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Of the 857 tuberculous patients 65 per cent were discharged in a
materially improved condition, 29 per cent in a fairly improved
condition, 5 per cent in about the same condition as when received,
and in only 1 per cent was the condition decidedly worse.

The economic results were satisfactory in 83 per cent of the
cases — that is, the earning capacity was restored for a reasonable
period of time; the results were also fairly satisfactory within the
meaning of paragraph 5 of section 4 and paragraph 15 of the
invalidity insurance laws, and in only 5 per cent of the cases were
the patients discharged with their earning capacity not at least par-
tially restored.

Much the same results, medical and eccmomic, were secured at the
other institutions maintained by the Invalidity Insurance Institution
of the Hanse Towns, and it would serve no practical purpose to en-
large upon the details, which are conveniently available to anyone
who may desire to inquire further into the facts.

The aggregate results are summarized for the period 1893 to 1910
for males, and for 1894 to 1910 for females, including in the former
10,067 patients under observation at least one year, and in the latter
6,485. The results are given in tabular form below, showing re-
spectively the number of patients retaining their earning capacity
for a stated period of time of from 1 to 12 years.



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CABB OF TirBBRCXJLOXJS WAGE BABNBBS IN GBBMANY. 158

KONOiaC KESULT8 OBTAINICI) BY SANATORIUM TREATMENT FOR TUBEECDXOSIf
OP THE LUNGS AT INSTITUTIONS MAINTAINED BY THE INVALIDITY INSURANCE
INSTirUTION OF THE HJ^NTSK TCWNS, 1893 TO 1910.

[Ftoffl Tveoty Years' Experieiu» in tbe Treatmeiit and Ou« of Tubeic^

ity Ixisoraiioe Institotkm of the Hanse Towns, 1801-1911, p. 179.]





Pati«it8 sucoesBfoliy treated and disdiarged, with earning capacity restored.


Too after discharge.


serv&^loiu


Number still at
work.


Nmnber not traced.


Per cent sucoess-
fuUy treated.




Males. Females.


Males.


Females.


Males.


Females.


Males.


Females.




6,363 5,654

7,55e 4,923

6,720 4,320

6,060 8,016

5.333 1 3,432

4,105 1 2,626

1,450 1 796

1,077 6T9

715 367

481 904

208 60


8,060

6,196

4,718

8,792

3,065

2,193

660

446

387

176

00

5


6,461

4,313

3,391

2,860

2,379

1,756

490

839

215

124

36

3






96
86
73
65
60
56
47
43
42
38
30
17


98




326

303

277

248

206

46

37

28

18

5

2


192
180
169
145
107
36
30
23
12
8


91




82




76




77




70




64




62




63


M.


66


IL


57


11


33 6


50







This table shoiw^s tliat of the 10,067 male patients under observation
at least one year dixring the period 1893 to 1910, 8,363 were discharged
as successfully treated with the anticipation of a continuance of
earning capacity for a reasonable period of time. Of the 8^853
patients 8,060 i?vere still at work at the end of the first year, w 96
per cent of the number of successful cases under observation, or 80
per cent of the total number treated and cared for.

The number of male patients under observation for two yfears was
7,556, and the number still at work at the end of this period was
6^96, excluding 326 for whom the informaticm was not obtainable.
The percentage of male patients retaining their earning capacity for
two years, therefore, was 86 per cent of those successfully treated and
69 per cent of the total number of cases, including those unsuccess-
fully treated. In a similar manner the results are traceable through-
out the entire experience of 12 years, the percentages becoming grad-
ually reduced to 73 for the third year cases, 66 for the fourth year,
60 for the fifth year, 56 for the sixth year, 47 for the seventh year,
43 for the eighth year, 42 for the ninth year, 38 for the tenth year,
30 for the eleventh year, and 17 for the twelfth year. For females
the results throughout are still better, but the facts can readily be
determined by reference to the table. The table is subject to the
correction that the number of not controlled cases requires to be de-
ducted from the total number of successful cases, the percentages
being calculated on the basis of the number of cases for which the
information for each year was ascertainable.

