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D EPA R TM E N T OF CO M M E R C E A N D L A B O R
.B U R E A U

OF

LABOR

CH A S. P. N EILL, Comm issioner

CR O
AE F
T B R UO S W G E R E S
UE C L U A E A NR
I GR A Y
N E MN
BU LLETIN O F T H E U N ITED
STA TE S BU REAU O F L A B O R
WHOLE NUMBER 101

*56

WORKMEN’S INSURANCE AND COMPENSATION SERIES
No. 1




JULY 1, 1912

W ASH IN G TO N
GOVERN M EN T P R IN T IN G O FFICE
1912




CO N TEN TS.
Page.
Introduction and summary....................................................................................... 5-11
Mortality from tuberculosis in the German Empire............................................... 11-15
Comparative mortality from tuberculosis in Germany and in the United States. 15-18
Estimated economic loss from tuberculosis to wage earners in the United States. 18,19
Estimated economic value of sanatorium treatment in Germany........................ 20-22
Legal provision for treatment and care by invalidity insurance institutions..........22,23
Number of German wage earners receiving sanatorium treatment in 1910......... 23,24
Cost of sanatorium treatment of German wage earners in 1910............................24-26
Restoration of earning capacity of wage earners resulting from sanatorium
treatment...................................................................................................................26-32
Comparative results of institutional and noninstitutional treatment................... 32,33
Comparative results of hospital and sanatorium treatment................................... 33,34
Organization and activities of the German Central Committee for the prevention
of tuberculosis......................................................................................................... 34-38
Dispensaries and information bureaus............................................................. 35,36
Treatment and care of tuberculous children...................................................
36
Present status of agencies for prevention and cure of tuberculosis............... 36,37
Conclusions in regard to work of German Central Committee...................... 37,38
Treatment of tuberculous wage earners in public institutions, 1896 to 1901........... 38-58
How cost of treatment is provided for..............................................................
39
Age, sex, and conjugal condition of patients under treatment..................... 40,41
Proportion of indoor and outdoor workers.......................................................
41
Dust and fumes as a predisposing cause of tuberculosis.................................41,42
Unfavorable occupational conditions............................................................... 42,43
Social condition..................................................................................................
43
Patients with a fam ily history of tuberculosis.................................................43,44
Predisposing or complicating causes in tuberculosis...................................... 44,45
Previous sanatorium treatment.........................................................................
45
Previous duration of disease.............................................................................. 45,46
Relation of treatment to stage of disease..........................................................46,47
Condition of patients on admission...................................................................47,48
Relation of treatment to gain in bodily weight...............................................48,49
Changes in condition during treatment...........................................................
49
Cough and expectoration on admission and discharge...................................
50
Tuberculous bacilli in the sputum on admission and discharge.................. 50-52
Duration of treatment........................................................................................ 52,53
Medical result of treatment............................................................................... 53,54
Economic results of treatment.......................................................................... 54,55
Importance of treatment in the incipient stage of the disease...................... 55,56
German sanatorium experience, 1896 to 1901.................................................. 56-58
Treatment and care of tuberculous wage earners by German invalidity insur­
ance institutions, 1897 to 1909.............................................................................. 58-98
Number of patients treated, by sex................................................................. 60,61
Expenditures on account of treatment and care, 1897 to 1909...................... 61-63
Increase in expenditures on account of treatment and care.......................... 63,64
Comparison of contributions and expenditures for treatment.......................
64
Expenditures during 1909................................................................................. 64,65
Proportion of insured population treated and cared for during 1909...........
65



3

4

CONTENTS.

Treatment and care of tuberculous wage earners b y German invalidity insur- P *
ag©
ance institutions, 1897 to 1909—Concluded.
Proportion of patients treated, by selected States.......................................... 65,66
Notification of army recruits who were rejected on account of tuberculosis.
66
Financial aid given by invalidity insurance institutions in the campaign
against tuberculosis.........................................................................................
67
Family support of tuberculous wage earners in public sanatoria................ 68,69
Methods of treatment and care..........................................................................69-75
Per capita cost of treatment and care...............................................................75,76
Financial statistics of sanatoria owned by German invalidity insurance
institutions....................................................................................................... 76,77
Loans provided for the erection of public sanatoria....................................... 77,78
Suitable employment of tuberculous patients................................................
78
Average cost and duration of treatment........................................................... 78-80
Effect of premature discontinuance of treatment...........................................
81
Statistics of readmissions for treatment............................................................ 81-83
Classification of tuberculosis according to Turban stage of disease.................83,84
Statistics of admission and discharge according to Turban stage of disease. 84-87
Postdischarge results of sanatorium treatment...................................................87-94
Financial statistics of successful and unsuccessful sanatorium treatment.. 94-96
General conclusions as to the value of institutional treatment for tuberculosis. 96-98
Administrative control of tuberculosis, with special reference to tuberculosis
dispensaries, information bureaus, and housing reform......................................98-116
Limitations of sanatorium treatment................................................................ 98,99
German tuberculosis dispensaries and information bureaus........................ 99,100
Organization and scope of the tuberculosis dispensary............................... 100,101
Tuberculosis dispensaries in Germany in 1911............................................ 101,102
Tuberculosis dispensaries in Berlin............................................................... 102-104
Tuberculosis dispensaries in Hamburg......................................................... 105,106
Tuberculosis dispensary in Leipzig.............................................................. 106,107
Tuberculosis dispensary in Munich.............................................................. 107-109
Tuberculosis dispensaries in Silesia..................................................................
109
Tuberculosis dispensary in Augsburg...................*....................................... 109,110
Tuberculosis dispensaries in Westphalia...................................................... 110, 111
Agricultural colony for tuberculous wage earners....................................... I l l, 112
Control of tuberculosis through housing reform........................................... 112-114
Building loans by invalidity insurance institutions................................... 114-116
Town planning and sanitary progress in Germany..........................................
116
Experience data of representative invalidity insurance institutions in the treat­
ment and care of tuberculous wage earners in 1910........................................ 117-161
Berlin................................................................................................................ 117-125
Westphalia....................................................................................................... 125-130
Rhenish Prussia............................................................................................... 130-136
Wurttemberg.................................................................................................... 136-143
Baden............................................................................................................... 143-149
The Hanse Towns............................................................................................ 149-161
Appendix I .—Treatment of tuberculous wage earners in public institutions,
1902 to 1904................................................................................ 162-164
. Appendix II.—Memorandum on tuberculosis, compiled by German Imperial
Board of Health at Berlin....................................................... 165-169
Appendix III.—Definition of German terms relating to treatment and care of
tuberculous wage earners.....................................................169,170
Appendix IV .—Legal provisions regarding treatment of actual or prospec­
tive invalids........................................................................... 171-173
Appendix V.*—B ibliography................................................................................173-179



B U L L E T IN O F T H E
U N IT E D

STA TE S

w hole n o . 101.

BU REAU

O F

W A SH IN G T O N .

LA B O R .
july i , 1 9 1 2 .

CARE O F TUBERCULOSIS W A G E EARNERS IN G E R M A N Y .
BY FREDERICK L. HOFFMAN.

INTRODUCTION AND SUMMARY.

Under the German compulsory invalidity insurance law which
went into effect on January 1, 1900, provision was made that—
I f an insured person is so ill that incapacity to earn a livelihood
is to be apprehended as a consequence o f the illness, which would
constitute a claim to a pension in accordance with the laws o f 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 institution can effect the cure by placing the
sick person in a hospital or in an establishment for convalescents.
I f the sick person is married, i f he has a household o f his own, or
if he is a member o f the household o f his people, his consent to
this step is required.
Since tuberculosis o f the lungs is responsible fo r 15 per cent o f
the disability annuities granted to males and fo r 9.5 per cent o f those
granted to females, extended provision has been made on the basis
o f the foregoing provision for the systematic treatment and care o f
tuberculous wage earners throughout the German Empire. The
importance o f tuberculosis as a cause o f invalidity or wage-earning
disability is better emphasized by the statement that o f the annuities
granted during 1896 to 1899 the proportion paid to males at ages
20 to 24 on account o f tuberculosis o f the lungs was 54.9 per cent;
at ages 25 to 29, 50.9 per cent; at ages 30 to 34, 43.9 per cent; and
at ages 35 to 39, 36.7 per cent. The proportions fo r females were, at
ages 20 to 24, 42.6 per cent; at ages 25 to 29, 34.3 per cent; at ages
30 to 34, 25.8 per cent; and at ages 35 to 39, 20.3 per cent.
F or the systematic treatment and care o f tuberculous wage earners
a chain o f special sanatoria was gradually established by the in­
validity insurance institutions. Commencing with 1 in 1895, the
number o f sanatoria by 1902 had increased to 15, and by 1909 to 37.
In addition thereto, a number o f public sanatoria were established by
provincial, communal, and other authorities, largely out o f funds
provided at low rates o f interest by the invalidity insurance institu


5

6

BULLETIN OP THE BUREAU OP LABOR.

tions. In 1911 there were 99 o f these public sanatoria fo r the treat­
ment o f tuberculous wage earners in the German Empire.
Commencing with 3,334 tuberculous wage earners provided with
systematic institutional treatment in public sanatoria in 1897, the
number had increased to 16,489 in 1902 and to 42,232 In 1909. Dur­
ing the period 1897 to 1909, in the aggregate, 272,480 tuberculous
wage earners were treated and cared for, and o f this number 194,787
were males and 77,693 were females.
Commencing with an annual expenditure on account o f tuber­
culous wage earners in 1897 o f 1,024,507 marks ($243,833), the
amount had increased to 5,858,615 marks ($1,394,350) in 1902 and
to 16,303,618 marks ($3,880,261) in 1909. During the period 1897
to 1909 the total amount disbursed on account o f institutional treat­
ment and care fo r tuberculous wage earners on the part o f in­
validity insurance institutions was 99,673,648 marks ($23,722,328).
The average cost o f treatment on account o f tuberculosis in sanatoria
owned and maintained by invalidity insurance institutions was 4.60
marks ($1.09) per patient per day. The maximum cost was 8.96
marks ($2.13) and the minimum cost 2.97 marks (71 cents).
The 37 sanatoria owned and operated by invalidity insurance in­
stitutions in 1909 provided 3,134 beds for males and 1,289 beds for
females. The cost o f the ground occupied was 2,256,438 marks
($537,032); the cost o f buildings, 38,238,124 marks ($9,100,674);
and the cost o f installation, 4,349,854 marks ($1,035,265). The
annual cost o f maintenance during 1909 was 7,820,388 marks
($1,861,252). The number o f male patients treated was 16,593, and
o f female patients, 6,141.
U p to December 31, 1909, the invalidity insurance institutions
had loaned 13,062,625 marks ($3,108,905) for the building o f sana­
toria maintained by provincial, communal, or other authorities.
O f this sum, 1,252,607 marks ($298,120) had been repaid, leaving
a net outstanding obligation o f 11,810,017 marks ($2,810,784).
The average cost o f treatment per patient per annum in all insti­
tutions was 386.05 marks ($91.88). The cost fo r male patients was
404.22 marks ($96.21) and for female patients 344.97 marks ($82.10).
The average cost per patient per day was 5.41 marks ($1.29), or 5.77
marks ($1.33) for males and 4.29 marks ($1.02) for females.
The average duration o f treatment was 73 days, having been 70
days for males and 80 days fo r females.
The economic results o f institutional treatment and care on ac­
count o f tuberculosis o f the lungs are determined by means o f special
inquiry for a period o f five years subsequent to the patient’s dis­
charge. B y economic results is meant the restored wage-earning
capacity to the extent, at least, o f 33.3 per cent o f the patient’s wage­
earning ability previous to the disease. Selecting, for illustration,
the FRASERpatients discharged during 1905 with their wage-earning
male
Digitized for


CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

7

capacity fully restored within the meaning o f the insurance laws,
the proportion retaining their earning capacity to the end o f 1905
was 76 per cent; to the end o f 1906, 63 per cent; to the end o f 1907,
54 per cent; to the end o f 1908, 48 per cent; and to the end o f 1909,
44 per cent. The corresponding economic results fo r women patients
were somewhat better, having been respectively, 78 per cent for
the first year, 67 per cent for the second, 60 per cent fo r the third,
55 per cent fo r the fourth, and 52 per cent fo r the fifth year.
The tendency is distinctly toward an improvement in the economic
results as is made evident by the fact that while o f the male patients
treated in 1897 only 68 per cent were discharged with their earning
capacity restored, the corresponding proportion for 1909 was 83
per cent. F or female patients the results were exactly the same.
On account o f 24,337 male patients successfully treated from an
economic point o f view, 10,456,400 marks ($2,488,623) was expended
during the year 1909, or an average expenditure o f 429.65 marks
($102.26). On account o f 4,940 male patients unsuccessfully treated
from an economic point o f view during 1909, the sum o f 1,378,094
marks ($327,986) was expended, or an average expenditure o f 278.97
marks ($66.40). On account o f 10,794 female patients treated suc­
cessfully from an economic point o f view during 1909 the sum o f
3,911,657 marks ($930,974) was expended, or an average expenditure
o f 362.39 marks ($86.25). On account o f 2,161 female patients un­
successfully treated from an economic point o f view the sum o f
557,467 marks ($219,912) was expended, or an average expenditure
o f 257.97 marks ($61.40).
The economic and medical results o f treatment are naturally more
or less determined by the condition o f the disease on admission. O f
the 24,766 male patients admitted fo r treatment during 1909, the
number in the first Turban stage o f the disease1 was 12,015, or 49
per cent; in the second stage, 9,161, or 37 per cent; and in the third
stage, 3,590, or 14 per cent. O f the 20,567 male patients successfully
treated and discharged with their earning capacity restored to them,
11,111 were in the first Turban stage o f the disease, or 92 per cent
o f all admitted in that stage o f the disease; the number in the second
Turban stage o f the disease on discharge was 7,777, or 85 per cent o f
those admitted in that stage; the *number discharged in the third
Turban stage was 1,679, or 47 per cent o f those in the third Turban
stage o f the disease when admitted.
O f the 10,379 female patients admitted, 5,826, or 56 per cent, were
in the first Turban stage o f the disease; 3,399, or 33 per cent, were in
the second stage; and 1,154, or 11 per cent, were in the third. O f
those successfully treated, on discharge, 5,507 were in the first
Turban stage o f the disease, or 95 per cent o f those admitted in that
1 For explanation of the term “ Turban stage,” see page 83.




8

BULLETIN OF TH E BUREAU OF LABOR.

stage. O f those discharged, 2,670 were in the second Turban stage
o f the disease, or 79 per cent o f those admitted in that stage o f the
disease. O f those discharged, 385 were in the third Turban stage, or
33 per cent o f those admitted in that stage o f the disease.
The economic and medical results are affected by the inclusion
o f patients who were less than 14 days under treatment* I f these
are deducted, the proportion o f male patients treated successfully
from an economic point o f view was increased from 83 to 86 per
cent; and the same results were secured in the case o f females.
O f every 1,000 male patients discharged, 5 required readmission
fo r treatment during the first year o f admission, 59 after one year
o f admission, 68 after two years, 45 after three years, and 33 after
four years. O f every 1,000 female patients, 3 required readmission
during the first year, 51 during the second, 48 during the third, 34
during the fourth, and 23 during the fifth year.
In addition to a large expenditure fo r institutional treatment and
care o f tuberculous wage earners through invalidity insurance insti­
tutions, considerable sums are paid out in support o f the general anti­
tuberculosis movement, which within recent years has made material
progress throughout the German Empire. In 1909, 288,365 marks
($68,631) was disbursed fo r various purposes, chiefly in support o f
tuberculosis dispensaries and inform ation bureaus. The correspond­
ing expenditure during 1908 was 248,805 marks ($59,216). In 1910
the sum o f 480,964 marks ($114,469) was expended for aid and sup­
port o f the general antituberculosis movement, and o f this sum
297,941 marks ($70,910) was in the nature o f subventions to tuber­
culosis dispensaries and inform ation bureaus.
There were in 1911 some 99 public sanatoria in the German
Empire, and o f this number, in 1910, 381 were owned and main­
tained by invalidity insurance institutions. There were in addi­
tion 34 private sanatoria, some o f which provided fo r wage earners
at reduced rates. F or tuberculous children 22 institutions were
in operation in 1911, and in addition thereto for children likely
to become tuberculous or scrofulous, or otherwise in need o f insti­
tutional care as a safeguard against tuberculosis, 86 institutions were
in operation, providing treatment free or at very reasonable rates;
the number o f sanatoria fo r school children only was 7, and the
number o f forest day and night camps was 98. The number o f
open-air or forest schools in 1911 was 15, and two agricultural colo­
nies had been established, one in the Province o f Brandenburg and
one in the Grand Duchy o f Oldenburg. F or far-advanced cases 96
homes for incurables were in operation, or in the form o f isolation
divisions o f hospitals established and maintained fo r general pur­
poses. F or the benefit o f discharged patients in need o f supple­
1Statistik der Heilbehandlung, 1905-1910, p. 69.



CARE OP TUBEBCULOTJS WAGE EARNERS IN GERMANY*

9

mentary treatment and care 17 convalescing homes were in opera­
tion, and for the study o f incipient cases to determine the stage o f
the disease, or the actual existence o f tuberculosis, there were 33 obser­
vation stations, chiefly in connection with sanatoria or general hos­
pitals. There were also 19 polyclinics for the tuberculous, conform ing
probably to the tuberculosis clinic as clearly differentiated from the
tuberculosis dispensary. The number o f tuberculosis dispensaries
and inform ation bureaus was 528, and in addition thereto 537 dispen­
saries were maintained in the Grand Duchy o f Baden. A large
number o f tuberculosis associations are in active operation, provid­
ing the means for a systematic warfare against the disease through­
out the entire German Empire, the work being directed through, and
if necessary sustained by the financial assistance o f the German Cen­
tral Committee, which is under the protection o f Her Im perial
M ajesty the German Empress, and the presiding honorary officer o f
which is the imperial chancellor.1
The German Central Committee had on January 1, 1910, funds
o f 370,349.55 marks ($88,143.19), receiving in membership fees
39,877 marks ($9,490.73); in gifts, 15,000 marks ($3,570); in interest,
16,245.28 marks ($3,866.40); and by way o f imperial subsidy, 60,000
marks ($14,280). It expended during the year, in the form o f finan­
cial aid to the establishment o f sanatoria and other tuberculosis
institutions, the sum o f 177,300 marks ($42,197.40). F or tuberculosis
museums, 33,316.68 marks ($7,929.37); fo r the special campaign
against lupus, 30,000 marks ($7,140); and for all other purposes the
sum o f 59,880.10 marks ($14,251.46), including 29,081.76 marks
($6,921.46) for administration.2
3
It is evident from the foregoing that the antituberculosis move­
ment throughout the German Empire is thoroughly organized and
sustained by ample funds. The results o f systematic treatment and
institutional care have been quite satisfactory and, as far as
known, sufficient to reimburse the insurance institutions by the release
o f funds that would otherwise have been required for the payment
o f disability annuities.
Largely as the result o f the general movement against tubercu­
losis and the provision for institutional and dispensary care, the
general tuberculosis death rate o f German cities has progressively
declined. From an average o f 23.08 per 10,000 during 1895-1899
the rate fo r the German Empire as a whole has declined to 21.16
during 1900-1904 and 18.45 during 1905-1909. The m ortality from
tuberculosis o f the lungs in German cities has declined from an aver­
age rate o f 34.6 per 10,000 o f population during 1889-1884, to 27.4
1Beilage zum GescMftsbericht, 1911. Published by the German Central Committee,
Berlin, 1912.
3 Annual Report of the German Central Committee for 1911.




10

BULLETIN OF THE BUREAU OF LABOR.

during 1890-1894, to 21.0 during 1900-1904, and finally to 17.9 during
1905-1909. The tuberculosis death rate o f Berlin has decreased from
34.7 per 10,000 in 1880 to 17.9 in 1909; o f Bremen, from 39.7 to 15.1;
o f Cassel, from 32.4 to 12.2; o f Chemnitz, from 27.7 to 12.6; o f
Cologne, from 41.4 to 15.6; o f Dresden, from 36.9 to 17.7; o f Essen,
from 40.9 to 10; o f Frankfort, from 37.7 to 15.8; o f Hanover, from
42.4 to 11.5; o f Leipzig, from 35.5 to 16.3; o f Munich, from 40.5 to
22.9; o f Strassburg, from 33.5 to 19; and finally, o f Stuttgart, from
23 to 16.8.
These results are unquestionably, in a large measure, due to the in­
telligent and well-sustained effort which has been made throughout
the German Empire to reduce the mortality and m orbidity, as well as
the economic consequences o f the form erly excessive death rate from
tuberculosis. The movement has been nation-wide and has enlisted
the hearty cooperation o f employers and employees, the public at
large, and the numerous governmental authorities—from the Empire
itself to the royal, provincial, municipal, and communal governing
bodies. A large number o f public associations have been established
and are being maintained by private subscription, which in the aggre­
gate must amount to a very considerable sum.
W ithin recent years vast sums o f money have been provided for
building purposes by invalidity insurance institutions, as well as
through provincial and communal authorities. U p to December 31,
1910, 320,000,000 marks ($76,160,000) had been furnished in the
form o f loans for building purposes through invalidity insur­
ance institutions, and the tendency is decidedly toward a gradual
reconstruction o f the housing accommodation o f the wage-earning
population. This effort is under strict governmental supervision
as a first requisite for the safeguarding o f the public interests
against speculation and misdirected effort contrary to the common
good. Extensive inquiries have fully established the direct relation
between insanitary housing accommodation and the excessive mor­
tality from tuberculosis and possibly from nontubercular lung dis­
eases. The problem o f housing reform is, therefore, one o f material
importance to the invalidity insurance institutions, and this explains
the considerable extent to which these institutions have financially
sustained the nation-wide effort to improve the living conditions o f
wage earners and their families.
What has been done in all o f these directions has naturally reacted
most favorably to the advantage o f the German people as a whole.
The activity o f invalidity insurance institutions in the field o f social
betterment is obviously conditioned by the vital interests which these
institutions have, perhaps not so much in a low death rate as in
a low m orbidity rate. Every case o f tuberculosis involves a material
risk to these institutions, which comprehend in their membership

practically the entire wage-earning population. The position o f life


OAEE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

11

insurance companies in this respect, however, is a very different one,
and it should be thoroughly understood that not a single German life
insurance company—all assertions to the contrary notwithstanding—
has seen its way clear to undertake the treatment and care o f its
tuberculous policy holders in the manner which has been found pos­
sible and expedient fo r members o f invalidity insurance institutions
maintained in compliance with law by the compulsory contributions
o f employers and employees, plus a subsidy from the imperial Gov­
ernment. In other words, the payment o f death claims by life insur­
ance companies involves totally different considerations from the
payment o f disability annuities by the invalidity insurance institu­
tions maintained in conform ity to the principle o f social insurance,
which in effect is no more and no less than a method o f special but
direct taxation.
The marvelous results achieved in the German Em pire through
the intelligent coordination o f public and private agencies enlisted
in the effort to reduce the m ortality from tuberculosis to a minimum
entitles the German experiment, as the first and most successful o f
its kind, to the admiration o f the entire civilized world. Whether
what has been done has paid fo r itself in a strict financial sense is
wholly secondary to the social results which have been achieved, and
which have unquestionably conferred an infinite amount o f good upon
the German people engaged in German industry in successful compe­
tition with the economically more advantageously situated wage
earners o f many other lands. From the social, economic, and med­
ical points o f view the treatment and care o f tuberculous wage
earners in Germany is a subject well deserving o f intelligent and
sympathetic study as a distinct contribution to the civilization o f
the present time.
MORTALITY FROM TUBERCULOSIS IN THE GERMAN EMPIRE.

The present discussion is largely lim ited to what has been done in
this direction during the period 1897 to 1909, but some consideration
has been given to earlier years. The modern movement may be said
to rest in part upon the statistical analysis o f the m ortality o f the
German Em pire fo r 1893, when out o f 268,500 deaths o f persons aged
15 to 60 years, 88,654, or 33 per cent, were caused by tuberculosis o f
the lungs. But in some Provinces o f the German Empire the propor­
tion was as high as 43 per cent, while in others it was as low as 22
per cent. In 1899 it was ascertained by means o f a special statistical
inquiry that there were then 226,000 tuberculous patients in hospitals
and other institutions o f the German Empire, or 42.2 per 10,000 o f
population. Between 1892 and 1900, in 10 o f the principal cities o f
the Empire, 1,066,722 persons died from tuberculosis o f the lungs,
or 24.2 per 10,000 o f population. In that portion o f the Kingdom



12

BULLETIN OF THE BUREAU OF LABOR.

of Bavaria w
hich lies on the left side of the R
hine, the rate w as
as
high a 32.9 per 10,000 of population, w in East Prussia, w
s
hile
hich is
alm entirely agricultural, th rate w only 14.6. For a full u
ost
e
as
nder­
standing, therefore, of th underlying reason for the extensive an
e
s
d
costly cam
paign against tuberculosis in G any it is n
erm
ecessary to
consider briefly the m
ortality data for a period of years.
The statistics for the G an Em
erm
pire extend only over the period
1892 to 1909, including in the last-nam year 24 States w a popu­
ed
ith
lation of nearly 63,000,000, or 98.3 per cen of the total. In this area
t
the average death rate from tuberculosis of the lungs w 21.2 per
as
10,000 of population during the period 1895 to 1899, dim
inishing to
19.2 during 1900 to 1904, an still further to 16.0 during 1905 and 1909.
d
There w an in
as
crease, how
ever, in the m
ortality from other form of
s
tuberculosis from 1.9 per 10,000 during 1895 to 1899 to 2.5 during
1905 to 1909. C bining all form of tuberculosis, the death rate
om
s
declin progressively from an average of 23.1 .during 1895 to 1899
ed
to 18.5 during 1905 to 1909. The m
ortality from nontubercular
lung d
iseases declined from 26.4 during the first five years u
nder
observation to 24.8 during the last five years. The evidence, there­
fore, is quite con
clusive that the d
ecrease in the m
ortality from tuber­
culosis of the lungs w not the result of possible changes in m
as
ethods
of m
edical diagnosis, nor w it d e to an in
as
u
crease in the m
ortality
from oth form of tubercu
er
s
losis or from nontubercular d
iseases of
th lungs. The details of th m
e
e ortality from tuberculosis in th
e
G an Em
erm
pire are given in the following table:
MORTALITY FROM TUBERCULOSIS OF THE LUNGS AND FROM OTHER LUNG DISEASES
IN THE GERMAN EMPIRE, 1892 TO 1909.

Year.

1892.............
1893.............
1894.............
1895.............
1896.............
1897.............
1898.............
1899.............
1900.............
1901.............
1902.............
1903.............
1904.............
1905.............
1906.............
1907.............
1908.............
1909.............
1895 to 1899..
1900 to 1904..
1905 to 1909..

Num­
ber of
States
in regis­
tration
area.

9
10
11
13
18
20
20
20
20
21
21
23
23
23
24
24
24
24

Deaths from
tuberculosis of
the lungs.
Popula­
tion.
Number.

41,475,116
47,625,932
48,684,503
49,752,057
50,331,987
51,528,038
52,084,384
53,510,403
54,662,484
55.061.664
55.061.664
57,619,810
58,433,571
59,768,198
59,912,782
61,260,509
62,111,705
62,954,673
257,206,869
280,839,193
306,007,867




97,599
115,641
115,034
113,786
109,659
110,225
103,425
107,633
111,804
106,941
105,376
107,299
106,709
106,552
93,152
97,555
95,402
90,962
544,728
538,129
488,623

Deaths from
other forms of
tuberculosis.

Deaths from
all forms of
tuberculosis.

Deaths from
other lung
diseases.

Rate
Rate
Rate
Rate
per Number. per Number. per Number. per
10,000.
10,000.
10,000.
10,000.
23.53
24 28
23.63
22.87
21.79
21.39
19.86
20.11
20.45
19.42
19.14
18.62
18.26
17.83
16.38
15.92
15.36
14.45
21. IS
19.16
15.97

7,051
8,434
8,870
9,373
9,452
10,099
10,136
9,786
10,244
10,655
10,940
12,140
12,237
15,440
15,280
15,135
15,200
14,948
48,846
56,216
76,003

1.70
1.77
1.82
1.88
1.88
1.96
1.95
1.83
1.87
1.94
1.99
2.11
2.09
2.58
2.55
2.47
2.45
2.37
1.90
2.00
2.48

104,650
124,075
123,904
123,159
119,111
120,324
113,561
117,419
122,048
117,596
116,316
119,439
118,946
121,992
113,432
112,690
110,602
105,910
593,574
594,345
564,626

25.23
26.05
25.45
24.75
23.67
23.35
21.80
21.94
22.33
21.36
21.12
20.73
20.36
20.41
18.93
18.40
17.81
16.82
23.08
21.16
18.45

150,241
156,831
135,332
127,824
131,930
134,403
132,133
151,661
162,413
144,561
151,622
153,948
149,199
156,120
142,933
154,019
153,526
150,627
677,951
761,743
757,225

36.22
32.93
27.80
25.69
26.21
26.08
25.37
28.34
29.71
26.25
27.54
26.72
25.53
26.12
23.86
25.14
24.72
23.93
26.36
27.12
24.75

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

13

The statistics for P
russia extend over a m longer period, includ­
uch
ing th years 1875 to 1909, but unfortunately the m
e
ortality from the
different form of tuberculosis w not separately retu ed previous
s
as
rn
to 1892. C
onsidering, therefore, only the m
ortality from all form
s
of tuberculosis, it is sh n by the official returns that the death rate
ow
from this group of cau has progressively d
ses
ecreased from 31.8 per
10,000 during 1875 to 1879 to 25.5 during 1890 to 1894, and finally
to 16.9 during 1905 to 1909. The m
ortality from other lung d
iseases
in Prussia, w
hich had b
een increasing up to 1893, d
ecreased pro­
gressively from an average of 28.6 per 10,000 during 1890 to 1894 to
24.6 during 1905 to 1909. The details of the m
ortality from tubercu­
losis by single years for the Kingdom of Prussia are given in the
table w
hich follows:
MORTALITY FROM TUBERCULOSIS OF THE LUNGS AND FROM OTHER LUNG
DISEASES, PRUSSIA, 1875 TO 1909.
Deaths from
tuberculosis of
the lungs.
Year.

Deaths from all
forms of
tuberculosis.

Deaths from other

Population.
Number.

1875 .......
1876 .......
1877 .......
1878 .......
1879 .......
1880 .......
1881..........
1882..........
1883 .......
1884 .......
1885 .......
1886 .......
1887 .......
1888 .......
1889 .......
1890 .......
1891 .......
1892 .......
1893 .......
1894 .......
1895 .......
1896 .......
1897 .......
1898 .......
1899 .......
1900 .......
1901 .......
1902 .......
1903 .......
1904 .......
1905 ........
1906 ........
1907 ........
1908 .......
ions
1875toi879
1880 to 1884,
1885 to 1889,
1890 to 1894.
1895 to 1899,
1900 to 1904,
1905 to 1909,1

Deaths from
other forms of
tuberculosis.

25,742,404
126,049,745
126,357,086
126,664,427
126,971,768
27,279,111
127,486,983
127,694,855
127,902,727
128.110.599
28,318,470
128.646.249
128,974,028
129,301,807
129,629,586
29,957,367
130,336,918
130,716,469
131,096,020
131,475,571
31,855,123
132.378.600
132,902,077
133,425,554
-33,949,031
34,472,509
135,036,672
135,600,835
136,164,998
136,729,161
37,293,324
137,857,487
138,421,650
138,985,813
139,549,976
131,785,430
138,474,275
144,870,140
153,582,345
164,510,385
178,004,175
192.108.250




Rate
Rate
• Rate
Rate
per Number. per Number. per Number. per
10,000.
10,000.
10,000.
10,000.

72,645
73,428
71,133
70,109
66,583
66,400
61,595
64,333
66,349
63,065
62,224
64,310
63,777
63,767
57,878
58,308
56,371
53,934

23.65
23.61
22.60
22.01
20.56
20.18
18.43
18.95
19.25
18.00
17.48
17.78
17.36
17.10
15.29
15.18
14.46
13.64

3,516
3.549
3,523
3,643
3,790
3,980
3,965
4,075
4,253
4,380
4,502
5,739
5.549
6,556
6,581
6,746
6,949
6,937

1.14
1.14
1.12
1.14
1.17
1.21
1.19
1.20
1.23
1.25
1.26
1.59
1.51
1.76
1.74
1.75
1.78
1.75

329,020
319,725
290,258

20.00
17.96
15.11

19,453
24,423
33,769

i.i8
1.37
1.76

1 Estimated.

82,122
79,770
83,769
86,294
87,294
84,895
84,363
85,359
88,837
87,756
88,056
88,283
84,124
84,109
82,529
84,086
80,151
76,161
76,977
74,656
73,752
70,373
70,380
65,560
68,408
70,602
67,445
66,726
70,049
69,326
70,323
64,459
65,054
63,320
60,871
419,249
431,210
427,101
392,031
348,473
344,148
324,027

31.90
30.62
31.78
32.36
32.36
31.12
30.69
30.82
31.84
31.22
31.09
30.82
29.03
28.70
27.85
28.07
26.42
24.79
24.75
23.72
23.15
21.73
21.39
19.61
20.15
20.48
19.25
18.74
19.37
18.87
18.86
17.03
16.93
16.24
15.39
31.81
31.14
29.41
25.46
21.18
19.33
16.86

42,065
41,221
42,595
42,991
44,736
49,182
55,602
54,973
61,387
58,525
62,745
64,455
63,584
63,238
63,708
85,693
78,542
94,627
97,921
82,000
80,881
83,716
84,308
81,516
95,972
104,157
90,702
96,275
96,235
95,112
96,170
89,090
97,068
96,513
94,258
213,608
279,669
317,730
438,783
426,393
482,481
473,099

16.34
15.82
16.16
16.12
16.59
18.01
20.23
19.85
22.00
20.82
22.16
22.50
21.95
21.58
21.50
28.60
25.89
30.81
31.49
26.05
25.39
25.86
25.62
24.39
28.27
30.21
25.89
27.04
26.61
25.90
25.79
23.53
25.26
24.76
23.83
16.21
20.20
21.93
28.57
25.92
27.11
24.63

14

BULLETIN OF TH E BUREAU OF LABOR,

A m useful contribution to the study of th m
ost
e ortality from
tuberculosis in P
russia according to sex and age w m for the
as ade
year 1905.1 According to this analysis the proportionate m
ortality,
by divisional periods of life, attains its m
axim
um at ages 20 to
25 years, w
hen of th m
e ortality from all cau 45.7 per cent are
ses
death from tuberculosis. For m
s
ales the proportion at this age w
as
44.1 per cen and for fem
t
ales 47.6 per cen It requires no further
t.
analysis to em
phasize the econ ic im
om
portance of tuberculosis pre­
vention to a State in w
hich practically the w
hole w
age-earning popu­
lation is insured against the risk of perm
anent or partial disability
resulting from d
isease. The details of the m
ortality from all form
s
of tuberculosis in Prussia according to age and sex during 1905 and
also during 1910 are given in the table w
hich follows:
MORTALITY FROM TUBERCULOSIS, PRUSSIA, ACCORDING TO SEX AND AGE, 1906 AND
1910.
[From Das Gesundheitswesen des Preussischen Staats, for 1905, p. 259, and for 1910,
p. 198. Published by Richard Schoetz, Berlin, 1907 and 1912.]
1905.
Deaths from tubercu­
losis.

Proportionate mortal­
ity by divisional
periods of life.

Mortality rate (per
10,000) from tubercu­
losis according to age.

Age at death.
FeFe­
Fe­
Total. Males. males. Total. Males. males. Total. Males.
males.
1,532
996
568
730
1,234
1,845
3,139
3,561
3,816
5,721
3,826
3,141
2,624
867
94
3

1.37
4.55
7.02
8.01
11.94
25.04
40.37
45.74
42.79
33.84
23.22
15.04
7.77
2.26
.47
1.95

1.35
4.64
6.85
7.43
10.86
17.75
34.85
44.10
41.41
33.35
23.71
16.48
8.69
2.49
.55
1.05

1.40
4.47
7.18
8.61
12.98
31.43
46.60
47.59
44.12
34.35
22.52
13.20
6.84
2.07
.41
4.55

31.42
21.71
11.52
7.27
5.24
7.03
17.16
22.11
24.96
23.84
25.33
29.75
33.17
22.32
10.09
5.15

23.81
22.71
11.43
6.81
4.70
4.63
15.54
22.94
23.65
24.04
30.91
38.98
40.94
25.86
12.03
3.62

28.96
20.70
11.62
7.73
5.79
9.45
18.81
21.30
26.27
23.63
20.01
21.63
26.71
19.55
8.66
7.17

Total........................... 70,323 36,626 33,697

9.68

9.66

9.70

19.13

20.21

18.08

998
701
425
615
1,111
1,455
2,848
3,371
3,345
5,572
3,433
2,560
2,103
770
82

1.18
4.38
7.24
8.68
12.52
24.14
39.35
44.20
41.89
32.91
21.73
12.87
6.18
1.85
.40
.36

1.19
4.62
7.50
8.23
11.14
18.33
33.14
41.69
39.98
32.24
22.31
14.30
6.76
1.92
.44
.50

1.17
4.13
6.95
9.17
13.91
29.65
46.51
47. u
O
43.73
33.57
20.94
11.06
5.61
1.80
.36

20.92
15.09
9.38
5.98
4.33
5.46
13.44
20.56
19.32
20.43
20.33
23.47
23.66
17.24
7.75

23.10
16.15
10.03
5.79
3.83
4.02
12.05
20.51
18.10
19.80
24.40
30.84
28.54
18.59
8.80

18.68
14.00
8.72
6.17
4.82
6.92
14.86
20.61
20.53
21.05
16.42
16.89
19.67
16.20
7.01

Total........................... 60,479 31,099 29,389

9.48

9.42

9.54

15.29

15.92

14.68

0 to 1 year.......................... 3,366
lt o 2 years........................ 2,093
2 to 3 years........................ 1,129
3 to 5 years........................ 1,379
5 to 10 years........................ 2,240
10 to 16 years........................ 2,757
16 to 20 years........................ 5,788
20 to 25 years........................ 7,306
25 to 30 years........................ 7,258
30 to 40 years........................ 11,476
40 to 60 years........................ 9,473
60 to 60 years........................ 8,126
60 to 70 years........................ 5,974
70 to 80 years........................ 1,764
190
80 years and over..................
5
Unknown.............................

1,833
1,097
661
649
1,006
912
2,649
3,745
3,442
5,756
5,647
4,985
3,350
897
96
2

1910.
0 to 1 year........................... 2,267
1 to 2 years.......................... 1,526
2 to 3 years..........................
920
3 to 5 years.......................... 1,199
5 to 10 years........................ 2,001
10 to 15 years........................ 2,307
15 to 20 years......................... 5,188
20 to 25 yea rs..,................... 6,702
25 to 30 years......................... 6,289
30 to 40 years......................... 10,814
40 to 50 years......................... 8,327
50 to 60 years......................... 6,732
60 to 70 years......................... 4,597
70 to 80 years......................... 1,454
80 years and over..................
155
1
Unknown.............................

1,269
825
495
584
890
852
2,340
3,331
2,944
5,242
4,894
4,172
2,494
684
73
1

1 The information for 1910 also is given in the table shown on this page.
brings out the considerable decline in the death rate at every period of life.




The table

CASE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

15

Since the m
ortality from tubercu
losis of th lungs is largely an
e
urban d
isease, although th are im
ere
portant exceptions to this rule,
it has seem advisable to include in this d
ed
iscussion a table of the
com ed m
bin
ortality from the d
isease in large G an cities for the
erm
period 1880 to 1909. The table w afford a m sof con ien com
ill
ean
ven t
­
parison w the corresponding m
ith
ortality of Am
erican cities, w
hich
will subsequently be referred to. The average death rate from tuber­
culosis of the lungs in the principal G an cities d
erm
ecreased from34.6
per 10,000 during the five years ending w 1884 to 17.9 per 10,000
ith
during the five years ending w 1909. The m
ith
axim rate during
um
the period prevailed during 1883 and 1884, w en it attained to*35.2
h
per 10,000. The m um rate prevailed during 1909, w it w
inim
hen
as
only 16.6 per 10,000 of population. The details, by single years, are
given in the table w
hich follow
s.
M of the data u in this table have been derived from volum
ost
sed
e
33, Part I, of Statistique D ographique d G
em
es randes Villes d
u
M
onde, published by the B
ureau of M
unicipal Statistics of Am
ster­
dam Holland.
,
MORTALITY FROM TUBERCULOSIS OF THE LUNGS, LARGE GERMAN CITIES,
1880 TO 1909.

COMPARATIVE MORTALITY FROM TUBERCULOSIS IN GERMANY AND
IN THE UNITED STATES.

W
hen the foregoing data relating to the m
ortality from tubercu
­
losis of the lungs in the G an Em
erm
pire are com
pared w th
ith e
corresponding data for the registration area of th United States,
e
it is sh n that w
ow
hile during the earlier years the m
ortality w
as
m higher in G any, th rate has fallen m rapidly, particu­
uch
erm
e
ore
larly during recen years, until th position of the G an Em
t
e
erm
pire
is n m favorable than the corresponding position of the United
ow ore
States. A com
parison, for illustration, sh s that the rate for
ow
G an cities in 1880 to 1884 w 34.6 per 10,000, an the corre­
erm
as
d




16

BU LLETIN OF TH E BUREAU OF LABOR.

sponding rate for Am
erican cities w 32.1. During the five years
as
en w 1909 the rate for G an cities w only 17.9 per 10,000,
ded ith
erm
as
against a rate of 18.5 for Am
erican cities. While, therefore, during
the first five years the m
ortality from tuberculosis of the lungs in
G an cities w 2.5 per 10,000 in excess of the corresponding m
erm
as
or­
tality in Am
erican cities, it is sh n that during the last five years
ow
under review the m
ortality from tuberculosis of the lungs in Am
eri­
can cities w 0.6 per 10,000 in excess of the corresponding m
as
ortality
in G an cities. The positions, therefore, have been reversed, and
erm
as will su
bsequ tly be show there are strong reason for believing
en
n,
s
that*th G an advance in this direction has b largely becau
e erm
een
se
of th system
e
atic and effective treatm and care of tuberculous
ent
w earn in special institutions or sanatoria established for the
age
ers
purpose, and m
any collateral institutions and efforts contributory
thereto. The details regarding the m
ortality from tuberculosis of
the lungs in the registration area of the United States and Am
erican
cities are given in the tw tables w
o
hich follow:
MORTALITY FROM TUBERCULOSIS OF THE LUNGS IN THE REGISTRATION AREA
OF THE UNITED STATES, 1900 TO 1909.
Pulmonary tuberculosis.
Females.

Males.
Deaths.

Years and
periods.
Population.

1900
1901
1902
1903
1904
1905
1906
1907
1908
1909

...
...
...
...
...
...
...
...
...
...

15,758,235
16,089,548
16,461,407
16,834,902
17,210,033
17,586,800
21,382,973
21,782,186
23,545,009
25,588,273

Deaths.

Deaths.

Num­
ber.

Rate Population.
per
10,000.

Num­
ber.

Rate Population.
per
10,000.

Num­
ber.

29,372
29,569
28,250
29,061
31,833
31,047
36,032
37,191
38,055
39,456

18.64
18.38
17.16
17.26
18.50
17.65
16.85
17.07
16.16
15.42

26,132
25,166
23,829
24,849
26,930
25,723
29,309
29,183
29,321
30,584

17.40
16.41
15.19
15.48
16.42
15.35
14.38
14.06
13.07
12.54

55,504
54,735
52,079
53,910
58,763
56,770
65,341
66,374
67,376
70,040

T otal... 192,239,366 329,866 17.16
1900 to 1904... 82,354,125
1905 to 1909... 109,885,241

Total.

148,085 17.98
181,781 16.54

15,019,568
15,335,351
15,689,779
16,045,766
16,403,313
16,762,419
20,380,647
20,761,146
22,441,336
24,388,823

183,228,148 271,026 14.79
78,493,777
104,734,371

30,777,803
31,424,899
32,151,186
32,880,668
33,613,346
34,349,219
41,763,620
42,543,332
45,986,345
49,977,096

Rate
per
10,000.
18.03
17.42
16.20
16.40
17.48
16.53
15.65
15.60
14.65
14.01

375,467,514 600,892

16.00

126,906 16.17 160,847,902 274,991
144,120 13.76 214,619,612 325,901

17.10
15.19

Tuberculosis other than 'pulmonary.
15,758,235
16,089,548
16,461,407
16,834,902
17,210,033
17,586,800
21,382,973
21,782,186
23,545,009
25,588,273

3,558
3,745
3,714
4,075
4,313
4,523
5,427
5,599
5,926
6,281

Total... 192,239,366
1900 to 1904... 82,354,125
1905 to 1909... 109,885,241

1900
1901
1902
1903
1904
1905
1906
1907
1908
1909

...
...
...
...
...
...
...
...
...
...




2.26
2.33
2.26
2.42
2.51
2.57
2.54
2.57
2.52
2.45

15,019,568
15,335,351
15,689,779
16,045,766
16,403,313
16,762,419
20,380,647
20,761,146
22,441,336
24,388,823

3,034
3,287
3,290
3,655
3,845
4,185
4,880
4,786
5,107
5,514

47,161

2.45

183,228,148

19,405
27,756

2.36
2.53

78,493,777
104,734,371

2.02
2.14
2.10
2.28
2.34
2.50
2.39
2.31
2.28
2.26

30,777,803
31,424,899
32,151,186
32,880,668
33,613,346
34,349,219
41,763,620
42,543,332
45,986,345
49,977,096

6,592
7,032
7,004
7,730
8,158
8,708
10,307
10,385
11,033
11,795

2.14
2.24
2.18
2.35
2.43
2.54
2.47
2.44
2.40
2.36

41,583

2.27 375,467,514

88,744

2.36

17,111
24,472

2.18 160,847,902
2.34 214,619,612

36,516
52,228

2.27
2.43

CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

17

MORTALITY FROM TUBERCULOSIS OF THE LUNGS IN THE REGISTRATION AREA
OF THE UNITED STATES, 1900 TO 1909—Concluded.
A ll forms o f tuberculosis.
Females.

Males.
Deaths.

Years and
periods.

Total.
Deaths.

Deaths.

Population.
Num­ Rato
per
ber. 10,000.

Num­
ber.

Rate Population.
per
10,000.

Num­
ber.

Rate
per
10,000.

32,930
33,314
31,964
33,136
36,146
35,570
41,459
42,790
43,981
45,737

20.90
20.71
19.42
19.68
21.00
20.23
19.39
19.64
18.68
17.87

29,166
28,453
27,119
28,504
30,775
29,908
34,189
33,969
34,428
36,098

19.42
18.55
17.28
17.76
18.76
17.84
16.78
16.36
15.34
14.80

62,096
61,767
59,083
61,640
66,921
65,478
75,648
76,759
78,409
81,835

20.18
19.66
18.38
18.75
19.91
19.06
18.11
18.04
17.05
16.37

T otal... 192,239,366 377,027

19.61

Population.

...
...
...
...
...
...
...
...
...
...

1900
1901
1902
1903
1904
1905
1906
1907
1908
1909

15,758,235
16,089,548
16,461,407
16,834,902
17,210,033
17,586,800
21,382,973
21,782,186
23,545,009
25,588,273

1900 to 1904... 82,354,125 167,490 20.34
1905 to 1909... 109,885,241 209,537 19.07

15,019,568
15,335,351
15,689,779
16,045,766
16,403,313
16,762,419
20,380,647
20,761,146
22,441,336
24,388,823

183,228,148 312,609 17.06
78,493,777
104,734,371

30,777,803
31,424,899
32,151,186
32,880,668
33,613,346
34,349,219
41,763,620
42,543,332
45,986,345
49,977,096

375,467,514 689,636

18.37

144,017 18.35 160,847,902 311,507
168,592 16.10 214,619,612 378,129

19.37
17.62

MORTALITY IN AMERICAN CITIES FROM TUBERCULOSIS OF THE LUNGS, 1870 TO 1909.

Year.

1870.
1871.
1872.
1873
1874,
1875
1876
1877
1878.
1879
1880
1881,
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
1893

Num­
ber

Popula­
tion.

Deaths.

3,064,248
3,152,034
3,671,562
4,241,333
4,057,378
4,670,708
4,830,045
5,254,820
5,530,567
6,064,577
6,721,841
7,011,801
7,191,252
7,505,986
7,736,682
7,979,952
8,298,185
8,305,090
8,905,415
9,441,109
9,878,969
10,722,433
11,022,883
10,877,321

10,224
10,257
12,270
13,635
12,394
14,625
15,486
15,973
17,244
18,416
21,047
23,502
23,431
24,028
23,995
23,906
24,522
23,720
24,120
24,061
26,280
26,691
27,059
25,987

o
f
cities.

Rate
per

Year.

1 ,000.
0
33.37
32.54
33.42
32.15
30.55
31.31
32.06
30.40
31.18
30.37
31.31
33.52
32.58
32.01
31.01
29.96
29.55
28.56
27.08
25.49
26.60
24.89
24.55
23.89

1894.
1895.
1896.
1897.
1898.
.
1900
1901
.
1902
..
1903
.
1904
..
1905
..
1906
..
1907
..
1908
..
1909
..
1870 to 1874..
1875 to 1879..
1880 to 1884..
1885 to 1889..
1890 to 1894..
1895 to 1899.,
1900 to 1904.,
1905 to 1909.,

Num­
ber

o
f
cities.

Popula­
tion.

11,188,919
11,451,786
11,870,008
12,181,994
12,436,938
13,208,505
13,129,350
14,252,940
14,500,917
14,962,711
15,325,964
15,586,747
16,170,144
16,636,665
17,064,491
17,492,509
18.186.555
26,350,717
36,167,562
42,929,751
53,690,525
61,149,231
72,171,882
82.950.556

Rate
Deaths. per
10,000.
25,303
25,928
25,768
25,253
25,554
27,358
26,080
28,758
27,459
29,220
31,790
30,349
30,719
31,514
30,753
30,091
58,780
81,744
116,003
120,329
131,320
129,861
143,307
153,426

22.61
22.64
21.71
20.73
20.55
20.71
19.86
20.18
18.94
19.53
20.74
19.47
19.00
18.94
18.02
17.20
32.32
31.02
32.07
28.03
24.46
21.24
19.86
18.50

For the purpose of convenient com
parison th essential facts are
e
sum arized for large G an an Am
m
erm
d
erican cities in the table
below in w
,
hich is given the total n ber of deaths fromtuberculosis
um
of the lungs and the rate per 10,000 of population, by qu
inquennial
periods sin 1880. It m be stated that the population of large
ce
ay
G an cities in
erm
creased from 3,516,914 in 1880 to 9,487,821 in 1909,
w
hile the population for large Am
erican cities in
creased from
6,721,841 in 1880 to 17,492,509 in 1909. The num of large G an
ber
erm
49397°— 2
1 ---2




18

BULLETIN OF THE BUREAU OF LABOR.

cities considered in the investigation of 1909 w 26, an the n m
as
d
u ber
of Am
erican cities w 63. It is a m
as
atter of regret that com
plete
returns for G an cities for a longer period of years are not avail­
erm
able, but the com
parison w
hich follows will serve the p
resent purpose
to em
phasize th decline in the death rate from tuberculosis of the
e
lungs w
hich has taken place in the case of the large cities of both
countries during the last 30 years.
SUMMARY OF MORTALITY FROM TUBERCULOSIS OF THE LUNGS IN LARGE
GERMAN AND AMERICAN CITIES, BY PERIODS, 1880 TO 1909.
German cities.
Number of
Aggregate deaths from
population. tubercu­
losis of
the lungs.

Periods.

1880 to 1884.....................................
1885 to 1889....................................
1890 to 1894.....................................
1895 to 1899.....................................
1900 to 1904.....................................
1905 to 1909....................................

