drinldng utensils of tuberculous persons may be used by others only after
thorough disinfection. Dry sweeping should give place to moist; if need be,
scour with hot soda or a hot solution of soft soap. The raising of dust in tlie
dwelling room, the work place, and on the street should be avoided wh^iever
I)08slble. Shun bars or refreshment rooms where spitting on the floor is
allowed. Children should be kept out of dusty workshops and from work that
develops dust (carpet beating).
2. Let the strictest cleanliness prevail in the preparation and preserving
(guard against flies) as well as in the eating of food, especially of that which
is eaten raw. Milk should be boiled and meat cooked thoroughly b^ore being
eaten ; the boiled milk should be covered and kept as cool as possible.
8. The hands, including the nails, the teeth, and mouth, should be cleansed
frequently and thoroughly. Putting the flngers into the mouth or nose and
also scratching the face should be discontinued. Every SQre should be protected
against Impurities by suitable bandages.
4. With regard to the tuberculosis of animals it will suffice to say that in
cattle it usually affects the lungs, in pigs usually the glands of the neck or the
Intestines; in the former, commonly, through Inhalation, in the latter through
the food, chiefly through the unboiled refuse and skim milk of dairies. Proper
means of extirpation are â€” gradual sorting -out of tuberculous cattle, chiefly of
those that betray visible signs of the disease (tubercular knots on the udder,
coughing, with emaciation and rough hair, and the like) firom special dairies
for children's milk and establishments for breeding; but also removal of all
other animals feverish from the injection of tuberculin; separation of calves
from tuberculous mothers; frequent exercise of the calves and young cattle, if
possible of the older animals, too, in the open air should be encouraged; the
use of boiled milk only ; and boiled dairy residues for the feeding of pigs ; ^
keeping the stalls clean.
^Many lar^e dairies now heat all tbe milk before manufactare so that all danger Is
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CABE OF TUBEBOXTLOUS WAGB EABNEBS IN QEBMAIfTr. 167
//. Measures for strengthening the body.
It will be impossible to extirpate all toberde bacilli^ therefore it is indis-
pensable so to strengtlieii and harden the body that the absorbed germs can not
tike hold upon it. The principal means ^ are :
Plain and wholeeome food, which by Judicious selection need not be expensive.
Dainties and intoxicating drinks should be avoided.
A dwelling accessible to the entrance of air and light ; rather in the suburbs
Vban in the heart of tbe city ; the best room selected as a sleeping room.
Plain, durable clothing made of material not too thickly woven, neither too
warm nor to cool ; in the case of a person in repose or of a sedentary occupation
wanner than in tliat of someone frequoitly in motion ; discarding the follies of
faihion that hamper the free movement of the body, e. g., the corset and belts.
Only after defraying the necessary costs of dw^ing, eating, and clothing,
other expenses may be considered.
Let order and cleanliness have the first place in the whole conduct of life.
Waah the whole body daily with moderately cold water or rub it vigorously
with a rough, damp doth, bathe in pure river or sea water, or take a shower
bath (sparing the head), keep hair and beard, teeth and mouth, also the nails
dean. Breathe through the nose keei^ng the mouth shut; the former is the
natural filter for impure and injurious substances. If breathing through the
noee is difficult, be examined by a physician; it is oft^i eaoy to r^nove the
Seek to perform your work in accordance with your health. Take advantage
of prescribed measures for protection. Avoid a bent position In intellectual
woriL If you are an employer, consider how you may remove noxious substances
or prevent such from arising (dust, smoke, etc.). The time for work and rest
should be in proper proportion.
Devote the hours free from work to the str^igthening of those parts of the
body that had little opportunity to be exercised during work. Take exercise
outside of your dwelling. Draw in long, deep drafts of fresh air while
holding the hands pressed against the sides. Accustom yourself also to being in
ttie open air in unfavorable weather. CHiange wet clothing and shoes. Gym-
nastic exercises â€” especially when out of doors â€” suited to the conditions of the
body, together with tramps on foot, games, moderate cycling, rowing, swimming,
and the like are the best allies in the fight with tuberculosis
(Jo to bed at a reasonable hour. Avoid excesses of every sort They destroy
in a few minutes what has been gained in years. As little as a glass of mod-
erately cool beer, a cup of moderatdy strong coffee or tea, a cigar â€” enjoyed at
tbe proper time â€” injure the normal adult body as much as every intemperance
Ftoally, shun intercourse with persons who are suffering from infectious
diseases; if duty or profession demands such intercourse, then bear constantly
in mind the prescribed measures of precaution. If you move into a house where
a tuberculous person has lived recently, have it first disinfected.