The economic results obtained in the treatment and care of tuber-
culous wage earners by the Invalidity Insurance Institution of the
Hanae Towns are a su£Gici^it inducement to believe in the accuracy

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160 BULLETIN OF THE BUBEAU OF LABOB.

of the theory that, in the long run, substantial financial gains must
result from adequate and effective methods of prevention and cure.
It is, in any event, suggestive to find that of the male patients treated
during the period 1893 to 1910, the proportion treated successfully
at the outset was 83 per cent, and for the females 86 per cent. These
results for tuberculosis of the lungs compare with some other im-
portant diseases, as follows : For anemia cases the proportion success-
fully treated at the outset was 90 per cent for males and 91 per cent
for females; for nervous diseases, 83 per cent and 83 per cent, re-
spectively; for rheumatism, 80 per cent and 73 per cent; and far
other diseases, 79 per cent and 83 per cent.

Considering the permanent results as measured by a six-year
period, the comparison shows that for male patients the wage-
earning capacity was retained in tuberculosis of the lungs in 43 per
cent of the cases ; in anemia, in 48 per cent ; in nervous diseases, in 46
per cent; in rheumatism, in 45 per cent; in sciatica, in 38 per cent;
and in other diseases, in 42 per cent. For females the respective
percentages as regards economic results to the end of the sixth year
were for tuberculosis of the lungs, 66; for anemia, 70; for nervous
diseases, 54; for rheumatism, 41; for sciatica, 47; and for other
diseases, 51.

A very important analysis of the results, extending over a period
of from 6 to 15 years, has been made by Dr. F. Keiche in behalf of the
Invalidity Insurance Institution of the Hanse Towns by means of a.
medical reexamination of patients discharged from the sanatoria
during the period under observation. Of the male patients dis-
charged in 1895, 36 per cent still retained their wage-earning capacity
to the end of 1910, but 8 per cent had undergone a subsequent treat-
ment in the meantime. Of the female patients discharged in 1896,
the proportion retaining their wage-earning capacity to the end of
1910 was 67 per cent, but 11 per cent had undergone a subsequent
treatment. Combining the results for patients discharged in 1895,
1896, and 1897, it was ascertained that out of 245 males observed and
reexamined from time to time to the end of 1910, 52 per cent had
retained their full earning capacity and 4 per cent additional had
retained a limited wage-earning capacity. For females, the respec-
tive percentages were 63 for full earning capacity and 18 for limited
earning capacity. Of these proportions, however, 20 per cent of the
males and 24 per cent of the females who had retained their full or
limited earning capacity had undergone a subsequent treatment.

Of the patients under observation from 1896 to 1904, excluding,
however, all patients less than four weeks in the institutions, the
results, according to ages on admission, were as follows : Of the male
patients admitted at ages 15 to 24, the proportion retaining their full

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CABE OF TUBBBCTJL0U8 WAGE EABNEBS IK QEBMAKY. 161

aiming capacity to the end of 1910 was 63 per cent, and a limited
earning capacity was retained in 7 per cent of the cases. The re-
spective percentages for females were 69 and 14. For male patients
at ages 25 to 49 on admission, a full earning capacity was retained
to the end of 1910 in 52 per cent of the cases and a limited earning
capacity in 9 per cent of the cases. For females, the respective per-
centages were 57 and 18. The numbers at ages over 50 are very small,
but of the males 19 per cent had retained their full earning capacity,
and of the females 5 per cent. It is shown, therefore, that the
economic results are most favorable in the case of men and women
admitted for treatment at ages under 25.

