the form of loans for wage-
earners' dwellings at the end of 1910. Of the sum stated, 39,001,500
marks ($9,282,357) was lent out at 3 per cent, 39,588 marks ($9,422)
at 3.25 per cent, and 3,421,420 marks ($814,298) at 3.5 per cent. Of
loans made for the erection of 8,113 dwellings, 2,728 provided for
single families, 4,233 for two families, 696 for three families, 62 for
four families, and 394 for five or more families — a total housing
provision for 16,423 families.* It is pointed out as especially signifi-
cant that 86 per cent of the houses erected through loans provided
by the Invalidity Insurance Institution of Rhenish Prussia were for
one or two families. Of the loans made to the end of 1910, 15.7 per
cent provided housing accommodation in villages and towns having
up to 5,000 inhabitants, 28 per cent provided for cities of from 5,000
to 20,000, 28 per cent for cities of from 20,000 to 100,000, and 28.3
per cent for cities with over 100,000 population. Of the loans made
to the end of 1910, amounting to 54,234,795 marks ($12,907,881),
70.8 per cent was lent to general building associations, 18.8 per cent
to cities, communities, and public savings institutions, and 10.4 per
cent to persons insured with the Invalidity Insurance Institution of
Rhenish Prussia. A special effort has been made to utilize life-in-
surance principles for the amortization of mortgages, and at the
end of 1910 there were 149 policies in force, insuring 732,180 marks
($174,259), against 103 policies in force in 1909, insuring 529,292
marks ($125,972). Thus far this effort can not be said to have been
a success from a commercial point of view.'
The territory of the Invalidity Insurance Institution of Wurttem-
berg is coextensive with the Kingdom of Wurttemberg, which has
an area of 19,511 square kilometers (7,533.2 square miles),andin 1910
^ A list of these institntions is given on p. 100 of the report for lOlO.
3 For a fall discussion, see Annual Report for 1010, p. 120 et seq.
•Annual Report for 1010, p. 127.
Digitized by VjOOQ IC
CABE OF TUBEBCTTLOXJS WAGE EABNSBS IK GBBMAKY. 187
had 8 population of 2,435,611, of which the increase during the last
decade was 1.16 per cent per annum, against an average annual in-
crease for the Grerman Empire of 1.41 per cent. The density of
population is 125 per square kilometer (824 per square mile), which
is but slightly above the average of 120 for the German Empire as
a whole. The principal cities are: Stuttgart, with a population of
285,589, and Ulm, with a population of 55,817. The average death
rate for the Kingdom during the 10 years ending with 1909 was
20.2 per 1,000, the rate having decreased from 23.4 in 1900 to IS.l
m 1909. The average death rate from tuberculosis of the lungs, of
males, ages 30 to 60 years, inclusive, during 1908, was 25 per 10,000
of populaticm, and for females, 20. The general death rate of Stutt-
gart decreased from 23.5 per 1,000 of population in 1880 to 19.2 in
1895 and to 14.7 in 1909. The death rate from tuberculosis decreased
from 23.0 per 10,000 in 1880 to 20.0 in 1895 and 16.8 in 1909. The
corresponding information for Ulm is not available.
In the experience of the Invalidity Insurance Institution of Wurt-
temberg the ratio of tuberculosis of the lungs as a cause of in-
validity, according to the investigation of 1896 to 1899, was 15.1
per cent for males, or practically the same as the general average
of 15 per cent for all insurance institutions, and 10.1 per cent for
females, against a general average of 9£ per cent. The rate of in-
enred patients imder treatment and care on accoimt of sickness from
all causes by the Invalidity Insurance Institution of Wurttemberg
during 1910 was 12.2 per 1,000 of the population subject to the in-
surance laws, which compares with the general average of 7.8 per
1,000 for all insurance institutions. The number of patients under
treatment on account of tuberculosis of the lungs during the year
was 1,759, or 3.75 per 1,000 of the insured population. The general
average admission rate for all institutions was 3.19 per 1,000. I'he
amount expended on accoimt of treatment and care of tuberculous
patients during 1910 was 676,341 marks ($160,969.16), or an aver-
age expenditure of 384.50 marks ($91.51) per case per annum. The
Invalidity Insurance Institution of Wurttemberg maintains two
sanatcttia, one at Wilhelmsheim, for male patients, with a bed accom-
modation of 177, established in 1904, and one at Uberruh, for female
patients, with a bed accommodation of 195, established in 1908.