18,423,010
21,920,532
30,661,604
34,905,723
40,606,352
46,342,006

63,709
70,833
84,087
79,909
85,195
82,961

American cities.
Number of Rate
Rate
per
per
Aggregate deaths from 10,000
tubercu­
10,000 population.
of pop­
losis of of pop­
ulation.
the lungs. ulation.
34.6
32.3
27.4
22.9
21.0
17.9

36,167,562
42,929,751
53,690,525
61,149,231
72,171,882
82,950,556

116,003
120,329
131,320
129,861
143,307
153,426

32.1
28.0
24.5
21.2
19.9
18.5

ESTIMATED ECONOMIC LOSS FROM TUBERCULOSIS TO WAGE
EARNERS IN THE UNITED STATES.

The im
portance to the United States of the subject of tuberculosis
prevention and cu is best em
re
phasized in the statem that during
ent
1910 there occu
rred in the registration area 86,309 deaths from
tuberculosis, of w
hich 73,214, or 84.8 per cent, w death from
ere
s
tuberculosis of the lungs. Since the registration area of th United
e
States com
prehends 58.3 per cent of the total population, the num
ber
of deaths from tuberculosis, for the country as a w
hole, m be con
ay
­
servatively estim
ated at 150,000, and the num of deaths from
ber
tuberculosis of the lungs at 125,000. Assum
ing, further* that th
ere
are at least five living cases of tuberculosis to every death from
tuberculosis occurring during theyear, thenum of casesof tubercu­
ber
losis in the United States is approxim
ately 750,000. Estim
ating the
num of w earn in the United States of ages 15 to 64 years,
ber
age
ers
inclusive, for the year 1912 at 27,313,160 m an 6,081,223 fem
ales d
ales,
the proportion of su w earn to the total population is 28.7
ch age
ers
per cen for m
t
ales an 6.4 per cen for fem
d
t
ales, respectively. S ce
in
according to the cen s m
su ortality data of 19001 the m
ortality rate
from tuberculosis of the lungs am
ong w
age earn w 2.37 per
ers as
1,000 for m
ales and 1.73 per 1,000 for fem
ales, the probable num
­
ber of deaths from tuberculosis of the lungs am
ong w
age earn
ers
in 1912 m be conservatively estim
ay
ated at 75,250, or, respectively,



xNo later data are at present available.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

19

64,730 m and 10,520 fem
ales
ales. The deaths occu chiefly at the pro­
r
ductive period of life w en its conservation, from an econ ic
h
om
point of view should b a m
,
e
atter of m seriou con
ost
s
cern to the
Nation and the several States. Assum
ing that th are only 5
ere
cases of tuberculosis of the lungs to every death from the dis­
ea there w
se,
ould be approxim
ately 376,250 cases or patients in the
different stages of the disease, fromthe incipient to the far advanced.
There are, how
ever, sou d reason for believing that the actual
n
s
n ber of ca is m larger, an that a ratio of 10 cases to every
um
ses
uch
d
death is, perhaps, not an exaggeration. If that ratio is accepted, the
num of cases of tuberculosis of th lungs am the w earn
ber
e
ong
age
ers
of the United States, ages 15 to 64 years, inclusive, during 1912 w
ould
be 752,500. T
hese estim
ates take n accou t of th m
o
n
e ortality or
m
orbidity from other form of tuberculosis, w
s
hich m safely b
ay
e
estim
ated at not m less than 5 per cen additional.1
uch
t
For the G an Em
erm
pire it h b estim
as een
ated that the num of
ber
cases is not less than 1,000,000, an som authorities have placed the
d
e
num as high as 1,300,000. This estim how
ber
ate,
ever, is for the en
tire
population, w
hile the preceding estim for the United States has
ate
referen only to the w
ce
age-earning elem t. In this con ection it
en
n
m also b stated that the average age at death from tuberculosis
ay
e
of the lungs in the United States during 1910 w 39.4 years for m
as
ales
an 36 years for fem
d
ales,2 an sin at this age the average expecta­
d ce
tions of life are approxim
ately 27.8 an 31.8 years, respectively, the
d
potential loss in years of life on the basis of the estim
ated n ber of
um
75,250 deaths of w earn w 2,135,400 years. The econ ic
age
ers as
om
value of a w earn life m b conservatively estim
age
er’s
ay e
ated at $100
per an um as the net gain or contribution tow the national w
n
ard
ealth
resulting from products of industrial an other econ ic activities.
d
om
W
hen this estim is applied to th num of years of curtailed ex­
ate
e
ber
pectation as previously given, the potential econom loss as the re­
ic
sult of tuberculosis of the lungs in the United States is $213,540,000.
While this loss is not an actual on in the sen of w
e
se
ealth destruction,
it is a real loss in the sen of curtailed w
se
ealth production, w
hich
w
ould unquestionably accru from a larger population engaged in
e
gainful occupations, but w
hich is prem
aturely destroyed in con
se­
q en of the com on prevalen of a strictly preventable d
u ce
m
ce
isease.
1 See in this connection report of the commission to investigate and report upon a
system of caring for tuberculous patients by State and local authorities made to the
Massachusetts Legislature under date of Nov. 1, 1910. (Senate No. 318, Boston, 1910.)
2 According to an official statement by the Division of Vital Statistics of the United
States Census Office for 1910 the average age at death was 39.4 years for males and 36
years for females and 38 years for both sexes combined.




20

BULLETIN OF THE BUREAU OF LABOR.
ESTIMATED ECONOMIC VALUE OF SANATORIUM TREATMENT IN
GERMANY.

An official G an estim of th econ ic value of sanatorium
erm
ate
e
om
treatm is contained in a report of the im
ent
perial board of health on
the statistical experience of public sanatoria for tuberculous patients,
published in 1904.1 In that report it is argued that if of the 90,800
deaths from tuberculosis of the lungs at ages 15 to 60 years occurring
annually inthe G an Em
erm
pire only about one-seventh or one-eighth,
that is, approxim
ately 12,000, could have received system
atic an
d
effective treatm in sanatoria established for that purpose, an if
ent
d
only about three-fourths of th
ese, or 9,000, could have returned to
their form occupations or industrial activity w a reason
er
ith
able
d
egree of their full earning capacity restored, and, that further, if
they could h m
ave aintainedthis gain for only three years, an assu ­
d
m
ing finally that th average earnings of w earn of both sexes
e
age
ers
are approxim
ately 500 m
arks ($ 1 1 9 ), th w
ere ould have b a gain
een
of 3 X 5 0 0 X ^ ,0 0 0 , or 13,500,000 m
arks ($ 3 ,2 1 3 ,0 0 0 ). This gain w
ould
have to be offset by the net exp ses of about 40 0 m
en
arks ($ 9 5 ) for
each of the 12,000 patients, w
ithout reference to interest on the in­
vestm in institutions, or approxim
ent
ately 5,000,000 m
arks ($ 1 ,1 9 0 ,0 0 0 ), or, including interest, estim
ated at 1,000,000 m
arks ($ 2 3 8 ,0 0 0 )
m
ore, th w
ere ould rem as the result of sanatorium treatm a
ain
ent
net orecon icgainto the G an N
om
erm
ation of 7,500,000 m
arks ($ 1 ,7 8 5 ,0 0 0 ). This estim
ate d not take into accou t all the collateral
oes
n
gains to the patient, his fam an the State resulting from restored
ily, d
earning capacity an prolonged longevity. Granting that this esti­
d
m is partly a m
ate
atter of conjecture, it is entitled to thoughtful
consideration, sin it w prepared a early as 1896 by an expert
ce
as
s
thoroughly fam
iliar w th facts and w published w the san
ith e
as
ith
c­
tion of th im
e perial health o e M recen estim
ffic . ore
t
ates of the eco­
nom value of sanatoriumtreatm w su
ic
ent ill bsequ tly be referred to,
en
for a the entire system of treatm an care of tuberculous w
s
ent d
ork­
m in special sanatoria, m
en
aintained at the cost of invalidity insur­
an institutions, rests upon an econ ic principle, the pecuniary
ce
om
considerations of gain an loss have not been lost sight of in th
d
e
discu
ssion an d
s d ebates w
hich have been had upon the m
erits of the
qu
estion from a public point of view
.
In 1907 an address on the past results of sanatorium treatm w
ent as
read before the G an N
erm
ational Association for the P
revention of
Tuberculosis, in w
hich add
ress the econ ic asp
om
ects of the d
isease
w d ssed at con
ere iscu
siderable length.2 The term “ restored earning
1 Deutsche H eilstaetten ftir Lungenkranke. G eschichtliche und statistische M itteilungen. I. B erichterstatter: Dr. Hamel, H ilfsarbeiter im K aiserlicken Gesundheitsamte.
M lt 12 Tafeln. Berlin, Verlag von Julius Springer, 1904, p. 40.
2 Die bisherigen Leistungen der H eilstaetten, yon Bielefeldt, May, 1907.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

21

capacity,” in an econ ic and legal sen according to the practice of
om
se,
G an invalidity in ran institutions, it w stated, requ that
erm
su ce
as
ires
the patient m be able to earn at least one-third of his previous
ust
norm w
al ages. The term “ disability ” is on w
e hich does not perm
it
of exact definition, either in G an or Am
erm
erican law but it is evi­
,
dent that the m
eaning is m broad in G an exp
ore
erm
erien than
ce
w
ould be the case in English or Am
erican in ran practice. If,
su ce
therefore, the definition by this authority, w
hich apparently is in
accord ce w section 4 of paragraph 5 of the G an invalidity
an
ith
erm
in
suran law applies to the econ ic results ach
ce
,
om
ieved by G an
erm
sanatoria for th treatm of tubercu
e
ent
losis of the lungs, it should b
e
u
nderstood throughout this discu
ssion that, u less oth ise stated,
n
erw
the term “ restored earning capacity” is subject to the lim
itation a
s
h
erein explained.
According to this authority, in 1905 th average am
e
ount of a dis­
ability annuity w abou 160 m
as
t
arks ($38.08) per an um This
n .
w
ould in five years am t to 800 iparks ($190.40), and to this
oun
period of tim m of th investigations of post-discharge results
e ost
e
of sanatorium treatm have b
ent
een lim
ited.1 In 1905 the aver­
age cost per ca of treatm and care on accoun of tuberculosis of
se
ent
t
the lungs w 363 m
as
arks ($86.39). Assum that the econ ic
ing
om
results of the treatm can be m
ent
aintained on an average for at least
five years after discharge, there w
ould accru a net gain to the insti­
e
tution of 437 m
arks ($104.01) in each case; that is, by deducting the
cost of treatm 363 m
ent,
arks ($86.39), from the am
ount w
hich w
ould
be required as a disability annuity for five years of 800 m
arks
($190.40). M
aking allow
ance for the differential duration of su
s­
tained earning capacity, it is sh n that if this duration w for
ow
ere
only four years th w
ere ould be a net gain to the institution of 277
m
arks ($65.93); and if for th years, of 117 m
ree
arks ($27.85). In
the case, how
ever, of patients retaining their earning capacity for
only tw years the loss w
o
ould b 43 m
e
arks ($10.23). W
ithout enlarg­
ing upon the details of the calculations by w
hich the econ ic gain
om
an loss w determ
d
as
ined it m be stated that it is estim
ay
ated that for
every 100 patients of the year 1901 discharged as successfully treated
th w a n saving in disabilityannuitiesof 2,900m
ere as et
arks ($690.20).
This figure w applied to the cases discharged during 1897 to 1906,
as
an for 159,802 patients there w calculated a net gain to the inva­
d
as
lidity in
suran institution of 4,631,300 m
ce
arks ($1,102,249.40).
It is adm
itted that objections m be raised against this estim
ay
ate,
but th are con ered in detail, and the con
ese
sid
clusion is reach that
ed
the facts w
arrant the assum
ption that the estim of gain is prob­
ate
ably under rather than over the actual am
ount realized. It is stated
1 Under the new regulations o f the Im perial Insurance Office the period o f observation
o f post-discharge results has been extended to six years.




22

BULLETIN OF THE BUBEAU OF LABOB.

that th average m after-lifetim in the case of tubercu
e
ean
e
lous dis­
ability annuitants is only four years for m and six years for
en
w en, or five years for both sexes com
om
bined, an that it m be
d
ay
safely assu ed that of the 34 per cen of tubercu
m
t
lous patients m
ain­
taining their earning capacity up to the fifth year a con
siderable
n ber w
um
ould retain their earning ability su u t to that period
bseq en
of tim It w also argued that vast financial gains m result to
e.
as
ust
poor-law authorities an d
d ecrease the cost of public support of
dependent survivors of those prem
aturely dying from the d
isease.
In addition to the financial results w
hich it w claim w
as
ed ould
accru to the G an invalidity in ran institutions from th su
e
erm
su ce
e c­
cessful treatm an care of tuberculous w
ent d
age earn in special
ers
sanatoria erected for the purpose, it w estim
as
ated by Bielefeldt that
upon th assum
e
ption of an average daily w
age of only 2 m
arks
(48 cents) (the net gain in w
ages earned as the result of prolonged
lifetim plus restored partial or com
e
plete earning capacity), the
159,802 patients treated an cared for during the period 1897 to
d
1906 represent for the five years of subsequently observed exp
erien
ce
a gain of 235,000,000 m
arks ($55,930,000) in w
ages. It w also
as
stated that w th cost of su treatm to the in ran institu­
hile e
ch
ent
su ce
tions w 56,000,000 m
as
arks ($13,328,000), the gross saving in dis:
ability annuities w 60,500,000 m
as
arks ($14,399,000), or a net gain
of 4,500,000 m
arks ($1,071,000). To this m be added th gain to
ust
e
poor-law authorities an sick funds an the addition to national
d
d
w
ealth and m
aterial w
ell-being, approxim
ately represented by 237,000,000 m
arks ($56,406,000) in additional w
ages earn by th
ed
ose
w ose w
h
age-earning capacity w restored for an average of at least
as
five years a th result of system an effective treatm an care
s e
atic d
ent d
in special institutions established for that purpose.
LEGAL PROVISION FOR TREATMENT AND CARE BY INVALIDITY
INSURANCE INSTITUTIONS.

The suggestion that the invalidity in ran institutions should
su ce
avail them
selves of the favorable opportunities offered by the special
exertions of the sick funds to dim
inish th m
e ortality and m
orbidity
from tuberculosis of the lungs in cases in w
hich the in
sured w
as
capable of recovery or im
provem for the purpose of lessening the
ent
burden of disability annuities originated in the im
perial in ran
su ce
departm
ent. The favorable exp
erien of sanatoria previous to 1899
ce
led to an extensive financial support of the efforts of th in ran
e su ce
institutions and, according to Bielefeldt, brought about the adoption
in the am d invalidity in
en ed
suran law of January 1,1900, of para­
ce
graphs 18 to 23 and 47, w
hich give legal sanction for the cooperation
of invalidity in ran institutions in the treatm and care of the
su ce
ent
tuberculous w earn insured w them
age
ers
ith
.



CAKE OF TUBEBCULOUS WAGE EABNEBS IN GEBMANY.

23

All lim
itations concerning the extent or the m
ethod of treatm
ent
w
hich m
ight have existed according to the law of 1891 w d e
ere on
aw w and the invalidity in ran institutions w therefore
ay ith,
su ce
ere
perm
itted to u their ow best judgm as to the am
se
n
ent
ounts to b
e
expended and the tim for w
e
hich they w to regard them
ere
selves as
respon
sible in undertaking cases for the treatm of the disease.1
ent
The in
suran institutions w perm
ce
ere
itted to sen th sick p
d e
erson
s
to hospitals or sanatoria for consum
ptives, or to health resorts or to
convalescent h es or to w
om
atering places, or even into private care,
and w further perm
ere
itted to pay th traveling expen to and from
e
ses
th places as an essen elem of cost in the treatm and care
ese
tial
ent
ent
of tuberculous w earners in
age
sured w them The treatm m
ith
.
ent ay
not b forced u the m bers, andthe m
e
pon
em
atter is entirely voluntary,
except in so far that the refusal to undergo su treatm m
ch
ent ight be
taken into accou t in the possible su
n
bsequ t paym of disability
en
ent
annuities conditioned m or less by optional advantages to the
ore
family of the in
sured. The ad
dress already qu
oted concluded w
ith
the suggestive statem that—
ent
The conviction m be expressed, after the experience of several
ay
years, that an effective battle against consum
ption am the w
ong
ork­
ing classes w
ould have b all but im
een
possible w
ithout the w
orkm
en’s
in ran of the G an Em
su ce
erm
pire, an by the support of their pow
d
er­
ful pecuniary resou
rces, an w the aid of rational social regula­
d ith
tions, in the end w are quite certain to b victorious.
e
e
NUMBER OF GERMAN WAGE EARNERS RECEIVING SANATORIUM
TREATMENT IN 1910.

In 1910, 46,717 patients received full institutional treatm on
ent
accoun of tuberculosis of the lungs, or at the rate of 3.19 per 1,000
t
of the population subject to the G an com
erm
pulsory invalidity insur­
an law as determ
ce s
ined by the occupation cen s of 1907. The rate
su
of adm
ission varied considerably from 0.67 per 1,000 for the Invalid­
ity Insurance Institution of M
ecklenburg, to 6.71 per 1,000 for the
G
rand Duchy of Baden and 7.17 per 1,000 for the pen
sion fund of
th im
e perial railw
ays. The details of adm
issions for each of the 41
institutions established to carry into effect the provisions of the
invalidity in ran law of 1900 are given in the table w
su ce
hich follows:
1 B ielefeldt, The battle against consumption as a sickness o f the people; address at the
British Congress for Tuberculosis, London, 1911.




24

BULLETIN OF THE BUREAU OF LABOR,

NUMBER OF PERSONS RECEIVING TREATMENT ON ACCOUNT OF TUBERCULOSIS
OF THE LUNGS, ACCORDING TO TERRITORIAL INSURANCE INSTITUTION, DURING
1910.
[From Statistik der Heilbehandlung bei den Versicherungsanstalten und zugelassenen
Kasseneinricbtim gen der Invalidenversicherung, p. 168. Published by Behrend & Co.,
Berlin, 1911.]
Persons treated.
Territorial invalidity insurance institutions.

Insured population.

Number.

Per 1,000.

East Prussia....................................................................................
West Prussia...................................................................................
Berlin..............................................................................................
Brandenburg...................................................................................
Pomerania..'!...................................................................................
Posen...............................................................................................
Silesia..............................................................................................
Saxony-Anhalt................................................................................
Schleswig-Holstein..........................................................................
Hanover..........................................................................................
Westphalia......................................................................................
Hesse Nassau...................................................................................
Rhine Province...............................................................................
Upper Bavaria............................. -.................................................
Lower Bavaria................................................................................
Pfalz................................................................................................
Upper Pfalz and Regensburg..........................................................
Upper Franconia.............................................................................
Middle Franconia............................................................................
Lower Franconia and Aschaflenburg..............................................
Swabia and Neuberg.......................................................................
Kingdom of Saxony........................................................................
Wurttemberg...................................................................................
Baden..............................................................................................
Hesse (Grand Duchy).....................................................................
Mecklenburg....................................................................................
Thuringia........................................................................................
Oldenburg.......................................................................................
Brunswick.......................................................................................
Liibeck, Bremen, and Hamburg....................................................
Alsace-Loraine.................................................................................
Prussia-Hesse Railroad Employees.................................................
North German Miners* Fund..........................................................
Saarbrucken Miners* Association....................................................
Bavarian Traffic Employees...........................................................
Saxony Railroad Employees* Fund...............................................
Saxony Miners* Fund.....................................................................
Baden Railroad and Salt Works Fund...........................................
Imperial Railroad Pension Fund....................................................
Bochum Miners* Union...................................................................
Marine Employees* Fund...............................................................

435,571
307,435
649,527
945,939
375,524
351,877
1,224,366
715,914
375,769
665,270
655,380
449,204
1,357,952
322,224
125,677
161,130
89,938
113,668
199,633
102,971
141,418
1,243,992
469,486
439,610
246,735
194,967
345,619
75,897
130,467
376,441
354,555
323,613
117,147
48,036
33,673
29,306
29,275
18,353
17,993
299,838
70,000

412
236
3,961
2,458
264
686
2,727
1,642
540
1,670
3,193
1,980
5,393
1,859
177
555
213
273
941
227
268
2,865
1,759
2,948
1,278
131
1,026
201
396
1, /ol
1,390
1,427
599
72
216
81
30
115
129
596
52

0.95
.77
6.10
2.60
.70
1.95
2.23
2.29
1.44
2.51
4.87
4.41
3.97
5.77
1.41
3.44
2.37
2.40
4.71
2.20
1.90
2.30
3.75
6.71
5.18
.67
2.97
2.65
3.04
4.60
3.92
4.41
5.11
1.50
6.41
2.76
1.02
6.27
7.17
1.99
.74

Total......................................................................................

14,631,093

46,717

3.19

COST OF SANATORIUM TREATMENT OF GERMAN WAGE EARNERS IN
1910.

The cost of treatm and care per person under treatm is h
ent
ent
ere
only briefly referred to, sin the facts are m fully d ssed in
ce
ore
iscu
another section of this report. The cost averaged 374 m
arks ($89)
per person treated and cared for during 1910, the cost having b
een
low in the case of the Invalidity Insurance Institution of Upper
est
Bavaria, or 154.74 m
arks ($36.83), an highest in the case of th
d
e
G
eneral M
iners’ Union of B
ochum or 714.39 m
,
arks ($170.02). The
details of th expenditures for each of the 41 institutions are given
e
in th table w
e
hich follows:



25

CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

COST OP TREATMENT OF PERSONS TREATED ON ACCOUNT OF TUBERCULOSIS OF
THE LUNGS, ACCORDING TO TERRITORIAL INSURANCE INSTITUTION, DURING
1910.
[Prom Statistik der Heilbehandlung bei den Versicherungsanstalten und zugelassenen
Kasseneinrichtungen der Invalidenversicherung, p. 168. Published by Behrend & Co.,
Berlin, 1911.]
Cost of treatment.
Territorial invalidity insurance institutions.

Persons
treated.

Amount.

412
134,035
East Prussia....................................................................................
West Prussia...................................................................................
22,089
Berlin..............................................................................................
465,851
3,961
Brandenburg...................................................................................
2,458
245,736
264
25,334
Pomerania. „T..................................................................................
Posen..............................................................................................
61,640
686
Silesia..............................................................................................
2,727
263,649
Saxony-Anhalt...............................................................................
1,642
153,507
Schleswig-Holstein..........................................................................
540
34,731
133,369
Hanover..........................................................................................
1,670
199,541
3,193
Westphalia......................................................................................
156,787
Hesse Nassau..................................................................................
1,980
463,142
5,393
Rhine Province...............................................................................
68,463
Upper Bavaria................................................................................
1,859
13,613
Lower Bavaria................................................................................
177
47,838
Pfalz................................................................................................
555
14,528
Upper Pfalz and Regensburg.........................................................
213
22,633
Upper Franconia............................................................................
273
941
78,645
Middle Franconia............................................................................
23,014
Lower Franconia and Aschaffenburg.............................................
227
21,791
Swabia and Neuberg......................................................................
268
275,840
Kingdom of Saxony........................................................................
2,865
W urttemberg..................................................................................
160,969
1,759
269,181
Baden..............................................................................................
2,948
109,666
1,278
Hesse (Grand Duchy)....................................................................
11,889
Mecklenburg...................................................................................
131
74,188
Thuringia........................................................................................
1,026
19,833
Oldenburg.......................................................................................
201
24,051
Brunswick......................................................................................
396
165,805
Liibeck, Bremen, and Hamburg....................................................
1,731
120,569
1,390
Alsace-Lorraine...............................................................................
143,159
Prussia-Hesse Railroad Employees...............................................
1,427
53,449
599
North German Miners’ Fund.........................................................
3,691
Saarbrucken Miners’ Association...................................................
72
25,852
Bavarian Traffic Employees...........................................................
216
11,298
81
Saxony Railroad Employees’ Fund..............................................
2,858
Saxony Miners’ Fund....................................................................
30
15,724
115
Baden Railroad and Salt Works Fund...........................................
12,202
Imperial Railroad Pension Fund...................................................
129
101,335
Bochum Miners’ Union.................................................................
596
7,061
52
Marine Employees’ Fund..............................................................
Total......................................................................................

46,717

4,158,555

Per
person
treated.
$82.61
93.60
236
117.61
99.97
95.96
89.85
96.68
93.49
64.32
79.86
62.49
79.18
85.88
36.83
76.91
86.19
68.20
82.90
83.58
101.38
81.31
96.28
91.51
91.31
85.81
90.76
72.31
98.67
60.74
95.79
86.74
100.32
89.23
51.26
119.69
139.48
95.26
136.73
94.59
170.02
135.78
89.02

The total am
ount expended for treatm an care of tubercu
ent d
lous
w earn in the G an Em
age
ers
erm
pire during 1910 in special sanatoria
erected for the purpose w 17,472,920 m
as
arks ($4,158,555). In addi­
tion to this am
ount large expenditures have been in rred in m
cu
ethods
of prevention and in a system national cam
atic
paign against tubercu
­
losis, w
hich has had the active cooperation of in ran institutions
su ce
an of the governing authorities of the Em
d
pire an of th several
d
e
States, principalities, m
unicipalities, an com u es. The am
d
mn
ount
expended on accou t of tubercu
n
losis prevention in the United States
in 1909, according to the assistant secretary of th National Associa­
e
tion for the Study an P
d revention of Tuberculosis, w $8,025,000, of
as
w
hich 53.5 per cen w from public funds. In 1910 the am
t as
ount w
as



26

B U LLETIN OF TH E BUREAU OF LABOR.

$14,740,000, of w
hich 62.6 per cent w from public funds, an in
as
d
1911 the am t expended w $14,450,000, of w
oun
as
hich 66.2 per cen
t
w derived frompublic reven es. It is extrem suggestive that th
as
u
ely
e
am
ount expended through associated effort in the United States in
the cam
paign against tuberculosis shouldhave progressively d
ecreased
from $975,000 in 1909 to $500,000 in 1911; that the am
ount expended
on accou t of m
n
iscellaneous tuberculosis w should have d
ork
ecreased
from $1,800,000 in 1910 to $1,300,000 in 1911, an that the am t
d
oun
expended on accoun of tuberculosis dispensaries, w
t
hich constitute
one of the m effective aids in the cam
ost
paign against the d
isease,
should have d
ecreased from $890,000 in 1910 to $850,000 in 1911. It
m further be stated that the am
ay
ount expended on accoun of
t
sanatoria in the United States in
creased from $11,300,000 in 1910 to
only $11,800,000 in 1911, but how m of this expenditure w for
uch
as
the benefit of tuberculous w earners is not a m
age
atter of record.1 i
The progressive in
crease in the am ts expended by G an
oun
erm
invalidity in
suran institutions indicates that the G an effort to
ce
erm
control and slow eradicate the d
ly
isease rests upon a m secu
ore
re
foundation. In part this result is to be ascribed to the financial
interest w
hich G an invalidity insurance institutions have in the
erm
actual reduction in the m
ortality and m
orbidity from tuberculosis,
as w as in the cu of patients w ose invalidity w
ell
re
r
h
ould entail a con
­
siderable econ ic burden upon the institutions, aside fromthe addi­
om
tional, cost of support for dependent w
idow and orphans, either
s
through the invalidity in ran institutions or public and private
su ce
poor relief. The im
portance of the econ ic aspects of the subject
om
w
arrants a som h m extended statem of the view and con
ew at ore
ent
s
­
clusions of recognized G an authorities on the subject.
erm
RESTORATION OF EARNING CAPACITY OF WAGE EARNERS RESULTING
FROM SANATORIUM TREATMENT.

In an im
portant statistical study of the results of sanatorium
treatm for tuberculosis of the lungs, by Dr. Otto Baer,2based on
ent
the experience of 22 sanatoria, w 8,568 patients, it w ascertain
ith
as
ed
that 3,932, or 45.9 per cent, w in the first stage of the disease;
ere
2,904, or 33.9 per cent, w in the secon stage; and 1,732, or 20.2
ere
d
per cent, w in the third stage. It w pointed out that the results
ere
as
m depen largely upon the condition of the patients on adm
ust
d
ission,
and that, of cou if the proportion of patients in the advan
rse,
ced
stages of the d
isease is too large the results could not possibly be
satisfactory. On discharge 3,850, or 44.9 per cen had their earning
t,
capacity fully restored; 3,760, or 43.9 per cent, had their capacity
1 The Survey, Jan. 20, 1912.
2 Statistische Beitraege zur Beurteilung des Wertes der Heilstaettebehandlung bei Lungentuberkulose, von Dr. Otto Baer. Bucbdruckerei Hermann & Otto Hallanzy, Zweibruecken, 1909.
,




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

27

partly restored; and only 958, or 11.2 per cent, were entirely unsuc­
cessful cases. Taking the patients admitted in the third stage o f the
disease only, the results were naturally much less satisfactory, and
only 5.2 per cent were discharged with their earning capacity fully
restored; 46.6 per cent with their earning capacity partly restored;
and 30 per cent were entirely unsuccessful cases. Even to this extent,
however, it would seem that the results o f the treatment were not
disproportionate to the probable expense.
The same writer found that out o f 2,255 patients admitted to the
sanatoria at Belzig during the period 1900 to 1906, 13.1 per cent
had been discharged as cured; 61.7 per cent as im proved; 19.3 per
cent as unchanged; 5 per cent as worse, and 0.9 per cent as having
died. In the experience o f the sanatoria at Marienheim 57 women'
patients had been under observation for nine years, and o f these
78.9 per cent were still in fu ll possession o f their earning capacity,,
19 per cent were partly able to earn their living, and only 1.8 per1
cent were entirely incapacitated.
An analysis o f 1,668 cases o f tuberculosis patients reexamined after
they had been two years discharged from the sanatorium at Holsterhausen-Werden-by-Essen, in the Rhine Province,1 where they were
treated, showed that 61.2 per cent were still in possession o f their
full earning capacity, 17.5 per cent retained a partial capacity for
work, 7.1 per cent were unable to work, and 14.2 per cent had died.
O f 879 patients controlled or supervised* for four years and re­
examined, 53.5 per cent had retained their full earning capacity,
14.2 per cent had retained a partial earning capacity, 7.1 per cent
were unable to work, and 25.2 per cent had died. These percentages,
however, must be accepted with some caution, in that they appar­
ently do not have reference to the original numbers discharged, but
to the numbers fo r which the inform ation could be secured. It is to be
assumed, however, that the number o f cases for which no inform a­
tion could be obtained was relatively small. In the opinion o f this
authority the results achieved had exceeded the expectations, but the
effort would have been hopeless but for the financial and general
cooperation on the part o f the invalidity insurance institutions.
The same writer estimates the number o f tuberculous patients in
the German Empire at 800,000, for which, o f course, the means do
not exist to afford to each sufferer effective treatment in a sanatorium
especially established for the purpose. Assuming for the present
discussion that the number o f such patients is as stated, the 46,717
patients provided with treatment during 1910 constituted 5.8 per
cent o f the total number o f tuberculous patients in the German Em­
pire, exclusive o f the patients afflicted with tuberculosis other than
1Die Lungenheilst&tten im Lichte der historischen Entwicklung der Tuberkulose-Bek&mpfung yon Chefarzt Dr. F. Kohler, Heilst&tte-Holsterhausen-Werden bei Essen (Ruhr).




B U LLETIN OF TH E BUREAU OF LABOR*

28

tuberculosis of the lungs and larynx. Of cou the G an cam
rse,
erm
­
paign against tuberculosis com
prehends a vast .organ
ization su
b­
sidiary to th sanatorium treatm an care of tuberculous w
e
ent d
age
earn at th exp se of the invalidity in
ers
e en
suran institutions.
ce
In discussing the statistical data o f sanatorium treatment as subse­
quently considered in detail, the German Central Committee empha­
sizes especially the remarkable results obtained for employees through
sanatorium treatment in behalf o f the members o f the pension fund
o f the Prussian-Hessian railways.1 The general data o f this fund for
each year, 1904 to 1910, are given in tabular form as follow s:
TREATMENT AND CARE, ON ACCOUNT OF TUBERCULOSIS OF THE LUNGS, OF
MEMBERS OF THE PRUSSIAN-HESSIAN RAILWAYS PENSION FUND, BY YEARS,
1904 TO 1910.
Patients
treated on Rate per Cost of treatment
Average
account of
and care (includ­
1,000
membership. tubercu­ members. ing family sup­
losis of the
port).
lungs.

Years.

1904 ......................................................................
1905........................................................................
1906........................................................................
1907........................................................................
1908........................................................................
1909........................................................................
1910........................................................................

256,934
272,478
292.435
324,241
327.436
314,268
319,694

716
810
1,180
955
1,152
1,268
1,422

2.79
2.97
4.04
2.95
3.52
4.04
4.45

$92,571.36
116,635.92
132,818.56
111,556.55
124,586.08
132,980.42
143,145.99

The experience o f the fund since 1904 is given in detail in the fo l­
low ing table, with the statistics for 1905 carried forward to 1910:
ECONOMIC RESULTS OF SANATORIUM TREATMENT FOR TUBERCULOSIS OF
THE LUNGS, OF EMPLOYEES OF THE PRUSSIAN-HESSIAN RAILWAYS SYS­
TEM, BY YEARS, 1904 TO 1910.

Years.

1904.................
1905.................
1906.................
1907.................
1908.................
1909.................
1910.................
i,

Patients fully able to work after—
Number
of pa­
tients un­
lyear.
2 years.
3 years.
4 years.
5 years.
6 years.
der full
treat­
ment. Num­ Per Num­ Per Num­ Per Num­ Per Num­ Per Num­ Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
716
810
1,180
955
1,152
1,268
1,422

585
691
1,013
775
951
1,095
1,221

81.7
85.3
85.8
81.0
82.6
86.4
85.9

534
621
921
697
869
917

74.6
76.7
78.1
73.0
75.4
72.3

477
582
861
658
866

66.6
71.9
73.0
68.9
75.2

451
552
824
626

63.0
68.2
69.8
65.6

427 59.6
528 65.2
815 69.0

519

64.0

The im
portance of concentrating the treatm upon patients in
ent
th secon stage of„the d
e
d
isease is em
phasized by the physician in
charge of the M
uellrose Sanitarium in the belief that patients in the
,2
1 Annual report for 1911, p. 20.
2 Das Krankenmaterial und die therapeutischen Leistungen der Lungenheilstaetten,
von Dr. H. Ulrici, Chefarzt der Heilstaette Muellrose. Reichs-Medizinal-Anzeiger, Jahrg.
1910 (Sonderabdruck).




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

29

first stage could, to advantage, be taken care o f in less expensive and
less highly specialized institutions. F or these he recommended con­
valescing homes or forest camps, except in the case o f patients in the
first stage with fever and who have bacilli in the sputum; such, o f
course, should be treated in a sanatorium. A further recommenda­
tion was made that all such patients should continue under medical
observation fo r at least one year.
The hope was held out that the results o f sanatorium treatment
may be further improved and that it may safely be expected that at
least in 70 per cent o f the cases the earning capacity o f the patients
can be restored for a reasonable period o f time. The actual cost o f
515 marks ($122.57) per case o f successful treatment, including the
expense o f the unsuccessful cases, was considered as fu lly justified
by the results.
According to the experience o f Dr. W eicker, o f Gobersdorf,1 pub­
lished in 1905, on the basis o f 3,299 cases treated in his institution
during the period 1895 to 1900, the conclusion seemed warranted that
cases in the incipient stage o f the disease did not necessarily produce
the best results. The statement is made that even fairly advanced
cases gave promise o f successful results, provided the treatment was
effected under otherwise satisfactory conditions. According to this
authority, o f those discharged from his institution, who, on admis­
sion, were in the second Turban stage o f the disease, there were, after
three years, still 51 per cent in full possession o f their earning ca­
pacity, and after four years 50.9 per cent; even o f those admitted in
the third stage o f the disease after four years there were still 17.8
per cent able to work.
The fact that the results o f treatment had gradually improved and
that successful cures, with a complete restoration o f earning capacity,
had been obtained among patients even in the third or far advanced
stage o f the disease was emphasized in 1901 by the director o f the
Friederichsheim Sanatorium.2 He stated that, as a rule, incapacity
fo r work fo r a more or less extensive period o f time precedes the
admission o f patients in the second and third stages o f the disease,
leaving the question open whether such economic disability was very
much less frequent among patients in the first Turban stage o f the
disease.3 O f all the patients treated, 42.6 per cent were in the first
stage, 21*6 per cent in the second stage, and 36.1 per cent in the third
stage.4 Evidently a disproportionately large number were in the
1Beitraege zur Frage der Volksheilstaetten, yon Dr. Weicker, Gorbersdorf. Berlin,
1905; Verlag: Medizinischer Verlag.
2Beitrag zur Bewertung der Heilstaettebehandlung Lungenkranker, von Direktor Dr.
E. Rumpf, Heilstaette Friederichsheim, Separatabdruck aus der Muenchener medizinischen
Wochenschrift, No. 38. 1904.
8 For classification of stages of tuberculosis, see p. 83.
4 These are the percentages given in the original report
Since they add to 100.3, there
Is apparently an error, but it is not of material importance.




30

BU LLETIN OF TH E BUREAU OF LABOR.

third or far advanced stage o f the disease. According to the analysis
o f the patients in the first stage o f the disease, there were after four
years still 70 per cent in possession o f their earning capacity, while
the corresponding proportion o f the patients who had died in the
third stage o f the disease was 63 per cent. In other words, nearly
as large a proportion o f those admitted in the third stage o f the dis­
ease for treatment had died as were still at work after four years o f
those admitted in the first stage o f the disease. The proportion
retaining their earning capacity admitted in the second stage o f the
disease was 55 per cent and in the third stage 23 per cent. These
results, it is declared, furnish conclusive evidence that the treatment
and care o f tuberculous wage earners in sanatoria must be considered
a success, and the rule is laid down, on the basis o f actual experience,
that it may safely be expected that o f the patients admitted in the
first Turban stage o f the disease three-fourths, and o f those in the
second stage over one-half, and o f those in the third stage at least
one-fourth w ill retain their earning capacity for from three to four
fu ll years after their discharge and to this extent relieve the inva­
lidity insurance institutions from the payment o f disability annuities.
In an extended discussion on the importance o f sanatoria in the
warfare against tuberculosis as a wage earners’ disease, one medical
authority1 considers the entire available material and comes to the
conclusion that the economic results in the case o f patients admitted
in the first stage o f the disease may be placed at 72 per cent, in the
second stage at 57 per cent, and in the third stage at 22 per cent;
but in the event that the tuberculin method is employed the results
are materially improved, with respectively 95 per cent for patients
in the first stage, 82 per cent fo r the second stage, and 50 per cent
fo r the third stage. The opinion is emphatically expressed that the
results o f sanatorium treatment, from an economic point o f view,
have fu lly justified the large expenditures incurred and that the oppo­
site conclusions o f Cornet are disproved by the facts o f actual and ex­
tensive experience. W ith regard to the cost o f treatment the author
points out that the average expense per bed per day may be placed
at from 5 to 7 marks ($1.19 to $1.67), and that the average expense
per day for board and treatment may be placed at 3 marks 50 pfennigs
to 4 marks ($0.83 to $0.95). Large institutions are not favored, but
sanatoria with from 100 to 150 beds are preferred. It is pointed out
that during 23 years the m ortality from tuberculosis in the German
Em pire has been decreased about 50 per cent, and that this result, in
part at least, has been through the systematic and effective treatment
o f patients in special sanatoria. However, the necessity for munici­
i Die Bedeutung der deutschen Lungenheilst&tten fuer die Bekampfung der Tuberkulose als Volkskrankheit, von Dr. med. Fr. ScMrmann, Stadtassistenzarzt, Dusseldorf.
Sonderabdruck aus der Vierteljahrsschrift fuer gerichtl. Medizin und oeffentliches
Sanitatswesen 3. Folge. XLI. 1.




CAKE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

31

pal and rural dispensaries, as well as day camps and other institutions
for the treatment o f cases not suitable for sanatoria, is emphasized.
In conclusion, suggestion is made as to the importance o f providing
suitable employment for discharged patients, and the official notifica­
tion o f cases o f tuberculosis is regarded as absolutely essential.
The annual report o f the German Central Committee fo r 1911 di­
rects especial attention to the results obtained by the Hanseatic
League, which is the invalidity insurance institution established for
the free cities o f Hamburg, Bremen, and Liibeck. According to this
experience, o f the male patients under treatment during the period
1895 to 1901 for a longer period than four weeks, there were at the
end o f 1910, o f those admitted in the first stage o f the disease, 63 per
cent in fu ll possession o f their earning capacity; in the second stage,
52 per cent; and in the third stage, 22 per cent. The corresponding
per cents for women were 66 for the first stage, 66 for the second
stage, and 26 for the third stage. In addition thereto a fairly large
proportion had retained a limited earning capacity. O f the male
patients in the first stage, 25 per cent had died; in the second stage,
31 per cent; and in the third stage, 65 per cent. The corresponding
percentages fo r the female patients were 11 for the first stage, 12
for the second stage, and 59 for the third stage.
In an address before the International Congress on Social Insur­
ance, held in Vienna in 1905,1 the statement was made that o f 100
tuberculous male annuitants in the experience o f German invalidity
insurance institutions, at ages 25 to 29, there survived after one year
only 17 and after four years only 4, so that in all probability the
maximum duration o f the disease in moderately advanced cases
entitling the insured to a disability annuity would be less than five
years. In contrast, it was pointed out that o f every 100 nontuberculous disability annuitants, ages 25 to 29, there were, after one
year, still 69 in receipt o f their annuities, proving the much more
serious and fatal character o f tuberculosis o f the lungs when con­
trasted with other diseases considered as a group.
In this connection it may be stated that out o f 366,327 disability
annuitants under observation during the period 1891 to 1899, only
5,474 had been discontinued up to 1903 as recipients o f annuities on
account o f the recovery o f their earning capacity.2 In other words,
when once a disability annuity is granted it is a question o f remote
contingency whether the same w ill be discontinued within a reason­
able period o f time on account o f restored earning capacity. This,
o f course, in German experience, may be due to the fact that such
annuities are granted only when the disease causing the disability has
1 Invalidenversicherung und Volksgesundheit (Heilverfahren), von. Bielefeldt. Internationaler Arbeiterversicherungs-Kongress, 17. bis. 23. September. Wien, 1905.
2 Amtliche Nachrichten des Reichsversicherungsamts, 1906, I Beiheft, pp. viii and ix.




32

BU LLETIN OF TH E BUREAU OF LABOR.

been determined to be o f a sufficiently serious nature, and it requires
to be said that no such annuities are granted until after the sick­
ness has continued 26 weeks, during which time the sick funds are
responsible fo r the maintenance and medical care o f the insured.
COMPARATIVE RESULTS OF INSTITUTIONAL AND NONINSTITUTIONAL
TREATMENT.

An attempt has been made to determine the comparative results
o f tuberculous patients treated in sanatoria and tuberculous patients
treated in their homes. From a study o f the sickness records o f the
Leipzig Communal Sick Fund, o f 188 tuberculous male patients ob­
served during the period 1890 to 1893, when no sanatorium treat­
ment had been in use, it was ascertained that after three years 74
per cent had died; after four years, 88 per cent; and after five years,
93 per cent.1 Granting objections to the absolute accuracy o f the
data and admitting the probably serious or advanced condition o f
the patients, the facts themselves can not be set aside as irrelevant
or inconclusive.
A special inquiry,2 however, was made with regard to 502 pa­
tients— constituting 4.6 per cent o f all the tuberculous patients under
consideration by the Invalidity Insurance Institution o f the Hanse
Towns in 1901—who had been for various reasons rejected or con­
sidered unsuitable fo r treatment. These patients were carefully ob­
served and reexamined from time to time, and it was ascertained in
1907—that is, after six years—that 41.8 per cent were drawing dis­
ability annuities, 30.3 per cent had died, and only 18.5 per cent were
at work and still members o f the insurance institution. Bielefeldt
compares these results with 715 tuberculous members, who, in 1900,
upon their own application, had been treated and cared for in the
sanatoria o f the Invalidity Insurance Institution o f the Hanse
Towns. B y 1905—that is, after six years—only 11 per cent o f these
patients were drawing disability annuities and only 18 per cent had
died, leaving 49.9 per cent in possession o f their fu ll earning capacity
and 15.4 per cent without a serious impairment o f their earning
capacity, or 65.3 per cent o f the patients after six years were not
drawing any disability annuities on account o f the disease fo r which
they had been successfully treated in the sanatoria provided for that
purpose. According to Bielefeldt’s special investigations, after six
years, o f those who had not been treated and cared for in sana­
toria, 72 per cent had died, against 29 per cent o f those who had
been treated and cared fo r in sanatoria during the same period o f
time. There was therefore a substantial saving in life and in earning
capacity which may safely be considered conclusive evidence o f the
1 Die bisherigen Leistungen der Heilstatten by von Bielefeldt.
2 Transactions German Central Committee, Berlin, May 23, 1907.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

33

social and economic value o f systematic and effective treatment o f
tuberculous wage earners in special institutions provided for that
purpose.
COMPARATIVE RESULTS OF HOSPITAL AND SANATORIUM TREATMENT.

An examination was made by B aer1 into the point raised by
Cornet, that similar results could have been secured in ordinary hos­
pital practice. Making a comparison between the data o f hospital
treatment furnished by De la Camp o f the patients admitted in 1895,
only 28 per cent were in possession o f their earning capacity in 1899;
but according to the data furnished by Seiche for tuberculous pa­
tients treated in sanatoria, 80 per cent o f those admitted in 1895 were
still able to earn their living in 1899. Similar results in favor o f
sanatorium treatment, from an economic point o f view, are given for
subsequent years, so that the contention by Comet* may be consid­
ered as having been conclusively disproved. Burckhardt, among
others, is quoted in the statement that—
It is self-evident that the results o f sanatorium treatment are de­
cidedly more satisfactory than those secured by other methods o f
treatment for tuberculosis o f the lungs, but particularly in two direc-.
tions, i. e., the death rate is less and the duration o f continued earning
capacity is much longer.
A table derived from the data o f hospital treatment furnished by
Stadler and the sanatorium statistics furnished by W alther, compar­
ing the subsequent mortality o f 100 patients, is given below :
COMPARATIVE MORTALITY IN HOSPITALS AND SANATORIA OF PATIENTS TREATED
FOR TUBERCULOSIS OF THE LUNGS.
Percentageofmortality.
Duration.

After 1 year______- ______
After 2 years......... ............
After 3 years......................
After 4 years......................

Hospital Sanatorium
treatment treatment
(Stadler). (Walther).
4.8
18.3
27.3
33.0

4.2
10.7
15.8
18.7

Percentage ofmortality.
Duration.

After 5 years....................
After 6 years....................
After 7 years....................

Hospital Sanatorium
treatment treatment
(Stadler). (Walther).
40.3
45.9
55.8

20.2
21.5
23.0

The foregoing comparison seems to show conclusively the decided
advantage o f sanatorium over hospital treatment for tuberculosis
o f the lungs in so far as a material reduction in the death rate is con­
cerned. Stadler estimates that by means o f sanatorium treatment it
is possible to secure at least an average duration o f subsequent earning
capacity o f five years; and Baer states that the average annual mor­
tality rate may be assumed to be 5 per cent. These, o f course, are
1 Statistical Contributions to the Tuberculosis Question, by Dr. Otto Baer. Zweibriieken,
1909.

49397°— 12----- 3




34

BU LLETIN OF TH E BUREAU OF LABOR.

very much better than the corresponding results secured by the usual
methods o f hospital treatment for tuberculosis o f the lungs. Baer
sums up his conclusions as follow s: The sanatorium treatment un­
questionably has been a success, but preference in the admission o f
patients should, o f course, be given to those who are in the first and
second stages o f the disease. Patients in the third stage, with only
one lung involved, may be admitted with the reasonable expectation
that a fairly large proportion o f successful results w ill be secured.
Special attention is necessary in the case o f patients who are treated
at home on account o f the liability to infect other members o f the
fam ily. The duration o f treatment may safely be diminished in the
case o f patients in the first stage o f the disease, but the duration
should be adjusted to the particular circumstances and no hard and
fast rule should be adopted. Patients in the third stage o f the disease
should be treated in small hospitals or small special institutions to
avoid the discouraging surroundings resulting from a large number
o f cases o f incurables.
ORGANIZATION AND ACTIVITIES OF THE GERMAN CENTRAL COM­
MITTEE FOR THE PREVENTION OF TUBERCULOSIS.

The foregoing brief account has been lim ited to the general aspects
o f the tuberculosis problem in Germany so far as the prevalence o f
the disease is a question o f public concern, with special reference to
the financial burdens resulting therefrom to the invalidity insurance
institutions. In addition thereto, o f course, a vast amount o f effort
exists in connection with the administrative control o f tuberculosis,
and numerous philanthropic and other institutional efforts are being
made to reduce the liability to the disease by various methods, which
are more or less the same throughout the civilized world. The ac­
count would not be complete, however, without at least a brief ex­
planation o f the activity o f the German Central Committee for the
Prevention o f Tuberculosis,1 which has been in active operation
since 1896.
Am ong other subjects discussed in the annual report o f the com­
mittee are the questions o f fam ily support during the treatment o f a
patient and the care o f the patient after discharge from the sana­
torium ; the importance o f supplementary treatment is recognized,
and the establishment o f convalescing homes and day and night
camps is advised to a much larger extent than is at present the case,
although much progress has been made in this direction during recent
years. It is pointed out that in all such cases it is o f the utmost im­
portance that the patient, after discharge, shall continue the sanitary,
wholesome, and otherwise healthful mode o f life acquired while in the*
*Der Stand der Tuberkulose-Bekaempfung im Fruehjahre 1911, yon Prof. Dr. Nietner,
Generalsekretaer des Zentral-Komitees. Berlin, 1911.




CARE OP TUBERCULOUS WAGE EARNERS IN GERM ANY.

35

sanatorium, and this, o f course, to a certain extent necessitates med­
ical and other supervision for a reasonable period o f time after dis­
charge. It is properly pointed out that it serves no real economic
purpose to provide adequate treatment and care in special insti­
tutions i f after discharge through lack o f proper care a relapse
occurs. It is therefore suggested that the term “ able to work ” be
construed with more caution, and that as far as practicable tuber­
culous patients discharged from public sanatoria should be provided
with work suitable to their condition as a reasonable safeguard
against a relapse.
In conclusion, the prevention o f the disease is enlarged upon and
the duty o f intelligent public education in the essential factors o f
the problem is emphasized, with particular reference to tuberculosis
exhibits. It is pointed out that tuberculosis is largely a social disease
and most intimately related to housing and living conditions. It is
stated also in this connection that much is being done by German in­
validity insurance institutions to bring about better housing conditions
fo r the wage-earning population, and that up to December 31, 1911,
the immense sum o f 318,016,000 marks ($75,687,808) had been loaned
fo r building purposes at rates o f interest not exceeding 3.5 per cent.1
DISPENSARIES AND INFORMATION BUREAUS.

In the report for 1911 emphasis is laid upon the imperative neces­
sity for more tuberculosis dispensaries, including information bureaus,
which are now considered as absolutely essential in the active warfare
against the disease. A special commission was authorized to promote
efforts in this direction and to collect all necessary inform ation having
reference thereto. W ith regard to organization, the question was
debated as to the sources from which income should be derived, and
the best means o f securing the cooperation o f physicians, nurses, etc.,
as well as all other public and private institutions having an active
interest in welfare work. The specific objects o f dispensaries o f this
kind were stated to be (1) competent advice to and provision for the
care o f tuberculous patients; (2 ) competent medical examination o f
members o f the patients’ fam ilies; (3) education and instruction with
regard to the risk o f infection, the conditions o f work in their rela­
tion to the disease, etc.; (4) the collection o f the sputum; (5) the sani­
tary handling o f the patients’ laundry; (6) the effective isolation o f
the patient in the hom e; (7) the disinfection o f homes infected by
tuberculous patients; and (8) material or pecuniary assistance. In
addition thereto the commission considered the best method o f utiliz­
ing the scientific material obtained through establishments o f this
kind.
On January 1,1911, the committee had a membership o f 1,501 per­
sons, and its income during 1910 was derived from 39,877 marks
1 Amtliche
 Nachrichten des Reichsversicherungsamts, No. 3, p. 529. Berlin, 1912.