Considering the results by duration of disease previous to admis-
sion, it is shown by the investigation referred to that of the male pa-
ti^its from 1 to 6 months under treatment 62 per cent retained their
fall wage-earning capacity to the end of 1910; with a stay of from
6 to 24 months the percentage was 56; with a stay of from 2 to 6
years it was 44 ; from 6 to 12 years it was 49 ; and over 12 years it
was 44 per cent. For females the economic results were as follows :
Tor a duration of the disease of from 1 to 6 months the percentage
was 73-; from 6 to 12 months it was 62; from 2 to 6 years it was 64;
from 6 to 12 years it was 65; and for over 12 years it was 49 per
cent It is therefore shown that the economic results were most sat-
isfactory in the case of patients with a comparatively short duration
of the disease previous to admission.

The economic results did not vary materially for patients with or
without a family taint of tuberculosis, having been 54 per cent
for male patients having a family history of tuberculosis, and 57
per cent for those not having a family history of the disease. For
female patients the respective percentages were 63 and 66.

Finally, it may be stated that the Invalidity Insurance Institution
of the Hanse Towns loaned 8,075,400 marks ($1,921,945) in the form
of building loans for wage earners' h(»nes, and it may also be stated
thai in appreciation of the social service rendered by the institution
a dock laborer by tlie name of Gustav Kiissner, who had since June
3, 1897, been in receipt of a disability annuity, left at the time of his
death, on March 26, 1904, the sum of 3,700 marks ($881) as a legacy
to the institution for welfare purposes to be used at its discretion. It
is clearly shown by the admirable analysis of the results, statistical or
otherwise, that the aim and efforts to advance in the most important
directions the well-being of wage earners insured with the Inva-
lidity Insurance Institution of the Hanse Towns have been realized.
48887'*— 12 ^11



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162 BULLETIN OP THE BUBEAU OF LABOB.

APPENDED L— TREATMENT OF TUBERCULOUS WAGE EARNERS IN
PUBLIC INSTITUTIONS, 1902 TO 1904.^

During the present year the Imperial Board of Health has pub-
lished a supplementary report on the results of sanatorium treatment
for the period 1902 to 1904, which confirms in all essentials the ex-
perience data for 1896 to 1901. The results of this supplementary
investigation are briefly summarized, as follows :

1. The statistical investigation includes 34,071 male and 12,632
female patients treated and cared for on account of tuberculosis of
the lungs, with an average duration of treatment for males of 86.6
days and for females of 95.8 days.

2. The cost of treatment was provided for by social insurance insti-
tutions in the case of male patients to the extent of 85.4 per cent and
of female patients to the extent of 75.7 per cent

3. Of the male patients 44.3 per cent and of the female patients
69.3 per cent were of the age period 20 to 29 years, and of the male
patients 31.8 per cent and of the female patients 18.8 per cent were
of the age period 30 to 39 years.

4. A parental history of tuberculosis was ascertained in the case of
25.2 per cent of the male patients and of 36.7 per cent of the female
patients. Tuberculosis among brothers and sisters was ascertained
in the case of 19.6 per cent of the male patients and of 24.4 per cent
of the female patients. In addition thereto, in the case of 2.6 per cent
of the male patients and of 2.9 per cent of the finale patients,
respectively, the wife or the husband was ascertained to be tubercu-
lous. The proportion of families with tuberculous children was only
0.5 per cent in the case of male patients and only 0.4 per cent in the
case of female patients.

5. About two-thirds of the patients, or 61.9 pw cent for males and
64.7 per cent for females, entered the sanatorium during the year in
which the disease first became apparent. In the case of 16.9 per cent

-of the male patients and of 12.3 per cent of the female patients
receiving institutional treatment, a previous treatment had been had
in sanatoria, in hospitals, or in air-cure establishments.