The importance of tuberculosis of the lungs as a cause of death in
the Kingdom of Wurttemberg is precisely shown in the following
table exhibiting the proportionate mortality, by divisional periods
of life, for the year 1908.
Digitized by VjOOQ IC
BULLETIN OF THE BUBEAU OP LABOB.
PROPORTIONATB MORTALITY FROM TUBERCULOSIS OF THE LUNGS IN TBM
KINGDOM OF WURTTEMBBRG, 1006 (EXCLUSIVE OF DEATHS NOT MEDICALLT
CERTIFIED TO AS TO THEIR CAUSES).
15 to 24 years.
25 to 34 years
35 to 40 years
50 to 50 years
60 years and ovw -,,,-^^,,.,,-
According to the occupation census of 1907, the number of perscms
subject to the insurance laws in the Kingdom of Wurttanberg was
469,594, and of this number the proportion of males was 66.5 per
cent, and of females 83.5 per cent The insured population repre-
sented 20.4 per cent of the total population of the Kingdom of Wurt-
temberg, estimated at 2,302,179. The distribution of insured per-
sons, by divisional periods of life, is given in the following table,
which is self-explanatory, and requires no extended comment
AGE DISTRIBUTION OF THE INSURED POPULATION OP THE KINQDOM OP WURTV
Nomber. Per cent.
16 to 17 years.....
18 to 10 years.....
20 to 24 years.....
26 to 20 years.....
80 to 30 years.....
40 to 40 years.
50 to £0 years.....
60 to 60 years
70 years and over
Out of 312,667 males subject to the compulsory insurance laws,
216,497, or 69.2 per cent, were employed in industries, mines, and
building. Of the insured female population of 156,927, the number
employed in these pursuits was 63,580, or 40.5 per cent.
According to the annual report of the Invalidity Insurance Insti-
tution of Wurttemberg, the amoimts expended for treatment and
care on account of sickness from all causes have rapidly increased
from 133,226 marks ($31,707.79) in 1898 to 665,162 marks ($155,-
928.56) in 1904 and 1,197,829 marks ($285,083.30) in 1910. The
amount of labor involved in the proper handling of the applicants
for treatment and care is made evident by the fact that 15 persons
Digitized by VjOOQIC
GABB OF TUBEBCTTLOUS WAQB EABNBBS IN QEBMAlTf •
were employed for this purpose during the year. Of the total in-
come of the Invalidity Insurance Institution of Wurttemberg during
1910, 13.6 per cent was expended in the treatment and care of patients
on account of sickness from all causes, including tuberculosis of the
lungs, which is the most important cause of disability in the experi-
ence of the institution.^ The tendency during the earlier years was
for tuberculosis of the lungs to increase proportionately to the total
number of cases under treatment, but during the last few years the
ratio declined. The facts are emphasized in the following table for
the period 1897 to 1910:
TTBERCULOSIS OF THE LUNGS AS A CAUSB OP DISABILrTY IN THE BXPBRIENCB
OF THE INVALIDITY INSTJBANCE INSTITUTION OF WURTTEMBERO, 1910.
Cases of tabercukisis of
Cases of taberoolosis of
Per cent of
Per cent of
This table shows that, commencing with the period 1897 to 1901,
ihe number of cases of tuberculosis was 31.60 per cent of the total
number of cases of sickness from all causes treated and cared for at
the expense of the insurance institution for the purpose of restoring
the wage-earning capacity for a reasonable period of time. This
proportion increased to the maximum of 48.73 per cent in 1907, but
subsequently to this year the proportion declined to a minimum of
42.59 per cent in 1910. It may be stated in this connection that the
next most important causes of sickness among wage earners, in the
experience of the Invalidity Insurance Institution of Wurttemberg,
were rheumatism (9.3 per cent), anemia (8 per cent), neurasthenia
(7.8 per cent), and general debility (7.7 per cent).