36

B U LLETIN OF TH E BUBEAU OE LABOR.

($9,491.76) in membership fees, an imperial subsidy o f 60,000 marks
($14,280), a g ift o f 15,000 marks ($3,570) from the Association for
W elfare Stamps, and 16,245 marks ($3,866) from other sources. It
had on hand on January 1, 1911, funds to the amount o f 370,349
marks ($88,143.06), and it made during the year the follow ing dis­
bursements: The sum o f 177,300 marks ($42,197.40) was paid out on
account o f financial aid to sanatoria and other tuberculosis institu­
tions; 30,000 marks ($7,140) was expended on account o f lupus
treatment; 33,317 marks ($7,929.45) fo r tuberculosis exhibits; 29,081
marks ($6,921.28) on account o f administrative expenses; and the
remainder for printing, meetings, exhibits, traveling, etc.
TREATMENT AND CARE OE TUBERCULOUS CHILDREN.

The treatment and care o f tuberculous children is brought forward
as a rather new but most important question in the administrative
control o f tuberculosis, and startling evidence has been adduced to
show that the disease is usually contracted in childhood but remains
latent until early adolescence, when, under favorable conditions, the
disease becomes active in an acute or chronic form , as the case may
be. This, however, is a medical rather than an economic question,
but it may be said that the imperative need o f adequate medical
inspection o f school children and the equally important medical
supervision o f children and young persons at work are recognized as
necessary steps toward the gradual reduction and eradication o f the
disease. Special emphasis, however, is placed upon the duty o f
employers to provide more satisfactory working conditions, par­
ticularly with regard to the prevention o f industrial dust. In addi­
tion to all o f the foregoing, attention is directed to the importance
o f personal hygiene and o f outdoor exercise and light manual labor
in gardens and on farms, to the prevention o f infection in convey­
ances used for purposes o f public transportation, to the prevention
o f spitting in public places, and to the intimate relation o f tubercu­
losis to abuse o f alcoholic drinks.
PRESENT STATUS OF AGENCIES FOR PREVENTION AND CURE OF
TUBERCULOSIS.
SANATORIA.

Summarizing the status o f tuberculosis prevention and cure in the
German Empire in the spring o f 1911, it is stated that there were
then in Germany 99 public sanatoria and three other institutions for
tuberculous patients in the various stages o f the disease. These 102
institutions provided 6,706 beds for male patients and 4,301 for female
patients, and 1,058 beds for both male patients and female patients, a
total o f 12,065 beds. In addition thereto 34 private sanatoria pro­



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

37

vided 2,121 beds, or a total o f 14,186 beds for adult curable tuber­
culous patients. Therefore, on the basis o f an average length o f
stay o f three months, the bed accommodation provides for 56,700
patients. F or tuberculous children there are now 22 sanatoria, with
1,000 beds; and in 86 institutions, with 8,122 beds, provision is made
for tuberculous and scrofulous children, chiefly, however, during the
summer months.
FOREST HOMES AND AGRICULTURAL COLONIES.

There are 99 forest convalescing homes or camps, chiefly open
during the daytime, but in some cases also for night accommodation
during the summer months. A very small number remain open
during the winter months. In some o f the forest homes provision is
made for-the education o f tuberculous children receiving treatment
therein. The number o f such forest schools, in which a fu ll course
is provided, is at the present time 15. The number o f agricultural
colonies remains rather small, the experiment not having been found
entirely satisfactory. Convalescing homes exist for tuberculous per­
sons, in addition to persons suffering from pther causes, but the
number o f such is not stated. For a careful selection o f patients
preliminary to admission to sanatoria, 34 observation stations or
special dispensaries have been established.
HOMES AND INSTITUTIONS FOR ADVANCED CASES.

F or tuberculous patients in the advanced stage o f the disease there
are 144 invalidity homes or asylums, or special sections in general
hospitals. Institutions o f this kind, however, have not met with much
favor among wage earners, who, in the advanced stage o f the disease,
prefer to remain with their families. On account o f this fact it has
been found necessary to concentrate recent efforts upon the further
establishment o f tuberculosis dispensaries, clinics, and information
bureaus, o f which there are now 525, exclusive o f 537 tuberculosis
associations in the Grand Duchy o f Baden, which exercise somewhat
similar functions. There are also 20 polyclinics, which provide
much the same accommodation and treatment as tuberculosis dis­
pensaries, the chief point o f difference being that these institutions
also provide fo r other patients and only in rare cases fo r the ma­
terial needs o f the patients5 families.
CONCLUSIONS IN REGARD TO WORK OF GERMAN CENTRAL COMMITTEE.

The activities o f the German Central Committee are so extensive
and varied that the foregoing account portrays but inadequately the
work which is done through its organization in the warfare in the
German Empire against tuberculosis, chiefly among the wage earners.



38

B U LLETIN OP T H E BUBEAU OF LABOR.

The organization has the active and intelligent cooperation o f the
numerous official bodies and authorities charged with public health
or police functions, as well as a large number o f philanthropic and
other organizations engaged in similar efforts, though, o f course, on
a lesser scale than the central committee itself. Foremost among
the public authorities engaged in the active warfare against tuber­
culosis are the imperial board o f health and the health authorities
o f the principal States and o f the larger cities and communes. It
may be said, in conclusion, that the Empire itself contributes annu­
ally 100,000 marks ($23,800) toward the campaign against tuber­
culosis, and that o f this sum 60,000 marks ($14,280) is paid to the
German Central Committee. It is evident, therefore, that the
administrative control o f the disease o f tuberculosis has been intelli­
gently coordinated to the nation-wide effort to reduce, for humane,
social, and economic reasons, the m ortality and m orbidity to a mini­
mum. It is further made evident by the statistical account o f
tuberculosis frequency in the German Empire that these efforts have
been quite successful. Finally, it is shown by the experience data o f
German invalidity insurance institutions that the expenditures in­
curred in the systematic and effective treatment o f the disease have
been justified by the economic results secured. T o the extent that
this has been the case the material welfare o f the German Em pire
in general, and its wage-earning population in particular, has been
substantially advanced during the last two decades, and probably
more so in this respect than in any otjier country in the world.
TREATMENT OF TUBERCULOUS WAGE EARNERS IN PUBLIC INSTITU­
TIONS, 1896 TO 1901.

In 1908 the German Im perial Board o f Health published a com­
prehensive report on the results o f institutional treatment for tuber­
culosis, derived from the experience o f 21 large public sanatoria
and 12 small institutions. In addition, the investigation included
the experience o f 2 large and 3 small private institutions fo r the
treatment and cure o f tuberculosis. The data, derived from the
experience o f the years 1896 to 1901, represented 15,869 male and
4,008 female patients in public sanatoria and 833 males and 469
female patients in private sanatoria. The method o f inquiry was by
means o f special cards provided by the imperial board o f health,
one being provided fo r each patient under systematic treatment and
care, excluding all those who had undergone less than six weeks’
treatment in sanatoria. A further exclusion was made o f those pa­
tients in whom tuberculosis was only suspected, the investigation be­
ing limited to patients in whom the disease had been objectively
established either by bacteriological or clinical methods or by means



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

39

o f the tuberculin test. Since the patients in private institutions were
only to a lim ited extent o f the wage-earning class, and comparatively
few in number, it would serve no useful purpose to consider the
same in the present investigation, and the follow ing discussion is
therefore limited to patients in public institutions, chiefly such as
were maintained by German invalidity insurance institutions.
HOW COST OP TREATMENT IS PROVIDED POR.

In the case o f patients in public sanatoria, the cost o f treatment
o f 79.5 per cent o f the males and o f 77.9 per cent o f the females was
provided for by these institutions. In addition, the sick funds on their
own account provided treatment fo r 6.1 per cent o f the male patients
and 1.2 per cent o f the female patients, while the industrial accident
associations paid for 0.6 per cent o f the male patients and for 0.07
per cent o f the female patients. In the aggregate, therefore, 86.2
per cent o f the male patients and 79.2 per cent o f the female patients
had their treatment provided fo r in accordance with provisions o f
the imperial social insurance laws. O f the remainder, the cost o f
treatment was provided for by public authorities in the case o f 2.3
per cent o f the male patients and o f 0.2 per cent o f the female
patients. Employers o f labor paid for 1.1 per cent o f the male
patients and for 0.07 per cent o f the female patients. The poor-law
authorities provided for 0.2 per cent o f the male patients and for 2.5
per cent fo r the female patients, while private benevolence paid for
1.4 per cent o f the male patients and for 5.2 per cent o f the female
patients. The proportion o f patients providing for their own insti­
tutional support or having the same provided for by their families
was 8.4 per cent fo r males and 11.8 per cent for females. The sup­
port was derived from other sources in the case o f 0.3 per cent for
male patients and o f 0.9 per cent fo r female patients.
In the private institutions, the experience o f which was included
in the collective investigation, the support o f patients was provided
fo r by State invalidity insurance institutions in the case o f 3.8 per
cent o f the male patients and o f 4.1 per cent o f the female patients.
It is, therefore, evident that nearly all the patients in public sana­
toria had their expenses provided fo r through the State invalidity
insurance institutions, the sick fund, or the industrial accident asso­
ciations, all established and maintained in conform ity to the imperial
social insurance laws.




40

BU LLETIN OF TH E BUREAU OF LABOR.

AGE, SEX, AND CONJUGAL CONDITION OF PATIENTS UNDER TREATMENT.

The number o f patients under treatment in public sanatoria by
single years during the period 1896 to 1901, with distinction o f sex,
was as follow s:
NUMBER OF PATIENTS TREATED IN GERMAN PUBLIC SANATORIA FOR TUBERCU­
LOSIS OF THE LUNGS, BY YEARS, 1896 TO 1901.
Males.
Year.

Females.

Number. Per cent Number. Per cent
of total.
of total.

Total.

1896.............................................................................
1897.............................................................................
1898.............................................................................
1899.............................................................................
1900.............................................................................
1901.............................................................................

377
907
1,857
3,238
4,762
4,728

90.4
82.4
85.7
85.1
76.3
76.9

40
194
310
565
1,476
1,423

9.6
17.6
14.3
14.9
23.7
23.1

417
1,101
2,167
3,803
6,238
6,151

Total.................................................................

15,869

79.8

4,008

20.2

1 19,877

According to this table the number o f male patients under observa­
tion increased from 377 in 1896 to 4,728 in 1901. The number o f
female patients increased from 40 in 1896 to 1,423 in 1901. The age
distribution o f 15,770 male patients and 3,991 female patients, or
99.4 per cent and 99.6 per cent, respectively, o f the total number o f
patients in public sanatoria was as follow s:
AGE DISTRIBUTION OF PATIENTS TREATED IN GERMAN PUBLIC SANATORIA FOR
TUBERCULOSIS OF THE LUNGS, DURING THE PERIOD 1896 TO 1901.
Females.

Males.
Age.

Total.

Per cent
of total.

Number.

Per cent
of total.

Under 15 years..................................
15 to 19 years.....................................
20 to 24 years....................................
25 to 29 years....................................
30 to 34 years...................................
35 to 39 years....................................
40 to 49 years....................................
50 to 59 years....................................
60 years and over.............................

50
1,608
3,459
3,480
2,734
2,014
2,008
390
27

0.3
10.2
21.9
22.1
17.3
12.8
12.7
2.5
.2

39
773
1,440
865
461
239
141
27
6

1.0
19.4
36.1
21.7
11.6
6.0
3.5
.7
.2

89
2,381
4,899
4,345
3,195
2,253
2,149
417
33

0.5
12.0
24.8
22.0
16.2
11.4
10.9
2.1
.2

Total.......................................

15,770

100.0

3,991

100.0

19,761

100.0

Number.

Number.

Per cent
of total.

O f the male patients 44.0 per cent o f the cases, and o f the female
patients 57.8 per cent, were o f the age period 20 to 29 years, inclusive.
A much larger proportion o f female patients were o f the younger
ages, or 19.4 per cent at ages 15 to 19 years, against 10.2 per cent for
males. In marked contrast, the proportion o f tuberculous male
patients was much larger at the older ages, or, for illustration, 25.5
per cent at ages 35 to 49 years, inclusive, against only 9.5 per cent
for females. These differences are partly the result o f variations in



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

41

the age distribution o f male and female wage earners and they are
also no doubt partly due to the more health-injurious effects o f male
employments, particularly occupations with exposure to industrial
dust.
The information as regards the conjugal condition o f the patients
was obtained only in the case o f 13,898 males and 3,815 females. O f
the males, 55.4 per cent and o f the females 20.6 per cent were mar­
ried. The difference is partly explained by the larger proportion
o f women o f ages under 25 and partly by the fact that married
women are to a less extent insured against the financial consequences
o f invalidity and, according to experience, are less readily induced
to submit to a long separation from the fam ily. The distribution o f
patients according to conjugal condition is, therefore, not to be con­
sidered o f value as evidence whether tuberculosis o f the lungs is rela­
tively more common among the married or the unmarried.
The same conclusion applies to the proportionate distribution o f
patients according to occupation. The analyses o f the returns do
not differentiate occupations in detail, but the results are considered
by groups, partly on account o f the fact that the statistical material
would not have been sufficient in most cases to warrant safe con­
clusions.
PROPORTION OP INDOOR AND OUTDOOR WORKERS.

The occupation was ascertained for 15,743 male patients and for
3,993 female patients. In the case o f males, 53.9 per cent were indoor
factory workers, 16.9 per cent were outdoor workers, 16.2 per cent
were home workers, 4.2 per cent were employed underground, and
8.1 per cent were general laborers or laborers not otherwise specified.
Am ong the specific employments mercantile occupations contributed
6.3 per cent, machinists 6.1 per cent, carpenters and joiners 5.9 per
cent, printers 4.8 per cent, clerks 4.2 per cent, miners 4.1 per cent, and
masons 2.7 per cent. Among female patients 42.7 per cent were home
workers and 34.5 per cent were indoor factory workers. The pro­
portion o f housewives and daughters was 14.9 per cent. The propor­
tion o f outdoor workers among women was only 0.6 per cent. The
specific occupations were in the proportion o f 19.2 per cent among
domestic servants, 7.9 per cent among seamstresses, 7.1 per cent among
saleswomen, 6.6 per cent among textile workers, and 4.7 per cent
among office employees; 4.6 per cent were tailoresses.
DUST AND EUMES AS PREDISPOSING CAUSES OE TUBERCULOSIS.

W ith a further regard to the health-injurious consequences o f cer­
tain occupations predisposing to tuberculosis, largely because o f the
exposure to the inhalation o f industrial dust, the report contains
inform ation for 12,284 male patients and 3,523 female patients. In
the case o f 3,913 male patients and o f 855 female patients it is stated



42

B U LLETIN OE TH E BUREAU OF LABOR.

that the inhalation o f dust was a predisposing cause favorable to
the disease, accounting for relatively 31.9 per cent o f the male patients
and 24.3 per cent o f the female patients. Every form and kind o f dust
exposure is represented in the detailed analysis, but the chief forms
o f dust were as follow s, fo r male patients: M etallic dust, 437 patients;
and specifically, iron dust, 35 patients; lead dust, 195 patients; chalk
dust, 56 patients; stone dust, 181 patients; coal dust, 65 patients;
paint-colors dust, 17 patients; flour dust, 68 patients; tobacco dust,88
patients; wood dust, 286 patients, and wool dust, 159 patients.
Am ong female patients the only important kinds o f industrial dust
specifically mentioned were wool dust with 124 patients, and tobacco
dust with 23 patients.
In the case o f 415 male patients and o f 53 female patients it would
seem that the disease had been favored in its development by the
inhalation o f smoke, gas, vapors, or steam. The more important
causes o f this kind are given in the case o f male patients as general
smoke exposure 85, poisonous gases 77, chemical vapors 25, alkali
vapors 14, acid vapors 113, and coal smoke 46.
UNFAVORABLE O
CCU
PATIO AL CO D
N
N ITIO S.
N
Am ong other unfavorable occupational conditions, mention is made
in the case o f male patients o f 128 working in badly ventilated rooms,
568 working in close rooms combined with an unfavorable bodily
position, 296 cases with exposure to radiating heat and abnormal
temperature, 83 working in damp rooms, 360 exposed to an unfavor­
able climate, and 597 subject to excessive bodily strain. Am ong
female patients there were 26 cases o f patients working in badly
ventilated rooms, 262 working in close rooms combined with an
unfavorable bodily position, 81 working in damp rooms, and 425
subject to excessive bodily strain. It is, therefore, shown that in the
case o f 52.4 per cent o f the male patients and o f 49.8 per cent o f the
female patients the development o f the disease was partly, at least,
attributable to unfavorable occupational conditions. In the case o f
only 173 male patients and only 40 female patients the occupation
itself, however, was specifically mentioned as a predisposing cause
o f the disease. The 173 male patients included 18 miners, 17 masons,
16 tailors, 15 brickyard workers, 14 printers, 13 cigar makers, 12
paint makers, 9 stonecutters, 5 millers, and 5 weavers. Am ong the
40 female patients there were 9 tailoresses, 6 domestic servants, 6
printers, and 5 cigar makers. The foregoing facts would warrant
the conclusion that the unfavorable occupational influences were, as
a rule, incidental to the occupation rather than comprehending the
entire field o f occupational activity. To the extent, therefore, that
the factors in industry which produce ill health, such as dust, smoke,
vapors, polluted air, etc., are reduced to a minimum by effective



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

43

factory control, the predisposing causes to the disease w ill be corre­
spondingly reduced. It, may be pointed out in this connection as a
very suggestive result o f the more lim ited investigation into the
experience o f private institutions, with a much more favorably situ­
ated class o f patients, that the occupation factors, as predisposing
causes, were mentioned in the case o f only 12 per cent o f the male
patients and 3.6 per cent o f the female patients.
SO IA CO D
C L N ITIO .
N
The social condition o f patients was ascertained for 11,858 males
and 3,799 females. F or males the social condition was returned as
good fo r 51.7 per cent o f the total, as medium for 36.9 per cent, and
as bad fo r 11.5 per cent. F or women patients the social condition
was good in 55.9 per cent o f the total, medium in 26.6 per cent, and
bad in 17.5 per cent. W ith regard to unfavorable housing conditions
the per cents were 4.2 for male patients and 9 for female patients.
W ith regard to insufficient food the per cents were 2.5 for male
patients and 6 fo r female patients.
PATIENTS WITH A FAMILY HISTORY O TU
F BER LO
CU SIS.
Inform ation as to probable predisposition to the disease was ascer­
tained for 14,997 male patients and 3,927 female patients. O f this
number 61.7 per cent o f the males and only 50.2 per cent o f the females
came from presumably healthy fam ilies; that is, such as were free
from a tuberculous taint. A history o f tuberculosis on the father’s
side was traced with certainty in the case o f 13.2 per cent o f the male
patients and o f 21 per cent o f the female patients, and on the mother’s
side in the case o f 9.1 per cent o f the male patients and o f 15.9 per
cent o f the female patients. In addition to the foregoing, the propor­
tion o f cases in which both parents were tuberculous was 2.1 per cent
for the male patients and 4.9 per cent for the female patients. In­
cluding brothers and sisters, as well as remote relatives, a fam ily
history o f the disease was ascertained with certainty in the case o f
29.1 per cent o f the male patients and o f 43.3 per cent, o f the female
patients. I f doubtful cases are included, the number o f male patients
with a fam ily history o f tuberculosis was 37.9 per cent, and in the case
o f female patients it was 50.5 per cent. The experience would, there­
fore, seem quite conclusive that a fam ily history o f tuberculosis was
ascertained with certainty in about one-third o f the cases o f male
patients treated for the disease and in about one-half o f the female
patients.
The foregoing information was amplified with regard to the con­
dition o f health o f the members o f married patients’ families. It
was ascertained that among 7,701 married male patients, 86.6 per
cent reported their wives as being in entirely good health. In 243



4
4

B U LLETIN OF TH E BUREAU OF LABOR.

cases, however, or 3.2 per cent, the w ife was reported as suffering
from tuberculosis, and 278, or 3.6 per cent additional, suffered from
diseases o f the chest. The proportion o f women without children was
7.2 per cent. O f the 6,569 families with children, 82.4 per cent had
entirely healthy children, but in 191 families, or 2.9 per cent, there
were tuberculous children, and in 145 families, or 2.2 per cent addi­
tional, children suffered from diseases o f the chest, and in 163 fam i­
lies, or 2.5 per cent additional, children suffered from scrofula.
Am ong 781 married women patients 603, or 77.2 per cent, reported
their husbands as being in entirely good health. In 94 cases, or 12
per cent o f the total, the husband was tuberculous, and in 44 cases,
or 5.6 per cent, the husband was suffering from some disease o f the
chest. The proportion o f childless marriages was 11.3 per cent. In
44 families, or 7.6 per cent o f the 581 fam ilies having children,
there were tuberculous children, and in addition 4.1 per cent had
children who were suffering from some disease o f the chest and 4.3
per cent had children who were suffering from scrofula. W hile
these conclusions require to be accepted with caution, since the in­
form ation was derived from the patients themselves and without
further medical inquiry, it is quite clear that to a not inconsiderable
extent the families o f the patients were affected by the disease and
particularly was this true of-th e husbands and children o f tuber­
culous married women.
PRED
ISPO G O CO PLICATIN C U S IN TU
SIN
R
M
G A SE
BERCU SIS.
LO
The inquiry was extended to preceding diseases favorable or con­
tributory to the development o f tuberculosis ascertained to have oc­
curred in the case o f 7,258 male patients and o f 2,413 female patients,
or 43.5 per cent and 53.9 per cent, respectively, o f the total number o f
persons under observation. The information secured was neither
entirely trustworthy nor conclusive, in that it was frequently im­
possible to ascertain whether the contributory or collateral diseases
were properly to be considered predisposing or com plicating causes
o f existing tuberculosis o f the lungs. Foremost among the com plicat­
ing diseases was influenza, with 1,787 cases among male patients, or
10.7 per cent o f the total number under observation, and 657 cases
among female patients, or 14.7 per cent. The next most important
collateral or contributory disease was pneumonia, reported in the
case o f 1,366 male patients and o f 382 female patients, or 8.2 per cent
and 8.5 per cent, respectively. Pleurisy was reported in 1,177 male
patients, or 7 per cent o f the total, and in 253 female patients, or 5.7
per cent. Bronchial catarrh was reported in 691 o f the male patients,
or 4.1 per cent o f the total, and in 106 o f the female patients, or 2.4
per cent. Catarrh o f the lungs, which, o f course^ is a rather indefinite
term, particularly when reported by the patients themselves, was



CABS OP TUBERCULOUS WAGE EARNERS IN GERMANY.

45

found in the case o f 537 male patients and o f 96 female patients, or
3.2 per cent and 2.1 per cent, respectively. Am ong the remaining
complications the most important among women patients was chronic
anemia, returned in the case o f 712 patients, or 15.9 per cent o f the
total. The other complications are too numerous and in most cases
numerically too unimportant to require separate consideration.
In the case o f 4,861 male patients and o f 1,126 female patients, or
respectively, 29.1 per cent and 25.2 per cent o f the total patients, the
existing tuberculosis o f the lungs was complicated by other diseases.
The inform ation obtained was from the patients and therefore sub­
ject to the criticism o f possible inaccuracy in the statement o f medical
facts. The principal complications were bleeding o f the lungs, re­
turned in the case o f 3^535 male and 501 female patients. The next
most important complication was pleurisy, accounted fo r in the case
o f 533 male and 131 female patients. Catarrh o f the larynx was
present in the case o f 311 male and 154 female patients, and tubercu­
losis o f the larynx in the case o f 146 male and 38 female patients.
These were the principal complications, but a large number o f others
occurred, which, however, can not be considered to be o f material
importance in affecting the course or the seriousness o f the cases in
the aggregate. In other words, the most important complications
were nontubercular lung diseases, emphasizing the close relation
which exists, unquestionably, between tubercular and nontubercular
lung diseases.
PREVIOUS SANATORIUM TREATM
ENT.
Previous treatment in sanatoria or allied institutions was reported
to have occurred in the case o f 1,880 out o f 15,869 male patients, or
11.8 per cent, and in the case o f 383 out o f 4,008 female patients, or 9.6
per cent. Am ong the former, 157 had been two or more times m an
institution for the treatment o f the disease, and 28 o f the latter, or
respectively, 1 per cent and 0.7 per cent o f the total. In the case o f
1,554 male patients and o f 327 female patients the previous treat­
ment had been at least six weeks. In the case o f 326 male patients
and o f 56 female patients the previous treatment had been o f less
than six weeks’ duration. The relation o f such treatment to the
ultimate restoration or maintenance o f wage-earning capacity was not
ascertainable.
PREVIOUS DURATION O DISEASE.
F
The commencement o f the disease was ascertained for 15,170 male
patients and fo r 3,812 female patients. O f the male patients 54.4
per cent, and o f the female patients 54.6 per cent, had on their
admission a record o f less than one year’s sickness duration. The
details by years and periods o f years are given in the follow ing



46

BU LLETIN OF TH E BUREAU OF LABOR.

table, according to which it is shown that there was a previous
duration o f sickness o f one year and over in the case o f 45.6 per
cent o f the male patients and in the case o f 45.4 per cent for the
female patients.
DURATION OF DISEASE PREVIOUS TO ADMISSION FOR TREATMENT IN GERMAN PUB.
LIC SANATORIA FOR TUBERCULOSIS OF THE LUNGS, BY SEX OF PATIENTS, FOR
THE PERIOD 1896 TO 1901.
Females.

Males.
Previous duration.
Number.

Per cent
of total.

Number.

Total.

Per cent
of total.

Number.

Per cent
of total.

Under 1 year......... ..........................
1 to 2 years........................................
2 to 3 years.......................................
3 to 5 years.......................................
5 to 7 years.......................................
7 to 10 years......................................
10 to 15 years....................................
Over 15 years....................................

8,251
2,512
1,417
1,434
630
476
298
152

54.4
16.6
9.3
9.5
4.2
3.1
2.0
1.0

2,082
682
361
367
140
98
51
31

54.6
17.9
9.5
9.6
3.7
2.6
1.3
.8

10,333
3,194
1,778
1,801
770
574
349
183

54.4
16.8
9.4
9.5
4.1
3.0
1.8
1.0

Total.......................................

15,170

100.0

3,812

100.0

18,982

100.0

The proportion o f cases with a duration o f from two to five years’
previous sickness was 18.8 per cent fo r male patients and 19.1 per
cent fo r female patients. In a fa ir proportion o f cases the previous
disease had been o f longer duration, extending in some cases to 15
years and over. O f the total male patients 10.3 per cent had a
previous sickness record o f over five years, the corresponding pro­
portion for female patients being 8.4 per cent. The results o f this
investigation, therefore, conclusively prove that in quite a number o f
cases tuberculosis had been a preexisting disease o f considerable du­
ration previous to admission for institutional treatment. It is selfevident that as a rule the chances o f recovery must be in an inverse
proportion o f the duration o f the disease, but a satisfactory result is
occasionally secured even in quite an advanced stage o f the disease.
It o f course does not necessarily follow that the seriousness o f the
lung impairment is always in proportion to the duration o f the dis­
ease, but the chances o f recovery are decidedly in favor o f incipient
cases or those with a comparatively short duration o f preexisting
disease.
RELATION O TREATMENT T STAG O DISEASE.
F
O
E F
The more complex interrelation o f degree o f seriousness o f the
disease and its duration previous to admission to institutional treat­
ment is shown in some detail in the follow ing table, in which the
cases are grouped according to the Turban stage1 o f the disease on
admission and by previous duration o f sickness by single years and
periods o f years.
1 For explanation of “ Turban stage,” see p. 83.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

47

TURBAN STAGE OF DISEASE OF MALES AND OF FEMALES ON ADMISSION FOR
TREATMENT IN GERMAN PUBLIC SANATORIA FOR TUBERCULOSIS OF THE LUNGS,
BY PREVIOUS DURATION OF DISEASE, FOR THE PERIOD 1896 TO 1901.
NUMBER.
Male patients admitted in Turban Female patients admitted in Turban
stage—
stage—
Previous duration of disease.
I.

I-H.

H.

H-HI.

HI.

I.

I-H .

II.

II-III.

HI.

Under 1 year........................... 2,588 1,767 1,758
1 year to 2 years.......................
765
480
519
244
282
2 years to 3 years.....................
466
250
3 years to 5 years.....................
402
312
101
5 years to 7 years.....................
186
127
7 years to 10 years...................
119
71
126
54
87
51
10 years to 15 years..................
Over 15 years..........................
44
17
27

880 1,126
303
411
173
234
170
287
82
123
88
67
50
53
20
41

689
138
77
79
28
16
11
5

467
177
79
90
32
20
6
4

424
166
101
93
33
32
17
11

224
93
49
54
20
12
10
7

251
96
54
48
25
17
7
4

Total.............................. 4,657 2,984 3,202

1,745 2,363

1,043

875

877

469

502

PER CENT.
55.6
16.4
10.0
8.6
4.0
2.6
1.9
.9

59.2
16.1
8.2
8.4
3.4
2.4
1.8
.6

54.9
16.2
8.8
9.7
4.0
3.9
1.6
.8

50.4
17.4
9.9
9.7
4.7
3.8
2.9
1.1

47.7
17.4
9.9
12.1
5.2
3.7
2.2
1.7

66.1
13.2
7.4
7.6
2.7
1.5
1.1
.5

53.4
20.2
9.0
10.3
3.7
2.3
.7
.5

48.3
18.9
11.5
10.6
3.8
3.6
1.9
1.3

47.8
19.8
10.4
11.5
4.3
2.6
2.1
1.5

50.0
19.1
10.8
9.6
5.0
3.4
1.4
.8

Total.............................. 100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Under 1 year...........................
1 year to 2 years......................
2 years to 3 years.....................
3 years to 5 years.....................
5 years to 7 years.....................
7 years to 10 years...................
10 years to 15 years..................
Over 15 years..........................

The larger ratio o f fatal cases in the advanced stage o f the disease
precludes accurate conclusions for a statistical comparison o f this kind,
and the table fails to fully confirm the previous observation that, as a
general rule, the seriousness o f the lung involvement is in proportion
to the duration o f the disease. F or illustration, however, o f 4,657
male patients in Turban stage I, the proportion having a previous dis­
ease record o f over five years was 9.4 per cent, against 10.3 per cent o f
the 3,202 patients in Turban stage I I and 12.8 per cent o f the
2,363 patients in Turban stage III. The general results for female
patients are about the same. Conclusions based upon these data
require, however, to be applied to individual cases with extreme
caution, for serious chronic cases may occur with a long previous
duration o f disease, and relatively light cases in an acute form may
terminate fatally after a short duration, being commonly known as
“ galloping consumption.”
CON
DITION O PATIENTS O ADM
F
N
ISSION.
The general condition o f the patients on admission was reported
for 15,844 male and 3,863 female patients, and considered good in the
case o f 32.9 per cent o f the form er and in the case o f 28.2 per cent o f
the latter. The condition was reported as medium in the case o f 36.8
per cent o f the male patients and o f 31.7 per cent o f the female
patients and as bad in the case o f 30.2 per cent o f the males and o f



48

B U LLETIN OF TH E BUBEAU OF LABOR.

40.1 per cent o f the females. According to this analysis, the propor­
tion o f cases was about the same for male patients fo r the three
groups, but for the female patients the proportion in bad general
condition on admission was somewhat larger.
The bodily condition of the patient at the time o f admission was
ascertained in the case o f 15,868 male patients and o f 4,002 female
patients. O f the male patients 17.9 per cent and o f the female
patients 18 per cent were stated to have been in a condition o f satis­
factory nutrition. In the case o f 48.9 per cent o f the male patients
and o f 44.5 per cent o f the female patients the condition o f nutrition
on admission was reported as medium, while in the case o f 38.2 per
cent o f the male patients and o f 37.5 per cent o f the female patients
the condition was reported as bad. The proportion o f patients o f
satisfactory nutrition was, therefore, relatively quite small, and the
results o f the analysis disclose the intimate relation which unques­
tionably exists between tuberculosis o f the lungs and impaired or
defective nutrition or malassimilation. The inform ation with re­
gard to nutrition is, o f course, subject to the criticism that it depends
more or less upon methods o f medical diagnosis and that there is an
element o f reasonable doubt, which impairs the value o f the results.
The close correspondence, however, between the respective percent­
ages for male and female patients would seem to warrant the conclu­
sion that, in a general way, the large m ajority o f patients on admission
were in an impaired or defective state o f bodily nutrition.
RELATION O TREATMENT T GAIN IN BO Y WEIGHT.
E
O
D
The relation o f treatment to body weight was ascertained in the
case o f 15,576 male patients and o f 3,964 female patients. O f the
male patients 93.6 per cent increased in weight during treatment and
o f the female patients 92.3 per cent. In the case o f 3.4 per cent for
males and o f 3.7 per cent fo r females the weight remained the same,
while in the case o f 3 per cent for males and 4.1 per cent for females
the weight decreased. The average increase in weight during the
time o f treatment was 5.9 kilograms (13 pounds) for males and 5.2
kilograms (11.6 pounds) for females. Since the normal average
weight o f women is less than the average weight o f men, the increase
in weight is proportionately about the same for both sexes. When the
increase in body weight is ascertained, with a due regard to the con­
dition o f nutrition on admission, it is almost invariably found that
the gain is greatest in the case o f those who were most impaired in
physique. In the case o f male patients, for illustration, who on ad­
mission were in a good physical condition, the gain was 5.7 kilograms
(12.6 pounds), in the case o f those who were in a medium condition
5.9 kilograms (13 pounds), and in the case o f those who were in poor
physical condition 6.1 kilograms (13.4 pounds). The respective gain



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

49

in weight o f females was 4.9 kilograms (10.8 pounds) for the first,
5.2 kilograms (11.6 pounds) fo r the second, and 5.4 kilograms (11.9
pounds) for the third class. Even in the case o f patients who were
in the third Turban stage o f the disease, numbering 2,871 males and
509 females, a gain in weight was obtained in the case o f 89.6 per
cent o f the form er and o f 88.5 per cent o f the latter, the average gain
in weight being 5.6 kilograms (12.3 pounds) for males and 4.4 kilo­
grams (9.7 pounds) for females.
CH
ANG IN PHYSICAL CO D
ES
N ITIO DURING TREATMENT.
N
The changes in condition resulting from the course o f systematic
treatment were ascertained for 15,740 males and for 3,857 females.
The results o f the analysis are set forth in tabular form , as follow s:
RESU LTS

OF

S A N A T O R IU M

TREATM ENT.

Males.

Females.

Physical condition of patient.
Number. Per cent. Number. Per cent.
Very much improved..................................................................
Improved....................................................................................
Not improved..............................................................................
Worse................................. ........................................................
Very much worse........................................................................

3,126
5,929
6,305
292
88

19.9
37.7
40.1
1.9
.6

1,036
1,237
1,482
70
32

26.9
32.1
38.4
1.8
.8

According to this table a favorable or promising medical result o f
treatment was secured in the case o f 57.6 per cent o f the male patients
and o f 59.0 per cent o f the female patients. In further illustration o f
the results o f treatment, it may be stated that in the case o f male
patients only 0.1 per cent were in very good general condition on
admission, but 3.2 per cent on discharge; the proportion in good gen­
eral condition on admission was 32.8 per cent, but 76.2 per cent on
discharge. In contrast, the proportion o f patients in medium condi­
tion on admission ranged from 36.9 per cent to 15.6 per cent on dis­
charge; while the proportion o f patients in bad general condition
ranged from 30.2 per cent on admission to 4.6 per cent on discharge.
The results were much the same for females; or, for illustration, 28.1
per cent were in good general condition on admission, against 71.5
per cent on discharge, and 31.7 per cent were in medium general con­
dition on admission, against 18.6 per cent on discharge. The propor­
tion in bad general condition was 40.1 per cent on admission, against
6.6 per cent on discharge. The general results o f treatment were
therefore much the same for both sexes, and throughout the marked
benefits resulting from sanatorium treatment are exhibited by the
much larger proportion o f patients on discharge in improved general
condition, with a corresponding increase in disease-resisting power,
which, o f course, chiefly conditions the ultimate outcome o f sys­
tematic diatetic-hygienic institutional treatment.

49397°— 12------4


50

BU LLETIN OF TH E BUBEAU OF LABOB.

C U H AND EXPECTORATION O ADM
OG
N
ISSION AND DISCH
ARGE.
W ith regard to expectoration and cough on admission and dis­
charge, the required inform ation was ascertained for 15,838 male
patients and for 3,989 female patients. O f this number 91.1 per cent
o f the males and 65.7 per cent o f the females had cough and expecto­
ration on admission, 4.5 per cent o f the males and 18.4 per cent o f
the females had cough without expectoration, and 4.4 per cent o f the
males and 15.9 per cent o f the females had neither cough nor expecto­
ration on admission. It is therefore shown that by far the large
m ajority o f patients had cough and expectoration on admission, which
conclusively proves that they were in a condition o f health not only
dangerous to themselves, but to the public at large. O f the patients
with cough and expectoration combined, 22.8 per cent o f the males and
26.2 per cent o f the females improved during treatment to the extent
that both cough and expectoration had disappeared, and in addition
4.7 per cent o f the males and 9.6 per cent o f the females on discharge
were free from expectoration but retained their cough, while 72.5 per
cent o f the males and 64.2 per cent o f the females retained both cough
and expectoration at the time o f their discharge. W hile, therefore,
the treatment resulted in a material improvement in general condi­
tion, it did not, to more than a rather lim ited extent, result in remov­
ing the most striking physical evidences o f lesions or impairment o f
the lungs. It is quite clear that the medical condition o f most o f the
patients on discharge was not so favorable as would have been desir­
able or perhaps necessary to provide a sound physical basis as a pre­
liminary condition fo r subsequently sustained wage-earning capacity.
On account o f the very much smaller number o f patients without
cough, or without cough and expectoration, it does not seem neces­
sary to consider the details o f this experience at length. In brief, o f
the patients with cough and expectoration on admission, about onefourth were free from cough and expectoration on discharge. O f
those with cough only, more than one-half, or 56.1 per cent, o f the
males, and 57.3 per cent o f the females, were free from cough on dis­
charge, and, finally, o f the patients free from cough and expectora­
tion on admission, 90.5 per cent o f the males and 89.7 per cent o f the
females were still free therefrom on discharge.
TU
BER LO S BACILLI IN THE SPU M O ADM
CU U
TU
N
ISSION AND DISCH
ARGE.
Even more important than the mere fact o f cough and expectora­
tion is, o f course, the bacillary contents o f the latter, as determined
by recognized bacteriological methods. Inform ation with regard to
the results o f examination o f the expectoration was obtained for
14,313 male patients and fo r 3,296 female patients. O f these, 6.7
per cent o f the males and 29.5 per cent o f the females were excluded,



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

51

since throughout their stay in the institution they were free from
expectoration, although unquestionably tuberculous in one o f the sev­
eral stages o f the diseasa O f the remaining patients, numbering
12,631 males and 2,265 females, the bacilli o f tuberculosis were found
in the sputum o f 47.3 per cent o f the male patients and o f 41.1 per
cent o f the female patients. F or some o f these the information as to
condition on discharge was not ascertained, but 3,462 o f the male
patients and 698 o f the female patients, or 65.6 per cent and 75 per
cent, respectively, o f the patients having bacilli o f tuberculosis in
their expectoration on admission still retained the bacteriological
evidence o f the disease in their expectoration on discharge. The
significance o f these facts can hardly be overrated. It is evident
that while the patients on discharge may have been in a satisfactory
general condition, while they had gained in weight and were other­
wise perhaps relatively free from serious physical impairment on
account o f the disease, they carried the bacilli o f tuberculosis in their
expectoration, which they retained on discharge, and to that extent,
o f course, they were not only a menace to themselves, on account
o f the risk o f reinfection, but a menace to the community, and par­
ticularly other employees, on account o f the risk o f spreading infec­
tion by carelessness or indifference with regard to expectoration.
The details o f the presence o f the bacilli o f the disease in the ex­
pectoration according to Turban stage o f the disease are given in
tabular form , as follow s:
NUMBER AND PER CENT OF MALE AND FEMALE TUBERCULOUS PATIENTS HAVING
BACILLI IN THEIR EXPECTORATION, ACCORDING TO TURBAN STAGE OF DISEASE.
Males.

Females.

Turban stage.
Number. Per cent. Number. Per cent.
I ........................................................................................................
I -I I ..............................................................................................

n .......................................................................
TT-TTT................................................................................................

H I.....................................................................................................

968
909
1,358
1,032
1,765

30.4
34.3
49.7
64.3
78.6

79
94
180
227
362

18.0
21.0
35.1
63.9
77.4

This table shows that o f the male patients in Turban stage I,
30.4 per cent were ascertained to have the bacilli o f tuberculosis in
their expectoration. The proportion o f bacillary expectorations in­
creased with the advancing stages o f the disease to 49.7 per cent
fo r stage I I and 78.6 per cent for stage III. Throughout the per­
centages are lower for female patients, having been 18.0 per cent for
Turban stage I, 35.1 per cent for stage II, and 77.4 per cent for
stage II I.
Under treatment the tendency is naturally for the bacilli to dis­
appear from the sputum and this, o f course, in itself is one o f the
most important factors in physical diagnosis. It was brought out



52

BU LLETIN OF TH E BUREAU OF LABOR.

by the investigation that o f the patients with bacilli in their sputum,
but in Turban stage I o f the disease, 59.3 per cent o f the male patients
had expectoration free from bacilli on discharge, the corresponding
per cent for females being 55.1. The proportion o f cases with favor­
able results naturally decreases with the advancing stages o f the dis­
ease, and, accordingly, for males the per cent with no bacilli in their
sputum in the Turban stage I I was only 36.5 and in stage I I I 21.1.
For females, the corresponding percentages were 37.1 for Turban
stage I I and 11.8 for stage III. Summarizing the foregoing data,
which have a most important bearing upon public considerations o f
tuberculosis o f the lungs as a labor problem, it is shown that o f the
11,145 male patients with expectoration on admission 5,275, or 47.3
per cent, had bacilli o f tuberculosis in their sputum, against 3,650, or
32.8 per cent, on discharge. O f the 2,265 female patients 931, or 41.1
per cent, had bacilli in their expectoration on admission, but 739,
or 32.6 per cent, retained bacilli in their sputum on discharge. In
other words, while a fair amount o f good resulted from the treat­
ment, it is quite evident that much too large a proportion o f the
patients under treatment were discharged with established evidence
o f the bacilli o f the disease in their sputum, involving, o f course, the
serious risk o f self-infection and the infection o f others, particularly
members o f the fam ily and fellow employees.
DURATION O TREATM
F
ENT.
The duration o f treatment, excluding those who were less than six
weeks in the institution and those who died, was ascertained for
15,802 male and 3,998 female patients. The duration is given in
tabular form below :
DURATION OF TREATMENT OF TUBERCULOUS PATIENTS IN GERMAN SANATORIA,
FOR THE PERIOD 1896to 1901, BY SEX.
Males.
Duration of treatment.

Females.

Number Per cent. Number Per cent.
of cases.
of cases.

6 to 8 weeks................................................... .............................
8 to 10 weeks................................................................................
10 to 12 weeks........................................................... ...................
12 to 14 weeks..............................................................................
14 to 16 weeks..............................................................................
16 to 20 weeks..............................................................................
20 to 26 weeks..............................................................................
Over 26 weeks..............................................................................

1,501
1,760
3,442
4,877
1,307
1,593
794
528

9.5
11.1
21.8
30.9
8.3
10.1
5.0
3.3

307
352
751
1,540
312
390
230
116

7.7
8.8
18.8
38.5
7.8
9.8
5.8
2.9

Total..................................................................................

15,802

100.0

3,998

100.0

According to this table, in about one-third o f the cases the patients
, underwent treatment fo r from 12 to 14 weeks. Most o f the patients
were from 10 to 14 weeks in the institution, which is chiefly due to



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

53

the fact that in the large m ajority o f cases the treatment was pro­
vided for by invalidity insurance institutions. The average duration
o f treatment was 89.2 days for males and 94.4 days fo r females.
M
EDICAL RESU
LTS O TREATMENT.
F
The general medical results o f institutional treatment were ascer­
tained fo r 15,231 male patients and 3,921 female patients. The con­
dition o f these patients on discharge was as follow s:
Entirely cured, 573 males, or 3.8 per cent o f the total; and 149
females, or also 3.8 per cent o f the total number discharged. B y
entirely cured is meant a complete restoration o f the lungs to their
normal condition, as determined clinically and by careful physical
examination.
The number and proportion relatively cured was 1,349 male pa­
tients, or 8.9 per cent, and 450 female patients, or 11.5 per cent. By
relatively cured is meant such a decided improvement in the general
condition o f the patient and disappearance o f the cough and expec­
toration that only slight evidences remained o f an impaired condi­
tion o f the lungs.
The number and proportion o f patients materially improved, in­
cluding an advance from a lower to a higher Turban stage, was 5,691
males, or 37.4 per cent, and 1,320 females, or 33.7 per cent.
The number and proportion o f patients who improved, but without
a change from the Turban stage in which they were on admission,
was 5,205, or 34.2 per cent, males and 1,051, or 26.8 per cent, females.
The number o f patients with their condition remaining unchanged
was 1,570 males, or 10.3 per cent, and 666 females, or 17 per cent.
The number o f patients whose general condition was worse,
although remaining within the same Turban stage o f the disease as
observed on admission, was 372 males and 116 females, and the num­
ber o f patients decidedly worse, with a change to a less favorable
stage o f the disease, was 413 males and 160 females. The number o f
deaths was only 58 males and 9 females, or 0.4 per cent and 0.2 per
cent, respectively. The analysis with regard to condition on dis­
charge was made in considerable detail, which, however, is too tech­
nical and medical for the present purpose with regard to the eco­
nomic results; that is, the proportion o f patients discharged with
their earning capacity restored within a reasonable period o f time.
Considering the entirely cured and relatively cured as a group,
there were 1,922 male patients o f this class and 599 female patients,
or, respectively, 12.7 per cent and 15.3 per cent o f the total patients
discharged during the period 1896 to 1901. The average duration o f
treatment o f the cured or materially improved cases was 91.5 days
for males and 100.9 days for females. The rate o f recovery, as diag­
nosed from a medical point o f view and having reference to restored



54

B U LLETIN OF TH E BUREAU OF LABOR.

earning capacity, according to ages on admission, is shown in tabular
form , as follow s:
RATE OF RECOVERY IN TUBERCULOSIS OF THE LUNGS UNDER SANATORIUM
TREATMENT DURING THE PERIOD 1896 TO 1901, FOR PATIENTS OF EACH SEX.
Males.

Ages on admission.

Females.

Number
Number
of
of
Number
Number
of
Per cent patients
of
patients
Per cent
under patients cured.
under patients cured.
treat­
cured.
treat­
cured.
ment.
ment.

Under 15 years...........................................
15 to 19 years..............................................
20 to 24 years..............................................
25 to 29 years..............................................
3 0 to 34 years..............................................
35 to 39 years..............................................
40 to 49 years..............................................
50 to 59 years..............................................
60 years and over.......................................

50
1,608
3,459
3,480
2,734
2,014
2,008
390
27

16
251
504
450
307
210
145
27

32.0
15.6
14.6
12.9
11.2
10.4
7.2
6.9

39
773
1,440
865
461
239
141
27
6

8
132
235
135
53
19
12
2
2

20.5
17.1
16.3
15.6
11.5
7.9
8.5
7.4
33.3

Total.................................................

15,770

1,910

12.1

3,991

598

15.0

According to this table, the recovery rate was highest at the
younger and lowest at the higher ages, ranging, fo r males, from 82
per cent at ages under 15 years to only 6.9 per cent at ages 50 to 59
years. F or females, the range in the recovery rate was from 20.5
per cent at ages under 15 years to 7.4 per cent at ages 50 to 59 years.
A t ages 60 years and over the numbers are too small for a safe con­
clusion.
E O O IC RESULTS O TREATMENT.
CNM
F
The economic results o f treatment were ascertained in the case o f
15,636 male patients and o f 3,953 female patients, or, relatively, 98.5
per cent and 98.6 per cent o f the total number o f patients under treat­
ment. It is pointed out that the economic results—that is, the re­
stored earning capacity—were not in all cases determined by identical
methods, but in a large m ajority o f the institutions by fu ll restored
earning power is meant a recovered earning capacity o f from 75 per
cent to 100 per cent o f the form er earnings, while by partial recovery
is meant a restored earning capacity o f from 33£ to 75 per cent o f the
form er wages. Persons able to earn less than 33J per cent o f their
form er earnings are considered as not having their earning capacity
restored to them, or, in other words, as unsuccessful cases from an
economic point o f view. Excluding, therefore, from the follow ing
comparison the returns which are not strictly comparable, upon the
basis o f the preceding explanation, as to the terms used, the facts were
utilized for 13,070 male patients, and fo r 2,356 female patients, as
follow s:




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

55

ECONOMIC RESULTS OF SANATORIUM TREATMENT FOR TUBERCULOSIS OF THE
LUNGS DURING THE PERIOD 1896 TO 1901, FOR PATIENTS OF EACH SEX.
Males.

Females.

Condition on discharge.
Number. Per cent. Number. Per cent.
Earning capacity fully restored with return to usual occupation.
Earning capacity fully restored with return to another occupa­
tion...........................................................................................
Earning capacity partly restored................................................
Unable to work...........................................................................
Died.............................................................................................

8,891

1,685

71.5

8.9
13.4
9.3
.4

53
283
329
6

2.2
12.0
14.0
.3

13,070

Total..................................................................................

68.0

1,161
1,745
1,221
52

100.0

2,356

100.0

According to this table 68.0 per cent o f the male patients and 71.5
per cent o f the female patients had their earning capacity fully re­
stored and were able to take up again the occupation at which they
had been employed before admission to the sanatorium. In the cases
o f 8.9 per cent o f the male patients and o f 2.2 per cent o f the female
patients the earning capacity was fully restored, but at a different
and more suitable occupation or industry in place o f the one form erly
follow ed. The proportion o f patients with their earning capacity
only partially restored, within the meaning o f the term, as previously
defined, was 13.4 per cent for males, and 12.0 per cent for females.
The proportion o f entirely unsuccessful cases, from an economic point
o f view, was 9.3 per cent for males and 14.0 per cent for females. In
addition thereto 0.4 per cent o f the male patients and 0.3 per cent o f
the female patients had died during the course o f treatment, but it
requires to be recalled that all patients under six weeks’ treatment
were excluded from the analysis o f the collective experience for the
period.
IM
PORTANCE O TREATMENT IN THE INCIPIENT STAGE O DISEASE.
F
F
The importance o f early treatment, in its relation to restored
earning capacity, is brought out in the follow ing table, which shows
the relation o f successful treatment to the Turban stage o f the
disease on admission:
RELATION OF ECONOMIC RESULTS OF SANATORIUM TREATMENT FOR TUBERCU­
LOSIS TO THE TURBAN STAGE OF THE DISEASE ON ADMISSION, DURING THE
PERIOD 1896 TO 1901, FOR PATIENTS OF EACH SEX.
Males.
Turban stage of disease on admission.

I ......................................................................................
I-II..................................................................................
II.....................................................................................
n -m .......................................................................................................




Females.

Per cent
Per cent
with fully with partly
restored
restored
earning
earning
capacity! capacity.

Per cent
Per cent
with fully with partly
restored
restored
earning
earning
capacity. capacity.

80.7
78.4
69.1
52.5
36.3

15.6
17.3
22.0
31.9
37.0

88.2
84.2
72.3
55.4
30.6

6.9
9.3
14.2
24.9
27.2

56

BU LLETIN OF TH E BUBEAU OF LABOB.