D. ADVICE TO PERSONS IN GREAT DANGER.
Every one should study the foregoing rules of health, but espedally all those
persons who, from any reason whatever, have cause to fear tuberculosis more
than others; weakly persons, such as have a long and slender figure vdth a fiat
1 Further partlcalan are contained In the " Gesnndheltsbllchlein." compiled in the Kais.
Gesondheitaamt. 13. Ausgabe, Berlbi, J. Springer, 1908.
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168 BULLETIN OF THE BUBEAU OF LABOB.
chest, particularly if they descend from tuberculous parents; again, such as
have a reason for the assumption that they have already taken up the germs
of tuberculosis through intercourse with consumptive persons (relatives, guar-
dians, fellow worlimen, or playmates) or in consequence of their own siclmess
in childhood from scrofula and the like; also those whom their vocation en-
dangers (who work indoors or in the midst of dust, etc.) ; finally, those recov-
ering from a severe siclmess, from measles, whooping cough, influenza, and gea-
erally such as have suffered or are still suffering from diseases of the lungs or
chronic affections of the throat, diabetes, chlorosis, or are inclined to severe
losses of blood (nose bleeding and the like).
Let him who possesses a body little capable of offering resistance have regard
to this fact when he chooses an occupation : An occupation that leads into fresh
air and steels the body through exercise is better than a business that confines
within doors. Persons with sensitive respiratory organs have to avoid not
only dust (and consequently dusty trades) but also smoke (tobacco smoke
included) and cold, rough winds or else to take corre^)onding measures of pre-
caution; talking in the cold air or while walking should be discontinued, and
one should guard against catching cold and excessive bodily exertion.
Not less important is the sensible observance of general measures of precan-
tion in every place where people assemble in large numbers through their occu-
pation or from other causes, (in schools, boarding schools â€” corresponding con-
duct of tuberculous teachers â€” ^f^ctories, hotels, poorhouses, orphanages). Neg-
lect of tuberculosis by individoala endangers the g^ieral public.
B. ADVICE TO DISBABED PERSONS.
If symptoms appear that arouse the suspicion of a not merely transit dis-
ease of the respiratory passages, repeated coughing (dry or with sputum), fre-
quent pains in the throat, breast, or back, lasting d^ression or tendency toward
exhaustion, recurring fever, especially in the evening, with night sweats
(though the covering be light), traces of blood in the sputum or even a dis-
charge of blood from the throat, then a radical examination by the physician
(also of the sputum for tubercle bacilli) should be made as soon as possible.
If the suspicion is not confirmed, yet the advice given under D should be care-
fully followed. If the suspicion is confirmed, then the regulations prescribed
by the physician are first of all to be observed. No cure is of avail if the
patient himself does not contribute thereto by his general hygienic conduct and
rigid observance of the prescribed measures of precaution. The patient should
realize the double duty of taking thought for his own cure, in order to become
once more a useful, earning member of human society, and also of preserving
his family, servants, and neighbors from infection by heeding the precautionary
regulations. Incipient tuberculosis is often curable ; advanced seldom. Success
depends chiefly on timely anticixmtion.
Especial attention should be paid to the sputum; it should neither be cast
upon the floor nor swallowed, but rather be voited into a separate, suitable
vessel, which should be regularly disinfected; better still are the saliva bottles
(something like the Dettweiler) which the patient takes with him. Should it
be necessary at times to vent the sputum into the handkerchief, the latter
should be boiled before becoming dry.
The disease can also be communicated by kissing. An evidently consump-
tive person should be urgently dissuaded from marrying; let him wait until he
Is cured. Tuberculous women should not suckle or nurse children.
The cure is most surely effected in a sanatorium devoted especially to the
restoration of consumptives and directed by an experienced physician. After
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GABB OF TUBEBOT7LOUS WAGB EABKEBS IN QBSMANY. 169
Bet too short a sojonrn (not under 3 months), the obedient and attentive pa-
timi ott&i regains not only his health, bat appropriates to himself also the
roles of living necessary to avoid relapses.