6.. The nutrition of the patients on admission for institutional
treatment was ascertained to be good in the case of 19.1 per cent of
the male patients and of 18.9 per cent of the females. For 51.2 per
cent of the males and for 50.5 per cent of the females the condition
as regards nutrition was considered average, and in 29.7 per cent of
the male patients and in 30.6 per cent of the female patients the
condition as regards nutrition was bad. An improvement in the
bodily condition took place in the case of 95.9 per cent of the male
patients and of 94.1 per cent of the female patients during treatment,

> Tuberkulose-Arbelten aus dem Kalserllchen Gesundheitsarote. Deutsche HeiUtfitten
fttr Lungenkranke. Verlag von J. Springer, Berlin, 1912. 18. hft



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GABB OF TUBBBCULOUS WAGE SABNEBS IN OBBMANY. 163

ind the average gain in weight was 6.6 kilograms (14.6 pounds) for
make and 5.8 kilograms (12.8 poimds) for females.

7. TTie general conditicm of patients on admission was apparently
good in the case of 23.1 per cent of the males and of 20.7 per cent of
the females. The condition was average in the case of 49.5 per cent of
the males and of 42.6 per cent of the females, and the condition was
bad in the case of 27.4 per cent of the males and of 36.8 per cent of the
fanales. An improvement in the general ccmdition during the period
of institutional treatment took place in the case of 64.2 per cent of
the males and of 66.1 per cent of the female patients.

8. On admission the proportion of patients with cough and expec-
toration was 92 per cent for males and 65.9 per cent for females. The
proportion of dry cough was 3.8 per cent for males and 17.6 per cent
for females. Of the patients with cough and expectoration 26.3 per
cent of the males and 32.7 per cent of the females were relieved there-
from entirely, and a partial result was obtained in the case of 14.3
per cent of the males and of 7.7 per cent of the females. Of the male
patients 69.9 per cent were relieved from dry cough as the result of
institutional treatment and of the female patients 66.1 per cent.

9. The bacilli of tuberculosis was bacteriologically ascertained to be
present in the case of 35.1 per cent of the male patients and of 21.8
per cent of the female patients. As the result of treatment 33.4
per cent of the male pati^its and 29.4 per cent of the female patients
were free from bacillary evidences on discharge.

10. Fever was present on admission in the case of 14.5 per cent of
the males and of 14.9 per cent of the females. On discharge 71.9 per
cent of the toale patients and 57.3 per cent of the female patients were
free from fever.

11. Night sweats on admission were present in the case of 25.4 per
cent of the male patients and of 18.3 per cent of the female patients.
Of the males 91.7 per cent were free from night sweats on discharge
and of the females 85.8 per cent.

12. Of. the male patients on admission 37.3 per cent were in the
first Turban stage of the disease, 46.2 per cent in the second, and 16.5
per cent in the third. Of the female patients 51 per cent were in
the first Turban stage, 37.4 per cent in the second, and 11.6 per cent
in the third. In the case of 23.3 per cent of the male patients and of
25.8 per cent of the female patients only one lung was- affected with
the disease on admission. The right lung only was affected in the
case of 67.5 per cent of the male patients and of 65.7 per cent of the
female patients.

13. A complete cure was obtained on discharge in the case of 4.5
per cent of the male patients and of 6.7 per cent of the female patients.
An improvement in the condition of the lungs was secured in the case
of 86.7 per cent of the male patients and of 81.7 per cent of the female
patients, and of these, in the case of 27 per cent and 23.1 per cent,

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164



BULLETIN OF THE BUBEAU OF LABOB.



respectively, the improvement was so decided that there was a change
to a more favorable Turban stage of the disease. In only 6.3 per
cent of the male patients and in only 8.8 per cent of the female pa-
tients was there no change in the condition of the Imigs during treat-
ment The proportion of deaths during treatment was only 0.3 per
cent for male patients and only 0.2 per cent for female patients.