It is shown by this table that, leaving out o f consideration the
minor exceptions o f no material importance, the percentage o f cases
successfully treated, from an economic point o f view, diminishes
progressively with the increasing stage o f seriousness o f the disease,
emphasizing therefore the economic importance o f early treatment,
when the outlook fo r recovery is reasonably assured.
GERMAN SANATORIUM EXPERIENCE, 1896 T 1901.1
O
The final results o f the collective investigation o f 1896 to 1901 are
briefly summarized as follow s:
The average duration o f treatment o f 15,869 male and o f 4,008
female patients was 89.2 and 94.4 days, respectively.
The patients were almost exclusively o f the wage-earning element
o f the nation, or 99.4 per cent in the case o f males and 85.1 per cent
in the case o f females.
The cost o f treatment was in most cases provided for by the
invalidity insurance institutions, or other institutions and funds
established to carry out the German compulsory insurance laws.
O f the male patients, 86.2 per cent, and o f the female patients, 79.2
per cent, were provided for at the expense o f compulsory social
insurance institutions.
O f the male patients 44.0 per cent were o f the age period 20 to 29
years, and o f the female patients 57.8 per cent. O f the male pa­
tients 80.1 per cent, and o f the female patients 17.6 per cent, were
o f the age period 80 to 39 years. The large m ajority therefore were
admitted fo r treatment at a period o f life when the economic and
social value o f health is a matter o f most serious concern to the indi­
vidual and to the State.
A fam ily history o f tuberculosis was established with certainty
in the case o f 20.2 per cent o f the male and 32 per cent o f the
female patients, and with reasonable probability, including the pre­
vious proportion, in 26.4 per cent o f the male and 36.7 per cent o f the
female patients. The proportion o f tuberculous brothers and sisters
o f the patient was ascertained with certainty, or reasonable proba­
bility, in the case o f 16.5 per cent o f the males and o f 21.2 per cent of
the females.
Over one-half o f the patients—that is, 54.4 per cent o f the males
and 54.6 per cent o f the females—were admitted to treatment in the
same year in which the symptoms o f the disease were first recognized.
In the case o f 9.8 per cent o f the males and o f 8.2 per cent o f the
females there was a record o f previous treatment o f at least six weeks’
duration in sanatoria or some special institution for the treatment o f
tuberculosis o f the lungs.
1 For summary account of the experience data for the period 1902-1904, see p. 162.




CARE OE TUBERCULOUS WAGE EARNERS IN GERMANY.

57

The bodily condition on admission, as determined by the evidence
o f nutrition, was good in the case o f 17.9 per cent o f the male and o f
18 per cent o f the female patients, and medium in the case o f 48.9
per cent o f the male and o f 44.6 per cent o f the female patients. The
condition was bad in the case o f 33.2 per cent o f the males and o f 37.5
per cent o f the females.
The bodily condition, or nutrition, was improved, as determined by
an increased weight, in the case o f 93.6 per cent o f the males and o f
92.3 per cent o f the females. The average gain in weight was 5.9
kilograms (13 pounds) and 5.2 kilograms (11.6 pounds), respectively,
in the case o f male and female patients.
The general condition o f the patients on admission was good in the
case o f 32.9 per cent o f the male and 28.2 per cent o f the female patients.
It was medium in the case o f 36.8 per cent o f the male and 31.7 per cent
o f the female patients; and, finally, it was bad in the case o f 30.2 per
cent o f the male patients and o f 40.1 per cent o f the female patients.
The general condition was improved during treatment in the case
o f 57.5 per cent o f the male and 59 per cent o f the female patients.
Cough and expectoration were present on admission in the case o f
91.1 per cent o f the male and 65.7 per cent o f the female patients, but
cough without expectoration was present in only 4.5 per cent o f the
male patients and in only 18.5 per cent o f the female patients. O f
the form er, 22.8 per cent o f the males and 26.2 per cent o f the females
were free from cough and expectoration on discharge, and dry cough,
present on admission, disappeared in the case o f 56.1 per cent o f the
male and 57.3 per cent o f the female patients during treatment.
The sputum o f patients was ascertained with certainty to contain
the tubercle bacillus in the case o f 45.3 per cent o f the male patients
and o f 30 per cent o f the female patients. O f this group o f patients,
separately considered, 34.4 per cent o f the males and 25 per cent o f
the females were free from tubercle bacillus on discharge.
Fever was present on admission in the case o f 13.8 per cent o f the'
male and 19.4 per cent o f the female patients. The fever disappeared
during treatment in the case o f 68.6 per cent o f the male and 63.3
per cent o f the female patients.
Night sweats were observed on admission in the case o f 29.8 per
cent o f the male and 27.3 per cent o f the female patients. Night
sweats disappeared during treatment in the case o f 90.7 per cent o f
the male and 85.2 per cent o f the female patients.
The seriousness o f the disease, or the degree o f lung impairment, as
determined by the Turban stage o f the disease, was as follow s:
O f the male patients, 31.3 per cent, and o f the female patients 28.4
per cent, were in stage I o f the disease, and 19.9 per cent o f the males
and 22.9 per cent o f the females were in stage I - I I o f the disease. O f
the patients in stage I I o f the disease, the proportion o f males was 21.3



58

BU LLETIN OF TH E BUREAU OF LABOR.

per cent and o f the females 23.1 per cent, and in stage I I -I I I , 11.7
per ceiit and 12.5 per cent, respectively. The proportion o f patients
in stage I I I , or the far-advanced stage o f the disease, was 15.8 per
cent for males and 13.2 per cent fo r females.
Only one lung was affected in the case o f 25 per cent o f the male
and 19.7 per cent o f the female patients. O f these, 62.6 per cent and
63.1 per cent, respectively, had the right lung affected, and 37.4 per
cent and 36.9 per cent, respectively, had the left lung affected.
Rales were observed in the case o f 93.4 per cent o f the male and
87.3 per cent o f the female patients, and o f this group rales combined
with consolidation was observed in the case o f 79.8 per cent o f the
males and o f 74.6 per cent o f the females.
A cure, from a medical point o f view, was obtained in the case
o f 12.7 per cent o f the male and 15.3 per cent o f the female patients.
A material improvement, including the cured cases, was obtained in
the case o f 50 per cent o f the male and 48.9 per cent o f the female
patients. A relative improvement was secured in the case o f 34.2
per cent o f the male and 26.8 per cent o f the female patients, and
10.3 per cent and 17 per cent, respectively, o f the patients remained
unchanged. In the case o f 5.1 per cent o f the male and 7.1 per cent
o f the female patients the condition on discharge was worse than on
admission, but the percentage o f deaths during the period o f treat­
ment was only 0.4 fo r male patients and only 0.2 fo r female patients.
An economic result, with entire restoration o f earning capacity,
was obtained in the case o f 76.9 per cent o f the male and 73.7 per cent
o f the female patients, but in addition thereto 13.4 per cent o f the
males and 12 per cent o f the females had their earning capacity par­
tially restored to them, while only 9.3 per cent o f the male patients
and only 14 per cent o f the female patients were unsuccessfully treated
from an economic point o f view.1
TREATMENT AND CARE OF TUBERCULOUS WAGE EARNERS BY GER­
MAN INVALIDITY INSURANCE INSTITUTIONS, 1897 TO 1909.

The combined experience data o f the German territorial govern­
ment invalidity insurance institutions have been published for a
number o f years in the form o f statistical summaries, including all
the essential facts emphasizing the financial, medical, and social re­
sults o f institutional or other treatment for the purpose o f preventing
or restoring the loss o f earning power through debilitating diseases
o f long duration. The latest available report2 is fo r the year 1910,
1 See page 162 for summary of experience, 1902-1904, published by the Imperial Board
of Health in 1912.
2Amtliche Nachrichten des Reicbs-Versicherungsamts 1910. 2. Beiheft. Statistik der
Heilbehandlung bei den Versicherungsanstalten und zugelassenen Kasseneinrichtungen
der Invalidenversicherung. Berlin, 1910.




CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

59

including the experience data for the period 1897 to 1909. The chief
object o f the statistical investigation is to ascertain from year to year
the actual results o f the special treatment extended to invalids, ac­
tual or prospective, undertaken at the expense o f the invalidity in­
surance institutions for the purpose o f preventing premature physical
infirmity and the resulting loss o f wage-earning capacity.1 On ac­
count o f the fact that tuberculosis o f the lungs is one o f the chief
causes o f physical impairment and resulting loss o f earning power,
the experience data throughout differentiate the statistics o f treat­
ment fo r tuberculosis o f the lungs and other diseases. W hile in the
main the sanatoria or the other special healing and curative institu­
tions have been established fo r the purpose o f granting special treat­
ment in behalf o f Government invalidity insurance institutions, it re­
quires to be taken into account that under the invalidity-insurance law
reasonable expenses may also be incurred by the insurance institu­
tions in behalf o f the general welfare in the furtherance o f public
measures and methods for the prevention o f sickness, invalidity, and
premature death.
In addition to the separation made in the statistical analysis o f
the data concerning patients treated on account o f tuberculosis o f the
lungs and those treated on account o f other diseases, a further sepa­
ration o f the facts is made regarding patients receiving full treatment,
which in practically all cases is institutional, and o f patients receiv­
ing only partial treatment, which is largely o f the nature o f medical
consultations, prescriptions, dispensary service, dental work, etc. For
the present purpose only the full treatment o f patients is o f practical
and conclusive value, since the final results o f partial treatment must
in most cases be more or less a matter o f conjecture. The fact
also that the treatment o f patients for diseases other than tuber­
culosis o f the lungs includes a considerable variety o f medical and
other causes precludes the scientific utility o f the data concerning
this group, and that this fact has been recognized by the Im perial
Insurance Office is made evident by a recent ruling, under which the
subsequent effects o f full or partial treatment for causes other than
tuberculosis o f the lungs2 w ill not longer be observed and reported
upon. Unless otherwise stated, therefore, the present discussion is
lim ited entirely to members o f Government invalidity insurance in­
stitutions receiving full and systematic treatment as patients suffer­
ing from tuberculosis o f the lungs and chiefly in special institutions
erected fo r the purpose or maintained by the insurance institutions
as an essential and more or less effective step toward the prevention
o f premature invalidity brought about by tuberculous diseases.
1 For a full statement of the legal provisions governing the treatment and care o$
members of invalidity insurance institutions, see Appendix IV.
2 This, term as used in the discussion is always inclusive of tuberculosis of the larynx.




B U LLETIN OF TH E BUREAU OF LABOR.

60

NUMBER OE PATIENTS TREATED, B Y SEX.

According to the report for 1910, the aggregate number o f patients
treated for all causes during the period 1897 to 1909 was 619,005, o f
whom 275,207, or 44.5 per cent, received treatment on account o f
tuberculosis o f the lungs. The details, by years, are given in the
table which follow s, according to which the percentage o f persons
treated on account o f tuberculosis o f the lungs, o f the total number
receiving treatment for all causes, has increased from 31.9 in 1897
to 42.4 in 1909.
NUMBER OF PERSONS TREATED ON ACCOUNT OF TUBERCULOSIS OF THE LUNGS IN
BEHALF OF GERMAN STATE INVALIDITY INSURANCE INSTITUTIONS, BY SEX AND
BY YEARS, 1897 TO 1909

Year.

Number of persons Per
treated.
cent of
tubercular
patients
On
account of per­
For all of tuber­ sons
causes. culosis of treated
for all
thelungs. causes.

Per cent.
Males
treated
for tuber­
culosis of
the lungs.

Females
treated
for tuber­
culosis of
Fe­
the lungs. Males. males.

1897.....................................................
1898.....................................................
1899.....................................................
1900.....................................................
1901.....................................................
1902.....................................................
1903.....................................................
1904.....................................................
1905.....................................................
1906.....................................................
1907.....................................................
1908.....................................................
1909.....................................................

10,564
13,758
20,039
27,427
32,710
35,949
43,593
49,491
56,420
66,883
74,023
86,990
101,158

3,374
4,937
7,759
11,150
14,757
16,516
20,171
23,511
26,834
31,375
32,543
39,340
42,940

31.9
35.9
38.7
40.7
45.1
45.9
46.3
47.5
47.6
46.9
44.0
45.2
42.4

2,625
3,822
6,074
8,469
10,862
12,205
14,956
16,985
19,241
22,172
22,557
26,790
29,747

749
1,115
1,685
2,681
3,895
4,311
5,215
6,526
7,593
9,203
9,986
12,550
13,193

77.8
77.4
78.3
76.0
73.6
73.9
74.1
72.2
71.7
70.7
69.3
68.1
69.3

22.2
22.6
21.7
24.0
26.4
26.1
25.9
27.8
28.3
29.3
30.7
31.9
30.7

Total..........................................

619,005

275,207

44.5

196,505

78,702

71.4

28.6

The available information concerning the general results o f sys­
tematic and full treatment o f German invalidity insurance institu­
tions is limited to the period 1897 to 1909. During this period 272,480
members received fu ll and systematic treatment on account o f tuber­
culosis, and o f this number 194,787 patients were men and 77,693
patients were women. The proportion o f male patients, therefore,
was 71.5 per cent. In addition, 2,727 members received temporary
treatment on account o f tuberculosis, and o f this number 1,718 were
men and 1,009 were women. The number and proportion o f patients
receiving temporary or partial treatment on account o f tuberculosis
were, therefore, relatively small. During 1909 the number o f mem­
bers receiving full treatment on account o f tuberculosis was 42,232,
and o f this number 29,277, or 69.3 per cent, were males. During the
same year the number o f members receiving temporary or partial
treatment on account o f tuberculosis o f the lungs was 708, and o f this
number 470, or 66.4 per cent, were males. Data fo r each year, 1897
to 1909, are given in the follow ing table:



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

61

NUMBER (BY SEX) AND PER CENT OF TOTAL PERSONS RECEIVING FULL TREAT­
MENT AND PARTIAL OR TEMPORARY TREATMENT ON ACCOUNT OF TUBERCU­
LOSIS OF THE LUNGS IN BEHALF OF GERMAN STATE INVALIDITY INSURANCE
INSTITUTIONS, BY YEARS, 1897 TO 1909.
Persons receiving full treatment.
Year.
Males.

Females.

Total.

Persons receiving temporary or partial
treatment.

Per
cent of
total
Males.
number
treated.

Females.

Total.

Per
cent of
total
number
treated.

1897..................................
1898..................................
1899..................................
1900..................................
1901..................................
1902..................................
1903..................................
1904..................................
1905..................................
1906..................................
1907..................................
1908..................................
1909..................................

2,598
3,806
6,032
8,442
10,812
12,187
14,937
16,957
19,085
21,959
22,258
26,437
29,277

736
1,104
1,666
2,652
3,844
4,302
5,211
6,520
7,536
9,063
9,816
12,288
12,955

3,334
4,910
7,698
11,094
14,656
16,489
20,148
23,477
26,621
31,022
32,074
38,725
42,232

98.8
99.5
99.2
99.5
99.3
99.8
99.9
99.9
99.2
98.9
98.6
98.4
98.4

27
16
42
27
50
18
19
28
156
213
299
353
470

13
11
19
29
51
9
4
6
57
140
170
262
238

40
27
61
56
101
27
23
34
213
353
469
615
708

1.2
.5
.8
.5
.7
.2
.1
.1
.8
1.1
1.4
1.6
1.6

Total......................

194,787

77,693

272,480

99.0

1,718

1,009

2,727

1.0

EXPENDITURES ON ACCOUNT OE TREATMENT AND CARE, 1897 TO 1909.

The total cost o f treatment and care fo r all causes fo r the period
1897 to 1909 was 151,217,587 marks ($35,989,774). O f this sum
99,673,647 marks ($23,722,328) was on account o f expenses incurred
for full treatment o f tuberculous wage earners, and 71,480 marks
($17,012) was paid out on account o f temporary treatment fo r tuber­
culosis, making a total expenditure o f 99,745,127 marks ($23,739,340),
or 66 per cent o f the expenditures on account o f all diseases, including
tuberculosis. W hile the total expenses on account o f treatment for
all diseases have increased from 2,011,148 marks ($478,653) in 1897
to 24,275,577 marks ($5,777,587) in 1909, the expenses for full treat­
ment on account o f tuberculosis have increased from 1,024,507 marks
($243,833) in 1897 to 16,303,618 marks ($3,880,261) in 1909. The
expenses on account o f irregular or temporary treatment on account
o f tuberculosis have increased from 2,589 marks ($616) in 1897 to
16,983 marks ($4,042) in 1909. The details by years are given in
the two tables which fo llo w :




BU LLETIN OF TH E BUBEAU OF LABOR,

62

AMOUNTS EXPENDED ON ACCOUNT OF TREATMENT AND CARE FOR TUBERCULOSIS
OF THE LUNGS IN BEHALF OF GERMAN STATE INVALIDITY INSURANCE INSTITU­
TIONS, BY YEARS, 1897 TO 1909.

Year.

1897.............
1898.............
1899.............
1900.............
1901.............
1902.............
1903.............
1904.............

Total amount expended on Per cent
account of treatment for— of total
expend­
iture on
account
of treat­
ment of
All causes. Tuberculosis tubercu­
of the lungs. losis of
the
lungs.
$478,653.40
659,100.59
965,560.10
1,478,151.44
1,883,108.32
2,155,385.26
2,737,286.90
3,030,949.25

$244,448.94
368,510.66
572,398.81
896,489.30
1,199,222.83
1,394,957.57
1,763,738.76
2,017,059.55

51.1
55.9
59.3
63.7
64.7
64.4
66.5

Year.

1905
1906
1907
1908
1909

Total amount expended on Percent
account of treatment for— of total
expend­
iture on
account
of treat­
ment of
All causes. Tuberculosis tubercu­
of the lungs. losis of
the
lungs.
..................
$3,438,625.19
..................
3,965,185.93
..................
4,273,220.03
..................
5,146,960.15
..................
5,777,587.33

$2,305,233.88
2,734,988.26
2,830,847.68
3,527,141.20
3,884,303.04

67.0
69.0

Total.. 35,989,773.90 23,739,340.46

66.0

66.2
68.5
67.2

AMOUNTS EXPENDED ON ACCOUNT OF FULL TREATMENT AND CARE AND ON
ACCOUNT OF PARTIAL OR TEMPORARY TREATMENT AND CARE FOR TUBER­
CULOSIS OF THE LUNGS IN BEHALF OF GERMAN STATE INVALIDITY INSURANCE
INSTITUTIONS, BY SEX OF PATIENTS AND BY YEARS, 1897 TO 1909.
Amounts expended on account of full treatment
and care.

Year.
Males.

Females.

Per
cent
oftotal
expen­
ditures Males.
for
tuber­
culosis.

Females.

Total.

Per
cent
of total
expen­
ditures
for
tuber­
culosis.

$243,832.73
368,128.58
571,594.45
896,108.77
1,198,281.60
1,394,350.42
1,763,458.75
2,016,878.99
2,303,729.23
2,732,962.05
2,828,889.90
3,523,851.56
3,880,261.08

99.75 $395.31 $220.90 $616.21
99.90
158.20
223.87
382.07
804.36
99.86
573.58
230.78
99.96
243.83
136.70
380.54
941.23
99.92
705.34
235.89
99.96
513.77
93.37
607.15
280.01
225i 04
99.98
54.97
102.71
77.85
180.55
99.99
99.93
918.91
585.74 1,504.64
99.93
891.27 1,134.93 2,026.20
787.54 1,957.79
99.93 1,170.25
99.91 1,770.72 1,518.92 3,289.64
99.90 2,720.34 1,321.61 4,041.95

0.25
.10
.14
.04
.08
.04
.02
.01
.07
.07
.07
.09
.10

Total... 17,544,561.95 6,177,766.17 23,722,328.12

99.93 10,389.27 6,623.06 17,012.34

.07

1897...............
1898...............
1899...............
1900...............
1901...............
1902 ...............
1903...............
1904...............
1905...............
1906...............
1907...............
1908...............
1909...............

$182,553.23
$61,279.60
278,543.63
89,584.95
445,489.33
126,105.12
693,424.86
202,683.90
896,977.42
301,304.17
1,044,766.99
349,583.43
1,329,012.77
434,445.98
1,509,013.60
507,865.39
1,727,466.05
576,263.18
2,033,071.47
699,890.58
2,056,997.59
771,892.31
2,530,635.44
993,216.13
2,816,609.57 1,063,651.51

Total.

Amounts expended on account of par­
tial or temporary treatment and care.

O f the total number o f male patients treated and cared for, 48.7
per cent were treated on account o f tuberculosis o f the lungs. The
corresponding proportion fo r female patients was 36.5 per cent.
Since 1897 the number o f persons treated and cared fo r in special
institutions owned or controlled by the State invalidity insurance in­
stitutions has increased nearly tenfold. In ’ 1909, o f all persons
treated and cared fo r 42.4 per cent were treated on account o f tuber­
culosis o f the lungs, and o f these 98.4 per cent received fu ll, sys­
tematic, and largely indoor or special institutional treatment. The



CARE OP TUBERCULOUS WAGE EARNERS I N GERM ANY.

63

tendency toward special institutional treatment o f tuberculous mem­
bers o f the German State invalidity insurance institutions is ex­
plained on the ground that from a considerable amount o f experi­
ence it has been shown that only by means o f such treatment can
the required economic results be secured. The considerable finan­
cial expenditures on this account are justified by the fact that tuber­
culosis o f the lungs, according to the investigations o f 1896 to 1899,
holds the third position as the primary cause o f invalidity among
men, and the second position as the primary cause o f invalidity
among women insured with German State invalidity insurance insti­
tutions.
During the period 1897 to 1909, out o f 619,005 patients treated and
cared for on account o f all diseases, 275,207 were treated and cared
fo r on account o f tuberculosis o f the lungs, at an expense o f nearly
100,000,000 marks ($23,800,000). The total expenses fo r all causes,
including tuberculosis, during the period were 151,217,537 marks
($35,989,774). A portion o f this expense was refunded to the inva­
lidity insurance institutions by sick funds, industrial accident asso­
ciations, local authorities, poor funds, etc. In 1909 the refunded
amount was 4,948,044 marks ($1,177,635) out o f a total expense on
account o f all causes o f 24,275,577 marks ($5,777,587), leaving a net
expense on account o f treatment and care incurred by the in­
validity insurance institutions during the year o f 19,327,533 marks
($4,599,953).
Summarizing the general results o f the experience fo r the period
1897 to 1909, it is shown by the report fo r 1910 that the total ex­
penses on account o f treatment and care amounted to 151,217,537
marks ($36,454,588). O f this amount the sum o f 27,807,094 marks
($6,618,088) was refunded by sick funds, industrial accident associa­
tions, local authorities, poor funds, etc., leaving a net aggregate ex­
pense paid for by the invalidity insurance institutions o f 123,410,443
marks ($29,371,685). O f this sum 16,902,514 marks ($4,022,698)
was paid for the support o f dependent members o f the patients’
families, equivalent to 11.2 per cent o f the total disbursements for
all causes.
INCREASE IN EXPENDITURES ON ACCOUNT OF TREATMENT AND CARE.

The expenditures on the part o f invalidity insurance institutions
on account o f treatment and care for diseases o f all kinds have
steadily risen from year to year. In 1897 the amount expended on
this account was 1.6 per cent o f the total amount paid in contribu­
tions by the members o f the State invalidity insurance institutions,
increasing gradually to 6.6 per cent in 1903, and finally reaching
10.3 per cent in 1909. The average expenditure for treatment and
care during the period 1897 to 1909 was 6.3 per cent o f the in­



64

B U LLETIN OF TH E BUREAU OF LABOR.

come derived from contributions and exclusive o f the income derived
from interest or other sources.
COMPARISON OF CONTRIBUTIONS AND EXPENDITURES FOR TREATMENT.

On the basis o f the annuity payments to beneficiaries o f the State
invalidity insurance institutions the expenditures fo r treatment and
care were 3.4 per cent o f this amount in 1897, increasing to 8.3 per
cent in 1903, and to 12.2 per cent in 1909. During the period 1897 to
1909 the average expenditure fo r treatment and care was 8.5 per
cent o f the total payments made on account o f disability and other
annuities payable in conform ity to the provisions o f the compulsory
invalidity insurance law.
EXPENDITURES DURING 1909.

W hile the foregoing expenditures include the treatment and care
o f patients fo r all diseases, the expenditures for particular classes o f
patients, with distinction o f sex, but only fo r the year 1909, are given
in the table below :
EXPENDITURES FOR TREATMENT AND CARE OF INVALID MEMBERS OF GERMAN
STATE INVALIDITY INSURANCE INSTITUTIONS DURING 1909, BY SEX.
Expenditures on account of—
Tuberculosis of the lungs, full treatment:
Males.............................................................................................................
Females.........................................................................................................
Tuberculosis, temporary or partial treatment:
Males.............................................................................................................
Females.......................................................................................................
All other diseases, full treatment:
.Males.............................................................................................................
Females.........................................................................................................
All other diseases, temporary or partial treatment:
Males.............................................................................................................
Females.........................................................................................................

Amount.

Per cent

$2,816,610
1,063,652

48.75
18.41

2,720
1,322

.05
.02

1,098,034
612,943

19.00
10.61

97,384
84,923

1.69
1.47

Total on account of tuberculosis................................................................
Total on account of other causes and diseases...........................................

3,884,304
1,893,284

67.23
32.77

Total expenditures for all causes...............................................................

5,777,588

100.00

According to this table, the total expenditures for treatment and
care for all diseases and causes during 1909 amounted to 24,275,577
marks ($5,777,588). O f this expenditure 67.23 per cent was on
account o f tuberculosis o f the lungs and 32.77 per cent on account
o f other diseases and causes. On account o f male patients receiving
fu ll treatment and care fo r tuberculosis o f the lungs 11,834,494 marks
($2,816,610) was expended during the year, or 48.75 per cent o f the
total expenditures for all diseases and causes. The expenditure on
account o f female patients treated and cared for during the year was
4,469,124 marks ($1,063,652), or 18.41 per cent o f the total expendi­
tures for all diseases and causes. The expenditures on account o f
tuberculosis o f the lungs for temporary or partial treatment are only
a minor consideration. The analysis clearly shows that over two-




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

65

thirds o f the expenditures on account o f treatment and care were
incurred on account o f tuberculosis o f the lungs. It, o f course, is
well known that the membership o f invalidity insurance institu­
tions constitutes practically the total active wage-earning popu­
lation o f the German Empire. Whatever, therefore, is done in this
respect, or in this direction, is prim arily for the uplift, protection,
and care o f the men and women engaged in German industry at the
present time.
PROPORTION OF INSURED POPULATION TREATED AND CARED FOR
DURING 1909.

In 19071 the population liable to insurance in conform ity to the
compulsory invalidity insurance laws was ascertained to be 14,631,390.
Since the total number o f persons receiving treatment and care on
account o f tuberculosis o f the lungs in 1909 was 42,940, the rate o f
persons receiving treatment and care on account o f this disease was
29.35 per 10,000. F or purposes o f comparison it may be stated that
the number o f persons receiving treatment on account o f diseases
and causes other than tuberculosis o f the lungs was 58,218, or at the
rate o f 39.79 per 10,000 o f population within the scope o f the com­
pulsory insurance laws. The total number o f persons receiving
treatment for all causes was 101,158 during 1909, or at the rate o f
69.14 per 10,000 o f insurable population. In marked contrast are
the results for 1897, when the population subject to the insurance
laws was ascertained to be 11,813,259, and the total number o f persons
receiving treatment and care for all causes was only 10,564, or at the
rate o f 8.94 per 10,000 o f insurable population. The actual number
o f persons receiving treatment for all causes has, therefore, increased
857.6 per cent between 1897 and 1909, while the rate per 10,000 o f
insurable population has increased 673.4 per cent.
PROPORTION OF PATIENTS TREATED, B Y SELECTED STATES.

The foregoing estimate applies to the German Empire as a whole.
The rate varies considerably for the different States or territorial
divisions o f the Empire, prim arily, o f course, because o f the greater
or lesser proportion o f the population within the scope o f the in­
surance laws. In Berlin, for illustration, in 1909 the ratio o f total
persons receiving treatment for all causes was 171 per 10,000 o f in­
surable population, for Upper Bavaria the rate was 153, for Baden
144, and for the Thuringian States 127. The lowest rate was 14
per 10,000 for Mecklenburg, which is almost exclusively an agri­
cultural section. It is hardly necessary to emphasize in this discussion
that tuberculosis, as well as many other diseases, is generally much
1 The date of the last industrial census.

49397°—12----- 5



66

B U LLETIN OF TH E BUREAU OF LABOR.

more common among the industrial than among the agricultural pop­
ulation and more common among the population o f cities with con­
gested districts than among the population o f rural districts.1 These
conditions largely govern the relative proportion o f insured members
receiving treatment in special institutions, the range being, as stated,
between a minimum o f 14 and a maximum o f 171 per 10,000. These
rates have no reference to the membership o f supplementary asso­
ciations or institutions within the scope o f the compulsory invalidity
insurance laws, limited practically to railways and mines, and for
which the rates o f members treated and cared for have ranged from
4 to 208 per 10,000 employees.
NOTIFICATION OF ARM Y RECRUITS WHO W E R E REJECTED ON ACCOUNT
OF TUBERCULOSIS.

F or the purpose o f securing the earliest possible information con­
cerning incipient cases o f tuberculosis o f the lungs, a regulation was
adopted in 1907, under which inform ation concerning army recruits
rejected on account o f tuberculosis o f the lungs was required to be
communicated to the State invalidity insurance institutions o f which
they were members. In 1909 notifications o f 575 cases o f incipient
tuberculosis, and o f 587 recruits otherwise diseased, were communi­
cated to the insurance institutions for the purpose o f providing, if
advisable, the required treatment in anticipation o f a cure. O f this
number, however, only 218 o f the tuberculous subjects received insti­
tutional treatment, and o f these 180, or 82.6 per cent, were subse­
quently discharged as cured, in conform ity to section 4, paragraph
5, o f the invalidity insurance law [art. 1255, par. 2, o f the W ork­
men’s Insurance Code o f July 19, 1911]. In the case o f those not
treated, the reasons for declining action on the part o f the insurance
institutions were chiefly the probability o f noneffectiveness o f the
treatment, or noneligibility to treatment on the part o f the insurance
institutions. In some cases the disease had advanced too far, and in
some others it was o f too incipient a nature to warrant the anticipa­
tion o f invalidity within a reasonable period o f time. In a general
way it would appear that while much had been expected from this
cooperation between the m ilitary authorities and the insurance insti­
tutions, the actual results have not been as satisfactory as had been
assumed would be the case. W hile the number o f cases may seem
relatively small, it requires to be considered that every case o f in­
validity involves a serious possibility o f material expense on the part
o f the insurance institutions, aside from the humanitarian considera­
tions, which make it o f the utmost importance that every case o f
incipient tuberculosis shall, i f practicable, be treated systematically
and effectively from the earliest stage o f the disease.
1 There are, however, exceptions to the rule, which have no bearing upon the present


discussion.


OAEE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

67

FINANCIAL AID GIVEN BY IN VALID ITY INSURANCE INSTITUTIONS IN
THE CAMPAIGN AGAINST TUBERCULOSIS.

In common with other civilized countries there are throughout
Germany to-day a large number o f voluntary associations for aid
and assistance o f wage earners and others in the event o f sickness,
but there are also many institutions other than those maintained by
charitable or philanthropic contributions, supplementary to the
institutions maintained by the State insurance funds. A s an en­
couragement and aid in the campaign against tuberculosis, the State
invalidity insurance institutions during 1909 paid out 288,365 marks
($68,631), against 248,805 marks ($59,216) in 1908. O f the expendi­
tures during 1909 the sum o f 116,175 marks ($27,650) was for con­
tributions and aid to societies, committees, etc., organized for the
establishment o f day camps, forest convalescing homes, etc. The sum
o f 159,265 marks ($37,905) was paid out for the establishment or
maintenance o f bureaus o f information and dispensaries for the
benefit o f persons afflicted with tuberculosis, while 12,925 marks
($3,076) was paid out in grants for miscellaneous similar purposes.
W hile these amounts are relatively not very large, the aid rendered
is often substantial and practically indispensable to the further­
ance o f the aims and objects o f the general campaign or warfare
against tuberculosis. F or illustration, the Invalidity Insurance In­
stitution o f Berlin, in 1909, paid out 40,550 marks ($9,651), o f which
30,000 marks ($7,140) was paid to the central committee for instruc­
tion and care o f tuberculous persons in Berlin and vicin ity; 50 marks
($11.90) to the German Central Committee for the establishment o f
institutions, day camps, etc., for tuberculous persons; 500 marks
($119) for the Provincial Antituberculosis Association o f Branden­
burg; and 10,000 marks ($2,380) to the Red Cross Society for the
establishment o f public sanatoria. Some o f the other territorial in­
surance institutions make even more varied contributions, partly for
educational purposes, but largely in aid o f direct efforts to combat
the disease by the institutional segregation and treatment o f patients
and their effective, systematic care.
In addition to the foregoing, the invalidity insurance institutions
make grants o f variable sums to communities in aid o f the establish­
ment or maintenance o f dispensaries, hospitals, district nursing asso­
ciations, etc. During 1909 the sum o f 288,449 marks ($68,651) was
paid out on this account by all o f the State invalidity insurance
institutions, against 214,093 marks ($50,954) paid out in 1908. The
m ajor portion o f this sum was in behalf o f the campaign against
tuberculosis and on account o f cases not suitable for institutional
treatment.




68
FAM ILY

BU LLETIN OP TH E BUBEAU OF LABOB.
SUPPORT

OF

TUBERCULOUS WAGE
SANATORIA.

EARNERS

IN

PUBLIC

T o encourage invalid members to make use o f institutions for the
treatment and cure o f tuberculosis o f the lungs the invalidity insur­
ance law provides for grants o f financial aid to dependent members
o f the patient’s fam ily in excess o f the amount payable in conform ity
to the sickness insurance laws. The use which is made o f this author­
ity varies considerably with different insurance institutions. The
institution o f East Prussia, fo r illustration, grants double the amount
o f legal aid to dependents in the event o f sickness, while Berlin and
Brandenburg provide, on the consideration o f cases on their indi­
vidual merits, to the extent o f three times the minimum legal aid.
Hanover provides in individual cases supplementary aid to depend­
ents to a maximum amount o f 15 marks ($3.57) a week, but in
most cases the aid is limited to double the amount receivable in the
event o f ordinary sickness, the supplementary assistance being
granted as an inducement fo r those in apparent need to make use at
the earliest possible moment o f the institutions providing fo r the
effective treatment o f diseases, chiefly tuberculosis o f the lungs. As
has been previously stated, during 1909, 3,221,957 marks ($766,826)
was paid out by invalidity insurance institutions on account o f the
- support o f dependent members o f the patients’ families—that is, on
account o f patients treated for all diseases and causes, including
tuberculosis o f the lungs—the expense being considered necessary,
and in fact indispensable, to induce patients in the incipient stage
o f the disease to seek treatment when the outlook is most favorable.
W ith further reference to the amounts disbursed in aid o f de­
pendents o f tuberculous patients it was brought out by the investiga­
tion o f 1909 that during that year, on account o f 4,456 patients
under treatment fo r tuberculosis o f the lungs the sum o f 122,985
marks ($29,270) was paid as supplementary aid to dependent mem­
bers o f the families, in addition to the aid provided in conform ity
to the sickness insurance laws. The particular importance attached
to this form o f support in behalf o f effective measures against tuber­
culosis is brought out by the fact that for all other diseases dealt
with by State invalidity insurance institutions during 1909 on ac­
count "of 1,993 patients, only 25,152 marks ($5,986) was paid out in
aid o f dependent members o f the patients’ families.
Summarizing the special expenditures on account o f treatment and
care o f invalid members o f State invalidity insurance institutions it
has been shown that the amount paid on this account to local authori­
ties for general sick aid was 288,449 marks ($68,651); in behalf o f
the general warfare against tuberculosis, 288,365 marks ($68,631);
on account o f disinfection o f premises, 3,770 marks ($897); and for
increased aid fo r dependent members o f the patients’ fam ilies.



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

69

122,985 marks ($29,270). Out o f 17,024,170 marks ($4,051,752)
paid for treatment and care on account o f tuberculous patients in
State invalidity insurance institutions 703,569 marks ($167,449), or
4.1 per cent, was paid for special purposes in behalf o f the general
campaign against tuberculosis or in behalf o f other measures and
means for effective treatment and the reduction o f the death rate.
Efforts have been made within recent years to enforce the general
laws and local regulations providing for the disinfection o f rooms
occupied by tuberculous patients, and particularly rooms in which
deaths from tuberculosis have occurred. The State invalidity insur­
ance institutions extend financial aid in behalf o f this movement in
special cases, and in 1909 the amount o f 3,770 marks ($897) was ex­
pended on this account. As a general rule the expenses o f disinfec­
tion are paid for by the local authorities, under police supervision.
METHODS

OE TREATMENT

AND

CARE.

The methods o f treatment and care naturally vary more or less with
the different territorial State invalidity insurance institutions, but
the general principle o f the so-called hygienic-dietetic treatment has
been almost universally adopted. This method affords abundant fresh
air and nutritious diet, systematic care o f the skin, and a wholesome
mode o f life generally. The use o f mineral baths or spas is rather
limited, and during 1909 the number o f tuberculous patients making
use o f this form o f treatment was only 3,374. The use o f baths, how­
ever, is increasing, as is shown by the fact that in 1905 the number
o f tuberculous patients at baths was only 1,457. O f the total number
o f 42,232 tuberculous patients receiving treatment and care during
1909, as many as 36,785, or 87.1 per cent, received such treatment
in sanatoria or other special institutions especially established for
the most effective and systematic treatment o f tuberculosis o f the
lungs. As has been previously stated, the number o f tuberculous
patients treated at baths during 1909 was 3,374, or 8 per cent.
In addition, 1,298, or 3.1 per cent, were treated at day camps or con­
valescing homes; 757, or 1.8 per cent, in general and special hospitals
and clinics, and 13 in private homes or on farm s; for 5 the method
o f treatment was not obtainable. It is evident, therefore, that the
large m ajority o f tuberculous patients treated or cared for in be­
half o f German State invalidity insurance institutions receive such
treatment and care in special institutions established for the most
effective and systematic treatment o f the disease. The foregoing
numbers, however, have reference only to such tuberculous patients
as received a fu ll and systematic treatment, and they have no refer­
ence to the relatively small number o f patients who received tem­
porary or partial treatment, chiefly in the form o f medical consulta­
tions, dispensary treatment, etc.



70

BU LLETIN OF TH E BUBEAU OF LAB OB,

The inform ation is shown in detail fo r each territorial insurance
institution in the table which follow s:
NUMBER OF PEBSONS BECEIVING FULL TKEATMENT AND CABE ON ACCOUNT OF
TUBERCULOSIS OF THE LUNGS, IN TEBRITORIAL AND EMPLOYEES INSURANCE
INSTITUTIONS DURING 1909, BY KIND OR METHOD OF TREATMENT.

Territorial and employees’ insurance
institutions.

East Prussia...................................................
West Prussia..................................................
Berlin.................... ........................................
Brandenburg..................................................
Pomerania. 7 . ..................................................
Posen..............................................................
Silesia..............................................................
Saxony-Anhalt...............................................
Schleswig-Holstein..........................................
Hanover..........................................................
Westphalia.....................................................
Hesse Nassau..................................................
Rhine Province..............................................
Upper Bavaria................................................
Lower Bavaria................................................
Pfalz................................................................
Upper Pfalz and Regensburg.........................
Upper Franconia............................................
Middle Franconia...........................................
Lower Franconia and Aschaffenburg.............
Swabia and Neuburg......................................
Kingdom of Saxony........................................
Wurttemberg..................................................
Baden.............................................................
Hesse (Grand Duchy)....................................
Mecklenburg...................................................
Thuringia........................................................
Oldenburg......................................................
Brunswick......................................................
Liibeck, Bremen, and Hamburg....................
Alsace-Lorraine...............................................
Prussia-Hesse railroad employees...................
North German miners’ fund...........................
Saarbmcken Miners’ Association....................
Bavarian traffic employees............................
Saxony railroad employees’ fund..................
Saxony miners’ fund......................................
Baden railroad and salt works fund...............
Imperial railroad pension fund......................
Bochum Miners’ "union..................................
Marine employees’ fund................................
Total......................................................

In
gen­
eralor
special
hospi­
tals.

In institutions
for the treat­ In con­
ment of
vales­ At In pri­
tuberculosis.
cent
vate Not
homes, baths, homes, speci­ Total.
day spas, etc. fied.
etc.
Num­
Per camps,
etc.
ber.
cent.
357
159
3,890
1,707
179
730
1,728
1,554
219
1,291
1,935
1,138
3,968
1,319
122
508
110
251
823
209
281
2,428
1,610
2,429
1,071
108
775
204
397
1,302
1,316
1,126
531
8
157
59
16
132
154
443
41

92.0
92.4
100.0
83.8
71.3
99.9
66.0
99.7
42.4
99.2
68.4
61.2
76.9
83.2
79.2
100.0
93.2
100.0
100.0
100.0
99.6
96.6
99.3
95.7
99.8
99.1
97.6
100.0
100.0
81.9
100.0
88.8
100.0
100.0
99.4
100.0
100.0
100.0
100.0
94.5
97.6

757 36,785

87.1

20
7
84
49
1
37
15
9
3
29
323
14
28

i
2
11
110
1
9
2

1
1

11

1

17

245
6

843
2
1

9
1
277

93

889
599
869
2

250
4

1
5
1
1

1

7

82
2

2
1

18
69

2io
140

1

25
1,298 3,374

13

5

388
172
3,890
2,036
251
731
2,617
1,558
517
1,301
2,827
1,860
5,160
1,585
154
508
118
251
823
209
282
2,514
1,621
2,539
1,073
109
794
204
397
1,590
1,316
1,268
531
8
158
59
16
132
154
469
42

5 42,232

There are throughout Germany a number o f forest and air cure
establishments, which are made use o f jointly by members o f sick
funds, industrial accident associations, and State invalidity insur­
ance institutions. The exact number o f tuberculous patients at these
establishments is not known, but the aggregate number o f persons
receiving treatment, either on account o f tuberculosis or on account
o f other diseases, in 1909 was 1,481 males and 1,330 females. The
form er received 46,381 days’ treatment and the latter 40,856 days.
The average number o f days’ treatment per patient, therefore, was
31.3 for males and 30.7 for females. The total expenditure on account
o f these establishments was 100,500 marks ($23,919) fo r males and




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

71

05,747 marks ($15,648) for females. The increasing use which is
made o f them is illustrated by the fact that the corresponding ex­
penditures for 1907 were only 66,579 marks ($15,846) fo r males and
26,997 marks ($6,425) for females.
F or the treatment and care o f tuberculous patients in the advanced
stages o f the disease, unfit on account o f their condition fo r treat­
ment in sanatoria or other special institutions, so-called invalid
homes are maintained by many o f the State invalidity insurance
institutions. The treatment is more in the nature o f a humane con­
sideration for the well-being and com fort o f hopeless cases than for
the economic object o f restoring the wage-earning capacity o f afflicted
members. During 1909 the number o f tuberculous patients taken
care o f in institutions o f this kind was 1,047 males and 300 females.
O f this number 229 males and 77 females died during the year, prov­
ing conclusively that these patients were in an advanced stage
o f the disease when admitted. A t the end o f 1909 the number re­
maining under treatment and care was 294 males and 108 females,
against 196 males and 82 females receiving care and treatment at the
end o f 1908. The use o f these institutions is therefore increasing.
The treatment and care o f tuberculous members o f German State
invalidity insurance institutions is largely confined to sanatoria, hos­
pitals, etc., owned, maintained, and managed by the insurance insti­
tutions themselves. The number o f owned sanatoria, etc., fo r the
treatment o f tuberculosis o f the lungs has increased from 1 in 1895
to 18 in 1903 and 37 in 1909, as is shown in the follow ing table:
NUMBER OF SPECIAL INSTITUTIONS FOR THE TREATMENT AND CARE OF INVALID
MEMBERS, OWNED BY GERMAN STATE INVALIDITY INSURANCE INSTITUTIONS,
BY YEARS, 1895 TO 1909.

Year.

Institu­
tions for General
the treat­ hospitals
ana con­
ment of valescent
tuber­
homes.
culosis.

1895.......................
1896.......................
1897.......................
1898.......................
1899.......................
1900.......................
1901.......................
1902.......................

1
1
3
5
8
9
11
15

1
2
5
7
12

Total.

1
1
3
6
10
14
18
27

Year.

1903.....................
1904.....................
1905.....................
1906.....................
1907.....................
1908.....................
1909.....................

Institu­
General
tions for
the treat­ hospitals
ana con­
ment of valescent
tuber­
homes.
culosis.
18
22
26
26
30
36
37

17
19
21
25
26
29
34

Total.

35
41
47
51
56
65
71

The first institution owned by an invalidity insurance fund was the
sanatorium o f Hanover, opened for the treatment o f patients on May
1, 1895. These institutions are not necessarily located within the
territorial boundaries o f the State insurance institutions, but they
are often located where the topography, natural drainage, forest
environment, climate, etc., are most suitable. The insurance institu­
tion o f Berlin owns also a tuberculin station, which is utilized to a




72

BULLETIN OF THE BUREAU OF LABOR,

limited extent by other insurance institutions. Full details con­
cerning the accommodation o f the principal institutions in active
operation at the present time, together with the most important
financial and other statistics, are set forth in the table which follow s:
FINANCIAL AND OTHER STATISTICS OF INSTITUTIONS FOR THE TREATMENT OP
TUBERCULOSIS OF THE LUNGS, OWNED BY GERMAN STATE INVALIDITY INSUR­
ANCE INSTITUTIONS, 1909.
Num­
ber of
insur­
ance
insti­
tu­
tion.

Name of hospital or sanatorium.

fBeelitz.....................................................................................
Beelitz annex...........................................
3 <
(
Tuberculosis station.................................
4 Cottbus...........................................................
6 Crown Prince W inj a m ....................................
....... .....................................................
8 fip.hipjo
Konigsbergbei Goslar.....................................
Schwarzenbach bei Clausthal.........................
10 ■ Erbprinzentanne bei Zellerfeld.......................
An d rp.fl-gTip.im
st. Andreasberg..................
Stiibeckshom bei Soltau................................
13 Ronsdorf.........................................................
16 Pfalzische Sanatorium in Ramberg................
21 Wasach bei Obertiefenbach............................
22 Hohwald bei Neustadt...................................
/ W iihp.lmsTiPim bei Oppenweiler............................
23 \tiberruh bei Bolstemang................................
|Friedrichsheim bei Marzell.............................
.n p T im
V r .ftll..................................
24 JT ig .n iP "bei ‘M u r
1Nordrach Colony............................................
26 /^mst-biidwig Sanatorium..............................
.................................................
i Rfimhilri
27 Sophia Sanatorium.........................................
/ Albrechtshaus bei Stiege................................
29 iMarie Home...................................................
nderberg-^ft
bbard^hftini................................
30 * Gluckauf in St. Andreasberg.........................
Gross-Hansdorf...............................................
f TjAopo1dinftnliP.in\_______________________
31 1Tannenberg.....................................................
/Stadtwald bei M
p.ignngp.n...............................
32 \Moltkefels........................................................
33 Miners Sanatorium—Siilzhayn........................
38 Frederick-Hilda Sanatorium...........................
40 August-Victoria Sanatorium...........................
i To Dec. 31,1909.




Number of beds
for—
Date of
Land
estab­
area
lish­
occupied
ment. Males. Females. (acres).

1902
1907
1908
1900
1903
1905
1895
1899
1898
1903
1902
1909
1905

196
294
20
100
143
70
70
65
138
61

1905
1904
1908
1899
1905
1908
1901

260
177

1908
1897
1899
1897
1901
1908
1903
1907
1904
1904
1898
1907
1904

120
86

1902

234
iio
132

180
32
140
120
104
130
59
118

Cost of
grounds

73
283

346.0

$95,788.10

110

40.5
33.6
81.9
18.1
36.8
36.3
29.8
73.8
91.5
64.0
68.2
56.0
18.4
75.6
53.9
37.7
45.5
27.4

22,597.15
9,064.47
28,384.83
4,093.60
5,331.20
11,233.60

232.5
3.6
1.6
144.8
11.4
56.2
10.6
25.9
42.1
53.2
23.5
24.2
456.4

68,091.80

63
43

180
1.99
80
36
100
92

30
* Leased.

8.2

m

(2)
29,585.78
14,125.06
19,168.28
17,046.75
8,752.45
15,654.21
6,323.66
14,267.15
26,180.00
14,586.31
1,214.28

(2)

(2)
13,621.45
4,163.10
18,271.02
14,756.00
5,950.00
17,124.34
16,933.94
7,278.04
13,140.69
14,280.00

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY,

73

FINANCIAL AND OTHER STATISTICS OF INSTITUTIONS FOR THE TREATMENT OF
TUBERCULOSIS OF THE LUNGS, OWNED BY GERMAN STATE INVALIDITY INSUR­
ANCE INSTITUTIONS, 1909—Continued.
Num­
ber of
insurance
insti­
tu­
tion.

Cost of—
Name of hospital or sanatorium.
Buildings.1

Interior
furnish­
ings, etc.1

Expenditures during
1909.

Total.

fBeelitz............................................................. $2,471,433.41 $261,272.35 $586,509.11
Beelitz annex........................................... 1,364,826.95 134,835.57
3 <
[
Tuberculosis station.................................
1,767.39
9,769.90
4 'Cottbus...........................................................
128,792.99 40,554.01 30,869.31
6 Crown Prince William....................................
140,398.58 16,254.45 34,725.39
196,368.80 21,950.74 52,136.28
8 Schielo.............................................................
fKOnigsberg bei Goslar....................................
64,902.60 13,328.00 16,780.67
Schwarzenbach bei Clausthal.........................
67,330.20 13,827.80
9,663.28
Erbprinzentanne bei Zellerfeld............. ........
55,573.00 16,112.60 14,978.77
10
Andreasheim bei St. Andreasberg;................
18,159.40
8,896.44
11,380.92
41,792.80 17,969.00 17,696.25
Sttibeckshom bei Soltau................................
138,040.00 13,090.00 54,205.69
13 Ronsdorf.........................................................
16 Pfalzische Sanatorium in Ramberg................
192,193.81 17,058.89 24,674.65
2,323.12
21 Wasach bei Obertiefenbach............................
467,067.15 46,418.33 89,085.78
22 Hohwald bei Neustadt..................................
/Wilhelmsheim bei Oppenweiler.....................
251,069.77 30,964.28 59,957.44
23 Uberruh bei Bolstemang................................
426,162.80 41,320.37 61,238.11
IFriedrichsheim bei Marzell.............................
395,592.65 42,092.92 86,539.89
259,749.63 27,013.24 50,428.39
24 ■Luisenheim bei Marzell..................................
Nordrach Colony............................................
65,130.37 20,855.70 60,229.71
265,961.19 43,956.70 46,895.28
25 Emst-Ludwig Sanatorium..............................
111,788.36 10,545.30 20,879.26
/Romhild..........................................................
27 ySophia Sanatorium........................................
69,328.21
7,140.00 31,491.92
44,684.50
7,665.74 17,432.79
29 /Albrechtshaus bei Stiege................................
\Marie Home....................................................
20,384.70
4,059.80
6,644.01
[Oderberg-Gebhardsheim................................
292,176.18 34,124.44 79,249.48
138,400.09 12,110.39 37,163.70
30 ■{Gliick auf in St. Andreasberg.........................
6,270.82 13,111.18
[Gross-Hansdorf...............................................
43,901.24
62,545.21
9,864.86 27,975.95
31 /Leopoldinenheim............................................
yTannenberg.....................................................
134,487.85 24,664.42 58,106.27
219,476.46 17,508.47 51,641.72
/Stadtwald bei Melsxmgen...............................
32 \Moltkefels.......................................................
181,292.93 15,811.53 48,590.32
206,004.71 16,660.00 44,075.46
33 Miners Sanatorium—Stilzhayn.......................
103,099.93 13,969.41 27,702.49
38 Frederick-Hilda Sanatorium...........................
460,233.93 25,331.29 79,422.98
40 August-Victoria Sanatorium...........................




i

To Dee. 31,1909.