T*) poor consumptive people advice and help is given free of charge by the
information and care offices recently so often established (Auskunfts- nnd Ftir-
wigest^en) and by disp^isaries for tuberculous people.
APPENDIX m.â€” DEFINITION OF GERMAN TERMS RELATING TO TREAT-
MENT AND CARE OF TUBERCULOUS WAGE EARNERS.
1. Heilbehandlung : This term has l)eÂ«i interpreted as " treatment and care."
There is no exact equivalent of this term in the Ehiglish language.
2. HeUverf^ren : This term has l>een interpreted as ** systematic institutional
treatment and care." There is no exact equivalent of this term in the
3. Landes-Versicherungsanstalt : This term has been interpreted as ** invalid-
ity insurance institution." In German law the term, however, is more
inclusive, since the insurance provides also for annuities on account of
4. Fflrsorge: This term has no exact equivalent in English, and the word
" care " very inadequately gives expression to the German meaning of the
word. In brief, the term comprehends the whole German paternal solici-
tude of the State toward wage earners and others in all matters summed
up in the approximate English equivalent of " welfare work."
5. Dauererfolg : This term has l)eÂ«i interpreted as " permanent economic re-
sults of treatment and care," but in actual practice the observed results
are gaierally limited to five or six years. By results is meant the re-
tained earning capacity of the patient after his or her discharge from the
6L Walderholungstatte : This term has been interpreted as ** forest day and
night camps," and on some occasions as ** forest convalesc^it homes."
7. Invalidenpensionen : This term has be^i interpreted as " homes for incura-
bles." The use of the term varies with different institutions, but in the
present sense applies to homes provided for tuberculous wage earners in
a stage of the disease too far advanced to warrant the anticipation of a suc-
cessful recovery of health, strength, and wage-earning capacity. Insured
meml)er8 provided with accommodation in homes of this kind pay for
their support by means of their invalidity or disability annuities.
& ErwerbsfEhigkeit : This term has been translated as " wage-earning capac-
ity,^ which, in the strict sense of the German invalidity insurance law,
means the ability to earn at least one-third of the normal dally wages
of the employment usually followed.
9. Erwerbsunfahigkeit : This term has been translated as " incapacity for
work," which, in the strict sense of the invalidity insurance law, means
inability to earn one-third of the usual wages in the occupation followed.
10. Yolksheilst&tten : This term has been translated as " public sanatoria," Irre-
spective of whether owned and maintained by invalidity insurance insti-
tutions or by States, provinces, municipalities, etc., provided the accom-
modation is primarily for wage earners, whether free or on payment of
rates within the paying ability of wage earners and their dependents.
IL Prlvatheilanstalt^i : This term has be^i interpreted in the usual sense of
private sanatoria maintained for the accommodation of pay patients, but
in many of these wage earners are provided with accommodations at re-
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170 BULLETIN OF THE BUBBAU OP LABOB.
12. Klnderheilst&tteii : This term has been interpreted as "sanatoria for chil-
dren," which is about the equivalent of the term " preventorium," since*
the object is not only to treat tuberculous children, but also to treat'
children of tuberculous wage earners who are scrofulous, ananic, or
otherwise impaired in health.
13. Schulsanatorien : This term is practically the equivalent of No. 12 (Kinder-
heilst&tten), except that the accommodation is limited to tuberculous
14. Waldschulen: This term has been interpreted as "open-air" or " forest"
schoola In the strict interpretation of the term the schools are op^i-air
schools, located in forests, and the provision is for tuberculous children
of school age, the treatment being combined with teaching methods
adapted to the situation.