14. A complete economic result — ^that is, restored wage-earning
capacity — was obtained in the case of 68.9 per cent of the male
patients and of 60 per cent of the female patients. But, in addition
thereto, in the case of 28.6 per cent and of 245 per cent, respectively,
a fairly satisfactory economic resolt was secured — ^that is, restored
wage-earning capacity of limited extent for a reasonable period of
tima

The comparative statistical facts for the investigations of 1896 to
1901 and 1902 to 1904 are conveniently summarized below :



COMPABATIVB RESULTS OF TREATMENT VOB TUBERCULOSIS IS GERMAN PUBUO

SANA!!F(UUA.



1800 to 1901



1908 to 1904



Number of patients ••••-••••••.

Ayeragedoretioii of treatment dijs..

Ages on admission:

Under 20 yean. .peroeot..

ao to 29 years do —

30 to 39 years do —

40 years and over do —

Tubenmlotis parents do —

Taberonlous brothers and sisters do —

Previoos duration of disease less than 1 year do —

Previoas sanatorium treatment of at least 6 ivMks do —

Good nutrition on admission do —

Average nutrition on admission do —

Poor nutrition on admission do —

Gain in weight do....

Average increase in weight I>ounds..

Physical condition on admission:

Good percent..

Average do —

Poor do —

Physical condition during treatment:

Improved do....

Unchanged do....

Worse do....

Cough and expectoration on admission. do —

Cough only do —

No cough and expectoration on discharge do —

Badllary diagnosis positive on admission. do —

Badllary diagnosis negative on discharge do —

Fever on admission do. . . .

No fever on discharge do —

Night sweats on adminkm do —

No night sweats on discharge do —

Turban stage on admission:

First do....

Second do —

Third do....

One lung aflteted do.

Condition of lungs on discharge:

Improved do.

Stationary do —

Worse do

Deaths do



16.869
89.2

10.6
44.0
80.1
16.4
26.4
16.6
64.4
9.8
17.9
48.9
88.2
98.6
18.0

82.9
86.8
30.2

67.6

40.1
2.4

91.1

4.6

122.8

46.8
*84.4

18.8
•68.6

29.8
<90.7

81.8
62.9
16.8
26.0

84.2
10.8
6.1
0.4



4,006
64.4

20.4
67.8
17.6

4.4
86.7
21.2
64.6

8.2
18.0
44.6
87.6
92.8
11.6

28.2
81.7
40.1

69.0

88.4
2.6

66.7

18.6
i26.2

80.0
•26.0

19.4
*68.8

27.8
4 86.2

28.4
68.4
18.2
19.7

76.7
17.0
7.1
0.2



84.on

86.6

8.6
44.3
31.8
16.4
26.2
19.6
61.9
16.9
19.1
61.2
29.7
96.9
14.6

23.1
49.6
27.4

64.2

84.0
1.8

92.0

8.8

i26.8

86.1
*88.4

14.6
•71.9

26.4
*91.7

87.8
46.2
16.6
28.8

91.2
6.8
2.2
0.8



1^8

16.6
60.8
18.8
6.3
86.7
24.4
64.7
12.3
18.9
o0.5
30.6
94.1
12.8

20.7
42.6
36.8

66.1

82.4
1.6

66.9

17.6
182.7

21.8
»29.4

14.9
•67.8

18.8
«86.8

61.0
87.4

^:S

88.4
8.8
2.6
0.2



1 Of those having cough and
« Of those showini

* Of those having

< Of those having night swmUs on admlwlan.



btSon on admission.
'^^gnosJa on admlsiiim.



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GABE OF TUBEBCXJL0U8 IIVAGB BABNEB8 IK QBBMANT. 165

APPENBK IL— MSMOJUHBUM ON TUBERCULOSIS.

(GoBpUed and pabllBhed In Bngllsh by German Imperial Board of Health at Berlin.]
A. WHAT IB TUBKBOUIXMIS?