For food
and drink.
$121,133.91
2,671.79
12,900.31
16,122.83
28,894.50
7,167.37
4,278.76
5,228.86
3,526.92
7,490.57
25,278.69
9,622.58
30,417.11
28,793.95
21,172.48
46,690.36
25,334.15
24,991.19
18,975.50
7,956.82
15,039.46
10,689.53
3,651.63
31,912.94
12,490.72
5,902.64
15,112.52
27,885.51
22,550.74
19,924.41
18,165.11
14,205.74
23,719.08

74

BULLETIN OF THE BUBEAU OF LABOR,

FINANCIAL AND OTHER STATISTICS OF INSTITUTIONS FOR THE TREATMENT OF
, TUBERCULOSIS OF THE LUNQS, OWNED BY GERMAN STATE INVALIDITY INSUR. ANCE INSTITUTIONS, 1909-Conoluded.

Total
days of
treatment
and
Days of
support
treat­
Num­ ment Num­ Days of and
sup­
and
ber.
ber. port. days of
sup­
sup­
port.
port.
Patients.

Num­
ber of
insur­
ance
insti­
tu­
tion.

3
4
6
8
10
13
16
21
22
23
24
25
27
29
30
: 31
32
33
38
40

Name of hospital or sanatorium.

[Beelitz.............................................
Beelitz annex...........................
Tuberculosis station.................
Cottbus...........................................
Crown Prince William....................
Schielo.............................................
fKonigsberg bei Goslar....................
Schwarzenbach bei Clausthal.........
«Erbprinzentanne bei Zellerfeld.......
Andreasheim bei St. Andreasberg..
Stiibeckshom bei Soltau.................
Ronsdorf.........................................
Pfalzische Sanatorium in Bamberg.
Wasachbei Obertiefenbach...........
Hohwald bei Neustadt...................
[ W ilhelmsheim bei Oppenweiler....
\TJberruh bei Bolstemang................
(Friedrichsheim bei Marzell.............
•jLuisenheim bei Marzell..................
INordrach Colony.............................
Emst-Ludwig Sanatorium..............
fBomhild..........................................
\Sophia Sanatorium........................
fAlbrechtshaus bei Stiege................
\Marie Home....................................
|
Oderberg-Gebhardsheim................
\ Gluck auf in St. Andreasberg.........
[Gross-Hansdorf...............................
fLeopoldinenheim............................
\Tannenberg.....................................
fStadtwald bei Melsungen...............
\Moltkefels........................................
Miners Sanatorium—Stilzhayn.......
Frederick-Hilda Sanatorium..........
August-Victoria Sanatorium...........

\
[

4,478 301,224

Employees.

Per capita cost per
day of food and #
drink.
Pa­
Treat­
ment Pa- tients
and tients and
em­
sup­ only. ploy­
port.
ees.

166 60,296 361,520 $1.42 $0.40

493
496
560
640
330
187
279
158
272
669
329

6,669
40,000
34,415
51,250
21,278
11,139
18,730
12,906
18,908
47,254
22,175

8 2,320
21 7,537
21 7,591
27 9,355
10 3,403
10 2,511
10 3,758
8 2,558
12 4,204
30 10,751
16 5,530

1,388
1,064
869
1,233
970
565
727
372
548
361
136
905
433
383
491
838
703
537
556
299
465

77,209
59,579
63,272
81,892
71,452
37,033
45,043
24,949
34,449
22,370
8,718
51,243
31,316
9,462
29,435
50,231
44,431
38,503
37,699
24,957
37,224

44
37
41
42
27
32
25
16
17
10
7
43
20
10
18
20
25
25
32
19
37

$0.34

8,989
47,537
42,006
60,605
24,681
13,650
22,488
15,464
23,112
58,005
27,705

1.47
.77
1.01
1.02
.79
.87
.80
.88
.94
1.15
1.11

.40
.32
.47
.41
.34
.38
.28
.27
.40
.54
.43

.30
.27
.38
.35
.29
.31
.23
.23
.32
.44
.35

14,756 91,965
13,650 73,229
13,721 76,993
19,056 100,948
11,290 82,742
11,076 48,109
5,860 50,903
6,021 30,970
6,367 40,816
4,302 26,672
2,742 11,460
13,418 64,661
5,744 37,060
3,136 12,598
5,701 35,136
7,084 57,315
9,830 54,171
9,531 48,034
10,156 47,855
6,868 31,825
11,431 48,655

1.15
1.01
.97
1.06
.71
1.63
1.04
.84
.91
.78
.76
1.55
1.19
1.39
.95
1.16
1.16
1.26
1.17
1.11
2.13

.40
.48
.34
.57
.35
.67
.42
.32
.44
.48
.42
.62
.40
.62
.51
.55
.51
.52
.48
.57
.64

.33
.39
.28
.46
.31
.52
.37
.26
.37
.40
.32
.49
.34
.47
.43
.49
.42
.41
.38
.45
.49

F or purpose o f illustration, mention may here be made o f the sana­
torium at Beelitz, maintained by the Berlin Invalidity Insurance
Institution, established in 1902, with an accommodation o f 196 beds
fo r men and 73 beds fo r women. B y December 31, 1909, the cost
o f the land had been 402,471 marks ($95,788), the cost o f buildings
10,384,174 marks ($2,471,433), and the cost o f installation, furniture,
etc., 1,097,783 marks ($261,272). This institution was enlarged by an
annex in 1907, providing 294 more beds for men and 283 more beds
fo r women, at an additional cost fo r buildings o f 5,734,567 marks
($1,364,827) and an additional cost o f installation o f 566,536 marks
($134,836). The cost o f maintenance fo r all purposes in 1909 was
2,464,324 marks ($586,509), o f which 508,966 marks ($121,134) , or
20.6 per cent, was on account o f the board and other personal mainte­
nance o f the patients. The number o f male patients treated at the
institution, including the annex, during 1909 was 2,659, and the num­



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

75

ber o f female patients was 1,819, or a total o f 4,478. The number o f
days’ treatment and care received by these patients was 801,224. The
number o f attendants and other employees in 1909 was 45 males and
121 females, who received 60,296 days o f personal support. The total
number o f days’ board or support and care, therefore, was 361,520
fo r the year 1909. The per capita cost per day for all purposes was
5.96 marks ($1.42), but considering expenditures for food and other
personal needs only, the cost was 1.41 marks (34 cents) per capita
per day, and excluding employees and other attendants, 1.69 marks
(40 cents) for patients only. Since full details concerning the per
capita cost per day o f treatment and o f other important financial
items are given in the table, it is not necessary to further enlarge
upon this subject.
P RC P
E
A ITA C S O T E T E T A D C R .
OT P R A M N
N
A E

The per capita cost o f treatment is necessarily higher in the case
o f tuberculous patients than in the case o f patients generally who are
treated fo r other diseases, and the same is true o f the length o f treat­
ment, which in the case o f tuberculosis exceeds considerably the aver­
age for other diseases considered as a group. The average cost o f
treatment per patient per day in German sanatoria for the treatment
and care o f tuberculous patients ranged from 3 to 5 marks (71 cents
to $1.19), against a range o f 2.50 to 4.50 marks (60 cents to $1.07)
in the case o f institutions, hospitals, etc., treating diseases other than
tuberculosis o f the lungs. The expense per patient per day for board
in the case o f patients treated in institutions fo r the treatment and
oare o f tuberculous persons ranged between 1 mark and 2.50 marks
(23.8 cents and 60 cents). An analysis o f the total expenditures o f 33
sanatoria fo r the treatment o f tuberculosis shows that the maximum
expenditure per day per patient was 8.96 marks ($2.13), the mini­
mum 2.97 marks (71 cents), and the average 4.60 marks ($1.09).
The corresponding expenditures for patients receiving treatment
other than fo r tuberculosis o f the lungs in 29 institutions ranged
from 6.11 marks ($1.45) maximum to 2.06 marks (49 cents) mini­
mum. The average was 4.04 marks (96 cents). The average expendi­
ture fo r board on account o f tuberculous patients only, and excluding
attendants, was 1.90 marks (45 cents) per patient per day, the maxi­
mum having been 2.83 marks (67 cents) and the minimum 1.15 marks
(27 cents). Including attendants, the average cost for board was
1.55 marks (37 cents) per patient per day, the maximum having been
2.18 marks (52 cents) and the minimum 96 pfennigs (23 cents). The
average expenditure on account o f patients only in institutions treat­
ing diseases other than tuberculosis was 1.57 marks (37 cents), and
including attendants, it was 1.25 marks (30 cents) per patient per day.



76

BULLETIN OF THE BUREAU OF LABOR.

The follow ing table gives data for 33 institutions operated by the
German State invalidity insurance institutions:
AVERAGE DAILY EXPENDITURES OF SPECIAL INSTITUTIONS FOR TREATMENT,
SUPPORT, AND MAINTENANCE ON ACCOUNT OF TUBERCULOSIS OF THE LUNGS, BY
GERMAN STATE INVALIDITY INSURANCE INSTITUTIONS, DURING 1909.
Expenditures for
food and drink
Num­ Aggregate of—
ber of expend­
institu­ itures.
tions.
Patients Patients
and em­
only.
ployees.
Ma-srimnm cost per capita per day................................................
M
tniTnyim cost per capita per day..................................................
Average cost per capita per day.....................................................

33
33
33

$2.13
.71
1.09

$0.67
.27
.45

$0.52
.23
.37

FIN N IA S A IS IC O SA A O IA O N D BY G R A INVALIDITY
A C L T T T S F
N T R
W E
E M N
IN R N E IN IT T N
SU A C
ST U IO S.

In 1909 there were 37 institutions owned or maintained, or in
course o f construction, in behalf o f State invalidity insurance insti­
tutions, providing an accommodation o f 3,134 beds fo r men and
1,289 for women. The cost o f the ground owned was 2,256,438
marks ($537,032); the cost, o f buildings occupied, 38,238,124
marks ($9,100,674); and the cost o f installation, 4,349,854 marks
($1,035,265). A ll o f these items show a substantial increase over
1908. The annual cost for maintenance and board was 7,820,388
marks ($1,861,252) for 1909 against 7,251,910 marks ($1,725,955) in
1908. The number o f patients receiving treatment during 1909 was
16,593 males and 6,141 females. These statistics have reference only
to sanatoria providing systematic treatment fo r tuberculosis o f the
lungs and have no reference to convalescing homes, hospitals, etc.,
provided for other purposes, numbering in 1909 thirty-four, and
providing 1,754 beds for men and 1,117 for women and accommodat­
ing 13,804 male patients and 6,940 female patients at an annual ex­
penditure o f 2,726,692 marks ($648,953). To what extent this
method o f treatment includes cases o f tuberculosis o f the lungs is
not accurately known.




77

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

In the table which follow s financial data are given relative to
sanatoria belonging to the German State invalidity insurance insti­
tutions and which provide systematic treatment fo r tuberculosis o f
the lungs:
GENERAL, FINANCIAL, AND OTHER STATISTICS OF THE SANATORIA OWNED BY
GERMAN INVALIDITY INSURANCE INSTITUTIONS.
Increase during 1909.
1908

1909
Actual.

Number of institutions...................................
Number of beds:
For men...................................................
For women...............................................
Area of land occupied (acres)..........................
Cost of—
Land.........................................................
Buildings.................................................
Furnishings..............................................
Expenditures for all purposes during year___
Number of patients:
Males........................................................
Females....................................................

Per cent.

36

37

1

2.8

2,985
1,276
2,145.6

3,134
1,289
2,329.2

149
13
183.6

5.0
1.0
8.6

$468,630.57
$8,747,025.50
$991,566.07
$1,725,954.58

$537,032.24
$9,100,673.51
$1,035,265.25
$1,861,252.34

$68,401.67
$353,648.01
$43,699.18
$135,297.76

14.6
4.0
4.4
7.8

14,352
5,306

16,593
6,141

2,241
835

15.6
15.7

Total.....................................................

19,658

22,734

3,076

15.6

Percent of male patients................................

73.0

73.0

L A S P O ID D F R T E E E T N O P B IC SA A O IA
ON R V E
O
H
R C IO
F U L
N T R .

In conform ity to the provisions o f the invalidity insurance laws,
the State invalidity insurance institutions may advance loans for the
building o f sanatoria for the treatment o f tuberculosis o f the lungs,
to be maintained by associations, trade guilds, etc. U p to the end o f
1909 the amounts lent out for this purpose reached 13,062,625 marks
($3,108,905), o f which 1,252,607.27 marks ($298,121.06) had been
repaid, leaving an outstanding amount o f loans on December 31,
1909, o f 11,810,017.73 marks ($2,810,784.22). The rate o f interest
paid varies from a minimum o f 1.5 per cent to a maximum o f 4 per
cent, but the average rate is between 3 per cent and 3.5 per cent.
Under the revised regulations o f the Im perial Insurance Office, loans
are no longer permitted to be made at a lower rate than 3.5 per cent,
except in cases o f special merit and subject to the approval o f the
Im perial Insurance Office. The largest amount o f outstanding loans
is provided fo r by the State Invalidity Insurance Institution o f
Rhenish Prussia, amounting to 2,645,257.63 marks ($629,571.32) lent
at a uniform rate o f 3 per cent. The next largest amount outstanding
is in the case o f the State Invalidity Insurance Institution o f West­
phalia, amounting to 1,515,054.47 marks ($360,582.96) lent out at an
interest rate o f from 3.25 per cent to 3.75 per cent. The State In­
validity Insurance Institution o f Alsace-Loraine has lent 400,000
marks ($95,200) at 1.5 per cent. O f the 11,810,017.73 marks
($2,810,784.22) outstanding in the form o f loans provided by 41 in­
validity insurance institutions and workmen’s pension funds,



78

BULLETIN OF THE BUREAU OF LABOB.

1,860,929.02 marks ($442,901.11), or 15.8 per cent, was not secured
in conform ity to the requirements applicable to orphans’ and minors’
trust funds.
SU A L E P O M N O T B R U O S P T N S.
IT B E M L Y E T F U E C L U A IE T

In the treatment and care o f patients an increasing amount o f at­
tention is being given to their suitable employment, partly for the
purpose o f meeting the cost o f treatment, but largely with the object
o f im proving the chances o f complete restoration o f earning capacity.
Labor is required o f patients able to perform light and suitable
duties in the case o f a few establishments, but as a general principle
the question o f employment is optional. Compulsory labor is the
rule in five institutions, under medical supervision, the labor being
considered an important factor in the effort to secure a permanent
cure. In all o f the institutions preference is given to outdoor labor,
chiefly agricultural, horticultural, or gardening. Domestic labor is
required or expected o f women patients in suitable cases, and to a
very lim ited extent labor is perform ed in workshops, provided
for the purpose. The time o f labor varies in the different insti­
tutions, ranging from a maximum o f about five hours to a min­
imum o f half an hour per day. The working time o f women is, on
the average, less than that o f men. A small compensation is paid
in some cases—about 10 pfennigs (2.4 cents) per hour. In a few in­
stances patients have been dismissed on account o f refusal to per­
form suitable duties under medical supervision and at medical
request.
A E A E C S A D D R T N O T E T E T.
V R G
OT N
U A IO
F R A M N

The average cost and duration o f treatment are partly determined
by the provisions o f the invalidity insurance laws. As a general rule
the lim it o f treatment is 90 days, but this may be varied in the dis­
cretion o f the insurance institution, and many exceptions are made
where the individual merits o f the case seem to require that this
should be done. It is open to question whether, in the ascertain­
ment o f the average cost o f treatment per case per annum all the
items o f expense properly chargeable are included. In the nature
o f the case there must be a considerable number o f items o f general
expense connected with the administration o f the State invalidity
insurance institutions which can not be taken into account in the
ascertainment o f the cost o f treatment in sanatoria, hospitals, or
other institutions. It may be safely assumed, however, that i f the
items o f expense, probably not included, had been taken into account
the reported cost would not be materially increased. The present
discussion is confined to the experience data o f average cost and dura­
tion o f treatment for the period 1897 to 1909. The details, by single
years, are fully set forth in the table on page 80. According to this
table the average cost o f treatment fo r male and female patients




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

79

combined increased from 307.29 marks ($73.14) in 1897 to 367.75
marks ($87.52) in 1903 and to 386.05 marks ($91.88) in 1909. The
cost o f treatment per person for male patients increased from 295.24
marks ($70.27) in 1897 to 373.84 marks ($88.97) in 1903 and to
404.22 marks ($96.20) in 1909. The corresponding averages for
women patients do not indicate the same tendency toward an increase,
possibly because the number o f women patients during the early
years was rather small. In 1897 the cost o f treatment per person
for women patients was 349.83 marks ($83.26), changing to 350.30
marks ($83.37) in 1903, and diminishing to 344.97 marks ($82.10)
in 1909. It is therefore shown that the per capita cost o f treatment
was higher for male patients than fo r female patients, and this differ­
ence has been maintained during each o f the 10 last years o f the
experience under review.
The per capita cost o f treatment per day for both sexes combined
increased from 4.05 marks (96 cents) in 1897 to 4.81 marks ($1.14)
in 1903 and to 5.41 marks ($1.29) in 1909. Comparing the last year
with the first, there has been an increase o f 34.4 per cent in the per
capita cost o f treatment per day for men and women combined.
Considering male patients only, the per capita cost o f treatment per
day has increased from 4.05 marks (96 cents) in 1897 to 5.77 marks
($1.37) in 1909. The corresponding cost o f treatment per capita
per day for women patients has increased from 4.04 marks (96 cents)
to 4.29 marks ($1.02).
The average duration o f treatment has undergone only slight
changes, having decreased from 76 days for men and women patients
combined during 1897 to 73 days during 1909. F or male patients
the average duration o f treatment has decreased from 73 days in
1897 to 70 days in 1909, and for female patients from 87 days in 1897
to 80 days in 1909. The tendency, therefore, appears to be toward
a slight reduction in the average duration o f treatment, but the
reasons fo r this reduction are obscure and somewhat difficult to deter­
mine from the available published information. For medical reasons
a sufficient length o f treatment is o f primary importance, and the
causes o f relapses or ultimately unfavorable results are often directly
traceable-to a curtailed stay in the sanatorium. I f the average re­
duction in treatment is the result o f economic reasons, partly because
o f the higher cost o f per capita support at the present time than in
form er years, it does not appear that the slightly shorter treatment
has had injurious effects on the after results since the proportion o f
patients retaining their earning power after five years is more favor­
able with patients discharged during recent years than with patients
discharged during the earlier years o f public sanatoria experience.
The follow ing table shows the number o f days o f treatment and
cost per person treated and cost per day o f treatment o f persons re­



80

BULLETIN OF THE BUREAU OF LABOR.

ceiving full treatment and care on account o f tuberculosis o f the
lungs by German State invalidity insurance institutions:
NUMBER OF DAYS OF TREATMENT, COST PER DAY OF TREATMENT, AND COST PER
PERSON TREATED, FOR PATIENTS RECEIVING FULL TREATMENT AND CARE, ON
ACCOUNT OF TUBERCULOSIS OF THE LUNGS, BY GERMAN STATE INVALIDITY
INSURANCE INSTITUTIONS, BY SEX OF PATIENTS, 1897 TO 1909.
Number of days treated.

Cost per day of treat­
ment.

Cost per person treated.

Year.
Males. Females. Total. Males. Females. Total.
1897.................................
1898................................
1899.................................
1900.................................
1901.................................
1902................................
1903.................................
1904.................................
1905.................................
1906................................
1907.................................
1908.................................
1909.................................

73
73
73
72
72
74
74
75
73
72
71
71
70

87
83
79
80
82
82
83
80
79
80
81
78
80

76
75
74
74
75
76
76
76
75
75
74
73
73

$0.96
1.00
1.01
1.14
1.15
1.16
1.20
1.19
1.24
1.28
1.30
1.35
1.37

$0.96
.98
.96
.95
.96
1.00
1.01
.98
.97
.96
.97
1.03
1.02

$0.96
.99
1.00
1.09
1.09
1.12
1.14
1.13
1.16
1.18
1.19
1.24
1.29

Males. Females. Total.
$70.27
73.19
73.85
82.14
82.96
85.73
88.97
88.99
90.51
92.58
92.42
95.72
96.20

$83.26
81.15
75.69
76.43
78.38
81.26
83.37
77.89
76.47
77.22
78.64
80.83
82.10

$73.14
74.97
74.25
80.77
81.76
84.56
87.52
85.91
86.54
88.10
88.20
91.00
91.88

A ll o f the foregoing observations have reference only to patients,
receiving fu ll institutional treatment and care. In addition to full
treatment a comparatively small number o f patients receive occasional
or irregular treatment, chiefly outside o f institutions, more or less in
the nature o f expert medical advice, dispensary aid, etc. The aver­
age cost o f such treatment and care has decreased from 64.73 marks
($15.41) per capita per annum in 1897 for male and female patients
combined, to 23.99 marks ($5.71) per annum in 1909. The amounts
vary for the different years, but the tendency has been toward a re­
duction in the expense. It requires to be considered that the number
o f such patients is relatively quite small, and as an element in the
general campaign against tuberculosis the irregular or occasional treat­
ment is not a matter o f material importance. The details, by single
years, are given in the follow ing table, according to which the cost
o f such treatment per person has decreased in the case o f male pa­
tients from 61.52 marks ($14.64) in 1897 to 24.32 marks ($5.79) in
1909. The corresponding reduction in expenses for females has been
from 71.40 marks ($16.99) in 1897 to 23.33 marks ($5.55) in 1909.
COST OF TEMPORARY OR PARTIAL TREATMENT PER PERSON ON ACCOUNT OF
TUBERCULOSIS OF THE LUNGS BY GERMAN STATE INVALIDITY INSURANCE INSTI­
TUTIONS, BY SEX OF PATIENTS, 1897 TO 1909.
Year.
1897........................
1898........................
1899........................
1900........................
1901........................
1902........................
1903........................

Males.
$14.64
9.89
13.66
9.03
14.11
28.54
11.85




Females.
$16.99
20.35
12.15
4.71
4.62
10.37
13.74

Total.
$15.41
14.15
13.19
6.79
9.32
22.49
12.17

Year.
1904........................
1905........................
1906........................
1907........................
1908........................
1909........................

Males.
$3.67
5.89
4.18
3.91
5.02
5.79

Females.
$12.97
10.28
8.11
4.63
5.80
5.55

Total.
$5.31
7.06
5.74
4.17
5.35
5.71

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

81

E E C O P E A U E D C N IN A C O T E T E T
E E T E R M T R
IS O T U N E E R A M N .

An important question in connection with sanatorium treatment on
account o f tuberculosis o f the lungs and larynx is the probable effect
o f premature discontinuance o f treatment on the general results. In
the German experience o f 1909 out o f 29,277 males receiving full
treatment on account o f tuberculosis of the lungs and larynx 1,063,
or 3.6 per cent, discontinued the treatment or were discharged for
various reasons from the sanatoria to which they had been admitted
during the first 14 days o f their stay. W hile the *proportion o f
patients treated successfully from an economic point o f view, as
shown by the table on page 88, was 83 per cent for all patients, it
was increased to 86 per cent after eliminating those who had been
discharged from the institutions during the first 14 days o f their
stay. In the case o f women patients, out o f 12,955 the number who
had discontinued the treatment during the first 14 days o f their stay
in the institutions was 358, or 2.8 per cent. The economic results o f
treatment were identically the same on the percentage basis as in
the case o f males; that is, there were 83 per cent o f successful cases,
including those who remained less than 14 days in the institutions,
and 86 per cent after eliminating those discharged or dismissed dur­
ing that period o f time.
S A IS IC O R A M S N E R T E T E T
T T T S E E D IS IO S O
R A M N .

The important question as to the proportion o f cases requiring
readmission to the sanatorium for further treatment is dealt with at
some length in the report for 1909, including, however, only the expe­
rience from 1905 to 1909. The aggregate number o f male patients
under treatment during this period was 97,392, o f which 510, or 0.5
per cent, were readmitted to institutional treatment during the year
o f first admission. O f the number under observation one year after
discharge, or 73,055, the number readmitted for treatment was 4,335,
or 5.9 per cent. During the second year the number o f discharged
patients under observation was 51,587, o f which 3,502 required read­
mission or further treatment, equivalent to 6.8 per cent o f the total
number under observation. O f the patients under observation for
three years after original discharge, numbering 33,517, the number
readmitted for treatment was 1,515, or 4.5 per cent. The number
under observation during the fourth year after discharge was 15,516,
o f which 506, or 3.3 per cent, were readmitted. It is shown, there­
fore, that the proportion o f readmissions was highest during the
second year follow ing tlie original discharge, and that throughout
the five-year period the proportion o f readmissions o f the number
remaining under observation ranged from 3.3 per cent to 6.8 per cent.
The results for women were about the same, but the percentage o f
readmissions was less. Out o f 43,542 women patients during 1905 to
49397°—12----- 6



82

BULLETIN OP THE BUREAU OF LABOR.

1909, 145, or 0.3 per cent, were readmitted for treatment during the
first year o f treatment. During the first year subsequent to the year
o f original admission, out o f 32,748 discharged patients, the number
requiring readmission was 1,654, or 5.1 per cent. During the second
year, out o f 22,237, the number readmitted was 1,078, or 4.8 per cent.
During the third year, out o f 14,020 patients, the number readmitted
was 472, or 3.4 per cent. During the fourth year, out o f 6,272 pa­
tients, 145, or 2.3 per cent, were readmitted. The range in readmis-,
sions subsequent to the first year o f treatment was, therefore, from
2.3 to 5.1 per cent.
When the foregoing results concerning readmissions on account o f
tuberculosis o f the lungs are compared with readmissions on account
o f treatment for other diseases, it appears that the necessity for sub­
sequent treatment is much greater in the case o f tuberculosis o f the
lungs than in the case o f any other disease. The details regarding
readmissions are set forth in the follow ing tables, including a com­
parison o f the period 1905 to 1909. The data are self-explanatory
and do not require extended consideration. It may be said, however,
that against the 17.7 per cent o f readmissions o f all male patients
under observation during the five-year period ending with 1905,
the corresponding percentage o f readmissions during the five years
ending with 1909 was 21.0. For females the percentage o f readmis­
sions increased from 14 during the first period to 15.9 during the last.
In this connection it may also be pointed out that the readmission
rate for male patients for treatment on account o f other diseases than
tuberculosis o f the lungs was 15 per cent for the five years ended
with 1909, against 13.1 per cent fo r females.
READMISSIONS FOR TREATMENT OF PATIENTS ON ACCOUNT OF TUBERCULOSIS
OF THE LUNGS, BY SEX AND BY YEARS, 1905 TO 1909.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

83

COMPARATIVE STATISTICS OF READMISSIONS FOR TREATMENT ON ACCOUNT OF
TUBERCULOSIS OF THE LUNGS, BY SEX OF PATIENTS, 1901 TO 1909.
Per cent of discharged male i>atients
readmitted for treatment dunng—
Period of first
treatment.

1901 to 1905..............
1902 to 1906..............
1903 to 1907..............
1904 to 1908..............
1905 to 1909..............

Year
of dis­
charge.

0.7
.6
.5
.5
.5

Per cent of discharged female patients
readmitted for treatment during—

First Second Third Fourth
First Second Third Fourth
year
year
year
Year
year
year
year
year
year
after
after
after
after of dis­ after
after
after
after
dis­
dis­
dis­
dis­ charge. dis­
dis­
dis­
dis­
charge. charge. charge. charge.
charge. charge. charge. charge.
7.1
6.6
6.2
6.0
5.9

4.9
5.1
5.4
6.3
6.8

3.2
3.2
3.4
3.9
4.5

1.8
1.8
2.3
3.1
3.3

0.4
.4
.4
.3
.3

6.0
5.7
5.2
5.2
5.1

4.0
4.1
4.3
4.6
4.8

2.2
2.3
2.3
3.0
3.4

1.4
1.6
1-9
2.6
2.3

C A S IC T N O T B R U O IS A C R IN T T R A S A E O
L S IF A IO
F U E C L S
C O D G O U B N T G
F
D E S .
IS A E

The classification o f patients treated in the sanatoria maintained
by German invalidity insurance institutions is in conform ity to the
Turban-Gerhardt (Im perial Board o f Health) method, which has
been quite generally adopted throughout the w orld and, with slight
modification, by the National Association for the Study and Preven­
tion o f Tuberculosis in the United States. The classification rests
on an anatomical basis and differentiates three stages, which, in a
general way, correspond to the incipient, the moderately advanced,
and the far-advanced conditions o f the disease as determined by the
usual methods o f physical diagnosis. The follow ing is the most
generally adopted English translation o f the Turban-Gerhardt clas­
sification o f tuberculous patients:
INTERNATIONAL STATISTICS ON TUBERCULOSIS (MORBIDITY) CLASSIFICA­
TION TURBAN-GERHARDT (IMPERIAL GERMAN BOARD OF H EALTH ).

R = R igh t.
L = L e ft.
1. Disease o f slight severity, limited to small areas o f one lobe,
that, for instance, in case o f infection o f both apices, does not extend
beyond the spine o f scapula and the clavicle, or, in case o f affection
o f one apex, frontal, beyond the second rib.
2. Disease o f slight severity, more extensive than 1, but affecting,
at most, the volume o f one lobe, or, severe disease, extending, at most,
to the volume o f one-half lobe.
3. A ll cases extending beyond 2, and all such with considerable
cavities.
By disease o f slight severity is to be understood disseminated foci
manifested by slight dullness, unclear, rough, or weak vesicular,
vesico-bronchial, or broncho-vesicular breathing and fine and medium
rales.
By severe disease: Compact infiltration recognized by great dull­
ness, very weak (indeterminate) broncho-vesicular or bronchial in­
definite breathing with or without rales.
Considerable cavities to be recognized by tympanitic sound, am­
phoric breathing, and extensive, coarse, consonating rales, come under
stage 3.



84

BULLETIN OF THE BUREAU OF LABOR.

Pleuritic dullness if only o f a few centimeters extent is to be left
out o f account; if it is considerable, pleuritis should be specially men­
tioned under tuberculous complications.
The stage o f disease is to be indicated fo r each side separately.
The case, as a whole, is to be classified according to the more diseased
side; fo r example, B2 L I— Stage 2.1
S A IS IC O A M
T T T S F D ISSIO A D D C A G A C R IN T T R A
N N
IS H R E C O D G O U B N
S A EO D E S .
T G
F IS A E

During 1909 the 41 institutions established for the administration
o f the invalidity insurance law treated 29,277 male patients and
12,955 female patients, or a total o f 42,232 persons, on account o f
tuberculosis o f the lungs. O f this number, for 2,434 males and 1,456
females the Turban stage o f the disease was not ascertained, either at
entry or discharge. It was further necessary to exclude 1,553 male
and 1,064 female patients because o f the fact that a different method
than the Turban-Gerhardt classification was adopted. Excluding a
few additional patients for other reasons, there remain 24,766 male
patients and 10,379 female patients, or a total o f 35,145 persons, for
which the stage o f the disease on admission and discharge was ascer­
tained in conform ity to the uniform method o f classification ap­
proved by the Imperial Board o f Health. It is obvious that one o f
the most certain means o f determining the results o f sanatorium
treatment is to ascertain the stage o f the disease on admission and
on discharge by the same method and, if possible, by the same medi­
cal practitioner. A change from one stage o f the disease to a more
favorable one may be considered fairly conclusive evidence that an
improvement has taken place, with a reasonable assurance that the
wage-earning capacity o f the patient has probably been restored and
can be maintained for a considerable period o f time. In cases where
it is shown that the patient has changed to a more serious stage o f
the disease, according to the Turban classification, it is evident that
the treatment has been more or less o f a failure, although even this
conclusion is not warranted in all cases.
O f the 24,766 male patients, 20,567, or 83 per cent, were discharged
from the sanatoria with a reasonable certainty that their wage-earn­
ing capacities had been restored for a considerable period o f time.
O f this number 11,111 were in the first Turban stage o f the disease
on admission, o f which 428, or 3.9 per cent, were discharged as being
entirely free from every symptom o f the disease, which, under the
form o f classification adopted, is represented by O in the tabular
analysis o f the collective experience. O f the patients discharged
who were in the first Turban stage on admission, 10,246, or 92.2 per
cent, remained in the same stage o f the disease, 416 were in the sec­
ond stage, and 21 were in the third stage. It is, therefore, shown
that the large m ajority o f patients, or 92.2 per cent, maintained the

1Page 12, 4th report King Edward VII Sanatorium, Midhurst.



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

85

most favorable stage o f the disease, only a relatively unimportant
proportion, or 3.9 per cent, were in a more serious, or the most seri­
ous, stage o f the disease, and 3.9 per cent were entirely cured. In a
general way, however, the analysis proves that for the large m ajority
o f patients admitted while in the first Turban stage o f the disease
the results o f institutional treatment, from the medical and economic
points o f view, were quite favorable.
The number o f male patients admitted while in the second stage o f
the disease and discharged with restored earning capacity was 7,777.
O f this number 107, or 1.4 per cent o f the total number o f the patients
o f this group, were discharged as being entirely free from symptoms
o f active tuberculosis. The number discharged as being in the first
Turban stage o f the disease was 2,206, or 28.4 per cent; in the
second stage o f the disease, 5,402, or 69.5 per cent; and in the third
stage o f the disease, 62, or 0.8 per cent o f the total number admitted
to treatment while in the second stage o f the disease and discharged
with the earning capacity restored for a reasonable period o f time.
It is shown, therefore, that nearly 30 per cent o f the patients in the
second stage o f the disease on admission were in a more favorable
stage o f the disease on discharge, while only about 1 per cent were in
a more serious stage o f the disease, or, in other words, in a condition
warranting the conclusion that the treatment had been unsuccessful.
The number o f male patients discharged with their earning capacity
restored, who, on admission, were in the third stage o f the disease, was
1,679. O f this number only 4 were entirely free from active symp­
toms o f the disease, and only 148, or 8.8 per cent, were in the first
stage o f the disease on their discharge. Even this relatively small
number, equivalent to not quite 10 per cent o f the total, is conclu­
sive evidence that in the advanced stages o f the disease the outlook
for successful treatment is not entirely hopeless. The number o f
patients in the second stage o f the disease was 484, or 28.8 per cent
o f the total number in this group, while the number o f patients in
the third stage o f the disease was 1,043, or 62.1 per cent. In other
words, nearly two-thirds o f the patients who, on admission, were in
the third stage o f the disease, but who were discharged with restored
earning capacity fo r a reasonable period o f time, had sufficiently
improved to advance to a more favorable stage o f the disease, war­
ranting the conclusion that the treatment had been at least fairly
successful.
It would serve no practical purpose to extend this analysis to the
patients who had been unsuccessfully treated from an economic
point o f view ; that is, those who did not have their wage-earning
capacity restored on discharge; but it may be stated that in a fair
proportion o f these cases a more favorable stage o f the disease had



BULLETIN OP THE BUREAU OF LABOR.

8 6

been attained on discharge than had been ascertained to exist at the
time o f admission to institutional treatment.
The results with regard to female patients were equally favorable
and so nearly like those obtained for male patients that it would
serve no practical purpose to discuss the statistical results in detail.
It needs only to be stated that o f the 10,379 women patients treated
and cared fo r on account o f tuberculosis o f the lungs, 8,562, or 82.5
per cent, were discharged with restored earning capacity fo r a
reasonable period o f time. Some additional details for both male and
female patients, according to the Turban stages o f the disease on ad­
mission and discharge, are contained in the table which follow s:
TURBAN STAGE OP DISEASE ON ADMISSION AND AT DISCHARGE OP PATIENTS
TREATED FOR TUBERCULOSIS BY GERMAN INVALIDITY INSURANCE INSTITU­
TIONS DURING 1909, BY SEX.
M a le s d is c h a r g e d w ith r e s t o r e d e a r n in g c a p a c it y .

Turban stage at discharge.

Num­
ber.

n.

I.

O.

Turban stage on Patients
treated.
admission.

Percent
Percent
Num­
of
of
patients Number. patients ber.
treated.
treated.

in .

Per cent
Per cent
Num­
of
of
patients ber. patients
treated.
treated.

I .........................
n .......................
m .....................

11,111
7,777
1,079

428
107
4

3.9
1.4
.2

10,246
2,206
148

92.2
28.4
8.8

416
5,402
484

3.7
69.5
28.8

21
62
1,043

0.2
.8
62.1

Total........

20,507

539

2.6

12,600

61.3

6,302

30.6

1,126

5.5

M a l e s d is c h a r g e d w i t h o u t r e s t o r e d e a r n in g c a p a c it y .

1.........................
n .......................
m ......................

904
1,384
1,911

18
6

2.0
.4

775
90
7

85.7
6.5
.4

71
1,108 #
107

7.9
80.1
5.6

40
180
1,797

4.4
13.0
94.0

Total........

4,199

24

.6

872

20.8

1,286

30.6

2,017

48.0

T o ta l.

1.........................
II.......................
i n ......................

12,015
9,161
3,590

446
113
4

3.7
1.2
.1

11,021
2,296
155

91.7
25.1
4.3

487
6,510
591

4.1
71.1
16.5

61
242
2,840

0.5
2.6
79.1

Total........

24,766

563

2.3

13,472

54.4

7,588

30.6

3,143

12.7

F e m a l e s d is c h a r g e d w i t h r e s t o r e d e a r n in g c a p a c it y .

I .........................
II.......................
m ......................

5,507
2,670
385

218
137
3

4.0
5.1
.8

5,119
844
65

93.0
31.6
16.9

165
1,671
77

3.0
62.6
20.0

5
18
240

0.1
.7
62.3

Total........

8,562

358

4.2

6,028

70.4

1,913

22.3

263

3.1

F e m a l e s d is c h a r g e d w i t h o u t r e s t o r e d e a r n in g c a p a c it y .

319
729
769

3

0.9

264
73
20

82.8
10.0
2.6

35
581
76

11.0
79.7
9.9

17
75
673

5.3
10.3
87.5

1,817

3

.2

357

19.6

692

38.1

765

42.1




87

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

TURBAN STAGE OF DISEASE ON ADMISSION AND AT DISCHARGE OF PATIENTS
TREATED FOR TUBERCULOSIS BY GERMAN INVALIDITY INSURANCE INSTITU­
TIONS DURING 1909, BY SEX—Concluded.
Total.
Turban stage at discharge.

Num­
ber.

I .........................

1
.

O.

Turban stage on Patients
admission.
treated.

II.

III.

Per cent
Per cent
Per cent
Per cent
Num­
of
of
Num­
of
of
patients Number. patients ber. patients ber.
patients
treated.
treated.
treated.
treated.

n .................

h i ......................

5,826
3,399
1,154

221
137
3

3.8
4.0
.3

5,383
917
85

92.4
27.0
7.4

200
2,252
153

3.4
66.3
13.3

22
93
913

0.4
2.7
79.1

Total........

10,379

361

3.5

6,385

61.5

2,605

25.1

1,028

9.9

P S D C A G R S L S O SA A O IU T E T E T
O T IS H R E E U T
F
N T R M R A M N .

B y far the most important and conclusive fact o f the collective
investigation is the statistical evidence regarding postdischarge
results, which are observed fo r a period o f five years to determine
the extent to which earning capacity has been maintained.1 Since
the object o f the treatment is to prevent invalidity or incapacity for
work, it is obvious that the efficacy o f the treatment is determined
by the proportion o f patients recovering their earning capacity
through sanatorium treatment and maintaining the same for a rea­
sonable period o f time. The facts in the case are ascertained by
careful official inquiry, which is facilitated by the permanent relation
o f the patients to the institutions and the cooperation o f Govern­
ment authorities such as the police, poor-law guardians, etc. For a
certain number o f patients, however, the inform ation could not be
secured because o f the fact that they had moved away or that the
requests fo r information concerning them were not complied with.
Lim iting the follow ing considerations, therefore, only to such patients
as furnished a record o f their subsequent personal history and restored
or lost wage-earning capacity, it requires further to be observed that
readmissions for treatment were considered as new cases. The
extent o f such readmissions has been previously dealt with in detail.
F or a full understanding o f the method by which the after results
o f sanatorium treatment are calculated it is necessary to refer to the
details in the table which follow s (p. 88), and which contains the
available facts for each o f the years 1897 to 1909. According to this
table, o f the 2,598 male patients receiving fu ll treatment and care on
account o f tuberculosis o f the lungs during 1897, the number dis­
charged as having had their earning capacity sufficiently restored to
warrant the anticipation that a loss o f earning power was not prob­
able within a reasonable period o f time was 1,760, or 67.7 per cent.
1 Since 1909 these observations are made a t two-year

six years, but in the case of tuberculosis o f the lungs and
http://fraser.stlouisfed.org/ diseases.
of nontubercular
Federal Reserve Bank of St. Louis

intervals for a total period of
larynx only, and not in the case

88

BU LLETIN OF TH E BUREAU OF LABOR,

ECONOMIC RESULTS OF FULL TREATMENT AND CARE ON ACCOUNT OF TUBER­
CULOSIS OF THE LUNGS BY GERMAN STATE INVALIDITY INSURANCE INSTITU­
TIONS, BY SEX OF PATIENTS, 1897 TO 1909.
Male patients.

Year.

1897....................
1898....................
1899....................
1900....................
1901....................
1902....................
1903....................
1904....................
1905....................
1906....................
1907....................
1908....................
1909....................

Number
receiving
full treat­
ment.

2,598
3,806
6,032
8,442
10,812
12,187
14,937
16,957
19,085
21,959
22,258
26,437
29,277

Female patients.

Total patients.

Discharged with
Discharged with
Discharged with
restored earning
restored earning
restored earning
Number
Number
power.
power.
power.
receiving
receiving
full treat­
full treatment.
ment.
Per
Per
Per
Number. cent.
Number. cent.
Number. cent.
1,760
2,812
4,476
6,117
8,272
9,437
11,763
13,341
15,516
18,001
18,070
21,468
24,337

67.7
73.9
74.2
72.5
76.5
77.4
78.8
78.7
81.3
82.0
81.2
81.2
83.1

736
1,104
1,666
2,652
3,844
4,302
5,211
6,520
7,536
9,063
9,816
12,288
12,955

497
811
1,220
1,920
2,977
3,448
4,284
5,293
6,272
7,748
8,217
10,511
10,794

67.5
73.5
73.2
72.4
77.4
80.1
82.2
81.2
83.2
85.5
83.7
85.5
83.3

3,334
4,910
7,698
11,094
14,656
16,489
20,148
23,477
26,621
31,022
32,074
38,725
42,232

2,257
3,623
5,696
8,037
11,249
12,886
16,047
18,634
21,788
25,749
26,287
31,979
35,131

67.7
73.8
74.0
72.4
76.8
78.1
79.6
79.4
81.8
83.0
82.0
82.6
83.2

NUMBER AND PER CENT OF PATIENTS RECEIVING FULL TREATMENT WHO
WERE DISCHARGED WITH RESTORED EARNING CAPACITY AND WHO RETAINED
THEIR EARNING CAPACITY AT THE END OF SPECIFIED YEARS SUBSEQUENT
TO THEIR DISCHARGE, BY SEX, 1897 TO 1909.
Number of males.l

l In calculating the percentages of those receiving full treatm ent who retained their

the
the
after discharge, cases lost sight
Digitized forearning power tocases, end of been specified periods the numbers representing personsof, th at
FRASER
is, uncontrolled
have
deducted from
receiv­
http://fraser.stlouisfed.org/
in g full treatment.
Federal Reserve Bank of St. Louis

89

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY,

NUMBER AND PER CENT OF PATIENTS RECEIVING FULL TREATMENT WHO
W ERE DISCHARGED WITH RESTORED EARNING CAPACITY AND WHO RETAINED
THEIR EARNING CAPACITY AT THE END OF SPECIFIED YEARS SUBSEQUENT
TO THEIR DISCHARGE, BY SEX, 1897 TO 1909—Concluded.
Number of females.
Retaining earning power at end of year.
Disch’ged
with
Year re­
of
dis- stored
ch'ge. earn­ 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906
ing
pow­
er.
1897..
1898..
1899..
1900..
1901..
1902..
1903..
1904..
1905..
1906..
1907..
1908..
1909..

497
811
1,220
1,920
2,977
3,448
4,284
5,293
6,272
7,748
8,217
10,511
10,794

465

348
751

231
464
1,082

252
225
441
409
399
801
690
636
589
1,735 1,308 1,167 1,010
848
2,645 2,173 1,822 1,546 1,245
3,184 2,537 2,121 2,048 1,894
3,892 3,171 2,854 2,629
4,692 4,072 3,654
5,581 4,749
6,980

1907

2,519
3,475
4,285
5,973
7,559

1908

1909

3,196
3,831 3,608
5,257 4,878
6,414 5,733
9,186 8,039
9,749

P er cent of females.^1897..
1898..
1899..
1900..
1901..
1902..
1903..
1904..
1905..
1906..
1907..
1908..
1909..

67.5
73.5
73.2
72.4
77.4
80.1
82.2
81.2
83.2
85.5
83.7
85.5
83.3

64

50
*69

35
49
67

36
43
51
67

32
39
43
52
72

38
40
46
60
76

37
40
51
62
77

35
45
54
64
76

39
50
57
66
78

4?
53
59
67
81

50
55
60
70
80

51
55
63
69
81

52
58
62
72
80

Total males and females.
1
858
1897.. 2,257 2,007 1,380 934 957
i
1898.. 3,623
3,280 1,952 1,796 1,566 1,442
l
1899.. 5,696
4,936 3,520 2,925 2,555 2,327
1
7,169 5,213 4,352 3,877 3,147
1900.. 8,037
1
10,035 7,649 6,413 5,312 4,314
1901.. 11,249
1
1902.. 12,885
11,758 9,138 7,668 7,238 6,559
14,699 11,567 10,250 9,184 8,671 j..........
1903.. 16,047
1904.. 18,634
16,539 13,998 12,201 11,295 10,412
1905.. 21,788
19,485 16,097 14,071 12,514 11,479
23,321 19,427 16,663 15,113
1906.. 25,749
24,208 20,268 17,366
1907.. 26,287
28,429 24,567
1908.. 31,979
32,154
1909.. 35,131
P er cent of total males and femalesA
1897..
1898..
1899..
1900..
1901..
1902..
1903..
1904..
1905..
1906..
1907..
1908..
1909..

67.7
73.8
74.0
72.4
76.8
78.1
79.6
79.4
81.8
83.0
82.0
82.6
83.2

62

44
68




30
45
67

30
38
48
66

27
33
40
49
70

31
35
41
55
73

32
37
46
58
74

i
i See footnote, p. 88.

31
40
50
60
74

34
46
53
62
77

42
48
54
64
78

45
50
56
65
78

46
50
57
66
78

46
52
57
68
80

90

BULLETIN* OF TH E BUREAU OF LABOR.

The first inquiry as to continued earning capacity was made at the
end o f 1897, and it was then found that o f the 1,760 male patients
just referred to 1,542, or 61 per cent, o f the original 2,5981 under
treatment still maintained their earning capacity within the definition
o f the law governing the treatment and care o f invalid members o f
State invalidity institutions. A t the end o f the second year (1898)
the number o f patients retaining their earning capacity was 1,032,
or 42 per cent o f the original number treated in 1897. B y the end o f
1899 this number has been further reduced to 703, or 29 per cent, with
a further reduction to 25 per cent at the end o f 1901. From an eco­
nomic as well as a medical point o f view these results for the year
1897 can not be considered very satisfactory.
The next group o f cases concerns the experience o f 1898, observed
to the end o f the year 1902. Recalling that the per cent o f cases dis­
charged as cured or with restored earning capacity was 67.7 fo r male
patients in 1897, it is shown that for 1898 the corresponding per­
centage was 73.9 or somewhat more favorable. O f the 3,806 male
patients receiving full treatment during 1898, there were ascertained
to be in good health and with maintained earning capacity at the end
o f 1898, 2,529, or 67 per cent. By the end o f the second year the per­
centage o f patients with maintained earning capacity was 44, at the
end o f the third year 37, at the end o f the fourth year 31, and at the
end o f the fifth year 28. There was, therefore, throughout a more
favorable result for each year o f subsequent experience during 1898
than during the year 1897.
O f the group o f 6,032 male patients receiving fu ll treatment during
1899, the number retaining their earning capacity at the end o f the
year was 3,854, or 67 per cent. During the second year the per­
centage retaining their earning capacity was 48, during the third year
39, during the fourth year 33, and during the fifth year 30. The
results, therefore, were slightly more favorable than during 1898 and
much more favorable than during 1897.
O f the group o f male patients comprehending those discharged
with restored earning capacity in 1900, and numbering 6,117, or 72.5
per cent o f the original total, the number retaining their earning
capacity at the end o f the year was 5,434, or 66 per cent. A t the end
o f the second year the percentage retaining their earning capacity
was 48, at the end o f the third year it was 40, at the end o f the fourth
year 35, and at the end o f the fifth year it was 30. The results, there­
fore, were quite similar to those o f the previous year.
During 1901, 8,272 male patients were discharged with restored
earning capacity, or 76.5 per cent o f the total number o f patients
originally under treatment. A t the end o f the first year 70 per cent



1 See footnote, p. 88.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

91

retained their earning capacity, at the end o f the second year 53 per
cent, at the end o f the third year 45 per cent, at the end o f the fourth
year 38 per cent, and at the end o f the fifth year 32 per cent. The
economic results, therefore, were much more favorable throughout
than during any one o f the previous four years.
During 1902 the number o f male patients discharged with restored
earning capacity was 9,437, or 77.4 per cent o f the original number
o f patients under treatment. O f the number receiving fu ll treatment
72 per cent retained their earning capacity at the end o f the first
year, 57 per cent at the end o f the second year, 48 per cent at the end
o f the third year, 44 per cent at the end o f the fourth year, and 40
per cent at the end o f the fifth year. The results, therefore, were
more favorable than during the previous year and much more so than
during any one o f the earlier years.
During 1903 the number o f male patients discharged with restored
earning capacity was 11,763, or 78.8 per cent o f the total number o f
patients under treatment. O f the patients receiving full treatment,
73 per cent retained their earning capacity at the end o f the first
year, 59 per cent at the end o f the second, 51 per cent at the end o f
the third, 46 per cent at the end o f the fourth, and 43 per cent at the
end o f the fifth year. The results throughout, therefore, were slightly
more favorable than during the previous year, and much more favor­
able than during any one o f the earlier years.
During 1904 the number o f male patients discharged with restored
earning capacity was 13,341, or 78.7 per cent o f the total number under
treatment. O f the number o f patients receiving full treatment 73 per
cent retained their earning capacity at the end o f the first year, 61 per
cent at the end o f the second, 53 per cent at the end o f the third,
48 per cent at the end o f the fourth, and 44 per cent at the end o f
the fifth year. The results, therefore, were more favorable than
during 1903, and much more favorable than in any one o f the earlier
years o f experience.
During 1905 the number o f male patients discharged with restored
earning capacity was 15,516, or 81.3 per cent o f the total under treat­
ment. O f the number treated, 76 per cent retained their earning
capacity at the end o f the first year, 63 per cent at the end o f the
second year, 54 per cent at the*end o f the third year, 48 per cent at
the end o f the fourth year, and 44 per cent at the end o f the fifth
year. The results, therefore, were slightly more favorable during the
previous year, but it is evident that the results approached a point
subsequent to which a material improvement is most difficult to be
realized.
W ith the experience o f 1905 the five-year periods come to an end,
and the number o f male patients subsequently treated have been
under observation only four years, three years, two years, and one



92

B U LLETIN OF TH E BUREAU OF LABOR.

year, respectively. Considering these briefly it appears that in 1906
the number o f patients discharged with restored earning capacity
was 18,001, or 82 per cent o f the total number under treatment. O f
the number treated and kept under observation after discharge 77 per
cent retained their earning capacity at the end o f the first year,
65 per cent at the end o f the second year, 55 per cent at the end o f
the third year, and 49 per cent at the end o f the fourth year.
During 1907 the number o f male patients discharged with restored
earning capacity was 18,070, or 81.2 per cent o f the total number
under treatment. O f the number treated and kept under observation
77 per cent retained their earning capacity during the first year,
65 per cent during the second year, and 55 per cent during the third
.year, or almost identically the same percentages as were obtained
with the patients o f the previous year.
During 1908 the number o f male patients discharged with restored
earning capacity was 21,468, or 81.2 per cent o f the total number
under treatment. O f the number treated and kept under observation
72.8 per cent retained their earning capacity at the end o f the first
year and 62.5 per cent at the end o f the second year.
During 1909 the number o f male patients discharged with restored
earning capacity was 24,337, or 83.1 per cent o f the total under
treatment. A t the end o f the first year 79 per cent retained their
earning capacity, or a larger percentage o f favorable results than had
been secured during any one year o f experience with the patients
discharged during the years 1897 to 1908.
The results o f the sanatorium treatment were even more favorable
in the case o f female patients, and the experience exhibits the same
tendency toward a material improvement from the earlier to the later
years. Commencing with 1897, there were 497 women patients dis­
charged with restored earning capacity, or 67.5 per cent o f the total
number under treatment. O f the number treated and kept under
observation 64 per cent retained their earning capacity at the end o f
the first year, 50 per cent at the end o f the second year, 35 per cent
at the end o f the third year, 36 per cent at the end o f the fourth year,
and 32 per cent at the end o f the fifth year.
During 1898, 811 women patients were discharged with restored
earning capacity, or 73.5 per cent o f the total number under treat­
ment. O f the number treated and kept under observation, 69 per
cent retained their earning capacity at the end o f the first year, 49
per cent at the end o f the second year, 43 per cent at the end o f the
third year, 39 per cent at the end o f the fourth year, and 38 per cent
at the end o f the fifth year.'
During 1899 there were 1,220 women patients discharged with
restored earning capacity, or 73.2 per cent o f the total number



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

93

under treatment. O f the number treated and kept under observation,
67 per cent retained their earning capacity at the end o f the first
year, 51 per cent at the end o f the second year, 43 per cent at the end
o f the third year, 40 per cent at the end o f the fourth year, and 37
per cent at the end o f the fifth year.
During 1900 there were 1,920 women patients discharged with
restored earning capacity, or 72.4 per cent o f the total number under
treatment. O f the number treated and kept under observation, 67
per cent retained their earning capacity at the end o f the first year,
52 per cent at the end o f the second year, 46 per cent at the end o f
the third year, 40 per cent at the end o f the fourth year, and 35 per
cent at the end o f the fifth year.
During 1901 there were 2,977 women patients discharged with
restored earning capacity, or 77.4 per cent o f the total number under
treatment. O f the number treated and kept under observation, 72
per cent retained their earning capacity at the end o f the first year,
60 per cent at the end o f the second year, 51 per cent at the end o f the
third year, 45 per cent at the end o f the fourth year, and 39 per cent
at the end o f the fifth year.
During 1902 there were 3,448 women patients discharged with
restored earning capacity, or 80.1 per cent o f the total number under
treatment. O f the number treated and kept under observation, 76
per cent retained their earning capacity at the end o f the first year,
62 per cent at the end o f the second year, 54 per cent at the end o f the
third year, 50 per cent*at the end o f the fourth year, and 47 per cent
at the end o f the fifth year.
During 1903 there were 4,284 women patients discharged with re­
stored earning capacity, or 82.2 per cent o f the total number under
treatment. O f the number treated and kept under observation, 77
per cent retained their earning capacity at the end o f the first year,
64 per cent at the end o f the second year, 57 per cent at the end o f the
third year, 53 per cent at the end o f the fourth year, and 50 per cent
at the end o f the fifth year.
During 1904 there were 5,293 women patients discharged with re­
stored earning capacity, or 81.2 per cent o f the total number under
treatment. O f the number treated and kept under observation, 76
per cent retained their earning capacity at the end o f the first year,
66 per cent at the end o f the second year, 59 per cent at the end o f
the third year, 55 per cent at the end o f the fourth year, and 51 per
cent at the end o f the fifth year.
During 1905 there were 6,272 women patients discharged with re­
stored earning capacity, or 83.2 per cent o f the total number under
treatment. O f the number treated and kept under observation, 78
per cent retained their earning capacity at the end o f the first year,



94

B U LLETIN OF TH E BUBEAU OF LABOR.