15. Lftndliche Kolonien: This term has been interpreted as "agricultural col-
onies" which provide treatmait and care for convalescing tubercnloos
wage earners, together with possibilities for light outdoor work under
16. Invalidenheime : This term is the equivalent of No. 7 (Invalidenpensionen).
17. Oenesungsheime : This term has be^i interpreted as " convalescing homes,**
but the meaning is somewhat ind^nite and the accommodation may be
for tuberculous as well as nontuberculous wage earners, chiefly, howevM*,
for convalescing patients who have received previous and systematic
treatment in sanatoria, hospitals^ etc
18. Beobachtungsstationen : This term has been translated as " observation sta-
tions " established for the purpose of ascertaining the patl^its' condition
and to safeguard against the admission of the nontuberculous to institu-
tions provided for the treatment and care of tuberculous wage eamer&
19. Polikliniken : This term has been translated " tuberculosis cllniC0Â»" usually
conducted in connection with ho&^itals and medical schools.
20. Auskunfts- und Fttrsorgestellen : This term has been translated as " infor-
mation bureaus and tuberculosis dispensaries," in clear distinction to
I>olyclinics and tuberculosis clinics, which provide medical treatment and
medicines, which is uot the case in German tuberculosis dispensaries on
the so-called PUtter plan.
21. Tuberkulose-Vereine : This term has been translated in the usual sense of
tuberculosis associations, chiefly such as are maintained by private sub-
scriptions, but also such as are under offlcial patronage and subsidized by
State and municipal contributions, or the flnancial aid rendered by inva-
lidity insurance institutions, sick funds, etc.
22. Deutsches Zentral-Konrite zur Errichtung von Heilstfttten Lungenkranker :
This term has been translated, briefly, as " The German Central Ck>mmit-
tee," which formerly had the subtitle "for the establishment of sanatoria
for tuberculous wage earners," but which now bears the subtitle "for
the warfare against tuberculosis." This committee sustains the efforts
throughout Germany to increase the number of public sanatoria and to
further flnancially the establishment of tuberculosis dispensaries, etc.
23. Invaliden-Versicherungs-Gesetz ( Juli 13, 1899) : This term has been trans-
lated as the "invalidity insurance law." The text of the law used is
the English translation published by the foreign office under date of
December, 1899, No. 618 of the miscellaneous section of diplomatic and
consular r^>ort8 and reprinted in Bulletin of the Bureau of Labor, No. 9L
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CABE OF TUBEBGULOUS WAGE EABKEBS IN OEBMAlirr. 171
APPSHDIX IV.â€” LEGAL PROVISIONS REOARDINO TREATMENT OF
ACTUAL OR PROSPECTIVE INVALIDS.
The special treatment of actual or prospective invalids was pro-
vided for in section 18 of the Grerman Invalidity and Old Age In-
surance Law of 1899/ as follows :
Sbction 18. If an Insured person Is so ill tbat incapacity to earn a liyellhood
is to be appreh^ided as a consequence of tlie illness, which would constitute a
claim to a pennon, in accordance with the laws of the Empire, the insurance
institution is entitled to cause him to undergo a cure to the extent it may
think desirable in order to avert this loss.
The insurance instituticxi can effect the cure by placing the sick person in a
hospital or in an establishment for convalescents. If the sick person is mar-
ried, if he lias a household of his own, or if he is a member of the hous^old
of his people, his consent to this step is required.
If the insurance institution orders a cure to be entered upon, the obligations
of the sick fund toward the insured person pass to the institution from the
commencement of this curative course to its conclusion, in the case of such in-
sured persons as come under the provision against illness, under the laws
either of the Empire or State.
The sick fund has to indemnify the insurance office to the amount of the
payment which the insured person could claim from it
During the cure, relief has to l>e paid to such persons as are dependent upon
the insured person, and for whose maintenance tlie insured person has hitherto
IR'ovided out of his earnings, as also when the Insured person does not come
under the provisions for sickness under the laws of the Empire or State. Re-
lief of this nature, in so far as the insured person had to be tended under the
provisions for sickness of the laws of the Empire or State, amounts to the half
of the money he ought to receive during the legal time of the sick relief, and
otherwise to a_jpurth of the standard daily wages of ordinary day laborers in
the locality of m last employmoit or of his last abode. If the insured person
is in receipt of an infirmity pension, the same can be also reckoned for the
relief of persons dependent upon him.