TobercnloelB is the most destructive of all infectious diseases. It attacks
various parts of the body, chiefly, however, the lungs; it spares no nation, no
age» no vocation, no class of people. More than 100,000 persons die each year
in Germany from the effects of it, the number of patients afflicted by it being
estimated as 10 times as numeroua Bv^ry third person who dies betweai the
ages of 15 and 60 years succumbs to tuberculosi&

Tuberculosis is caused by the tubercle bacillus discovered by Robert Koch.
Tikis is a minute creature of the lowest scale, visible only when very highly
magnified. It thrives best at blood temperature (about 08"* F.) and multiplies in
the interior of the body. It reaches the outer world chiefly in the q;)utum of
BidL posons and in the milk of diseased animals.

Every perscm is exposed to the danger of taking up the germs of tuberculosis
Into his own system, and many harbor them a long time without knowing it^
Bverycme must therefore be prepared for battle with this esiemj.

The tubercle bacillus is most efflcioitly destroyed by burning, boiling, or
steaming. It can not long resist the action of sunlight Other means of
diainftedon, such as cresol water, a solution of carbolic acid» formaldehyde*
require a special previous knowledge for safe and effective use.

& HOW DOES THS IHTBOTIOZI TAKB PLAOS?

Hereditary tuberculosis is rare.

Tubercle bacilli enter the human body mainly by the respiratory organs and
fbe digestive ssrstem.

Tubercle l)acilll are taken up —

L By inimiing with the air germs either from the dried sputum of tuberculous
persons in the dust, whirled by winds and drafts while sweeping out, or
carried <m clothing or shoe soles; or from the minute moist drops which invalids
diffuse in their immediate vicinity by coughing or talking.

2. With the food, flrst through unboiled milk, also, in case of unsatisfactory
in&pection of meat through the flesh of tuberculous animals, which, admitted
in trade, was not afterwards thoroughly cooked before being eat^L

3. By means of unclean hands and unclean utensils, e. g., in the case of chil-
dren crawling on the floor, seizing soUed objects (clothing, handkerchiefs, and
the like) and immediately afterwards putting the flngers into the mouth
(sacking flngers, biting nails, licking fingers when turning over leaves), picking
the nose, and similar bad habits as putting into the mouth toys, drinking glasses,
eating utensils, wind instruments used by others.

TubCTcle bacilli may also enter through injured or diseased places in the skin
or in the visible mucous membrane (unnoticed small sores, scratches, eruptions).

The result of the absorption of tubercle bacilli usually in the case of children
at first a disease of the glands (e. g., of the neck and abdomen) and, in con-
nection therewith, of the lungs, the bones, and Joints (scrofula of the bones,
tobercular excrescences, voluntary limping), the cerebral membrane, etc. In
file case of adults infection by inhalation predominates and leads to tuberculosis
of the lungs, more infrequeitly of the larynx (consumption). Through absorption

^ODe-fonrth of the corpses of persons who have died from other diseases show internal
tcaees of tabercalosia that had been overcome.



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166 BULLETIN OF THE BUBEAU OF LABOB.

of the tubercle bacilli Into the skin there is arising tuberculosis of the skin
(e. g., lupus, corrosive herpes.)

Most usually tuberculosis progresses slowly (chronically) ; exception, gallop-
ing consumption.

C. HOW DOES ONE PBOTECT ONESELF AGAINST TUBEBOUIiOSIS ?

Each person, even the weakest and poorest one, will highly contribute to
guarding himself against tuberculosis by merely combining Judgmoit with self-
controL

/. Measures against contracting tuberculosis.

1. Let every person, whether well or sick, provide for the safe removal of the
sputum, since one can not detect from the simple appearance whether q[>utum
is tuberculous or not Do not spit on the floor of closed rooms (Including
street cars and railway coaches) or on frequented thoroughfares. Place in con-
venient comers spittoons filled with water which, to Insure safety, should be
cleansed at shoirt Intervals by disinfecting methoda Hold your hand before
your mouth when coughing. Turn away from a coughing neighbor that does
not do so. Articles of clothing should always be kept clean, the trailing of
garments should not be tolerated. -The clothes, beds, linen, eating and



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