67 per cent at the end o f the second year, 60 per cent at the end o f the
third year, 55 per cent at the end o f the fourth year, and 52 per cent
at the end of the fifth year.
During 1906 there were 7,748 women patients discharged with re­
stored earning capacity, or 85.5 per cent o f the total number under
treatment. O f the number treated and kept under observation, 81
per cent retained their earning capacity at the end o f the first year,
70 per cent at the end o f the second year, 63 per cent at the end o f the
third year, and 58 per cent at the end o f the fourth year.
During 1907 there were 8,217 women patients discharged with re­
stored earning capacity, or 83.7 per cent o f the total number under
treatment. O f the number treated and kept under observation, 80
per cent retained their earning capacity at the end o f the first year,
69 per cent at the end o f the second year, and 62 per cent at the end
o f the third year.
During 1908 there were 10,511 women patients discharged with re­
stored earning capacity, or 85.5 per cent o f the total number under
treatment. O f the number treated and kept under observation, 81
per cent retained their earning capacity at the end o f the first year
and 72 per cent at the end o f the second year.
During 1909 there were 10,794 women patients discharged with re­
stored earning capacity, or 83.3 per cent o f the total number under
treatment. O f the number treated and kept under observation, 80
per cent retained their earning capacity at the end o f the first year
after discharge.
FIN N IA S A IS IC O S C E S U A D U S C E S U SA A O IU
A C L T T T S F UCSF L N
NU C SF L N T R M
T E T E T
R A M N .

The economic and other results o f fu ll special treatment on account
o f tuberculosis o f the lungs during 1909 are briefly summarized as
follow s:
O f the total number o f male patients treated and cared fo r during
the year, 24,337, or 83.1 per cent, were discharged with restored wageearning capacity, in conform ity to paragraph 5, Section IY , o f
the Invalidity Insurance Law [art. 1255, par. 2, o f the Workmen’s
Insurance Code o f July 19, 1911]. The number o f days’ treatment
on account o f this group o f patients was 1,817,965, or an average
o f 75 days per patient successfully treated. The amount expended
on account o f this group was 10,456,400 marks ($2,488,623), or 88.36
per cent o f the total expenditures on account o f male patients suc­
cessfully and unsuccessfully treated during the year. The average
expenditure per patient successfully treated was 429.65 marks
($102.26), and the average expenditure per day o f treatment was 5.75
marks ($1.37).



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

95

The number o f male patients unsuccessfully treated—that is, cases
in which the wage-earning capacity was not restored—was 4,940, or
16.9 per cent o f the total number o f male patients treated on account1
o f tuberculosis o f the lungs during the year. The number o f days*
treatment received by this group o f patients was 233,488. The aver­
age number o f days’ treatment per male patient unsuccessfully
treated, from an economic point o f view, was 47. The total amount
expended on account o f this group was 1,378,094 marks ($327,986),
or 11.64 per cent o f the expenditures on account o f male patients suc­
cessfully and unsuccessfully treated during the year. The average
expenditure per male patient unsuccessfully treated was 278.97 marks
($66.39), and the average expenditure per day o f treatment was 5.90
marks ($1.40).
O f the total number o f female patients treated and cared fo r dur­
ing the year, 10,794, or 83.3 per cent, were discharged with restored
wage-earning capacity, in conform ity to paragraph 5, Section IY , o f
the Invalidity Insurance Law [art. 1255, par. 2, o f the Workmen’s
Insurance Code o f July 19, 1911]. The number o f days’ treatment
on account o f this group o f patients was 910,929, or an average o f 84
days per patient successfully treated. The amount expended was
3,911,657 marks ($930,974), or 87.53 per cent o f the total expenditures
on account o f female patients successfully and unsuccessfully treated
during the year. The average expenditure per patient successfully
treated was 362.39 marks ($86.25), and the average expenditure per
day o f treatment was 4.29 marks ($1.02).
The number o f female patients unsuccessfully treated—that is,
cases in which the wage-earning capacity was not restored—was
2,161, or 16.7 per cent o f the total number o f female patients treated
on account o f tuberculosis o f the lungs during the year. The number
o f days’ treatment received by this group o f patients was 131,416.
The average number o f days’ treatment per female patient unsuc­
cessfully treated from an economic point o f view was 61. The total
amount expended on account o f this group was 557,467 marks
($132,677), or 12.47 per cent o f the expenditures on account o f female
patients successfully and unsuccessfully treated during the year.
The average expenditure per female patient unsuccessfully treated
was 257.97 marks ($61.40), and the average expenditure per day o f
treatment was 4.24 marks ($1.01).




96

BU LLETIN OF TH E BUREAU OF LABOR,

The data are presented in further detail in the table which follow s:
RESULTS OF SPECIAL TREATMENT OF MALES AND FEMALES, ON ACCOUNT OF
TUBERCULOSIS OF THE LUNGS, COMPLETED DURING THE YEARS 1905 TO 1909.
Cases wherein disability was removed or arrested: Mates.
Persons treated.
Year.

Num­ Per cent.
ber.

Cost of treatment.

Days of treatment.

Number.

Per
Per cent. person.

Amount.

15,516
18,001
18,070
21,468
24,337

81.3
82.0
81.2
81.2
83.1

1,228,538
1,394,445
1,386,727
1,635,793
1,817,965

88.0
88.0
87.6
87.4
88.6

79
77
77
76
75

Total.. 97,392

81.8

7,463,468

88.0

Per
Per
Percent. person day of
treat­
treated. ment.

76 9,845,307.60

1905..............
1906.............
1907..............
1908..............
1909..............

$1,529,332.20
1,791,927.02
1,815,277.88
2,220,147.30
2,488,623.20

88.53 $98.57
88.14 99.55
88.25 100.46
87.73 103.42
88.36 102.26

$1.24
1.29
1.31
1.36
1.37

88.18

101.09

1.32

Oases wherein disability was not removed: Males.
3,569
3,958
4,188
4,969
4,940

18.7
18.0
18.8
18.8
16.9

167,128
189,818
196,050
235,987
233,488

12.0
12.0
12.4
12.6
11.4

47
48
47
47
47

$198,133.85
241,144.45
241,719.70
310,488.14
327,986.37

11.47
11.86
11.75
12.27
11.64

$55.52
60.93
57.72
62.48
66.39

$1.19
1.27
1.23
1.32
1.40

Total.. 21,624

18.2

1,022,471

12.0

47 1,319,472.51

11.82

61.02

1.29

89.51 $82.24
90.18 81.46
88.87 83.48
89.96 85.00
87.53 86.25

$0.97
.96
.97
1.03
1.02

1905.............
1906..............
1907..............
1908.............
1909.............

Cases wherein disability was removed or arrested: Females.
$515,794.64
631,172.87
685,968.12
893,452.48
930,974.37

1905.............. 6,272
1906............. 7,748
1907.............. 8,217
1908.............. 10,511
1909............. 10,794

83.2
85.5
83.7
85.5
83.3

533,430
660,057
707,041
864,683
910,929

90.0
90.6
89.1
89.8
87.4

85
85
86
82
84

Total.. 43,542

84.3

3,676,140

89.2

84 3,657,362.48

89.10

84.00

.99

Cases wherein disability was not removed: Females.
1905.............
1906..............
1907.............
1908..............
1909.............

1,264
1,315
1,599
1,777
2,161

16.8
14.5
16.3
14.5
16.7

59,172
68,530
86,671
97,957
131,416

10.0
9.4
10.9
10.2
12.6

47
52
54
55
61

$60,468.54
68,717.71
85,924.19
99,763.65
132,677.15

10.49
9.82
11.13
10.04
12.47

$47.84
52.26
53.74
56.14
61.40

$1.02
1.00
.99
1.02
1.01

Total..

8,116

15.7

443,746

10.8

55

447,551.24

10.90

55.14

1.01

G N R L C N L S N A T T E V L E O IN ITU IO A T E T
E E A
O C U IO S S O H
A U
F
ST
T N L R A ­
M N F R T B R U O IS
E T O
U E C L S .

The foregoing analysis proves conclusively that in a general way
the present results o f sanatorium treatment are o f great economic
value. Assuming, as may rightfully be done, that without such sys­
tematic and effective treatment the large m ajority o f patients would
have died from the disease within two years from the date o f at­
tack, it is evident that whether such treatment was provided by
insurance institutions or at public cost through direct taxation
or at the personal expense o f the patients, assuming ability to
pay, the results are decidedly gratifying and conclusive. W ith­



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

97

out question an immense amount o f most valuable experience has
been gained fo r the development o f the most effective methods o f
treatment, and comparing the results secured during recent years
with those o f the earlier years the proportion o f men and women
wage earners retaining their earning capacity, after sanatorium treat­
ment, for a reasonable period o f years is much larger now than fo r­
merly. Taking, for the purpose o f further illustration, the year 1905,
when at the end o f the fifth year (that is, in 1909) 41.2 per cent o f
the male patients and 47.9 per cent o f the female patients were still
in possession o f their earning capacity, sufficient at least to pro­
vide in part for their own support, it is self-evident that such results
are o f the greatest possible economic value to the State, even though
under present conditions the cost o f treatment may be somewhat
larger than the direct financial gain to the insurance institutions on
account o f diminished payments in the form o f disability annuities.
Recalling that during 1905 the average expense per patient was 380.31
marks ($90.51) for males and 321.29 marks ($76.47) for females, it is
clear that the after results o f the 1905 experience paid largely, if not
entirely, for the expenses incurred in behalf o f tuberculous patients
who otherwise would have died, or themselves and their dependents
would have become a charge upon the community at large. O f
course, the advantage to an invalidity insurance institution from such
treatment is much greater than would be the case in a life insurance
company or society, which, in any event, would have to pay the face
value o f the policy at death. The life insurance company would
be interested only in the deferred payment o f the amount due at
death, and the expense o f treatment, if incurred in its own behalf,
would have to be made good by additional premium receipts fo r a
number o f years sufficient to cover the expenses.
The case is quite different with invalidity insurance institutions,
which may or may not have to pay large sums, according to the
degree and duration o f the disability, and in the case o f which
preventive or curative treatment may bring about a material reduc­
tion in the liability, so that the treatment and care o f patients in
special institutions may prove a sound and substantial financial in­
vestment. Whether this actually has been the case with German
State invalidity insurance institutions up to the present time is still
open to question. Neither in the official reports nor in the general
literature o f the subject is there anywhere sufficient statistical or
other evidence to conclusively prove that the efforts made to bring
about restored earning capacity o f invalid members have paid a full
return on the money invested in special institutions and the annual
disbursements in behalf o f patients and their immediate dependents.
In course o f time no doubt such proof w ill be forthcom ing, and con493970— 12----- 7




98

BU LLETIN OF TH E BUREAU OF LABOR.

sidering that the entire plan o f compulsory social insurance rests,1
prim arily, not upon financial but upon general considerations o f!
public welfare, it is self-evident that the efficacy and value o f the
system can not be tested solely by reference to the annual balance
sheets o f the institutions individually considered, or even on the
basis o f their aggregate experience.
ADMINISTRATIVE CONTROL OF TUBERCULOSIS, W ITH SPECIAL REF­
ERENCE TO TUBERCULOSIS DISPENSARIES, INFORMATION BUREAUS,
AND HOUSING REFORM.

L IT T N O SA A O IU T E T E T
IM A IO S F N T R M R A M N .

The sanatorium treatment o f tuberculosis has its inherent lim ita­
tions, which, however, do not in the least detract from the farreaching usefulness o f these special institutions for the treatment o f
the disease. In the nature o f the case, only a relatively small propor­
tion o f patients can be treated and cared fo r in sanatoria for the
required period o f time. F or illustration, out o f a probable number
o f from 600,000 to 800,000 cases o f tuberculosis in the German Empire
only 45,609 patients were, in 1910, provided with treatment in 99
public sanatoria1 chiefly maintained by invalidity insurance institu­
tions. Since the number o f beds available for public sanatorium
treatment at the present time is only about 12,000, it is self-evident
that unless the accommodation is materially increased, or the dura­
tion o f treatment substantially diminished, a very large proportion
o f tuberculous patients must be taken care o f in their homes or in
special institutions not established fo r the purpose o f systematic
treatment and care.
In sanatorium treatment the preference naturally is fo r patients
in the first and second stages o f the disease, although a fairly large
proportion are treated and cared fo r while in the third or terminal
stage. In 1910 out o f 27,857 male patients admitted to German sana­
toria 18,633, or 49.8 per cent, were in the first Turban stage; 10,256,
or 37.5 per cent, were in the second; and 3,468, or 12.7 per cent, were
in the third, Out o f 13,905 female patients, 8,648, or 62.2 per cent,
were in the first Turban stage o f the disease; 4,175, or 30 per cent,
were in the second; and 1,082, or 7.8 per cent, were in the third. The
corresponding distribution o f tuberculous wage earners in the gen­
eral population is not ascertainable.
A large number and proportion o f persons are at any given time
in the very earliest stage o f the disease, when accurate diagnosis and
effective treatment are o f the greatest practical importance. In due
consideration, therefore, o f the needs o f the tuberculous population
in general, and clearly differentiated from the patients in a definitely
1 There were in addition 34 private sanatoria w ith 2,078 endowed beds, 22 institutions
fo r tuberculous children, and 86 institutions for scrofulous children liable to tuberculosis.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

99

recognized stage o f the disease suitable for sanatorium treatment,
efforts have been made within recent years, and to an ever-increasing
extent, to provide inform ation bureaus aud tuberculosis dispensaries
for the rendering o f competent medical advice and material assistance
in cases o f urgent need.
G R A T B R U O IS D E S R S A D IN O M T N B R A S
E M N U E C L S
ISP N A IE N
F R A IO
U E U.

The establishment o f information bureaus and tuberculosis dispen­
saries dates only from 1904, when the first properly equipped institu­
tion o f this kind in Germany was established in the city o f Berlin.1
The chief object o f information bureaus and tuberculosis dispensaries
is to prevent the spread o f pulmonary tuberculosis, through the edu­
cation o f the patients and the effective utilization o f approved
methods and means o f public or private control. The work o f the
dispensary is therefore intelligently coordinated to rational methods
o f detection or ascertainment o f all serious cases o f tuberculosis and
the dissemination o f useful information regarding the best possible
means o f providing for the needs o f tuberculous wage earners in the
different stages o f the disease. The public control o f tuberculosis, to
be really effective, requires a thoroughly coordinated administrative
organization acting intelligently in cooperation with charitable asso­
ciations and medical institutions established and maintained by public
or private enterprise. The chief function o f the tuberculosis dis­
pensary is to concentrate preventive and ameliorative efforts in a cen­
tral station, and although methods vary in different localities and
countries, the essential principles o f the dispensary are well summed
up in the follow ing program o f the first institution o f this kind,
established by Dr. B. W . Philip, in Edinburgh, in 1887:
1. The reception and examination o f patients at the dispensary,
the keeping a record o f every case, with an account o f the patient’s
illness, history, surroundings, and present condition, the record being
added to on each subsequent visit.
2. The bacteriological examination o f expectoration and other dis­
charges.
3. The instruction o f patients how to treat themselves and how to
prevent or minimize the risk o f infection to others.
4. The dispensing o f necessary medicines, sputum bottles, disin­
fectants, and, where the patient’s condition seemed to warrant it,
foodstuffs, and the like.
5. The visitation o f patients at their own homes by (1) a qualified
medical man, and (2) a specially trained nurse for the double pur­
pose o f treatment and o f investigation into the state o f the dwelling
and general conditions o f life and the risk o f infection to others.
6. The selection o f more likely patients fo r hospital treatment,
either o f early cases for sanatoria or o f late cases fo r incurable
homes, and the supervision, when necessary, o f patients after dis­
charge from hospital.
1 There had, however, been a previous effort o f this kind at Halle.




100

BU LLETIN OF TH E BUREAU OF LABOR.

7.
The guidance, generally, o f tuberculous patients and their
friends and for inquiries from all interested persons on every ques­
tion concerning tuberculosis.
The German information bureaus and tuberculosis dispensaries, on
the model o f the Berlin institution, have been developed along
somewhat different lines, and they preclude as a first and essential
consideration the medical treatment o f patients on the premises.
Such treatment to be effective, it is held, should be provided by pri­
vate physicians or by the physicians employed by sick funds or,
as a last resort, through the poor-law authorities. According to a
comparatively recent imperial statute, the acceptance by tuberculous
patients o f medical treatment provided by poor-law authorities
does not involve a forfeiture o f civil rights and privileges. The
tuberculosis dispensaries are not municipal institutions, but are, as
a rule, under the control o f a local committee acting in cooperation
with the board o f health and other public authorities. Any con-,
sumptive can obtain free advice at the dispensaries, whether in an
early or advanced stage o f the disease and irrespective o f his ability
to pay for qualified advice. In the event that the applicant is found
to be tuberculous all the members o f his fam ily are required to pre­
sent themselves at the dispensary for the purpose o f a thorough med­
ical examination, which is also made free o f charge.
O G N T N A D S O E O T E T B R U O IS D E SA Y
R A IZA IO
N
C P
F H
U E C L S
ISP N R .

The organization o f the dispensary includes a bureau official, who
has general charge and who must be present during office hours to
give general information and advice. The attending physician has
more limited office hours, during which those who apply are subjected
to a medical examination, which is amplified by a bacteriological
examination o f the sputum, etc. Attached to every dispensary is
at least one visiting nurse, who, without delay, carefully examines into
the home conditions o f the patients and reports her findings. The
function o f the medical examiner is limited to the exact determina­
tion o f the condition o f the lungs and the degree to which the disease
has advanced, and the results o f the examination are immediately
communicated to the patient’s own physician or to such as he may
select or as may be provided for him through the sick fund o f which
he is a member, or, i f not otherwise, through the poor-law authori­
ties. In other words, the medical function o f the dispensary is
lim ited to the determination o f the applicant’s condition, and no
specific medical treatment is rendered, as is the case in French, Bel­
gian, and some English dispensaries.
The first essential function o f the visiting nurse is to ascertain the
home conditions o f the applicant, and to determine what is necessary
to prevent the infection o f other members o f the fam ily. In the



CARE OP TUBERCULOUS WAGE EARNERS IN GERM ANY.

101

event that the patient is unable to provide a room for his own needs,
or even a single bed, the dispensary renders material assistance in so
far as this may be absolutely necessary. T o enable the fam ily to
rent an additional room, pecuniary aid is rendered, or, if that is
not possible, sanitary beds are lent, which are surrounded by screens
to diminish as far as practicable the risk o f infection to other mem­
bers o f the fam ily. The nurse further supervises the diet o f the pa­
tient and, i f necessary, supplies nutritious food at the expense o f the
dispensary. Patients to whom institutional treatment is suited are
provided fo r in so far as this is possible, particularly at forest day
and night camps, the number o f which has rapidly increased during
recent years. The aim is to provide such treatment near to the home
o f the patient and his place o f work in case the disease is not too
far advanced. It is held that the net cost o f effective treatment at
forest day and night camps need not exceed 1 mark (23.8 cents) per
day, which is in marked contrast to the generally rather high average
cost per day per patient— 4.66 marks ($1.11) in 1910— treated and
cared for at public sanatoria.
Am ong other functions o f the tuberculosis dispensary are the dis­
infection o f infected premises and a general supervision o f housing
conditions in so far as they have reference to the possible prevention
or spread o f tuberculosis o f the lungs.
The work o f the dispensaries, in brief, is a combination o f public
hygiene and public nursing, and a vast amount o f good has resulted.
The dispensary aims to provide fo r every pronounced case o f tuber­
culosis o f the lungs a separate room in the home o f the sufferer and
to see that the fam ily has ample protection against the danger o f
infection. The dispensary further aims to improve the economic
position o f the fam ily in order that the patient may have the care
and attention which are considered o f paramount importance in the
treatment o f the disease. Patients in the far-advanced stage are
placed in homes for incurables, but efforts in this direction have, on
the whole, been rather discouraging. The patients prefer to be
treated in their own homes and to die there rather than among
strangers in distant institutions.
T B R U O IS D E SA IE IN G R A Y IN 1911.
U E C L S
ISP N R S
E M N

The remarkable development o f tuberculosis dispensaries and infor­
mation bureaus in the German Empire during recent years is best
emphasized in the statement that while in 1908 there were only 175
o f these institutions, the number by 1911 had increased to 528. In
addition thereto the number o f forest day and night camps increased
from 82 in 1908 to 98 in 1911. There had also been established 15
forest schools for tuberculous children and 2 agricultural colonies
for tuberculous wage earners. F or tuberculous patients in advanced



102

B U LLETIN OF TH E BUREAU OF LABOR.

stages of the disease ad ate provision is m in a large num of
equ
ade
ber
hospitals an in h es for incurables. For the treatm an care
d
om
ent d
of patients discharged from sanatoria in a condition m
aking a con
­
tinuation of institutional treatm advisable 17 con
ent
valescen h es
t om
exist, and in addition thereto there are 33 observation stations,
chiefly, how
ever, in the principal cities of the P
rovince of Silesia.
Finally, reference m be m
ust
ade to 19 polyclinics, m
aintained by
m
unicipalities, for the m
edical treatm of ca referred to them
ent
ses
by m
edical practitioners or by tuberculosis dispensaries.
A large n ber of associations of all kinds have been estab­
um
lished in recen years throughout G any for the study and pre­
t
erm
vention of tuberculosis, including m w
any hich com e their activity
bin
w general w
ith
elfare w
ork, chiefly, how
ever, for the purpose of ren­
dering effective assistan to w earners of the low and m or
ce
age
er
ore
less depen
dent classes. There are probably not few than 500 su
er
ch
associations, the w of w
ork
hich is m or less coordinated to the
ore
activity of the G an Central C m
erm
om ittee for the P
revention of
Tuberculosis. The tendency is to further coordinatethew of local
ork
associations to the activities of tuberculosis dispensaries and infor­
m
ation bu s, w
reau hich are gradually developing uniform and cen
­
tralized efforts for the prevention and control of the disease. The
following is a brief accou t of the m
n
ethods and results of som of
e
the m
ore im
portant tuberculosis dispensaries and inform
ation
bureaus for the year 1910.
TUBERCULOSIS DISPENSARIES IN BERLIN.

During the four years ending w O
ith ctober 1, 1908, the Berlin
inform
ation bu s and tuberculosis dispensaries m
reau
edically exam
­
ined 82,006 persons for sym
ptom of tuberculosis of the lungs. The
s
num of h es of tuberculous w earn exam
ber
om
age
ers
ined and reported
upon, and placed in a m or less com
ore
plete sanitary condition, w
as
45,583. The dispensary aim particularly at im
s
proved hygienic h e
om
conditions, an w is d e in this direction is practically equivalent
d hat on
to a cou in elem
rse
entary dom
estic and personal hygiene. In quite a
num of ca tubercu
ber
ses
lous patients w found to occu the sam
ere
py
e
bed w healthy m bers of the fam but in 835 su ca sepa­
ith
em
ily,
ch ses
rate bed w provided through th dispensary. For th object of
s ere
e
e
providing additional room for sleeping accom odation, 10,720 m
s
m
arks
($2,551.36) w paid out as pecuniary aid, an in addition thereto
as
d
63,371 m
arks ($15,082.30) w advanced in particularly urgent cases,
as
chiefly, no doubt, for the purpose of furnishing a m substantial
ore
diet or oth aid n
er
ecessary to effect an im
provem or a cu
ent
re. The
tw item com
o
s
bined, am
ounting to 74,091 m
arks ($17,633.66), w
ere
not reim
bursed to the dispensary by the local poor-law authorities.



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

103

Patients in a far advan
ced stage of the disease an p
d ronoun
ced
u
nfit for sanitary treatm
ent, num
bering 3,048, w cared for in
ere
hospitals, air-cure establishm
ents, etc., an of this num
d
ber 1,565
w subsequently discharged as m
ere
aterially im
proved. It is held that
but for the intervention of th dispen
e
saries th patients w
ese
ould prob­
ably have died, or w
ould have b
ecom a seriou econ ic burden
e
s
om
upon the im ediate fam or the public at large. In addition to
m
ily
the foregoing, 3,231 children of tu
bercu s patients w provided
lou
ere
w accom odation in sanatoria for children, an 2,787 oth
ith
m
d
er
children w placed in various forest convalescing h es. The dis­
ere
om
pensaries also con ered 1,241 applicants in a far-advanced stage
sid
of th d
e isease, advising im ediate hospital treatm w how
m
ent, ith,
ever,
but a slight ch ce of im
an
provem or cu
ent
re.
The city of Berlin in 1910, w a population of 2,070,695, had
ith
six tuberculosis dispensaries and inform
ation bu s, atw
reau
hich37,415
persons received consideration, including 5,699 adult m
ales, 10,825
fem
ales, and 20,891 children. The rapid grow of the institutions
th
is brought out by the fact that during 1909 the n ber of applicants
um
w only 20,396. It is explained in the annual report for 1910 that
as
this in
crease is entirely the result of public appreciation of b efits
en
obtained. Am
ong the 37,415 person con ered during 1910, th
s
sid
ere
w 1,100 far-advanced cases of tubercu
ere
losis, w
hich w effectively
ere
isolated in their ow h es for the purpose of dim
n om
inishing the risk
of infection to other m bers of the fam
em
ily. By m
eans of su isola­
ch
tion the m dan
ost
gerou foci of infection are brought under public
s
control, and that m rable results have been obtained is m evi­
easu
ade
dent by the actual d
ecrease in the m
ortality from tuberculosis, the
rate having declined from 18.2 per 10,000 of population in 1908, to
17.9 in 1909, and to 17.6 in 1910.
The visiting nurses are provided w a brief outline of the essen
ith
­
tial facts w
hich requ to be brought to the attention of tubercu
ire
­
lous patients an of th p
d
ose erson w are exposed to the im inent
s ho
m
danger of infection. It is pointed out that tuberculosis can be pre­
vented, and that the infection of healthy person can be avoided upon
s
recognition of the infective character of the d
isease. The hygiene of
the hom is em
e
phasized w referen to dryness, cleanliness, su ­
ith
ce
n
shine, air conditions, etc., an the num as w a the position of
d
ber
ell s
the beds u for sleeping pu oses. The danger of a consum
sed
rp
ptive
sharing the bed w a healthy person is explained, and in the event
ith
that a single bed is not available, on m b provided at the ex­
e ay e
p se of th dispensary. C
en
e
leanliness in toilet accom odation is in­
m
sisted upon an the duty of d estic cleanliness in every oth direc­
d
om
er
tion. Patients are w ed not to kiss u on the m
arn
p
outh an to u
d
se
only their ow toothbrush, on accoun of the im inent risk of
n
t
m
infection.




104

BU LLETIN OF TH E BUREAU OF LABOR.

Sleeping by the op w
en indowis suggested, an inthe event that th
d
e
sputum gives positive evidence of the d
isease by its bacterio­
logical con ts a separate sleeping room is advised, and in extrem
ten
e
cases is provided at the expense of the sanatorium M bers of the
. em
patient’s fam are requ
ily
ired to report for a m
edical exam
ination at
the dispensary. It is also advised that u laundry articles m
sed
ust
not rem in a dry condition, and all cooking utensils em
ain
ployed
by the patient m be clean im ediately after u
ust
ed m
se. Spitting is
prohibited, and for th sputum con
e
tainers m be provided w
ust
ith
a sod or a lysol solution. Patients are w
a
arned not to sh their
are
food w other m bers of th family, and they are further w
ith
em
e
arned
against sm
oking, alcoholic drinks, and m
arriage. The prem are
ises
required to be disinfected. The econ ic condition of the patient is
om
d ssed w the visiting n
iscu
ith
urse, and if th aid ren ered by the dis­
e
d
pensary is in
adequ the poor-law authorities are called upon.
ate
The financial aid provided by the Berlin dispen
saries during 1910
am
ounted to 26,746 m
arks ($6,365.55). From a special fund 822
person w provided w m
s ere
ith eals for a period of six w s each
eek
.
In addition thereto, 91,439 m
eals w provided for tuberculous
ere
children at public diet kitch s. Pure m w provided for 339
en
ilk as
person exclusiveof fam
s
ilies takencare of by thepoor-lawauthorities.
The n ber of tu
um
bercu s person sen to sanatoria and to h es
lou
s t
om
for incurables through the intervention or assistance of the dispen­
saries w 932 adults an 1,029 children. Finally, 1,085 patients
as
d
w d
ere irected to physicians and polyclinics and 367 w taken care
ere
of in hospitals.
The 6 dispen
saries em
ployed 17 visiting n
urses, w during the
ho
year m 37,750 visits to the h es of tuberculous patients, or an
ade
om
average of from 7 to 8 visits a day.
The chief object of the tuberculosis dispensaries is to protect th
e
healthy, but m is d e for the afflicted particularly w regard
uch
on
,
ith
to the recovery of the patients’ earning capacity. As far as prac­
ticable th children in tubercu
e
lous fam
ilies are rem
oved therefrom
an taken care of in children’s hom or in forest day cam
d
es
ps. The
present effort is largely directedtow th protection of the children
ard e
against infection, as perhaps the m prom
ost
ising m s of ultim
ean
ately
reducing the m
ortality from tuberculosis. It is pointed out in th
e
report for 1910 that on of the results of preventive effort will b to
e
e
in
crease the num an proportion of young m fit for m
ber d
en
ilitary
service, w
hich at present, in the large cities, is not m than 50 per
ore
cen of th n ber exam
t
e um
ined.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

105

TUBERCULOSIS DISPENSARIES IN HAMBURG.

The city of Ham
burg in 1910, w a population of 932,166, had
ith
five tuberculosis dispensaries, tw of w
o
hich had been established dur­
ing th previous year. The d
e
ispen
saries are subsidized to the extent
of 10,000 m
arks ($2,380) per an u by the State of H burg, and
nm
am
in addition 9,000 m
arks ($2,142) is provided by th H
e anseatic In­
validityInsurance Institution. The G an C
erm
entral C m
om ittee fur­
nished 2,000 m
arks ($476) for the establishm of tw n dis­
ent
o ew
pensaries. The various com un sick funds furnished 4,529.65
m al
m
arks ($1,078.06), and a n m of other sick an burial funds pro­
u ber
d
vided 3,564.50 m
arks ($848.35). In addition to this in e th
com e
su of 2,487.53 m
m
arks ($592.04) w derived from m
as
iscellaneous,
chiefly charitable, sou
rces, m
aking a total in e of 31,581.68 m
com
arks
($7,516.45). The d rsem ts during the year w
isbu
en
ere, in som
e
detail, as follows: For m
edical fees, 10,490 m
arks ($2,496.62); for
n
urses, 5,900 m
arks ($1,404.20); for clerical assistan 2,787.60 m
ce,
arks
($663.45); financial aidtopatients, 1,475 m
arks($351.05); for beds an
d
bedding, 1,571.65 m
arks ($374.05); for rent, 1,066.65 m
arks ($253.86);
for therm eters, 193.80 m
om
arks ($46.12); for printing, 670.05 m
arks
($176.14); an for furniture an m
d
d iscellan s expen
eou
ses, 1,693.63
m
arks ($403.08), m
aking a total d
isbursem
ent for th year of
e
25,848.28 m
arks ($6,151.89).
The n ber of n patients or applicants con ered during the
um
ew
sid
year w 5,004, including 1,720 m 1,867 w en, an 1,417 children.
as
en,
om
d
Of the total num
ber, 2,302 w m bers of sick funds an 2,391
ere em
d
w m bers of invalidity in ran institutions. Am th appli­
ere em
su ce
ong e
cants w 59 disability annuitants, including 40 m an 19fem
ere
ales d
ales.
Of the 5,004 person con
s sidered, 1,870, or 37.4 per cent, w found to
ere
be tubercu
lous. The n m of m
u ber
edical exam
inations m during
ade
the year w 12,520. Of the 5,004 p
as
erson con
s sidered, 2.340 applied
at th dispensaries on their ow accoun 1,369 w sen to the dis­
e
n
t,
ere t
pen
saries by physicians, an 169 applied at th suggestion of th in­
d
e
e
validity in ran institution, an 61 at th suggestion of sick funds.
su ce
d
e
The dispensaries received notifications of 2,638 tu
bercu s p
lou erson
s
through th invalidity in ran institution, but of this n m 1,140
e
su ce
u ber
had b previously con
een
sidered by the tuberculosis d
ispen
saries. The
n ber of person sleeping alon w 1,841, the n ber sleeping
um
s
e as
um
w other adults w 499, an the n ber sleeping w children
ith
as
d
um
ith
w 381. Only 759 had their ow bedroom but in 2,907 ca th
as
n
,
ses e
hom w found to b clean an in a sanitary condition, in 533 cases
e as
e
d
the condition w fairly satisfactory, an in only 40 w the condition
as
d
as
decidedly unsatisfactory.
The n ber of person m
um
s aking application for sanatorium treat­
m w 678, including 238 m 318 w en an 122 children.
ent as
en,
om , d



106

B U LLETIN OF TH E BUREAU OF LABOR.

Sanatorium treatm w provided at the exp se of the invalidity
ent as
en
in
suran institution in the ca of 118 m
ce
se
ales and 93 fem
ales, an
d
at the expense of sick funds in the case of 45 m
ales and 35 fem
ales,
and by public authorities in the case of 46 m 84 w en and 97
en,
om ,
children. In addition thereto 8 m 19 w en, an 6 children w
en,
om
d
ere
provided w sanatorium treatm at their ow expense, an 5
ith
ent
n
d
persons w taken care of at the exp se of others. The n ber
ere
en
um
of cases declin a u
ed s nsuitable for sanatorium treatm w 162.
ent as
There w 95 children of tuberculous parents provided w vaca­
ere
ith
tions or treatm in th country, the expen being paid for in 11
ent
e
ses
cases by the invalidity insurance institution an in the rem
d
ainder
of th cases by various authorities, societies, etc.
e
Of the tuberculous applicants, 209 w provided w accom o­
ere
ith
m
dation in hospitals, an there w 168 deaths, probably of person
d
ere
s
in the advan stages of the d
ced
isease. In 1,103 cases the hom of
es
tuberculous persons w disinfected m or less in cooperation
ere
ore
w th public authorities. In 34 cases beds w provided an in
ith e
ere
d
239 cases financial assistan w ren ered to th total am
ce as
d
e
ount of
615.96 m
arks ($146.60); in 69 ca m w furnished; and in 39
ses ilk as
cases additional rent w provided to the am
as
ount of 3,317.68 m
arks
($789.61); 55 person w provided w clothing, and in 67 ca
s ere
ith
ses
financial assistan w secu through private sou
ce as
red
rces. There w
ere
95 cases in w
hich coal w furnished, an in 107 cases the tubercu
as
d
lous
patients w supplied w suitable sputum cu s.
ere
ith
p
A considerable proportion of th m applicants w com on
e ale
ere
m
laborers or sm w earn
all age
ers, but practically all occupations are
represented, including a fair n m
u ber of persons in em
ploym
ents
of a higher grade, su as clerks, stenographers, etc. The total
ch
n ber of n applicants at the dispen
um
ew
saries in
creased from 3,480
in 1909 to 5,004 in 1910, an the n m of p
d
u ber
erson m
s edically ex­
am
ined in
creased from 7,338 in 1909 to 12,520 in 1910. The general
results are con ered entirely satisfactory and a determ
sid
ined effort
is being m to in
ade
crease the usefulness of the institutions in every
direction. The grow of the institutions is conclusive evid ce of
th
en
public appreciation, an the practical results are m evident by
d
ade
the fact that the tuberculosis death rate has persistently declin
ed
from 14.9 per 10,000 in 1907 to 13.3 in 1908, to 13.1 in 1909, an to
d
12.6 during 1910. It m safely be assu ed that the establishm
ay
m
ent
and intelligent adm
inistration of the tuberculosis dispensaries an
d
inform
ation bu s throughout the city of Ham
reau
burg has m
aterially
contributed tow this gratifying reduction in the m
ard
ortality from
this disease.
TUBERCULOSIS DISPENSARY IN LEIPZIG.

In Leipzig, w
hich in 1910 had a population of 587,635, a tuber­
culosis dispensary an inform
d
ation o e has been established
ffic

through the
are of Sick W
orkm w
en, hich has
http://fraser.stlouisfed.org/ Association for the C
Federal Reserve Bank of St. Louis

CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

107

given special and extended consideration to the problem of tuber­
culosis prevention an relief. The n ber of n applicants during
d
um
ew
1910 w 2,162, w
as
hich com
pares w 1,999 during 1909, an 765
ith
d
during 1908. Of th applicants con ered during 1910, 809 w
e
sid
ere
m
ales insured w invalidity in
ith
suran institutions, an 854 w
ce
d
ere
insured fem
ales. The n m of children con ered during 1910
u ber
sid
w 499. The n ber of m
as
um
edical exam
inations w 4,118, and 4,515
as
visits w m
ere ade to h es of persons w o actually had or w
om
h
ere
su ected of having tuberculosis. T
sp
hese visits w m by on
ere ade
e
m nurse and tw fem n rses. The dispensary provided 15,340
ale
o
ale u
liters (16,209.5 quarts) of m and 758 m
ilk
arks ($180.40) in cash for
rent, etc. A considerable am
ount of food an m
d edicines, as w a a
ell s
large n ber of sputum cups, etc., w provided, but in a general
um
ere
w the m
ay
ethods and results conform to th of th tuberculous
ose
e
dispensaries of H burg an of Berlin. A special effort w m in
am
d
as ade
the direction of public edu
cation in all m
atters relating to tubercu
­
losis, an am
d ong th publications distributed w th following:
e
ere e
A Brief Outline of th Effective P
e
rotection of th P
e erson against
Tuberculosis; An Advisory Circular for the Tuberculous; Inform
a­
tion a to the First Indications of Tuberculosis; C
s
hronic LeadPoisoning as an O
ccupation'Disease; The D
angers of Dusty Trades;
and The D
angers of Living in D p, Sm
am
all, an O
d vercrow
ded
Dw
ellings.
The foregoing is only a brief outline of th activity of th tuber­
e
e
culosis dispensary of Leipzig during the year 1910. Effective w
ork
of far-reaching im
portance is also don by a n ber of charitable
e
um
and philanthropic association as w as through the C m
s,
ell
om unal
Sick Fund, w w
ith hich a large m
ajority of th w earn of the
e age
ers
city of Leipzig are in red The tuberculosis d
su .
eath rate of Leipzig
h d
as ecreased w
ithin recen years from 18.6 in 1907 to 17.4 in 1908
t
and to 16.3 in 1909. The data for 1910 are not available.
TUBERCULOSIS DISPENSARY IN MUNICH.

M
unich, w a population in 1910 of 595,053, h only on dis­
ith
as
e
pensary, op ed on M
en
arch 1, 1908. In 1909 (the report for 1910 n
ot
being available) the dispensary w visited by 1,204 person w
as
s, ho
m
ade 4,210 calls during 86 hours of available m
edical advisory
service. The visiting n
urse m
ade 1,794 calls at the hom of th
es
e
patients, w represen all of the principal occu
ho
ted
pations and in­
cluded 216 m
arried w en and w
om
idow and 403 children. The w
s
ork
of the dispensary is as yet very lim
ited, considering the large popu­
lation contributory thereto. In 1909, out of 1,204 person m
s edically
exam
ined, 745 w found to b tubercu
ere
e
lous an in an advan stage
d
ced
of the d
isease, 362 w probably tubercu
ere
lous, w
hile only 97 w
ere



. 108

BU LLETIN OP TH E BUREAU OP LABOR.

entirely free from th d
e isease or indications thereof. M of th
ost
e
person w of the age period 21 to 50 years. Of the 1,204 persons,
s ere
229 w recom en ed to th dispensary by physicians, 155 by
ere
m d
e
polyclinics, an 790 oth ise. The num of persons found to have
d
erw
ber
a tubercular fam history w 446, an of this num 256 w
ily
as
d
ber
ere
certainly tubercu
lous, 156 w probably tuberculous, and 34 w
ere
ere
free from th d
e isease or indications thereof. Of the 745 persons w
ho
w certainly tuberculous, 14.7 per cen w of the age period 21
ere
t ere
to 30 years and 17.2 per cen of the ages 31 to 40 years. The num
t
ber
of p
erson having their ow beds w 994, or 82.6 per cen of th
s
n
as
t
e
total. The n ber sharing their bed w on other person w
um
s ith e
as
198, or 16.4 per cen an the num sharing their bed w tw
t, d
ber
s ith o
p
erson w 12, or 1 per cen
s as
t.
All ca of tuberculosis a determ
ses
s
ined at the dispensary are regis­
tered on cards an indicated on a m of the city, show pre­
d
ap
ing
cisely the relation of con
gestion of population to th occu ce of
e
rren
d
isease.
The w of th dispensary is further em
ork
e
phasized in the extent to
w
hich n
ecessary articles w lent for tem
ere
porary u chiefly ther­
se,
m eters, beds, m
om
attresses, bedding m
aterial, sputumcups, spittoons,
etc. The total am t of financial support on behalf of patients pro­
oun
vided w accom odation in sanatoria, forest day cam etc., in
ith
m
ps,
112 cases w 6,712.90 m
as
arks ($1,597.67). In 18 cases an addition to
the rent w paid for th purpose of providing better living quarters,
as
e
am
ounting to 234.25 m
arks ($55.75). There w
ere 15,198 liters
(16,059.5 quarts) of m furnished, at a cost of 2,735.68 m
ilk
arks
($651.09), and other expenditures for relatively sm am ts w
all oun ere
incurred for financial assistan to patients in urgent n thereof.
ce
eed
The w of the dispensary is aided m
ork
aterially by the efforts of
the M
unich Association for the P
revention of Tuberculosis, w
hich
carries on an effective propaganda against the d
isease, an m
d aintains
tw day cam on each for m and w en The day cam for
o
ps, e
en
om .
p
w en is com ed w an open-air school for children, w
om
bin
ith
hich dur­
ing 1909 w op from M 10 to Septem 26 an provided ac­
as en
ay
ber
d
com odation for 67 children. The day cam for w en w op
m
p
om
as en
from M 1 to D
ay
ecem 26 and 829 persons w cared for5chiefly at
ber
ere
the expense of the com unal an trade sick funds an the Invalidity
m
d
d
Insurance Institution of Upper Bavaria. The physical results of the
institution are m evident by the fact that for 663 patients th
ade
ere
w an average gain in w
as
eight of 2.7 kilogram (5.95 pounds) as th
s
e
result of an average stay of 28 days. The atten ce has rapidly in­
dan
creased from an average of 30 p
erson per day in 1904 to 158 in 1909.
s
Of 236 patients for w
hich the inform
ation is given, 107, or 45.3 per
cent, w tubercu
ere
lous. Of th 236 patients under treatm an care,
e
ent d
80.9 per cen recovered their full earning capacity, and 7.2 recovered
t




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

109

partial earning capacity. The physical results in the ca of children
se
w particularly satisfactory, the average gain in w
ere
eight having
b 3.7 kilogram (8.16 pounds), an th average in
een
s
d e
crease in height
4.4 centim
eters (1.7 inches). U
nder the p
resen lim
t itations the u
se­
fulness of th tuberculosis dispensary is, how
e
ever, far from w th
hat e
local conditions requ
ire, for the death rate from tuberculosis in
M
unich is high, having b 22.9 per 10,000 in 1909 against 17.9 for
een
Berlin, an 15.6 for C
d
ologne. The tuberculosis death rate of M
unich
h b practically stationary for the three years 1907 to 1909, but
as een
th has b a declin in the occu ce of the d
ere
een
e
rren
isease w com
hen
­
parison is m w earlier years.
ade ith
TUBERCULOSIS DISPENSARIES IN SILESIA.

The results of dispensary treatm have b fully as encourag­
ent
een
ing in sm com unities, and even in rural districts, in w
all
m
hich, in
som section of G any, the tubercu
e
s
erm
losis death rate is higher than
in the cities. What h b d e in this direction in th P
as een on
e rovince
of Silesia is particularly interesting in view of the fact that 32 com
­
m
unities, in 1910, m
aintained inform
ation bu s an tuberculosis
reau d
dispensaries, an that in th 4,853 person w m
d
ese
s ere edically exam
ined,
of w
hom 2,186, or 45 per cen w found to be tubercu
t, ere
lous. The
visiting n rses m
u
ade 16,419 calls in behalf of 1,847 tubercu
lous
patients or fam
ilies. In 490 cases infected hom w disinfected
es ere
by scientific m
ethods, aside from a large am t of disinfection by
oun
public authorities. The n ber of m provided w institutional
um
en
ith
treatm w 189; of w en, 208; an of children, 214. The finan
ent as
om
d
­
cial n s of the dispensaries w provided for in part by 25 com
eed
ere
­
m
unities furnishing 9 8 0 m
^ 6 arks ($2,346.68). In addition thereto th
e
invalidity insurance institution of Silesia subsidized th dispen
e
saries
w th su of 9,615 m
ith e m
arks ($2,288.37), an the G an C
d
erm
entral
C m
om ittee furnished 1,000 m
arks ($238). Finally, three com un
m ities
w aided to the extent of 13,000 m
ere
arks ($3,094) for the establish­
m an support of forest day cam s.
ent d
p
TUBERCULOSIS DISPENSARY IN AUGSBURG.

In the city of Augsburg, w
hich in 1910 had a population of 102,570,
a tuberculosis dispensary w established in 1909. From the ou
as
tset
the institution m w a d ed respon an in 1910 97 m
et ith ecid
se, d
edical
consultations w held, during w
ere
hich, on an average, from 15 to 20
persons w exam
ere
ined as to evid ces of tubercu
en
losis. The n ber
um
exam
ined included all of the patients discharged from the sana­
torium of the invalidity in
suran institution, w provision for
ce
ith
their su
bsequ t observation an record. The chief aim of the insti­
en
d
tution is the education of the public in all that pertains to the pre­
vention, treatm
ent, an cu of tuberculosis, an included in this
d re
d



110

B U LLETIN OP TH E BUREAU OP LABOR.

propaganda are the m bers of the patients’ fam
em
ilies. The effort is
to control, as far as possible, the housing conditions of those infected
w the d
ith
isease, an the visits of the n
d
urse are largely directed to­
w rem
ard
edial m res and a m
easu
oderate am
ount of financial support.
During the tw years the dispensary has been established 680 h es
o
om
have beeninspected and as far as n
ecessary the im ediate living con
m
­
ditions have b im
een proved as a first requisite in providing an en
­
vironm favorable for the cure of th d
ent
e isease. In m
any in ces
stan
very unsatisfactory housing conditions w disclosed by the in
ere
spec­
tion an brought to the attention of the public authorities. A special
d
effort is m to control the expectorations of the patients, for th
ade
e
purpose of preventing th infection of other m bers of the fam
e
em
ily
or the reinfection of the patient. Disinfection is practiced to a con
­
siderable extent, and in all cases w en a tubercu
h
lous person m
oves
from on locality to an er or in the event of death.
e
oth
On January 1,1910, there w 294 person under observation, an
ere
s
d
during the year 359 n applicants received consideration. Of the
ew
359 n applicants, 119 w m 139 w w en, and 101 w
ew
ere en,
ere om
ere
children. Of th 119 m 100, or 84 per cent, w tuberculous or
e
en,
ere
probably so; and of the 139 w en, 110, or 79.1 per cent; an of the
om
d
101 children, 55, or 50.5 per cen The num of fam
t.
ber
ilies under ob­
servation on January 1, 1911, w 179. The num of m
as
ber
edical ex­
am
inations, including reexam
inations, m
ade during 1910, w 476.
as
The visiting n rse during the year m
u
ade 1,105 visits, an in 115
d
cases m
aterial im
provem
ents w brought about in the h e an
ere
om d
living conditions of the patients. The am
ount of financial assistan
ce
in the case of eight fam
ilies w 334 m
as
arks ($79.49). For the pre­
vention of infection, 106 sputum cups and a considerable am
ount of
disinfecting m
aterial w provided. Disinfection of prem took
ere
ises
place in 150 cases, of w
hich 135 w on accou t of death and 15 on
ere
n
accou t of change of resid ce. The dispensary provided for 734
n
en
patients 11,055 liters (11,682 quarts) of m an for 52 patients
ilk d
1,650 noonday m
eals.
The death rate from tuberculosis in Augsburg is gradually de­
clining. In 1900 the rate w 37.0 per 10,000 population, in 1904 it
as
w 30.7, in 1909 it w 22.9, and in 1910 it w 22.6. The actual
as
as
as
n ber of death had d
um
s
ecreased from 328 in 1900 to 232 in 1910,
although the population had in
creased from 88,749 to 102,570.
TUBERCULOSIS DISPENSARIES IN WESTPHALIA.