The cooperation of the invalidity insurance institution and the
sickness insurance association in connection with the special treat-
ment of invalids was provided for in section 19 of the law, as follows :
SicnoN 19. The insurance institution which causes a cure to be entered upon
is authorized to transfer the provision for the sick person to the sick fund to
which he belongs or last belonged, to the extent which the insurance institution
considers fitting. If a burd^i is thereby imposed on the funds which exceeds the
extent of the provision to l>e made by it according to law or statute, the insurance
institution has to make good the surplus costs arising. If the obligation of
provision on the part of the sick fund no longer existed, the insurance insti-
tution, by awarding the services specified in section 6, paragraph 1, of the sick-
ness insurance law, has to indemnify it with half of the money paid to the
sick pÂ«Â«on; and if the insured person is placed in a hospital or in an estab-
lishment for convalescents, one and a half times the amount of that money, in
BO far as greater expenses are not proved.
The cooperation of industrial accident associations was provided
for in section 21 of the law, as follows:
Section 21. If the illness, on account of which the cure is entered upon, is due to
an accident which entitles to compensation under the imperial laws on accident
insurance, and if the entering upon a state of incapacity to earn a livelihood is
prevoited by the curative course, and, at the same time, a burden to the person
upon whom the cost of indemnification in cases of accid^it insurance has taken
place from the fact of the accident compensation having been withheld alto-
gether or granted in part only, then the insurance institution has a claim
> For text of thlÂ«i law nee BoUetin of the Bureau of Labor, No. 91, p. 966 et seq.
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172 BULLETIN OP THE BUBEAU OP LABOB.
a^ninst this person for reimbursement of the costs of the cure to the extent
provided in section 19, sentence 3. A reimbursement of the costs of the cure,
which arose before the beginning of the fourteenth weelc after the accident oc-
curred, can not be claimed.
It was further provided by the law of 1899, under section 22, that :
Section 22. If the Insured In consequence of the Illness becomes incapable ot
earning a livelihood, he can, in cases where he lias declined without good
cause to follow the measures adopted by the insurance institution in accordance
with sections 18 and 19, be deprived for a time of the Infirmity pension either
wholly or partially, in so far as these consequences were pointed out to him,
and If it is proved that his Incapacity to earn a Uvelihood is the result of his
Under section 45 of the law of 1899 authority was granted to the in-
validity insurance institutions to advance loans for the establishment
of sanatoria or to erect such sanatoria on their own account. The
section follows :
Section 45. By unanimous Jeclsion of the directors and of the committee it
can be decided that the surpluses of the special capital of an Insurance institu-
tion over the permanent requirements for covering their obligations can be .
applied to other services than those provided for in the law in the economic
interest of the pension recipients of insured persons^ and of their depend^its
provided for by the Insurance institution.
Such decisions require the sanction of the Federal Council. The sanction can
be withdrawn if the special capital of the insurance institution no long^ suf-
fices to permanently cover their obllgationa
â€¢In addition to the above provisions the following articles of the
Workmen's Insurance Code of July 19, 1911, proviJfc for medical
treatment for the prevention of invalidity:*
v. MBDICAL TBBATMENT.
In order to prevent impending invalidity of an insured person or of a widow
resulting from sickness, the insurance institute may inaugurate a course of
Pabaobaph 1. The insurance institute may in particular place the insured
person In a hospital or in an institution for convalescenta
Pab. 2. If the sick person is married and lives together with his family or
has a household of his own, or is a member of the household of his family,
then his consent thereto shall be required.
Pab. 3. In the case of a minor person, his consult shall be sufiident
The relatives of the sick person whose support he has either wholly or prin-
cipally defrayed out of his earnings ^all, during the course of treatm^it (art
1270) receive house money even in cases where he has no claim against the
sick fund, the miners' sick fund, or the substitute fund. It shaU amount to
one-fourth of the local wage for an adult day laborer. If, however, up to the
^ For text of this law see BalleCln of the Bareao of Labor, No. 9e, p. 614 et seq.
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GABB 07 TUBEBOULOUS WAOB BABNBB8 DT OBBICAKY. 173
aara4)tion of the matter by the insurance institute, the sick person was subject
to the sickness insurance, the house money shall be based on the provisions of
the sickness insurance for that time also for which the obligation of the sick
fund no longer exists. An invalidity pension or widow's pulsion may be either
wboUy or partly refused for the duration of the course of treatment The
hoose money shall not be paid, for the time and to the extent that wages or
salary are paid, on the basis of a legal claim.
If the sick person without legal or other reasonable ground declines to receive