A significant fact disclosed by the experience of the Invalidity
Insurance Institution of Wurttemberg is the large proportion of
tuberculous women patients, and it is emphasized in the report for
1910 that tuberculosis of the lungs is of exceptional frequency among
domestic servants, saleswcHnen, and female clerks.^
By an arrangement with the military authorities, the invalidity
insurance institution is notified of the rejection of recruits for tuber-
culosis of the lungs or other diseases liable to bring about permanent
wage-earning incapacity. While much had been anticipated from
* Annual Report lor 1910, p. 41.
• Idem, p. 43.
Digitized by VjOOQ IC
140 BULLETIN OP THE BUBBAU OP LABOR.
this arrangement, in actual practice the number of notifications has
been small and the tendency has been toward a decrease in the nimiber
reported. In 1907 the institution was notified of 152 cases, but this
number decreased to 53 cases during each of the years 1908 and 1909,
and finally to only 36 cases during 1910.
The number of applications for treatment on account of tubercu-
losis of the lungs, which, during 1910, received favorable considera-
tion, was 1,759, and of this number 876 were males and 883 were
females. The number of applications for treatment and care on
account of tuberculosis of the lungs which were declined was 596, and
of this number 354 were males and 242 were females.* Of the 1,759
cases of tuberculosis treated and cared for during 1910, 1,1*2, or 64.9
per cent, were discharged as materially improved, with a reasonable
expectation of restored earning capacity, and 617 were discharged as
unsuccessfully treated, but of this number 407 improved during the
course of treatment, though not sufficiently so to warrant the antici-
pation of restored wage-earning capacity for a reasonable period of
The number of male patients treated on account of tuberculosis
of the lungs during 1910 wa$ 876, and the number of days of treat-
ment was 62,953, or an average duration of treatment of 72 days.
The expenditure incurred was 330,975 marks ($78,772), or an aver-
age expenditure of 377.83 marks ($89.93) per patient per case, or of
5.26 marks ($1.25) per patient per day. On account of dependent
members of male patients' families, 41,095 marks ($9,781) was dis-
bursed, and in addition thereto 6,810 marks ($1,621) was paid in
cash as pecuniary assistance to single persons in financial need.
There were 883 female patients treated on account of tuberculosis of
the lungs during the year 1910, receiving 77,031 days of treatment,
or an average duration of treatment of 87 days. The expenditui*es
amounted to 345,365 marks ($82,197), or 391.13 marks ($93.09) per
person per case, or 4.48 marks ($1.07) per patient per day. The
pecuniary assistance to members of male patients' families amounted
to 3,061 marks ($729), and the pecimiary assistance" to single persons
amounted to 5,824 marks ($1,386). In the case of male patients the
insurance institution was reimbursed to the extent of 97,358 marks
($23,171), and on account of female patients to the extent of 47,752
marks ($11,365), by communal, industrial, and other sick funds liable
to the insurance institution in conformity to the compulsory-insur-
ance laws. The total number of persons treated during the year on
account of tuberculosis was, therefore, 1,759, receiving 139,984 days
of treatment, or an average duration of treatment of 80 days.
Of 839 male patients treated during the year, for whidi the infor-
mation was available, 338, or 40.3 per cent, were in the first Turban
^ Annual Report for 1910, p. 65.
Digitized by VjOOQ IC
GABB OF TUBEBCTJLOUS WAGE EABKEBS IK QEBMANY. 141
stage of the disease; 231, or 27.5 per cent, were in the second; and
270, or 32.2 per cent, were in the third. Of 877 female patients
treated during the same period, 431, or 49.1 per cent, were in the first
Turban stage of the disease ; 366, or 41.7 per cent, were in the second ;
and 80, or 9.1 per cent, were in the third stage. ' It is therefore shown
that the proportion of male patients received in the third Turban
btage of the disease, when the prognosis is decidedly less favorable
than during the earlier stages, was much larger than in the case
Of 876 male patients treated and cared for on accoimt of tuber-
cnlosis of the limgs during the year 1910, 410, or 46.8 per cent, were
of the age period 21 to 30. Of 883 female patients, 481, or 54.5 per
cent, were of this period of lift* when the prevention of wage-earning
incapacity and the conservation of life are of the highest economic