In concluding this brief review of som of th m im
e
e ore portant
and typical tuberculosis dispensaries an inform
d
ation bu s, w
reau hich
w
ithin recen years have b
t
een established throughout the G an
erm
Em
pire, reference m be m to w has been d e in this direcay
ade
hat
on



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

I ll

tion in the P
russian Province of W
estphalia, w
hich in 1910 had a
population of 4,125,904. The n ber of dispensaries, w
um
hich in 1909
had b
een 14, w in
as creased by 14 during 1910. The problem is
seriously com
plicated by m or less unsatisfactory housing condi­
ore
tions, an the w
d
ork of the dispen
saries is therefore intelligently
coordinated to a w
ell-organized system of h se inspection. In the
ou
aggregate 5,698 person applied to the dispensaries during 1910, an
s
d
of this num 2,774 w m
ber
ere edically exam
ined. An exam
ination of
the sputa w m in 1,299 cases and a positive diagnosis of tuber­
as ade
culosis w m in the ca of 1,839 applicants. The total n m
as ade
se
u ber
of person under supervision an care w 1,925, an of this num
s
d
as
d
­
ber 585 w provided w nourishing food, 123 w beds, 736 w
ere
ith
ith
ith
m
edicinal baths, 49 w financial assistan on accoun of rent, an
ith
ce
t
d
193 w sputum cups an disinfecting m
ith
d
aterial, etc. In 531 cases
the prem
ises w disinfected, including 284 on account of death
ere
s
from tuberculosis.
AGRICULTURAL COLONY FOR TUBERCULOUS W AGE EARNERS.

O special effort should h b referred to for the purpose of
ne
ere e
com
pleten and that is the establishm of an agricultural colony
ess,
ent
by th Invalidity Insurance Institution of H
e
anover chiefly for the
benefit of patients discharged from sanatoria for the treatm of
ent
tuberculosis. The colony is located at Stubeckshom in th Luneburg
,
e
Heath, w
ithin a reason
able distan of the city of H
ce
anover an abou
d
t
5 m from the city of Soltau. The estate com
iles
prises 750 h
ectares
(1,853.3 acres) of land, of w
hich 650 h
ectares (1,606.2 acres) con
sist
of pine w
oods. A sim provision has b m for the housing
ple
*
een ade
of th patients, w are em
e
ho
ployed in the op air, chiefly in
en
the m
aking of roads in the w
oods, in th preparation of asparagus
e
beds, and in light field w during th harvest season The value
ork
e
.
of the property in 1910 w 175,587 m
as
arks ($41,789.70). The w
ork
is d e under m
on
edical supervision, but every inm is requ
ate
ired to
perform certain duties punctually an to the best of his ability. The
d
principle of com
pulsory labor is therefore fundam
ental. The m
ini­
m w
um orking tim per day is four hours, the patients being divided
e
into three grades, those in the first grade w
orking up to four hours,
th in the secon grade to six hours, and those in the third grade
ose
d
to eight hours, according to their strength an capacity. The stay
d
in the colonyis usuallylim
ited to tw m
o onths. The patients adm
itted
m a a rule be tubercu
ust s
lous person w up to the tim of their ad­
s ho,
e
m
ission, had been treated in a sanatorium but w w relatively
,
ho ere
free from definite sym
ptom of the d
s
isease on their discharge. Per­
son are also adm
s
itted w are not tuberculous, but w o have had
ho
h
inflam ation of the lungs an w to that extent w
m
d ho
ould b predis­
e



112

B U LLETIN OF TH E BUREAU OF LABOR.

p
osed to th d
e isease. The tw classes of patients are, how
o
ever, kept
entirely separate.
The m
axim duration of w is eight h rs a day, the w
um
ork
ou
ork
being paid for at the rate of 10 pfennigs (2.4 cents) an hour, w
hich
m es possible m
ak
axim earnings of 80 pfennigs a day (19 cents),
um
w
hich is credited to the patient and paid to him on his discharge, if
not before. The patients are requ
ired to be insured m bers of
em
the Invalidity Insurance Institution of H
anover.
This institution w op ed on M 5, 1902. As far as the results
as en
ay
have b reported to date, the experim on the w
een
ent
hole appears to
have b satisfactory. Of the cases reportedupon in 1905,78percen
een
t
w finally discharged as fully capable of w
ere
ork. Of those w had
ho
previously w
orked in factories 9 per cen on discharge changed their
t
occu
pations to different an m suitable em
d ore
ploym
ents. The aver­
age gain in w
eight during the stay in the colony w 3.1 kilogram
as
s
(6.8 pounds). The average earnings per patient am
ounted to 27.15
m
arks ($6.46). The average hours of labor for days actually em
­
ployed am
ounted to 6.9. The average cost per patient per day dur­
ing the first year of the establishm w 98 pfennigs (23 cents).1
ent as
The food served is th ordinary nutritious diet of agricultural
e
laborers an not the specially prepared diet of tuberculosis sanatoria.
d
Provision is m for a m
ade
axim of 65 patients.
um
A draw
back to the su
ccess of this establishm has b the in­
ent
een
clination of the better class an m industrious m
d ore
arried w
orkm
en
to return to their fam
ilies too soon after their discharge from th
e
sanatorium even though su a return w likely to be follow
,
ch
as
ed
by con u ces injurious to health. Another draw
seq en
back is that dur­
ing w
inter m
onths, w en there is little agricultural w to be d e
h
ork
on
throughout the section, p
erson w can not find any em
s ho
ploym seek
ent
to be adm
itted to the colony. The hope is held out that th colony,
e
in cou of tim w becom a m valuable connecting link in the
rse
e, ill
e
ost
chain of institutions established for the com on w
m
elfare of G an
erm
w earn prim
age
ers,
arily for th purpose of conservingthehealthan
e
d
w
ell-being of m an w en em
en d om
ployed in industry.
CONTROL OF TUBERCULOSIS THROUGH HOUSING REFORM.

The public control of tuberculosis through housing reform re­
ceived extended consideration for the first tim in 1901 in an ad ress
e
d
read before the G an C
erm
entral C m
om ittee.2 Earlier observers had
em
phasized the intim relation betw
ate
een density of population,
1 During 1910 a total of 19,087 days’ support was provided at the colony, of which
only 16 days was on account of patients other than those who, on admission, were
tuberculous or who had received treatment on account of tuberculosis of the lungs pre­
vious to their admission.
2 Dr. Heydweiller, Ueber Bek&mpfung der Tuberkulose durch Wohnungsfiirsorge. Ber­
lin, 1901.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

113

unsatisfactory housing conditions, an tu
d bercu
losis frequency, indi­
cating that the d
isease is m often cau by dom
ost
sed
estic infection,
family infection, overcrow
ding, an bad air. It had b
d
een sh n
ow
that “ the death rate from phthisis steadily in
creases w the pro­
ith
portion of th total population living m than tw in a room in
e
ore
o
ten ents com
em
prising less than five room
s.”1 The average annual
phthisis rate of London w found to range from 11.1 per 10,000 of
as
population in districts practically free from congestion to 25.9 in
badly con
gested districts. O
fficial inquiries into housing conditions
established the fact that adequ treatm and care of tubercu
ate
ent
lous
w earn in their h es w often prevented by seriou defects
age
ers
om as
s
in structural arrangem or bybad sanitaryconditions su as dam
ent
ch
p­
n
ess, defects in lighting, ventilation, etc. Adequate and sanitary
housing accom odations for w earn an their depen
m
age
ers d
dents w
ere,
therefore, urged as a first step in the cam
paign against tuberculosis.
M had already b d e in this direction by local w
uch
een on
elfare organi­
zations an building societies, particularly in the Rhine P
d
rovince
and in th G
e rand D
uchy of H
esse. Attention, how
ever, w draw
as
n
at about the sam tim to the vital interest of invalidity in
e e
suran
ce
institutions in the reduction of the m
orbidity an m
d ortality from
tuberculosis, and to the service to be ren ered by th institutions in
d
ese
providing the m s for a nation-w reform in housing conditions
ean
ide
along lines of rational sanitary requ en
irem ts.
An address on th relation of housing to tuberculosis before the
e
G an Central C m
erm
om ittee at its fourteenth annual session in 1910,2
em
phasized the view that the adm
inistrative control of tuberculosis
w la r g e ly a housing p r o b le m , not o n ly in th e c o n g e ste d sec tio n s of
as
large cities, but also throughout the agricultural districts. The
argum w su
ent as stain by statistical data, show the existence of
ed
ing
a vast am
ount of overcrow
ding an the intim relation thereto of
d
ate
the excessive occu ce of tubercu
rren
losis. For M
annheim for illus­
,
tration, it w sh n that in the overcrow h es th death rate
as ow
ded om
e
from tuberculosis w nearly double w it had b ascertain to
as
hat
een
ed
be in h es w suitable accom odation. The con sion w ad­
om
ith
m
clu
as
van that by providing norm housing conditions the m
ced
al
ortality
from tubercu
losis w
ould b m
e aterially red ced but also that m ch
u ,
u
could b d e by rigid h se inspection along the lines developed in
e on
ou
the G
rand D
uchy of H
esse, w
hich provides a trained building inspec­
tor for every territorial division. In sum arizing the con
m
clusions it
w pointed out that (1) tuberculosis w a h se d
as
as
ou isease w a
ith
variable degree of frequency, according to overcrow
ding an density
d
of population; (2) the im
provem in housing conditions an the
ent
d
ed cation of w earn in rational m
u
age
ers
ethods of living w
ould largely
1 The Prevention of Tuberculosis, by Arthur Newsholme, M. D., p. 147.
1908.
aZur Tuberkulose-Bekampfung, 1910, pp. 22, by Dr. Paul Romer.

49397°—
http://fraser.stlouisfed.org/ 12------ 8

Federal Reserve Bank of St. Louis

New York,

114

BU LLETIN OP TH E BUREAU OP LABOR.

affect the future reduction of th death rate; (3) the im
e
portance of
utilizing the services of trained building inspectors; (4) the noti­
fication of cases of tuberculosis and the disinfection of the prem
ises
in the event of change of resid ce or death; (5) the intelligent co­
en
ordination of the investm of surplus funds of invalidity in
ent
suran
ce
institutions in approved building projects prim
arily adapted to the
n s of w earn w a d e regard to advanced sanitary and
eed
age
ers, ith u
social requirem
ents; and (6) the general sanitary im
provem of
ent
cities, ad ate drainage, an effective m
equ
d
ethods of dust prevention
an the eradication of the sm n isan
d
oke u ce.
In discussing the foregoing con
clusions, Dr. Sarason, of Berlin,
em
phasized the n
ecessity of personal hygiene as a prerequisite for the
attainm of requ
ent
ired results in public hygiena Dr. F. Kohler, of
H
olsterhausen, sustained the argum of Building Inspector Gretzent
sch by an analysis of returns for 1,000 w earn in the R
el
age
ers
hine
Province, show that of 636 tuberculous m
ing
arried m only 24.7
en,
per cen occu
t
pied their ow beds, w
n
hile 75.3 per cen sh
t ared their
beds w other m bers of th fam in this w exposing the
ith
em
e
ily,
ay
other m bers to additional risk of infection. Of 649 m
em
arried
tuberculous w earners, including w
age
idow having 1,866 children,
ers
it w found that th large m
as
e
ajority of th children occupied bed
ese
s
w tuberculous m bers of the fam
ith
em
ily. Under conditions like
these, w
hich are fairly typical at least for the industrial districts of
the G an Em
erm
pire, it is evident that th gradual eradication of
e
tuberculosis is largely conditioned by the problemof housing reform
.
BUILDING LOANS B Y IN V A LID ITY INSURANCE INSTITUTIONS.

The intim relation w
ate
hich exists betw the local o rren of
een
ccu ce
tuberculosis and the m or less unsatisfactory housing conditions
ore
early suggested to the invalidity insurance institutions the propriety
and advantage of investing a con
siderable proportion of their surplus
funds in the erection of m
odel dw
ellings, prim
arily for th u of
e se
w earn and their fam
age
ers
ilies.
In a statistical analysis published in 19051 of w had b d e
hat
een on
by invalidity in
suran institutions it w show that 109,533,296
ce
as
n
m
arks ($26,068,925) had b
een invested by D
ecem 31, 1903, in
ber
building projects, or 10.8 per cent of the total funds accu u
m lated as
reserve. The largest am
ount had been invested by th Invalidity
e
Insurance Institution of the R
hine Province, or 21,793,584 m
arks
($5,186,873), or 18.8 per cen of the total funds. The institution
t
of H
anover, how
ever, had invested 40.4 per cent of its funds in build­
ings an hom for w earn
d
es
age
ers, or a total of 16,374,215 m
arks
($3,897,063). By 1903, therefore, substantial results had been
1 Die Vorteile der Invalidenversicherung und ihr Einfluss auf die deutsehe Volkswirtschaft. Bearbeitet yon Gustav Vogt, Berlin-Grunewald, 1905.




CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

115

achieved, and in resp se to a strong agitation larger investm
on
ents
in this direction w m by th invalidity in ran institutions,
ere ade
e
su ce
so that by D
ecem 31, 1910, the total am n invested in housing
ber
ou t
accom odation for G an w
m
erm
age earn an their fam
ers d
ilies w
as
320,065,539 m
arks ($76,175,598), an of this su 39,600,000 m
d
m
arks
($9,424,800) w provided by the invalidity in ran institutions
as
su ce
during 1910.
According to an analysis of the investm
ents for the year 1910 in
th publications of the Im
e
perial Insurance O
ffice for M
arch 15,1911,
of the 320,065,539 m
arks ($76,175,598), the sumof 301,280,659 m
arks
($71,704,797) w invested in h es for fam purposes, w
as
om
ily
hile
18,784,880 m
arks ($4,470,801) w in
as vested in lodging h ses an
ou
d
other m s of providing for the n s of unm
ean
eed
arried w earn
age
ers.
Of the 301,280,659 m
arks ($71,704,797) provided for the building of
fam hom 184,241,241 m
ily
es,
arks ($43,849,415) w lent to building
as
societies, stock building associations, an philanthropic building
d
societies, at an average rate of interest of from 2.5 per cent to 4.25
per cen The su of 37,571,717 m
t.
m
arks ($8,942,069) w lent to
as
provinces, com unities, an savings banks an other public institu­
m
d
d
tions at rates of in
terest of from 2.5 per cen to 3.75 per cen
t
t.
The su of 63,426,736 m
m
arks ($15,095,563) w lent to w earn
as
age
ers
in
sured w invalidity insurance institutions at rates of in
ith
terest
of from 2 per cent to 4.5 per cen The su of 16,040,965 m
t.
m
arks
($3,817,750) w lent to em
as
ployers of labor at rates of interest of
from 3 per cen to 4.5 per cen
t
t.
Of the 18,784,880 m
arks ($4,470,801) lent for building pu
rposes
to provide accom odation for unm
m
arried w
age earn
ers, 15,905,180
m
arks ($3,785,433) w lent to building societies, stock building asso­
as
ciations, and philanthropic building associations at rates of interest
of from 3 per cent to 4 per cen
t.
The sum of 2,259,950 m
arks ($537,868) w lent to provinces, com
as
­
m
unities, and savings banks an oth public institutions at rates of
d er
interest of from 3 per cen to 3.75 per cen The su of 619,750
t
t.
m
m
arks ($147,501) w lent to em
as
ployers of labor at rates of interest
of from 3.5 per cent to 4 per cen
t.
The Invalidity Insurance Institution of th R
e hine Province pro­
vided the largest am t in loans for building purposes, or 55,982,937
oun
m
arks ($13,323,939). The next m im
ost portant invalidity in ran
su ce
institution w that of H
as
anover, w 34,822,174 m
ith
arks ($8,287,677);
follow by that of W
ed
estphalia, w 33,682,841 m
ith
arks ($8,016,516);
the Kingdom of Saxony, w 25,451,670 m
ith
arks ($6,057,497); the
G
rand Duchy of B
aden, w 22,580,197 m
ith
arks ($5,374,087); the
Kingdom of W
urttem
berg, w 17,755,224 m
ith
arks ($4,225,743); the
pension fund of the Prussian-H
essian railw
ays, w 14,681,276
ith
m
arks ($3,494,144); an the P
d
rovince of H
esse-N
assau, w
ith



116

BU LLETIN OF TH E BUBEAU OF LABOB.

13,680,356 m
arks ($3,255,925). N
one of th oth invalidity insur­
e er
an institutions provided a su am
ce
m ounting to as m as 10,000,000
uch
m
arks ($2,380,000).
TOWN PLANNING AND SANITABY PROGRESS IN GERMANY.

A very com en accou t of building reformin G an cities,1
preh sive
n
erm
largely for the purpose of im
proving the living conditions of w
age
earn
ers, w published by the Im
as
perial Statistical O
ffice in 1910.
The report brings out the rem
arkable progress w
hich has b
een
ach
ieved w
ithin recen years, not only in the direction of providing
t
better living quarters, but also in the m effective adm
ore
inistrative
control by m s of trained building inspectors an carefully devised
ean
d
rules and regulations governing the erection of sanitary dw
ellings
for w earn an oth
age
ers d ers. To the extent that th aim an
ese
s d
plans are realized, the conditions favorable for the spread of tuber­
culosis will largely be d e aw w and, as has been previously
on
ay ith,
pointed out, a special effort in this direction has been m in the
ade
R
hine Province, largely su
stain by the R
ed
henish-Prussian Associa­
tion for the Housing of the Working C
lasses. The report of this
association for 1909-10 contains an interesting accou t of w
n
hat
thus far has been ach
ieved an w will be done in the near future,
d hat
including a statem of the m
ent
ethods an m
d eans by w
hich the
requ
ired funds have b
een provided. The m
odel building rules of
this association, as adopted at the general m
eeting in 1910, are a
su foundation for the intelligent control of future building opera­
re
tions conditioning not only the erection of n housing qu
ew
arters but
also the gradual rem
odeling of existing h
ouses for their better
adaptation to the n s of w earn w a particular regard to
eed
age
ers, ith
the required raising of th level of physical and m
e
aterial w
ell-being.
Equally interesting in this direction has been the effort m by th
ade
e
Association of Industrial Em
ployers of Saxony, as em
phasized in an
exhibit m at the International Exposition of Hygiene, at D
ade
resden,
in 1911. The efforts of this association are not lim
ited m
erely to
providing h ses an gardens, but also estim
ou
d
ates are supplied of th
e
cost of rational furnishings, including all thearticles requ
ired for sani­
tary housekeeping and at reason
able expen
se. Finally, m
ention m
ay
be m of w h b d e by the Friederich Krupp Corporation,
ade
hat as een on
of E
ssen. All of th efforts, local or general, are in effect a further­
ese
an of the aim and efforts to im
ce
s
prove the social an econ ic
d
om
condition of w earn throughout the G an Em
age
ers
erm
pire, an to
d
the extent that this laudable purpose is ach
ieved w
ithin a reason
able
period of tim th am
e e ount of tuberculosis d e to social and eco­
u
nom cau m necessarily b m
ic ses ust
e aterially dim
inished.
1 Wolmungsfiirsorge in deutschen St&dten.




Berlin, Carl Heymanns Verlag.

1910.

CARE OF TUBERCULOUS WAGE EABNERS IN GERMANY.

117

EXPERIENCE DATA OF REPRESENTATIVE INVALIDITY INSURANCE
INSTITUTIONS IN THE TREATMENT AND CARE OF TUBERCULOUS
WAGE EARNERS IN 1910.
BERLIN.

The territory o f the Invalidity Insurance Institution o f Berlin is
coextensive with the administrative area o f the city o f Berlin, which
includes 63 square kilometers (24.3 square m iles), and in 1910 had a
population o f 2,070,695, o f which the increase during the last decade
was 0.92 per cent per annum, against an average annual increase for
the German Empire o f 1.41 per cent. The density o f population is
32,661 per square kilometer (0.386 square m ile). The average death
rate during the 10 years ending with 1909 was 16.3 per 1,000, but the
rate decreased from 18.9 in 1900 to 14.7 in 1909. F or the purpose o f
convenient comparison it may be stated that the general death rate
o f the city o f New York during the year 1910 was 16 per 1,000.
Comparing the five years ending with 1910, the death rate o f Berlin
decreased 42 per cent when compared with the death rate prevail­
ing during the period 1881 to 1885. The corresponding decline
during the same period in the general death rate for the city o f New
York was 38 per cent. The death rate o f Berlin decreased from
29.7 per 1,000 in 1880 to 20.2 in 1895 and 15.1 in 1909. The death
rate from tuberculosis decreased from 34.7 per 10,000 in 1880 to 23.4
in 1895 and to 17.9 in 1909. The average death rate from tuberculosis
o f the lungs, o f males, ages 30 to 60 years, inclusive, during the year
1908 was 35 per 10,000 o f population o f corresponding ages, and for
females 17.
In the experience o f the Invalidity Insurance Institution o f Ber­
lin the proportion o f tuberculosis o f the lungs as a cause o f invalidity,
according to the investigation o f 1896 to 1899, was 25.2 per cent for
males against 15.0 for all institutions, and 14.9 per cent for females
against a general average o f 9.5 per cent. The rate o f insured per­
sons treated and cared for on account o f sickness from all causes by
the Invalidity Insurance Institution o f Berlin during 1910 was 15.7
per 1,000 o f the population subject to the insurance laws, or almost
exactly twice the average rate o f 7.8 per 1,000 fo r the German Em­
pire as a whole. The number o f patients under treatment and care
on account o f tuberculosis o f the lungs during the year was 3,961,
or 6.10 per 1,000 o f the insured population. The corresponding aver­
age for all insurance institutions was 3.19 per 1,000. The amount ex­
pended on account o f treatment and care during the year 1910 for
tuberculosis was 1,957,358 marks ($465,851), or an average expendi­
ture o f 494.16 marks ($117.61) per patient per annum. The In­
validity Insurance Institution o f Berlin maintains two sanatoria o f
its own and a tuberculin station, to which more extended reference is
made further on.



118

BU LLETIN OP TH E BUREAU OF LABOR.

According to the annual report for 1910 o f the Invalidity Insur­
ance Institution o f Berlin, diseases o f the lungs, including tubercu­
losis, accounted for the largest number o f applicants for disability
annuities. Out o f every 100 disability annuities granted during the
year at ages 20 to 24 years on account o f diseases o f the lungs, the
proportion o f males was 56 per cent and of females 62 per cent; at
ages 25 to 29 years the corresponding percentages were 54 and 42,
respectively. The details, by divisional periods o f life, are given in
the follow ing table:
PER CENT OF DISABILITY ANNUITIES GRANTED TO MALES AND TO FEMALES IN
SPECIFIED AGE GROUPS ON ACCOUNT OF TUBERCULOSIS AND OTHER DISEASES
OF THE LUNGS1 BY THE INVALIDITY INSURANCE INSTITUTION OF BERLIN, 1910.
Per cent granted
to—

Per cent granted
to—
Age groups.

Age groups.
Males.
20 to 24 years..........................
25 to 29 years. _.......................
30 to 34 years..........................
35 to 39 years.. .......................
dn tft dd yftars
45 to 49 years..........................
50 to 54 years..........................

56
54
45
33
30
30
24

Males.

Females.
62
42
39
26
15
15
13

Females.

55 to 59 years..........................
60 to 64 years..........................
65 to 69 years..........................
70 years and over...................

20
19
18
13

11
10
8
7

Total.............................

28

18

1Includes also chronic bronchial catarrh.

(See p. 32 of the report for 1910.)

It is brought out by this comparison that the relative frequency
o f lung diseases including tuberculosis was much greater among males
than among females, except at the age period 20 to 24 years. The
relative frequency diminishes with increasing age, reaching at ages
70 years and over a minimum o f 13 per cent fo r males and 7 per cent
for females.
The proportion o f disability annuities granted on account o f tuber­
culosis o f the lungs has gradually decreased for males from 27.6
per cent in 1900 to 19.7 per cent in 1910; for females the rate in­
creased during the corresponding period from 11.7 per cent in 1900
to 13.1 per cent in 1910. Considered by groups o f employment, the
percentage o f disability annuities granted on account o f tuberculosis
o f the lungs was highest for persons employed in the manufacture
o f metals and machinery, or 24.6 per cent, follow ed by persons em­
ployed in commerce and trade, with 23.9 per cent. The lowest rate
prevailed among porters and servants, or 9.3 per cent. For females
the percentage o f disability annuities granted on account o f tuber­
culosis o f the lungs was 20.7 per cent for those employed in the
clothing industry, and only 7.4 per cent for domestic servants.
During the year 1910, 3,404 persons were under treatment on
account o f tuberculosis o f the lungs at the sanatorium at Beelitz,
and o f this number 2,031 were males and 1,373 females.1 In addi­



1 See p. 63 of the report for 1910.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

119

tion to the sanatorium the invalidity insurance institution aids in
the maintenance o f information bureaus and dispensaries, and on
this account during the year 1910 a subvention o f 25,000 marks
($5,950) was paid out. The accommodations at Beelitz were en­
larged during the year by the erection o f a building fo r infectious
diseases, a restaurant, and a school for the children o f the employees
o f the institution. F or the support o f patients during the year 1910
the net sum o f 1,740,946 marks ($414,345) was paid out, equivalent to
an expenditure o f 4.19 marks ($1) per patient per day, against an
expenditure o f 4.16 marks (99 cents) for the previous year. In­
cluding, however, interest payments on capital account, amounting
to 657,519 marks ($156,490) for the year 1910, the true expenditure
per patient per day was 5.77 marks ($1.37) for 1910, against 5.72
marks ($1.36) for 1909. The increase in expenditure is accounted
for by higher salaries and interest payments. The average duration
o f treatment fo r male patients was 70 days and fo r female patients 75
days. The available accommodation during the summer half year
is 490 beds fo r male patients and 356 beds for female patients. The
corresponding accommodation during the winter half year is 474
beds for males and 356 beds for females. The total number o f days’
treatment on account o f tuberculosis o f the lungs during the year
was 363,134, consisting o f 303,774 days’ support for patients, and
59,360 days’ support, or 16.3 per cent o f the total, on account o f
employees. The average expenditure per patient per day for board
was 1.37 marks (32.6 cents) fo r patients only, and 1.41 marks (33.6
cents) for patients and employees combined. The individual items
o f expenditure per day on account o f board are given in tabular form
below for the two years 1909 and 1910 to illustrate the comparative
expenditures for the two years:
ITEMIZED DAILY EXPENDITURES ON ACCOUNT OF BOARD FOR PATIENTS AND
EMPLOYEES AT THE BEELITZ SANATORIUM, BERLIN, 1909 AND 1910.
[From Annual Report for 1910, p. 68.]
Articles.

1910

Cheese, etc.'............................ $0.0112
.0193
.................................... Pastry
B u tter...................................
.0438
.0093
Eggs.......................................
.0112
General groceries....................
.0031
Fish........................................
Meat and sausage...................
.1495
.0012
VoorotahlAis (froaVi
.0143
Wine, beer, mineral waters,
.0214
etc.......................................

1909
$0.0119
.0205
.0443
.0102
.0117
.0024
.1442
.0017
.0126
.0236

Articles.

1910

Fowl....................................... $0.0014
Spices..................................... . .0038
Peas, beans, etc......................
.0007
Milk........................................
.0417
Flour......................................
.0019
.0014
Fruit (dried and preserved)..
Fruit (fresh)...........................
.0005
.0002
Fruit (w ild)...........................
Total.............................

.3358

1909
$0.0014
.0040
.0007
.0417
.0021
.0017
.0005
.0002
.3353

It is brought out by this table that for the three important items
o f milk, butter, and eggs, 0.398 marks (9.48 cents) per patient per
day was paid during 1910, or 28.2 per cent o f the total per capita
expenditure on account o f board. The total expenditures on account




120

BU LLETIN OF TH E BUBEAU OF LABOB.

o f food and drink, comprehended under the term “ board ” as an equiv­
alent o f the term “ support,” as used in the German reports, amounted
to 547,682 marks ($130,348), but deducting 35,129 marks ($8,361)
received in payment for board and for meat, etc., sold, the net ex­
penditure during the year was 512,553 marks ($121,988).
According to the annual report o f the medical director o f the In ­
validity Insurance Institution o f Berlin for the treatment o f tuber­
culosis o f the lungs, the number o f patients on January 1, 1910, was
824, o f which 356, or 43.2 per cent, were women. The number o f
patients discharged during 1910, including 3 deaths, was 3,411, o f
which 2,031 were males and 1,380 were females. The number o f pa­
tients remaining on December 31, 1910, was 817. o f which 349, or
42.7 per cent, were women.
O f the patients discharged during the year, 213 left the institution
for personal or other reasons before completing their respective
course o f treatment. There were also 37 patients who subsequent to
a definite period o f observation were discharged as apparently not
tuberculous. There remained, therefore, 3,374 patients under treat­
ment for tuberculosis o f the lungs, and these were distributed accord­
ing to the Turban stage o f the disease, as follow s: O f 2,018 male
patients, 1,513, or 75 per cent, were in the first stage o f the disease;
231, or 16.4 per cent, were in the second stage; and 174, or 8.6 per
cent, were in the third stage. O f the 2,018 male patients, the sputum
o f 519, or 25.7 per cent, contained the bacilli o f tuberculosis. O f the
patients in the first stage o f the disease 7.34 per cent were carriers o f
bacilli; in the second stage, 75.8 per cent; and in the third stage,
90.23 per cent. During the course o f treatment 26.8 per cent o f the
patients having bacilli in the sputum on admission were free there­
from on discharge.
O f the 1,356 female patients, 1,067, or 78.7 per cent, were in the
first Turban stage o f the disease; 198, or 14.6 per cent, in the second
stage; and 91, or 6.7 per cent, in the third stage. O f the 1,356 female
patients, 309, or 22.86 per cent, were found to have the bacilli o f tuber­
culosis in their sputum. O f these numbers the respective proportions
having bacilli in their sputum were 8.8 per cent for the first stage,
66.7 per cent for the second, and 91.2 per cent for the third stage o f
the disease. O f the total patients with bacilli in their expectoration,
52.4 per cent were free therefrom at the time o f their discharge.
The total number o f patients subjected to the tuberculin treatment
was 763, against 590 during the previous year. There was, therefore,
a material increase in the number o f patients treated by specific thera­
peutic methods, and the results were in every respect satisfactory.
Objections on the part o f patients are stated to have practically dis­
appeared, and the most o f them underwent the treatment voluntarily
and carried the same conscientiously through from beginning to end.



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY,

121

The essentials o f successful treatment are stated to be a sufficient
duration, an extremely careful selection o f patients, and most pains­
taking observations during the course o f treatment. It is held that
even in the second and third stages o f the disease a material im­
provement can be brought about by tuberculin treatment under the
conditions stated.
A special tuberculin station is maintained at Lichtenberg, where
582 new patients received treatment during 1910. In addition to this
establishment preliminary medical examinations were made o f pa­
tients intended for the institution at Beelitz, numbering in the aggre­
gate 8,895 for the year. In the case o f 3,875 persons the treatment
was declined, partly on account o f the fact that a considerable pro­
portion o f the patients were in too advanced a stage o f the disease to
warrant the anticipation o f favorable economic results.
A number o f tuberculosis dispensaries are maintained or substan­
tially aided by the Invalidity Insurance Institution o f Berlin. The
results during 1910 were quite favorable in that many cases received
consideration in the very early stages o f the disease, including an
opportunity fo r fam ily protection much in the nature o f the work o f
visiting-nurse associations. In the case o f 127 families additions were
granted to the amount paid for rent so as to provide more wholesome
living accommodation. In 479 cases the living quarters were disin­
fected on account o f having been inhabited by tuberculous patients
or because o f a death from tuberculosis. In the case o f 234 families
infected members were removed therefrom for treatment or were
otherwise adequately provided for to prevent the spread o f the dis­
ease. In most o f these cases persons were affected who had made no
application for institutional treatment and who themselves were not
aware o f the fact that they were afflicted with the disease. This form
o f thorough fam ily examination in suspected cases has in practice
been decidedly effective. In other words, if reasons exist for suppos­
ing one or more members o f a fam ily to be infected with the disease,
the entire fam ily is subjected to a thorough medical examination and,
if necessary, is placed under medical observation for a required
period o f time.
V isiting nurses connected with the dispensaries are, as a rule,
required to make each month at least one visit to the homes o f pa­
tients who have been removed to institutions for systematic treat­
ment. Such visits are utilized for purposes o f instruction and the
amelioration o f more or less adverse economic conditions at small
expense. In cases where the patients are treated at home additional
beds are provided so as to prevent the sleeping together o f tubercu
lous and nontuberculous members o f the same family. Such beds are
lent, and when no longer required they are thoroughly disinfected.
Through private philanthropy further provision is made for provid­
 weeks’ medical treatment free o f cost, and the care o f the
ing six


122

BU LLETIN OF TH E BUREAU OF LABOR.

fam ily is extended to the protection o f children, who, as far as prac­
ticable, are removed to wholesome surroundings. During 1910, 88
children apparently affected with tuberculosis were taken care o f in
special institutions, and in 221 cases adults were provided for in city
homes for the incurable. A record is kept o f all infected houses.
Summarizing the results o f the three dispensaries, established
almost exclusively for the benefit o f the wage-earning population o f
Berlin and vicinity, the number o f persons examined during 1910
was 6,991, and o f this number 1,428, or 20.4 per cent, were children.
The number o f persons ascertained to be tuberculous was 3,003, and
the number seriously predisposed to infection was 901. In addition
to the foregoing 1,299 tuberculous persons receiving disability annui­
ties, or patients discharged from the Beelitz institution as more or
less improved, were taken care o f during the year. O f this number
564 were ascertained to be in a condition involving the risk o f infec­
tion o f others. The number o f deaths follow ed by disinfection o f
the premises was 212, and the number o f visits made by nurses o f
the institution was 9,046. The total number o f patients to whom
financial aid was extended was 127, and the total amount disbursed
was 6,068 marks ($1,444).
The number o f patients discharged from the Beelitz institution for
the treatment o f tuberculosis o f the lungs during 1910 was 2,037
males and 1,367 females. O f the males 158 received less than 30 days’
treatment, and 184 more than 180 days’ treatment. Am ong the
females 108 received less than 30 days’, and 140 more than 180 days’
treatment. The average duration o f treatment during 1910 was 87.1
days fo r males and 92.9 days for females. The average duration o f
treatment has increased considerably during recent years, having
been 68.4 days for males and 74.5 days for females in 1908.
The number o f male patients receiving over three months’ treat­
ment was 483, and o f this number 6 recovered their fu ll earning capac­
ity, 299 recovered 75 per cent, 117 recovered 60 per cent, and 26 re­
covered 50 per cent o f their previous earning capacity. Thirty-five
were discharged without having their earning capacity restored. O f
the female patients 346 were more than three months under treat­
ment, and o f this number 1 was discharged with fu ll restoration o f
earning capacity, 276 with 75 per cent restored, 33 with 60 per
cent, and 18 with 50 per cent o f previous earning capacity restored.
The number o f females discharged without restored earning capacity
was 18.
O f the 2,037 male patients discharged during 1910, 484, or 23.8
per cent, were discharged as cured; 1,302, or 63.9 per cent, as im­
proved; and 251, or 12.3 per cent, as unimproved. O f the 1,367
female patients, 71, or 5.2 per cent, were discharged as cured; 1,148,
or 84 per cent, as im proved; and 148, or 10.8 per cent, as unim­

proved. In nearly all cases, however, a physical improvement was


123

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

obtained, as was made evident by an average increase in weight o f
from 11 to 13 pounds.
The age distribution o f patients discharged from the Beelitz insti­
tution during 1910 is given in the follow ing table:
AGE DISTRIBUTION OF PATIENTS DISCHARGED FROM THE BEELITZ INSTITUTION
FOR THE TREATMENT OF TUBERCULOSIS OF THE LUNGS, 1910.
Males.

Females.

Age periods.
Number.

Per cent.

Number.

Per cent.

Under 20 years................................................................
20 to 29 years...................................................................
30 to 39 years...................................................................
40 to 49 years...................................................................
50 to 59 years.................................................................
60 to 69 y ea rs................................................................

171
961
662
214
29

8.4
47.2
32.5
10.5
1.4

188
862
258
56
2
1

13.8
63.1
18.9
4.1
.1
.1

Total.....................................................................

2,037

100.0

1,367

100.0

It is shown by this table that the actual numbers and relative pro­
portions o f admissions are largest at comparatively young ages, and
that the older ages are affected to but a very limited extent. W ith
regard to occupations, it may be stated in this connection that the first
position, as measured by the number o f admissions, is held by workers
in metal, including, no doubt, a relatively large number o f polishers,
grinders, machinists, etc.
The pecuniary assistance extended to families o f patients treated
on acount o f tuberculosis o f the lungs at the Beelitz institution during
1910 was as follow s: T o 1,257 families o f males the sick funds paid,
in accordance with the provisions o f the sickness insurance law,
176,068 marks ($41,904). In addition thereto the invalidity insur­
ance institution paid 55,655 marks ($13,246) in the form o f supple­
mentary fam ily aid, in accordance with the discretionary powers
permitted under the invalidity insurance laws. In the case o f 1,784
fam ilies the sick funds reimbursed the invalidity insurance institu­
tion to the amount o f 276,997 marks ($65,925). In 473 cases small
amounts were granted to patients fo r personal purposes. In the case
o f 232 female patients pecuniary aid was extended to the families
amounting to 19,097 marks ($4,545) and paid by the sick fund in con­
form ity to the sickness insurance laws. In addition thereto the
invalidity insurance institution granted 3,206 marks ($763) o f sup­
plementary aid. The sick funds reimbursed the invalidity insurance
institution on account o f 1,095 patients to the amount o f 111,099
marks ($26,442). In the case o f 677 female patients small amounts
were granted for personal use.
The number o f patients discharged with restored earning capacity
from the Beelitz institution during the period 1901 to 1910 was 13,813
males and 8,143 females. O f this number 949 males, or 6.9 per cent,
and 327 females, or 4 per cent o f the respective numbers discharged,
became subsequently entitled to disability annuities on account o f the



BU LLETIN OF TH E BUREAU OF LABOR.

124

loss o f their earning capacity. In the case o f six males and five
females o f the number discharged during the decade, disability oc­
curred but no annuities were granted. The number o f male patients
readmitted for treatment was 1,348, or 9.8 per cent o f the number
discharged, and o f female patients 500, or 6.1 per cent. The number
o f deaths during the period was 248 males, or 1.8 per cent, and 25
females, or 0.3 per cent. In a general way these results may safely
be considered as proving conclusively the economic value o f the treat­
ment as measured by general welfare considerations. It is not pos­
sible by means o f the available statistical data to measure accurately
the financial value o f the results; but as far as it is possible to judge,
the objects o f the treatment—that is, the prevention o f needless loss o f
earning power and the restoration o f the same—were secured in a
large number o f cases. In a considerable proportion, however, the
restored wage-earning capacity was not^ o f course, a full 100 per
cent, but it would obviously be extremely difficult to ascertain pre­
cisely the results for any considerable period o f time subsequent to
discharge.
The essential facts concerning the ultimate results o f treatment
and care on account o f tuberculosis are given in the follow ing table
for the period 1901 to 1910, showing the proportion o f patients
originally treated, but who subsequently became incapacitated for
work, for each o f the years o f the period for which the information
is available:
ECONOMIC RESULTS OP TREATMENT ON ACCOUNT OP TUBERCULOSIS OF THE
LUNGS.
MALES.
Number of
Per cent of patients successfully treated, but subsequently becoming
Total
patients
incapacitated for work in number discharged
Year
with
of pa­
of dis­
charge. tients dis­ restored
charged. earning
capacity. 1901 1902 1903 1904 1905 1906
1901.
1902.
1903.
1904.
1905.
1906.
1907.
1908.
1909.
1910.

867
867
1,442
1,420
1,461
1,491
1,547
2,450
2,434
2,031

745
725
1,278
1,249
1,282
1,329
1,331
2,054
2,086
1,734

9.0

14.2
7.4

19.2
12.8
5.0

23.9
21.8
11.7
3.2

25.5
24.4
13.9
6.2
1.7

27.2
26.9
17.4
11.5
5.5
1.3

29.1
28.7

11.9
11.4
9.5
3.8
2.0

12.3
12.6
11.9
7.8
3.5
1.4

13.4
13.0
13.9
10.6
5.8
1.6
1.1

20.1
14.4
7.8
3.6
1.8

33.4
32.6
26.9
21.6
14.2
12.3
8.3
3.0

35.7
35.6
30.8
27.1
19.9
19.8
15.5
6.4
.4

15.3
14.7
17.1
14.7
10.6
7.7
5.1
1.4

16.2
17.4
19.3
17.1
14.0
12.4
10.4
2.9

37.0
33.1
29.0
23.6
24.0
21.5
9.9
3.6
2.0

FEMALES.
1901.......
1902.......
1903.......
1904.......
1905.......
1906.......
1907.......
1908.......
1909.......
1910.......

499
464
597
673
743
774
809
1,631
1,456
1,362

464
430
555
631
686
731
721
1,464
1,253
1,208




3.0

5.8
3.5

8.2
6.3
2.5

9.9
9.3
7.0
2.2

17.4
17.9
22.0
20.3
17.3
15.7
14.4
5.5
1.8
.6

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

125

According to this tabulation, which is o f unusual importance in
that the period o f observation for the patients treated in 1901 extends
over the 10 successive years, the ratio o f male patients becoming in­
capacitated within 10 years was only 36.9 per cent o f the total origi­
nally discharged as successfully treated from an economic point o f
view. The results throughout were much better for female patients,
and only 17.4 per cent o f the patients treated in 1901 became in­
capacitated for work by the end o f 1910. As far, therefore, as it is
possible to judge, the economic results were in full conform ity to the
expectations, but whether the results justified the expense incurred
it is not possible to determine from the data at hand. It would seem
to be a safe assumption, however, that, without attempting to deter­
mine the value o f the results upon the basis o f precise financial and
actuarial calculations, the object o f restoring a considerable propor­
tion o f wage earners for a reasonable time to their form er full or
partial earning capacity was successfully attained.
WESTPHALIA.

The territory o f the Invalidity Insurance Institution o f West­
phalia is coextensive with the Prussian Province o f Westphalia,
which has an area o f 20,214 square kilometers, and in 1910 had a
population o f 4,125,904. The increase in population during the last
decade was 2.57 per cent per annum, against an average annual in­
crease for the German Empire o f 1.41. The density o f population is
204 per square "kilometer, which is considerably above the average of
120 for the German Empire as a whole. The principal cities are D ort­
mund, with a population o f 214,333; Gelsenkirchen, with a popula­
tion o f 169,530; Bochum, with a population o f 136,916; and Munster,
with a population o f 90,283. The average death rate for the Prov­
ince during the 10 years ending with 1909 was 17.8 per 1,000, the
rate having decreased from 20.1 in 1900 to 15.7 in 1909. The average
death rate from tuberculosis o f the lungs, o f males, ages 30-60, inclu­
sive, during 1908, was 25 per 10,000 o f population; and fo r females,
21. The general death rate o f Dortmund decreased from 31 per
1,000 in 1880 to 19.2 in 1895, and 16.7 in 1909. The death rate from
tuberculosis decreased from 49.5 per 10,000 in 1880 to 16.3 in 1895,
and 12 in 1909. The general death rate o f Bochum decreased from
31.4 in 1880 to 22.4 in 1895, and 19 in 1909. The death rate from
tuberculosis decreased from 35 per 10,000 in 1882 (inform ation for
earlier years not being available) to 30.7 in 1895, and to 13.4 in 1909.
In the experience o f the Invalidity Insurance Institution o f W est­
phalia the p r o p o r t i^ '^ t il^ c u lp s jl *o£ tli$ lungs as a cause o f in­
validity, accpird.jng^ ^ ‘investigation Of •L$8££l$#95was 18.2 per cent




126

B U LLETIN OF TH E BUREAU OF LABOR.

for males against 15 per cent for all insurance institutions; and 10.6
per cent for females against a general average o f 9.5 per cent. The
rate o f insured persons treated and cared for on account o f sickness
from all causes by the Invalidity Insurance Institution o f W est­
phalia during 1910 was 9.1 per 1,000 o f the population subject to the
insurance laws, or slightly above the average o f 7.8 per 1,000 for all
insurance institutions. The number o f patients under treatment on
account o f tuberculosis o f the lungs during the year was 8,193, or
4.87 per 1,000 o f the insured population. This rate is considerably
in excess o f the general average o f 3.19 per 1,000 for all insurance
institutions, but the excess is largely due to the fact that the popula­
tion o f the Province is almost exclusively engaged in mining and
other industrial pursuits. The amount expended on account o f
treatment and care during 1910 fo r tuberculosis was 838,409 marks
($199,541) or an average expenditure o f 262.58 marks ($62.49) per
case per annum.
According to the annual report o f the Invalidity Insurance Insti­
tution o f Westphalia, the number o f male patients treated and cared
for on account o f tuberculosis o f the lungs was 2,144, and the num­
ber o f female patients was 921.1 O f the 2,144 male patients, 2,034, or
94.9 per cent, were discharged as successfully treated from an eco­
nomic point o f view. Out o f 921 female patients, 867, or 94.1 per
cent, were treated successfully during the year.
Special efforts have been made during recent years to reduce the
average duration o f treatment, and o f the patients treated at the
sanatorium at Hellersen the average duration o f treatment was 72
days in 1905, 60 days in 1909, and 59 days in 1910; and at Ambrock
the average duration was reduced from 83 days in 1905 to 55 days
in 1910. This reduction was apparently brought about by a more
careful selection o f patients, and it may be stated in this connection
that out o f 2,144 male patients treated and cared fo r during 1910,
1,135, or 52.9 per cent, were in the first Turban stage o f the disease;
771, or 36 per cent, were in the second stage; and 238, or 11.1 per
cent, were in the third stage. O f 921 female patients treated and
cared for during the same period, 582, or 63.2 per cent, were in the
first Turban stage o f the disease; 271, or 29.4 per cent, were in the
second stage; and 68, or 7.4 per cent, were in the third stage on admis­
sion to institutional treatment and care.
Special efforts have also been made to increase the number and
enlarge the scope and function o f tuberculosis dispensaries through­
out the Province o f Westphalia, and as elsewhere discussed in
more detail, the number
tlleSe usftfbl.*ui^titutions was doubled
*
during the year
ihfrhasi«g*ffom 4*tt»*28i2\^This'feffort probably
*:**.••* 1 Annual Report for 1910, p. 25.
*
2 Idem, p. 29.




:
»
•
•••

.

‘**V*

•••
.•*
•*
!
•••• • . • • • (•. • • • •
*
•••
•.*

OAEE OF TUBERCULOUS WAGE EARNERS IN GERM ANY.

127

accounts also in part for the reduction in the average duration o f
institutional treatment.
The Invalidity Insurance Institution o f Westphalia has been par­
ticularly active in the lending o f funds for building purposes, and
during the year 1910, 473 loans were made, for an aggregate amount
o f 6,968,825 marks ($1,658,580). The total amount loaned out to
the end o f 1910 fo r building purposes was 41,567,407 marks
($9,893,043). It should be understood that loans o f this character
are governed by very specific rules and regulations, aiming to provide
healthful homes for wage earners in place o f the more or less in­
adequate and ill-health-producing housing conditions and accommo­
dations o f an antiquated form and prim itive methods o f construction.
The importance o f tuberculosis o f the lungs as a cause o f invalidity
is emphasized by the statement that during 1910 20.1 per cent o f the
disability annuities granted were on account o f this disease.1 O f the
total number o f patients treated and cared for on account o f all dis­
eases and causes, 56.1 per cent were treated on account o f tuberculosis
o f the lungs.
A t the public sanatorium at Hellersen the number o f patients
treated during the period 1898-1910 was 5,862. O f this number 12.1
per cent were discharged with their earning capacity fully restored;
75.6 per cent had their earning capacity partly restored; and 12.3 per
cent were unsuccessfully treated. O f all the patients at least five
years under observation subsequent to their discharge from the institu­
tion, 33.2 per cent had retained their full earning power, 23 per cent
had retained partial earning capacity, and 43.8 per cent had either
died or become incapacitated for work and entitled to disability
annuities. The economic results show a distinct tendency toward an
improvement, and while, for illustration, o f the patients discharged
in 1898, only 28.4 per cent had retained their full earning capacity
after five years, o f the patients discharged in 1905 the corresponding
proportion was 38.6 per cent.2
A t the Sanatorium Auguste Victoria S tift, at Lippspringe, opened
in 1902, the number o f patients treated to the end o f 1910 was 3,018.
O f this number, 25.18 per cent were discharged with their earning
capacity fully restored, 63.75 per cent had their earning capacity
partly restored, and 11.07 per cent were treated unsuccessfully. O f
the patients treated at least five years, the economic results at the end
o f the period as determined by special inquiry showed that 33 per
cent o f the patients still retained their full earning capacity, 26.5
per cent retained a partial earning capacity, and 40.6 per cent had
either died or become incapacitated for work and entitled to disability
annuities.
1 Annual Report for 1910, p. 107 (843 cases of tuberculosis out of a total of 4,185).
2 Idem, p. 33.




128

B U LLETIN OF TH E BUREAU OF LABOR.

A t the Sanatorium Ambrock, opened in 1903, the total number o f
patients treated to the end o f 1910 was 4,178. O f this number, 27.33
per cent were discharged as successfully treated from an economic
point o f view, 63.43 per cent were discharged with their earning
capacity partly restored, and only 9.2 per cent o f the cases were un­
successful. O f the patients at least five years under observation, 37.8
per cent had retained their full earning capacity, 30.6 per cent had
retained partial earning capacity, and 31.6 per cent had either died
or become incapacitated for work and entitled to disability annuities.
The number o f tuberculosis patients treated at the baths at L ippspringe and in private homes, or elsewhere than in a sanatorium, was
7,474 during the period 1896-4910. O f this number only 11.16 per
cent had their full earning capacity restored, but 82.70 per cent had
their earning capacity partly restored, and only 6.14 per cent were
unsuccessfully treated. O f the patients under observation at least
five years the proportion retaining their full earning capacity to the
end o f the period was 28.99 per cent, those retaining partial earning
capacity represented 29.29 per cent, and the proportion that had
died or become incapacitated for work and entitled to disability
annuities was 41.72 per cent. The results at the baths o f Lippspringe^
however, show a tendency toward an improvement, and o f the patients
discharged in 1905 the proportion retaining their full earning
capacity to the end o f 1910 was 33.33 per cent, the proportion retain­
ing a partial earning capacity was 37.88 per cent, and the proportion
that died or became incapacitated fo r work was 28.79 per cent.
Combining all o f the patients treated on account o f tuberculosis o f
the lungs during the period 1905-1910, numbering 14,307, the propor­
tion discharged with their earning capacity fully restored was 18.3
per cent, the proportion discharged with their earning capacity
partly restored was 73.7 per cent, and the proportion unsuccessfully
treated was 8 per cent. A fter one year, o f the number discharged
and observed by means o f subsequent inquiry, 33 per cent still re­
tained their full earning capacity, 46.5 per cent retained a par­
tial capacity for work, and 20.5 per cent had either died or become
incapacitated. A t the end o f the third year 35.8 per cent still re­
tained their full capacity for work, 37 per cent-retained a partial
capacity, and 27.2 per cent had either died or become incapacitated
for work. A t the end o f the fifth year 36.8 per cent retained their
fu ll earning capacity, 32.2 per cent retained a partial earning
capacity, and 31.1 per cent had either died or become incapacitated
for work.
These results may safely be considered evidence o f successful treat­
ment from an economic point o f view. They require to be considered,
however, with great caution to avoid erroneous inferences on account
o f the methods o f statistical analysis employed. It w ill have been



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY,

129

noted that the proportion discharged as successfully treated, with
their fu ll earning capacity restored, was only 18.3 per cent at the end
o f the treatment, but this proportion was increased to 33 per cent at
the end o f the first year, 35.8 per cent at the end o f the third year,
and 36.8 per cent at the end o f the fifth year. There was a corre­
sponding reduction in the proportion retaining a partial earning
capacity from 73.7 per cent at the end o f the treatment to 46.5 per
cent at the end o f the first year, to 37 per cent at the end o f the third
year, and to 32.2 per cent at the end o f the fifth year. There was an
increase in the proportion incapacitated for work from 8 per cent at '
the end o f the treatment to 20.5 per cent at the end o f the first year,
to 27.2 per cent at the end o f the third year, and to 31.1 per cent at
the end o f the fifth year. These apparent inconsistencies are made
clear by the table below, which gives the actual numbers as well as
the resulting percentages. In other words, the foregoing percentages
are derived from each grou p 1 and not from the original number under
treatment and care.
ECONOMIC RESULTS OF SANATORIUM TREATMENT AND CARE OF TUBERCULOUS
WAGE EARNERS INSURED WITH THE INVALIDITY INSURANCE INSTITUTION OF
WESTPHALIA, 1905 TO 1910.
Number.

Per cent.

Total patients treated and cared for......................................................................

14,307

Discharged with full earning capacity restored.....................................................
Discharged with partial earning capacity restored................................................
Unsuccessfully treated...........................................................................................

2,617
10,541
1,149

18.29
73 68
8.03

N um ber retaining full earning capaeity after one year..........................................
Number retaining partial earning capacity after one year.....................................
Number incapacitated for work after one year..... ..... ..........................................
Number retaining full earning capacity after three years......................................
Number retaining partial earning capacity after three years................................
Number incapacitated for work after three years.................................................
Number retaining full earning capacity after five years.........................................
Number retaining partial earning capacity after five years...................................
Number incapacitated for work after five years.....................................................

3,667
5,178
2,282
2,090
2,162
1,591
656
574
554

32.96
46.54
20.50
35.77
37.00
27.23
36.77
32.17
31.06

According to this table the percentages as here given and as derived
from the annual report o f the Invalidity Insurance Institution o f
Westphalia for 1910 apply to each group and have no reference to
the original number o f 14,307 patients treated and cared for, with
or without economic results. The results are more precisely indi­
cated, however, by the statement that o f the 14,307 patients treated
and cared for during the period 1905-1910, the number, as far as
known, retaining their full earning capacity to the end o f the fifth
year was 656, or 4.6 per cent. The number retaining a partial earn­
ing capacity to the end o f the fifth year was 574, or 4 per cent, and the
number becoming incapacitated for work or dying during the fifth
year was 554, or 3.9 per cent. The number o f cases not traced or con­
trolled is not shown in the report. It a^so requires to be considered

49397°—12----- 9


i Annual Report lor 1910, pp. 32-39.

130

B U LLETIN OF TH E BUREAU OF LABOR.

that quite a considerable proportion o f the patients treated and cared
for during the period 1905-1910 had not been five fu ll years under
subsequent observation. The method o f analysis is crude and not
conclusive, but it may be questioned whether the application o f
actuarial methods in conform ity to the theories o f Pearson and
Elderton would serve the purpose o f bringing the essential facts o f
successful sanatorium treatment home to the public at large. Even
the crude statistical data are fairly conclusive in showing that out o f
a total number o f 14,307 tuberculous patients treated, 1,784 survived
to a period o f five years, with a reasonable assurance o f a continued
lifetim e for a number o f years more. O f the 1,784, as has been pre­
viously stated, 36.8 per cent retained their fu ll earning capacity,
32.2 per cent retained partial earning capacity, and 31.1 per cent had
either died or become entitled to disability annuities on account o f
incapacity for work. It can not be too often emphasized that tuber­
culosis o f the lungs is a most important cause o f invalidity in the
experience o f invalidity insurance institutions, and it may be stated
again in this connection that out o f 3,027 disability annuities granted
to males by the Invalidity Insurance Institution o f Westphalia dur­
ing 1910, 620, or 18.5 per cent, were on account o f tuberculosis o f the
lungs. Out o f 1,158 females to whom invalidity disability annuities
were granted, 223, or 19.3 per cent, were on account o f tuberculosis o f
the lungs. The relation o f tuberculosis to industry is further empha­
sized by the statement that o f 2,749 disability annuities granted dur­
ing 1910 to persons employed in industry and mining, 629, or 22.9
per cent, were granted on account o f tuberculosis o f the lungs. The
importance o f the disease as a cause o f disability in early life is em­
phasized by the statement that out o f 274 disability annuities granted
to males at ages 20-30,145, or 52.9 per cent, were granted on account
o f tuberculosis o f the lungs. The corresponding number and pro­
portion for females was 202 disability annuities granted for all
causes, o f which 115, or 56.9 per cent, were granted on account o f
tuberculosis o f the lungs.
RHENISH PRUSSIA.
The territory o f the Invalidity Insurance Institution o f Ehenish
Prussia is coextensive with the Prussian Province o f Khenish
Prussia,1 which has an area o f 26,996 square kilometers (10,423.2
square m iles), and in 1910 had a population o f 7,120,519. The in­
crease in population during the last decade was 2.11 per cent per an­
num, against an average annual increase for the German Empire o f
1.41. The density o f population is 264 per square kilometer (0.386
1 The territory also includes the principalities of Hohenzollern and Birkenfeld.
Hohenzollern has an area of 1,142 square kilometers (440.9 square miles), and in 1910 had a
population of 71,009. The corresponding information for Birkenfeld is not available.




CAKE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

131

square m ile), which is more than double the average o f 120 fo r the
German Empire as a whole. The principal cities are: Cologne, with a
population o f 516,167; Dusseldorf, with 357,702; Essen, with 294,629;
Duisburg, with 229,478; Elberfeld, with 170,118; and Barmen, with
169,201. The average death rate for the Province during the 10
years ending with 1909 was 18 per 1,000, but the rate decreased from
20.9 in 1900 to 15.6 in 1909. The average death rate from tubercu­
losis o f the lungs o f males, ages 30 to 60 years, during the year 1908
was 26 per 10,000 o f population, and for females 19, which compare
with the corresponding averages o f 27 and 20, respectively, fo r the
male and female populations o f the German Em pire as a whole. The
general death rate o f Cologne decreased from 29.2 in 1880 to 22.8 in
1895 and 16.8 in 1909. The death rate from tuberculosis decreased
from 41.4 per 10,000 o f population in 1880 to 27.1 in 1895 and 15.6
in 1909. The general death rate o f Essen decreased from 27.3 in
1880 to 21 in 1895 and 13 in 1909. The death rate from tuberculosis
decreased from 40.9 in 1880 to 29.4 in 1895 and 10 in 1909. The
general death rate o f Dusseldorf decreased from 30 per 1,000 in
1880 to 22.6 in 1895 and 14 in 1909. The death rate from tubercu­
losis decreased from 38.8 per 10,000 in 1880 to 25.4 in 1895 and to 11.9
in 1909.
In the experience o f the Invalidity Insurance Institution o f Rhenish Prussia the ratio o f tuberculosis o f the lungs as a cause o f in­
validity, according to the investigation o f 1891 to 1899, was 20.8
per cent for males, against 15 fo r all insurance institutions, and 11.7
for females, against a general average o f 9.5. The rate o f insured
persons treated and cared for on account o f sickness from all causes
by the Invalidity Insurance Institution o f Rhenish Prussia during
1910 was 7.5 per 1,000 o f the population subject to the insurance laws,
or slightly below the general average o f 7.8 per 1,000 for all insur­
ance institutions. The number o f patients under treatment on ac­
count o f tuberculosis o f the lungs during the year was 5,393, or 3.97
per 1,000 o f the insured population. The amount expended on
account o f treatment and care during 1910 fo r tuberculosis was
1,945,974 marks ($463,142), or an average expenditure o f 360.83
marks ($85.88) per case per annum. The Invalidity Insurance In­
stitution o f Rhenish Prussia has the largest population subject to
the insurance laws, or, according to the occupation census o f 1907,
1,357,952.
The Invalidity Insurance Institution o f Rhenish Prussia maintains
only one public sanatorium fo r tuberculosis o f the lungs for male
patients, at Ronsdorf, to which, during 1910, 704 new patients were
admitted, while 662 were discharged. Not all o f these patients, how­
ever, were provided for at the expense o f the insurance institution,
although probably this was the case with most o f them. The sana-




132

BU LLETIN OF TH E BUREAU OF LABOR.

torium at Ronsdorf was established in 1909, and has a bed accommo­
dation o f 138. The number o f days o f treatment in 1910 was 49,474,
and the average expenditure per patient per day was 4.26 marks
( $ 1 .0 1 ) .

According fco the annual report o f the Invalidity Insurance Insti­
tution o f Rhenish Prussia, out o f 9,093 invalidity annuities granted
during 1910,1,865, or 20.5 per cent, were granted on account o f tuber­
culosis o f the lungs. The inform ation, in detail, for the period 1900
to 1910, is given in tabular form below :
DISABILITY ANNUITIES GRANTED BY THE INVALIDITY INSURANCE INSTITUTION
OF RHENISH PRUSSIA, 1900 TO 1910.
Annuities granted each year.
Years.
For all
causes.

On account of tubercu­
losis of the lungs.
Number.

Per cent.

1900....................................................................................................
1901.....................................................................................................
1902.....................................................................................................
1903...............................................................................................1 ...
1904.....................................................................................................
1905.....................................................................................................
1906.....................................................................................................
1907.....................................................................................................
1908.....................................................................................................
1909.....................................................................................................
1910.....................................................................................................

10,746
12,174
13,503
13,713
13,693
10,608
8,850
8,221
9,166
8,747
9,093

1,808
2,085
2,260
2,209
2,081
1,957
1,856
1,650
1,773
1,740
1,865

16.8
17.1
16.7
16.1
15.2
18.4
21.0
20.1
19.3
19.9
20.5

Total.........................................................................................
1900 to 1904.........................................................................................
1905 to 1910.........................................................................................

118,514
63,829
54,685

21,284
10,443
10,841

18.1
16.4
19.8

It would be unsafe, perhaps, to draw definite conclusions from the
foregoing comparison, since various important factors, aside from
the general practice o f the institution, would determine the ratio o f
disability annuities granted for all causes in general and for tuber­
culosis o f the lungs in particular. As far as it is possible to judge,
however, the ratio o f disability annuities granted on account o f
tuberculosis o f the lungs to the insured population has increased
during recent years, which may be due chiefly to more careful
methods o f selection and to a more extended use o f sanatorium
methods o f treatment.1
The number o f male patients treated and cared fo r on account o f
tuberculosis o f the lungs by the Invalidity Insurance Institution o f
Rhenish Prussia during 1910 was 4,160 and o f female patients 1,356.
The total number discharged during the year was 4,260. The dura­
tion o f treatment is given in detail in the table below : 2




* Annual Report for 1910, p. 29.
2 Idem, p. 45.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

133

NUMBER AND PER CENT OF PATIENTS DISCHARGED, BY DURATION OF TREAT­
MENT ON ACCOUNT OF TUBERCULOSIS OF THE LUNGS, PUBLIC SANATORIA,
RHENISH PRUSSIA, 1910.
Duration of treatment.
Under 2 weeks.......................
2 to 4 weeks............................
4 to 6 weeks............................

6 to 8 weeks............................

8 to 10 weeks
10 to 12 weeks.........................
12 to 14 weeks.........................

Number. Per cent.
131
201
316
389
598
754
1,517

3.1
4.7
7.4
9.1
14.0
17.7
35.7

Duration of treatment.
14 to 16 weeks.........................
16 to 18 weeks.........................
18 to 20 weeks..................
20 weeks and over.

Total.............................

Number. Per cent.
183
123
36
12

4.3
2.9

4,260

100.0

.8

.3

The bed accommodation in the public sanatoria in Rhenish Prussia
in 1910 was 916. On an average a waiting period o f six weeks was
necessary previous to admission. In some o f 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 o f
more or less doubtful cases, and a considerable number o f tubercu­
losis dispensaries have been established in the principal cities, and
the value o f 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 o f public addresses on tuberculosis
during the year in connection with the traveling tuberculosis exhibits
was 75.1
The number o f male patients receiving full treatment and care
on account o f tuberculosis o f the lungs during 1910 was 4,129, and
the number o f days o f treatment was 262,049, or an average duration
o f treatment o f 63 days. The expenditures on account o f male
patients amounted to 1,559,595.33 marks ($371,183.69), or an average
expenditure o f 377.72 marks ($89.90). O f the disbursements on
account o f 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 fam ily support o f male
patients treated on account o f tuberculosis o f the lungs was 431,614
marks ($102,724.13), or an average support per patient per case o f
104.53 marks ($24.88). O f the 4,129 male patients treated, 3,513, or
85.08 per cent, were treated successfully from an economic point o f
view ; that is, with regard to the required degree o f restored wageearning capacity.
,
The number o f female patients receiving full treatment on account
o f tuberculosis o f the lungs during the year 1910 was 1,263, and the
number o f days o f treatment was 90,519, or an average duration o f
treatment o f 72 days. The total disbursement on account o f female
patients was 386,338 marks ($91,948.44), or an average expenditure
o f 305.89 marks ($72.80). O f the expenditures incurred on account
o f female patients, 16 per cent was reimbursed to the invalidity



1 Annual Report for 1910, p. 4.

134

BU LLETIN OF TH E BUREAU OE LABOR.

insurance institution by communal, industrial, and other sick funds.
The amount o f fam ily support granted to female patients was 13,746
marks ($3,271.55), or an average support o f 10.88 marks ($2.59) per
case. O f the 1,263 female patients treated, 1,079, or 85.43 per cent,
were treated successfully from an economic point o f view or with
regard to restored wage-earning capacity.
O f the 2,777 male patients treated in 1905,928, or 39 per cent, had re­
tained their earning capacity to the beginning o f the year 1911. O f 803
female patients treated during 1905, 286, or 41 per cent, had retained
their earning capacity to the commencement o f 1911.1 The results
with patients treated during subsequent years are equally favorable
and fu lly justify the conclusion that, from an economic point o f view,
the treatment and care o f tuberculous wage earners is warranted by
the facts o f extended experience. It may be stated, however, that out
o f 11,682 male wage earners successfully treated and cared fo r on
account o f tuberculosis o f the lungs during the period 1905-1910, only
595, or 5.1 per cent, became subsequently entitled to disability annui­
ties. In the case o f 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. O f 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 number o f
deaths o f male patients during the period under observation was 370,
or 3.2 per cent o f the number treated successfully; and the number
o f deaths o f female patients was 69, or 2 per cent. The number o f
male patients who required readmission for institutional treatment
was 1,144, or 9.8 per cent; and o f female patients, 288, or 8.2 per cent.
The number o f male cases which could not be ascertained or made
subject to control was 875; and o f female cases, 362.1
The experience data o f the public sanatorium at Eonsdorf conform
to those o f similar institutions and do not require extended considera­
tion. Out o f 662 patients discharged during 1910, 140 were from 12
to 13 weeks in the institution, and only a relatively small number
received treatment fo r more extended periods o f time. O f the
patients discharged during the first six weeks o f treatment, 25 were
dismissed on account o f the fact that the disease was too far advanced,
46 on account o f nostalgia, personal reasons, etc., and 13 because they
were not tuberculous.
In probably no other part o f the German Empire has the tuber­
culosis campaign been more effectively organized than in Ehenish
Prussia. Throughout the entire territory tuberculosis dispensaries




1 Annual Report for 1910, pp. 56, 57.

CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

135

have been established, including rural communities, and efforts are
being made to extend the campaign to all o f the rural communities.
F or illustration, at Essen and vicinity,1 tuberculosis dispensaries were
established, in 1910, in five communities, with a total population o f
245,000. The total number o f persons making application for treat­
ment and advice was 1,577, o f which one-third were ascertained to be
tuberculous. That the importance o f early treatment is clearly recog­
nized is made evident by the fact that o f 545 persons provided for
with treatment and care, 357, or 65.5 per cent, were in the first stage
o f the disease. The number o f 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 m arks2 ($2,737), and the num­
ber o f cases considered during that year was 866, including 220
bacteriological examinations o f the sputum. The expenditures dur­
ing 1910 and 1911 were larger, but fu ll information is not available.
The medical results have been much the same as in other sections o f
Rhenish Prussia, and a consideration o f details would involve need­
less repetition.
Unusual attention has been given to the treatment and care o f
tuberculous invalids; that is, persons in receipt o f disability an­
nuities on account o f tuberculosis, but in too advanced a stage o f
the disease to warrant treatment and care on economic grounds.3
The number o f far-advanced cases cared fo r in return for the sur­
render o f the annuity has rapidly increased from 167 in 1907 to
222 in 1908, 293 in 1909, and 411 in 1910. The treatment is in hospi­
tals or homes for incurables, and the social importance o f 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 fo r a reasonable period o f time. Most o f the patients
undertake voluntarily the performance o f suitable duties, chiefly
domestic or farm labor. Many o f the patients have agreed to re­
main permanently in the institutions providing fo r their care, which,
o f course, secures the best possible results from a sanatorium point o f
view. The 411 persons treated during 1910 received 73,652 days o f
treatment, or an average duration o f treatment per person o f 179.2
days. The total expenditure amounted to 132,805 marks ($31,607.59),
and o f this amount 34,367 marks ($8,179.35) was reimbursed by the
surrender o f disability annuities. The number o f patients under
treatment at the end o f the year increased from 44 in 1906 to 128 in
1909 and 221 in 1911. The provision is chiefly in small hospitals




1 Annual Report for 1910, p. 94.
2 Idem, p. 48.
8 Idem, p. 106.

136

BU LLETIN OF TH E BUBEAU OF LABOB.

widely distributed throughout the territory o f the Invalidity Insur­
ance Institution o f Ehenish Prussia, but also in special hospitals for
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
beds.1
The Invalidity Insurance Institution o f Ehenish Prussia has been
especially active in fostering the movement fo r housing reform
throughout the congested industrial districts o f its territory, and up
to the end o f 1910 the sum o f 54,234,795 marks ($12,907,881) had
been provided for this purpose, and o f this amount, 42,482,509 marks
($10,110,837.14) was still outstanding in the form o f loans fo r wageearners’ dwellings at the end o f 1910. O f 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. O f
loans made for the erection o f 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.2 I t is pointed out as especially signifi­
cant that 86 per cent o f the houses erected through loans provided
by the Invalidity Insurance Institution o f Ehenish Prussia were for
one or two families. O f the loans made to the end o f 1910,15.7 per
cent provided housing accommodation in villages and towns having
up to 5,000 inhabitants, 28 per cent provided fo r cities o f from 5,000
to 20,000, 28 per cent for cities o f from 20,000 to 100,000, and 28.3
per cent for cities with over 100,000 population. O f the loans made
to the end o f 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 o f
Ehenish Prussia. A special effort has been made to utilize life-in­
surance principles for the amortization o f mortgages, and at the
end o f 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 o f view.3
WURTTEMBERG.

The territory o f the Invalidity Insurance Institution o f Wurttemberg is coextensive with the Kingdom o f Wurttemberg, which has
an area o f 19,511 square kilometers (7,533.2 square m iles), and in 1910
1A list of these institutions is given on p. 109 of the report for 1910.
2 For a full discussion, see Annual Beport for 1910, p. 120 et seq.

8 Annual Beport for 1910, p. 127.




CARE OF TUBERCULOUS WAGE EARNERS I N GERM ANY.

137

had a population o f 2,435,611, o f which the increase during the last
decade was 1.16 per cent per annum, against an average annual in­
crease fo r the German Empire o f 1.41 per cent. The density o f
population is 125 per square kilometer (324 per square m ile), which
is but slightly above the average o f 120 for the German Empire as
a whole. The principal cities are: Stuttgart, with a population o f
285,589, and Ulm, with a population o f 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 1S.1
in 1909. The average death rate from tuberculosis o f the lungs, o f
males, ages 30 to 60 years, inclusive, during 1908, was 25 per 10,000
o f population, and for females, 20. The general death rate o f Stutt­
gart decreased from 23.5 per 1,000 o f 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 o f the Invalidity Insurance Institution o f W urttemberg the ratio o f tuberculosis o f the lungs as a cause o f in­
validity, according to the investigation o f 1896 to 1899, was 15.1
per cent for males, or practically the same as the general average
o f 15 per cent for all insurance institutions, and 10.1 per cent fo r
females, against a general average o f 9.5 per cent. The rate o f in­
sured patients under treatment and care on account o f sickness from
all causes by the Invalidity Insurance Institution o f Wurttemberg
during 1910 was 12.2 per 1,000 o f the population subject to the in­
surance laws, which compares with the general average o f 7.8 per
1,000 for all insurance institutions. The number o f patients under
treatment on account o f tuberculosis o f the lungs during the year
was 1,759, or 3.75 per 1,000 o f the insured population. The general
average admission rate for all institutions was 3.19 per 1,000. The
amount expended on account o f treatment and care o f tuberculous
patients during 1910 was 676,341 marks ($160,969.16), or an aver­
age expenditure o f 384.50 marks ($91.51) per case per annum. The
Invalidity Insurance Institution o f Wurttemberg maintains two
sanatoria, one at Wilhelmsheim, for male patients, with a bed accom­
modation o f 177, established in 1904, and one at Uberruh, for female
patients, with a bed accommodation o f 195, established in 1908.
The importance o f tuberculosis o f the lungs as a cause o f death in
the Kingdom o f Wurttemberg is precisely shown in the follow ing
table exhibiting the proportionate mortality, by divisional periods
o f life, for the year 1908.




138

BU LLETIN OP TH E BUREAU OP LABOR.

PROPORTIONATE MORTALITY FROM TUBERCULOSIS OF THE LUNGS IN THE
KINGDOM OF WURTTEMBERG, 1908 (EXCLUSIVE OF DEATHS NOT MEDICALLY
CERTIFIED TO AS TO THEIR CAUSES).
Males.

Females.

Tuberculosis of
lungs.

Ages.
All
causes.

All
causes.

Tuberculosis of
lungs.
Number. Per cent.

Number. Percent.
15 to 24 years..............................................
25 to 34 years..............................................
35 to 49 years..............................................
50 to 59 years..............................................
60 years and over........................................

689
805
1,559
1,600
5,356

274
335
459
235
194

39.8
41.6
29.4
14.7
3.6

800
1,087
1,520
1,491
5,836

446
519
345
123
162

55.8
47.7
22.7
8.2
2.8

Total................................................

15,142

1,630

10.8

15,282

1,798

11.8

According to the occupation census o f 1907, the number o f persons
subject to the insurance laws in the Kingdom o f Wurttemberg was
469,594, and o f this number the proportion o f males was 66.5 per
cent, and o f females 33.5 per cent. The insured population repre­
sented 20.4 per cent o f the total population o f the Kingdom o f W urt­
temberg, estimated at 2,302,179. The distribution o f insured per­
sons, by divisional periods o f life, is given in the follow ing table,
which is self-explanatory, and requires no extended comment.
AGE DISTRIBUTION OF THE INSURED POPULATION OF THE KINGDOM OF WURT­
TEMBERG, 1907.
Males.
Ages.

Females.
---------------r
Number.
Per cent.

Number.

Percent.

16 to 17 years...................................................................
18 to 19 years...................................................................
20 to 24 years... ...............................................................
25 to 29 years...................................................................
30 to 39 years...................................................................
40 to 49 years...................................................................
50 to 59 years...................................................................
60 to 69 years...................................................................
70 years and over............................................................

24,889
26,419
50,334
52,975
74,377
42,238
25,289
14,275
1,871

8.0
8.4
16.1
16.9
23.8
13.5
8.1
4.6
.6

21,370
20,894
41,068
22,348
22,758
13,425
9,042
5,352
670

13.6
13.826.2
14.2
14.5
8.6
5.8
3.4
.4

Total.....................................................................

312,667

100.0

156,927

100.0

Out o f 312,667 males subject to the compulsory insurance laws,
216,497, or 69.2 per cent, were employed in industries, mines, and
building. O f the insured female population o f 156,927, the number
employed in these pursuits was 63,580, or 40.5 per cent.
According to the annual report o f the Invalidity Insurance Insti­
tution o f Wurttemberg, the amounts expended for treatment and
care on account o f sickness from all causes have rapidly increased
from 133,226 marks ($31,707.79) in 1898 to 655,162 marks ($155,928.56) in 1904 and 1,197,829 marks ($285,083.30) in 1910. The
amount o f labor involved in the proper handling o f the applicants
for treatment and care is made evident by the fact that 15 persons



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

139
I

were employed for this purpose during the year. O f the total in­
come o f the Invalidity Insurance Institution o f Wurttemberg during
1910,13.6 per cent was expended in the treatment and care o f patients
on account o f sickness from all causes, including tuberculosis o f the
lungs, which is the most important cause o f disability in the experi­
ence o f the institution.1 The tendency during the earlier years was
for tuberculosis o f the lungs to increase proportionately to the total
number o f cases under treatment, but during the last few years the
ratio declined. The facts are emphasized in the follow ing table for
the period 1897 to 1910:
TUBERCULOSIS OF THE LUNGS AS A CAUSE OF DISABILITY IN THE EXPERIENCE
OF THE INVALIDITY INSURANCE INSTITUTION OF WURTTEMBERG, 1910.
Cases of tuberculosis of
lungs treated.
Years.
Number.

1897-1901..........................
1902..................................
1903..................................
1004................................
1905..................................

1,864
826
1,122
1,163
1,114

Per cent of
total cases
treated.
31.60
38.42
40.98
44.83
44.99

Cases of tuberculosis of
lungs treated.
Years.
Number.

1906..................................
1907..................................
1908..................................
1909..................................
1910..................................

Per cent of
total cases
treated.

1,318
l,o77
1,646
1,621
1,759

48.39
48.73
47.54
44.04
42.59

This table shows that, commencing with the period 1897 to 1901,
the number o f cases o f tuberculosis was 31.60 per cent o f the total
number o f cases o f sickness from all causes treated and cared for at
the expense o f the insurance institution for the purpose o f restoring
the wage-earning capacity for a reasonable period o f time. This
proportion increased to the maximum o f 48.73 per cent in 1907, but
subsequently to this year the proportion declined to a minimum o f
42.59 per cent in 1910. It may be stated in this connection that the
next most important causes o f sickness among wage earners, in the
experience o f the Invalidity Insurance Institution o f 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 o f the Invalidity
Insurance Institution o f W urttemberg is the large proportion o f
tuberculous women patients, and it is emphasized in the report for
1910 that tuberculosis o f the lungs is o f exceptional frequency among
domestic servants, saleswomen, and female clerks.2
By an arrangement with the m ilitary authorities, the invalidity
insurance institution is notified o f the rejection o f recruits for tuber­
culosis o f the lungs or other diseases liable to bring about permanent
wage-earning incapacity. W hile much had been anticipated from




1 Annual Report for 1910, p. 41.
2 Idem, p. 43.

140

B U LLETIN OF TH E BUBEAU OF LABOB.

this arrangement, in actual practice the number o f notifications has
been small and the tendency has been toward a decrease in the number
reported. In 1907 the institution was notified o f 152 cases, but this
number decreased to 53 cases during each o f the years 1908 and 1909,
and finally to only 36 cases during 1910.
The number o f applications for treatment on account o f tubercu­
losis o f the lungs, which, during 1910, received favorable considera­
tion, was 1,759, and o f this number 876 were males and 883 were
females. The number o f applications for treatment and care on
account o f tuberculosis o f the lungs which were declined was 596, and
o f this number 354 were males and 242 were females.1 O f the 1,759
cases o f tuberculosis treated and cared for during 1910, 1,142, or 64.9
per cent, were discharged as materially improved, with a reasonable
expectation o f restored earning capacity, and 617 were discharged as
unsuccessfully treated, but o f this number 407 improved during the
course o f treatment, though not sufficiently so to warrant the antici­
pation o f restored wage-earning capacity for a reasonable period o f
time.
The number o f male patients treated on account o f tuberculosis
o f the lungs during 1910 was 876, and the number o f days o f treat­
ment was 62,953, or an average duration o f treatment o f 72 days.
The expenditure incurred was 330,975 marks ($78,772), or an aver­
age expenditure o f 377.83 marks ($89.93) per patient per case, or o f
5.26 marks ($1.25) per patient per day. On account o f dependent
members o f 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 o f tuberculosis o f
the lungs during the year 1910, receiving 77,031 days o f treatment,
or an average duration o f treatment o f 87 days. The expenditures
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 o f male patients’ fam ilies amounted
to 3,061 marks ($729), and the pecuniary assistance to single persons
amounted to 5,824 marks ($1,386). In the case o f male patients the
insurance institution was reimbursed to the extent o f 97,358 marks
($23,171), and on account o f female patients to the extent o f 47,752
marks ($11,365), by communal, industrial, and other sick funds liable
to the insurance institution in conform ity to the compulsory-insur­
ance laws. The total number o f persons treated during the year on
account o f tuberculosis was, therefore, 1,759, receiving 139,984 days
o f treatment, or an average duration o f treatment o f 80 days.
O f 839 male patients treated during the year, fo r which the in for­
mation was available, 338, or 40.3 per cent, were in the first Turban



1 Annual Report for 1910, p. 55.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

141

stage o f the disease; 231, or 27.5 per cent, were in the second; and
270, or 32.2 per cent, were in the third. O f 877 female patients
treated during the same period, 431, or 49.1 per cent, were in the first
Turban stage o f 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 o f male patients received in the third Turban
stage o f the disease, when the prognosis is decidedly less favorable
than during the earlier stages, was much larger than in the case
o f females.
O f 876 male patients treated and cared for on account o f tuber­
culosis o f the lungs during the year 1910, 410, or 46.8 per cent, were
o f the age period 21 to 30. O f 883 female patients, 481, or 54.5 per
cent, were o f this period o f life when the prevention o f wage-earning
incapacity and the conservation o f life are o f the highest economic
importance. The economic results o f sanatorium treatment are
shown by the experience o f 1905 observed to the end o f 1910.1 O f
691 patients, including both sexes, only 60 became subsequently
entitled to disability annuities during this period o f time, but 51
became incapacitated for work though not entitled to annuities in
conform ity to the insurance laws. Only 36, or 5.2 per cent, died
during the period o f observation, and 55, or 8 per cent, required
readmission for institutional treatment. In 23 cases, or 3.3 per cent,
the inform ation was not available. Out o f the original 691 patients,
therefore, 466, or 67.4 per cent, remained at the end o f the period
o f 6 years in a more or less satisfactory condition o f health, and
with a sufficient degree o f restored earning capacity so as not to
require the payment o f disability annuities in conform ity to the
compulsory insurance laws. The data, therefore, seem to prove that,
from an economic point o f view, the expenditures incurred in the
systematic treatment and care o f tuberculous wage earners other­
wise likely to become a serious charge upon the funds o f the inval­
idity insurance institution, were apparently justified by the results.
O f course, these figures have no reference to the number o f persons
unsuccessfully treated, with regard to which it only needs to be said
that there were 423 such cases in 1905, o f which 122, or 28.8 per cent,
were still alive and not a charge upon the funds o f the invalidity
insurance institution at the end o f 1910.
The sanatorium at Wilhelmsheim was originally established by
the Wurttemberg Association for Public Sanatoria, in the summer o f
1900, with a bed accommodation o f 100. On October 1, 1904, the
same was purchased by the Invalidity Insurance Institution o f W urt­
temberg for 496,000 marks ($118,048). B y additions made during
1904 to 1906 the bed accommodation was increased to 177 in 59 rooms.
There are now 10 rooms with 1 bed each, 20 with 2 beds each,



1 Annual Report for 1910, p. 66.

142

B U LLETIN OF TH E BUREAU OF LABOR.

18 with 4 beds, and 11 with 5 beds. The total cost o f the insti­
tution to December 81, 1910, was 1,244,109 marks ($296,098). The
cost o f installation per bed amounted to 7,000 marks ($1,666). The
staff o f the sanatorium consists o f 1 medical director in chief, 2 to 3
medical assistants, 1 bookkeeper, 1 sister superior, 4 nurses, and 35
other employees. The number o f patients has increased from 128
in 1904 to a maximum o f 1,075 in 1908. During 1909 the number o f
patients was 1,064, and during 1910 it was 1,010. This is partly
explained by the unwillingness o f the patients to undergo treatment
during the winter months. A n important experiment has been tried
at this institution to diminish the use o f alcoholic drinks. The rule
is that fo r dinner each patient is entitled to one-fourth o f a liter o f
wine, and at supper to one-half o f a liter o f beer. W hile there is
quite a number o f patients who, upon their own volition, abstain
from the use o f alcoholic drinks and prefer mineral waters, which
are provided in place thereof, it is suggestive that only 11.3 per cent
o f the total number o f patients were abstainers from wine during
1910, and 13.5 per cent were abstainers from beer.1
The sanatorium at XJberruh was established during the period
1905 to 1908 at an expenditure o f over 2,000,000 marks ($476,000).
The institution is for female patients only, and the number o f beds
is 195, in 61 rooms. There is only 1 room with one bed, 28 with two
beds, 2 with three beds, 26 with four beds, 2 with six beds, and 2
with eight beds. The average expenditure per bed amounted to
11,000 marks ($2,618). The administration, consists o f a medical
director in chief, 3 assistant physicians, 2 clerks, 1 sister superior,
8 nurses, and 32 domestic servants and other persons. The number
o f patients has increased from 336 in 1908 to 869 in 1909 and 904
in 1910. A lcoholic drinks are not provided in this institution, except
upon medical request.2
Much has been done by the Invalidity Insurance Institution o f
Wurttemberg to render material assistance to the cause o f housing
reform , but what has been done in this respect does not materially
differ from corresponding efforts by other invalidity insurance insti­
tutions. It may be stated, however, that a special effort has been
made to utilize life insurance principles for the purpose o f amortiza­
tion o f building loans, but while the economic value o f this effort
is realized, the results as yet have not been very encouraging.2 It is
pointed out in the report for 1910 that in view o f the fact that all
loans are supposed to be repaid within a period o f 35 years, the best
security for complete amortization is provided by life insurance, and
the advantage o f this method is made clear by numerous illustrations
within the understanding o f anyone with average intelligence. As



1 Annual Report for 1910, p. 68.
a Idem, p. 81.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

143

previously pointed out, however, the effort to combine life insurance
with building loans has not as yet in actual experience been very
successful, although every borrower is furnished with printed in­
structions pointing out the advantages o f the plan.
In conclusion, it may be said that o f 4,573 disability annuities
granted during 1910, the number granted on account o f tuberculosis
o f the lungs was 659, or 14.4 per cent. The number granted to males
was 2,774 fo r all causes, and 398, or 14.3 per cent, for tuberculosis o f
the lungs, and to females 1,799 for all causes, o f which 261, or 14.5
per cent, were on account o f tuberculosis o f the lungs. The im por­
tance o f tuberculosis as a cause o f disability, therefore, is clearly
established by the experience o f the institution, extending over many
years.
BADEN.

The territory o f the Invalidity Insurance Institution o f Baden is
coextensive with the Grand Duchy o f Baden, which has an area o f
15,067 square kilometers (5,817.4 square m iles), and which in 1910
had a population o f 2,141,832. The rate o f increase during the last
decade was 1.37 per cent per annum, against an average annual in­
crease fo r the German Empire o f 1.41 per cent. The density o f
population is 142 per square kilometer (368 per square m ile), which
is greater than the average o f 120 for the German Empire as
a whole. The principal cities are Mannheim, with a population o f
193,379, and Karlsruhe, with a population o f 134,161. The average
death rate o f the Grand Duchy o f Baden for the 10 years ending
with 1909 was 19.7 per 1,000, the rate having decreased from 22.4 in
1900 to 17.7 in 1909. The average death rate from tuberculosis o f
the lungs o f males aged 30 to 60, inclusive, during 1908, was 30 per
10,000 o f population, and for females, 24. The general death rate
o f Mannheim decreased from 23.8 per 1,000 in 1880 to 20.9 in 1895
and 15.1 in 1909. The death rate from tuberculosis decreased from
37.7 per 10,000 in 1880 to 28.6 in 1895 and to 16.9 in 1909. The gen­
eral death rate o f Karlsruhe decreased from 21.1 per 1,000 in 1885
(earlier data not being available) to 17.6 in 1895 and 15.3 in 1900.
The death rate from tuberculosis decreased from 44.7 per 10,000 in
1885 to 26.6 in 1895, and to 15.8 in 1909.
In the experience o f the Invalidity Insurance Institution o f Baden
the ratio o f tuberculosis o f the lungs as a cause o f invalidity, accord­
ing to the investigation o f 1896-1899, was 23.1 per cent for males,
against the general average o f 15 per cent for all insurance insti­
tutions; and 21.4 per cent fo r females, against a general average o f
9.5 per cent. The rate o f insured persons treated and cared fo r by
the Invalidity Insurance Institution o f Baden on account o f sickness
from all causes during 1910 was 16.8 per 1,000 o f the population



144

BU LLETIN OF TH E BUREAU OF LABOR.

subject to the insurance laws, or very considerably above the aver­
age o f 7.8 per 1,000 for all insurance institutions. The number o f
patients under treatment on account o f tuberculosis o f the lungs
during the year was 2,948, or 6.71 per 1,000 o f the insured popula­
tion. This rate is considerably in excess o f the general average
o f 3.19 for all insurance institutions, and the rate conforms to the
excessive death rates from tuberculosis in the general population and
to the high ratio o f tuberculosis as a cause o f disability in the
experience o f the Invalidity Insurance Institution o f Baden during
the period 1896 to 1899. The amount expended by the Invalidity
Insurance Institution o f Baden on account o f treatment and care
o f tuberculous patients during 1910 was 1,131,011 marks ($269,181),
or an average o f 383.65 marks ($91.31) per case per annum. The
only invalidity insurance institutions expending larger amounts
on account o f systematic treatment and care o f tuberculous wage
earners during 1910 were those o f Berlin, Rhenish Prussia, and the
Kingdom o f Saxony, with, however, much larger populations subject
to the administration o f the compulsory insurance laws.
The actual importance o f tuberculosis in the Grand Duchy o f
Baden as a cause o f death in the general population is emphasized in
the statement that during the year 1909 there were 3,598 deaths
from tuberculosis o f the lungs, 942 deaths from tuberculosis o f other
organs, and 104 deaths from m iliary tuberculosis, a total tubercu­
losis m ortality o f 4,644 during the year. On the basis o f the enumer­
ated population o f 2,141,832 in 1910, this would be equivalent to a
tuberculosis death rate o f 2.2 per 1,000 o f population; and consider­
ing tuberculosis o f the lungs only, o f 1.7. It is gratifying to find
that during the last five years there has been a persistent reduction
o f the actual mortality from tuberculosis in the Grand Duchy o f
Baden of, respectively, from 4,066 deaths in 1905 to 3,725 in 1907 and
to 3,598 in 1909. O f 3,740 deaths from tuberculosis o f the lungs in
1909, there occurred at ages under 1, 57, or 1.5 per cent; at ages 1 to
14, inclusive, 275, o f 7.4 per cent; at ages 15 to 29, inclusive, 1,255,
or 33.6 per cent; at ages 30 to 59, inclusive, 1,818, or 48.6 per cent;
and at ages 60 and over, 335, or 9 per cent o f the m ortality from
tuberculosis at all ages. It is evident, therefore, that the mortality
from this disease, although on the decrease in the Grand Duchy o f
Baden, is a question o f unusual social and economic importance.
The Invalidity Insurance Institution o f Baden maintains three sana­
toria— one at Friedrichsheim, established in 1899, fo r male patients,
with a bed accommodation o f 234; one at Luisenheim, established in
1905, for female patients, with 199 beds; and one at NordrachKolonie, established in 1908, for male patients, with 110 beds.
According to the annual report o f the Grand Duchy o f Baden, the
expenditures on account o f treatment and care for all causes, includ-




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

145

ing fam ily support, have increased from 155,411 marks ($36,988) in
1897 to 605,463 marks ($144,100) in 1903, and 1,117,157 marks
($265,883) in 1910. It is stated in the report that, according to
the occupation census o f 1907, there were then enumerated 458,146
persons making contributions to invalidity insurance institutions,
and o f this number 66.8 per cent were males and 33.2 per cent were
females. The foregoing numbers are exclusive o f the persons in­
sured with the railway pension funds and salt works, numbering
18,087 and including 170 females. O f the insured male population,
69 per cent were employed in industries and trades, and o f the
females, 43.5 per cent. O f the total population o f the Grand Duchy
o f Baden for the year 1910, it is estimated that 22.3 per cent were
insured with the invalidity insurance institution; or, respectively,
30 per cent o f the male population and 14.7 per cent o f the female
population.
In the year 1910, 4,736 new disability annuities were granted, and
o f these 18 per cent were on account o f tuberculosis o f the lungs and
3 per cent on account o f tuberculosis o f other organs.1 In addition
thereto the proportion o f disability annuities granted on account o f
nontubercular diseases o f the respiratory organs was 10.5 per cent.
Next to tuberculosis the most important causes o f disability were
anemia and general debility, accounting for 13.6 per cent; rheuma­
tism, 7.5 per cent; and diseases o f the heart and circulatory organs,
8.9 per cent. Reviewing the experience for the 19-year period ending
with 1910, and including 63,483 disability annuitants, the number o f
annuities granted on account o f tuberculosis o f the lungs was 12,647,
or 19.9 per cent o f the disability annuities granted for all causes.
The results for 1910, therefore, were below the average for the
experience as a whole, indicating a tendency toward a decrease in the
occurrence o f tuberculosis o f the lungs as a cause o f disability among
the insured population o f the Grand Duchy o f Baden.
O f the 854 disability annuities granted in 1910 on account o f
tuberculosis o f the lungs, 520, or 60.9 per cent, were to males, and 334,
or 39.1 per cent, were to females. O f the number referred to, 74.6 per
cent were persons employed in industries and trades and 8.4 per
cent were employed in agriculture and forestry. O f the 854 dis­
ability annuities granted on account o f tuberculosis o f the lungs, 289,
or 33.9 per cent o f the total, were granted at ages 30 to 39. Con­
sidering only the earlier periods o f life, it is stated that 18.7 per cent
o f the total number were granted at ages 25 to 29, and 11.2 per cent
at ages 20 to 24. It is shown, therefore, that o f the total number o f
disability annuities granted during 1910 on account o f tuberculosis
o f the lungs, 63.8 per cent were granted to persons under 40 years o f
age.
49397°—12----- 10



1 Annual Report for 1910, p. 24.

146

BU LLETIN OF TH E BUREAU OF LABOR.

The treatment and care o f tuberculous wage earners insured with
the Invalidity Insurance Institution o f Baden proceeds upon very
liberal conditions, but it is required that at least 50 weekly con­
tributions must have been paid, and in the case o f persons having
their permanent domicile outside o f the German Empire a minimum
requirement o f 200 contributions is insisted upon. Exceptions are
occasionally made in the case o f very young persons who, on account
o f their age or by reason o f their employment, have not' paid the
minimum o f 50 contributions.1
It is pointed out in the annual report fo r 1910 that the number o f
persons treated and cared for on account o f sickness from all causes,
and tuberculosis o f the lungs in particular, shows a constant tend­
ency to increase. The number o f tuberculosis cases treated in 1901
was 1,710, against 3,171 in 1910* This is exclusive o f tuberculous
patients under observation only, the number o f which increased from
43 in 1905 to 416 in 1910. Most o f the patients treated are from
the large cities, particularly Mannheim, Karlsruhe, Pforzheim , and
Freiburg.
During 1910 the number o f days o f treatment provided for tuber­
culosis patients was 219,641, or an average duration o f treatment o f
65.8 days, against 68 days during 1909. The comparatively short
duration o f treatment is accounted for by the method adopted to
place suspected cases under preliminary observation, and to provide
dispensary treatment through the 536 tuberculosis associations o f the
Grand Duchy o f Baden, thoroughly organized and intelligently co­
ordinated to one another as perhaps the most effective aid in the
state-wide campaign against tuberculosis.
Inform ation is available with regard to the duration o f treatment
in detail o f 2,720 patients during 1910, it being shown that 9.5 per
cent were treated from 1 to 14 days, 4.8 per cent from 15 to 35 days,
39.4 per cent from 36 to 91 days, and 46.3 per cent were treated for
92 days or longer, including a very small number who remained in
the institution for 176 days or more.
The economic results o f treatment have not been as satisfactory as
the average for the German Empire as a whole, but the tendency is
toward an improvement in the persistency o f post-discharge results.
It is claimed that the less favorable results fo r Baden are due in part
to differences in methods o f diagnosis, and partly because the aver­
age duration o f treatment is higher fo r all the invalidity insurance
institutions combined than fo r the Invalidity Insurance Institution
o f Baden considered alone. Considering, fo r illustration, the cases
treated during 1904 and observed to the end o f 1908, the percentage
o f patients retaining their earning capacity was only 37 per cent for
Baden against 46 per cent fo r the Em pire as a w hole; and for the



1 Annual Report for 1910, p. 32.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

147

four-year period ending w 1909 the percen
ith
tage of successful ca
ses
for Baden w 31, against 46 for the G an Em
as
erm
pire. It is selfevident that u less th percentages are corrected for possible im
n
ese
­
portant variations in the age, sex, an occupation distributions of th
d
e
patients, and w a d e regard to th average duration of treat­
ith
u
e
m t and condition on adm
en
ission, the com
parison can not be en
­
tirely conclusive.
The n ber of patients treated and cared for on accoun of
um
t
tuberculosis of the lungs h in
as creased from 1,710 in 1901 to 2,265
in 1907, and 3,171 in 1910. The proportion of cases adm
itted in th
e
first stage of the d
isease varies w
idely for the different sanatoria,
having b highest for N
een
ordrach village, for fem patients, or
ale
61 per cent, and low for N
est
ordrach colony, for m patients, or 27
ale
per cen At Friedrichsheim for m patients, the proportion ad­
t.
,
ale
m
itted in the first stage of th disease w 36 per cent, against 41 per
e
as
cent for fem patients at L
ale
uisenheim It is adm
.
itted that no satis­
factory explanation can b given for th variations in conditions,
e
ese
w
hich, in part, of cou are d e to differential diagnosis.1
rse,
u
During the year 1910 the treatm an care, on accoun of tuber­
ent d
t
culosis of th lungs, w com
e
as
pleted in the case of 2,968 patients, an
d
of th 58.06 per cen w treated w entire su
ese
t ere
ith
ccess, 29.54 per cen
t
w partial su
ith
ccess, 0.99 per cent unsuccessfully, 11.26 per cen left
t
the institution previous to com
pleting the regular cou of treat­
rse
m and 0.15 per cen died.
ent,
t
Of the patients treated in the first Turban stage of the disease,
90.05 per cent w successfully treated from an econ ic point of
ere
om
view; of those treated in the secon stage, 91.93 per cent; an
d
d
of those in the third stage, 72.60 per cen The general results for
t.
the w en patients w m satisfactory than for the m .
om
ere ore
en
The accom odation in public sanatoria is inadequate, and as a
m
rule a w
aiting period of from th to four w s is requ . The
ree
eek
ired
w
aiting period during the w
inter m
onths, how
ever, is m shorter
uch
than during the su m m
m er onths; for illustration, the average w
ait­
ing period for m patients during January w 20 days and during
ale
as
July 28 days. For fem patients the m um w
ale
inim
aiting period w
as
30 days in April and 83 days, respectively, in Septem and O
ber
ctober.
These w
aiting periods have been som hat red ced during the first
ew
u
half of 1911.2
The details of adm
inistration and th m
e edical as w as econ ic
ell
om
results of the several sanatoria conform in their essentials to those
obtained in other institutions, m
aking it u n
n ecessary to enlarge upon
the facts given in full detail in the report for 1910. It m be
ay
pointed out, how
ever, that th m
e edical reports are exceptionally



1 Annual Report for 1910, p. 38.
2 Idem, p. 41.

148

BULLETIN OF THE BUREAU OF LABOR.

com
plete, w am statistical data an oth inform
ith ple
d er
ation, proving
th value of th treatm and the econ ic justification of the
e
e
ent
om
exp se incurred.
en
The total n ber of disability annuities granted during 1910 w
um
as
4,376, an of this n ber 802, or 18.3 per cent, w granted on
d
um
ere
accou t of tuberculosis of the lungs; and 116, or 2.7 per cent, on
n
accou t of tuberculosis of oth organs. The n ber of disability
n
er
um
an uities granted to m w 2,707, an of this n ber 489, or 18.1
n
ales as
d
um
per cent, w on accoun of tuberculosis of the lungs, and 66, or
ere
t
1.5 per cen on accou t of tuberculosis of oth organs. The num
t,
n
er
­
ber of disability annuities granted to fem
ales w 1,669, and of this
as
num 313, or 18.8 per cent, w on accou t of tuberculosis of the
ber
ere
n
lungs, an 50, or 3 per cent, on accou t of tuberculosis of oth
d
n
er
organs. At the age period 20 to 24 the num of disability annuities
ber
granted for all cau w 144, and of this n ber 93, or 64.6 per
ses as
um
cent, w on accou t of tuberculosis of the lungs; at ages 25 to 29
ere
n
the total n ber of disability annuities granted for all cau w
um
ses as
246, an of this n ber 151, or 61.4 per cent, w granted on ac­
d
um
ere
cou of tuberculosis of the lungs; at ages 30 to 39 the total n ber
nt
um
of disability annuities granted w 543, and of this num 267,
as
ber
or 49.2 per cent, w on accou t of tuberculosis of the lungs; at
ere
n
ages 40 to 49 the total n ber of disability annuities granted w
um
as
561, an of this n ber 145, or 25.8 per cent, w on accoun of
d
um
ere
t
tuberculosis of the lungs. S bsequ t to this period of life the
u
en
n m of disability annuities granted on accou t of tuberculosis
u ber
n
of th lungs is of less econ ic im
e
om
portance and therefore d not
oes
requ extended consideration.
ire
The n ber of disability annuities granted to person em
um
s ployed
in agriculture an forestry w 961, an of this num 67, or 7
d
as
d
ber
per cent, w granted on accou t of tuberculosis of the lungs. The
ere
n
n ber of disability annuities granted to person em
um
s ployed in in­
dustry, m
ining, an building w 2,510, an of this n ber 603, or
d
as
d
um
24 per cent, w granted on accoun of tuberculosis of the lungs.
ere
t
The num of disability annuities granted to persons em
ber
ployed
in com erce, trade, and transportation w 248, and of this n ber
m
as
um
55, or 22.2 per cent, w granted on accoun of tuberculosis of th
ere
t
e
lungs. The n m of disability annuities granted on accoun of
u ber
t
dom
estic service an casu labor w 183, an of this n ber 20,
d
al
as
d
um
or 10.9 per cent, w granted on accoun of tuberculosis of th lungs.
ere
t
e
Other occupations are of less econ ic im
om
portance, and the actual
n bers are too sm for d ite conclusions.1
um
all
efin
Of 3,587 persons treated an cared for on accou t of tubercu
d
n
losis
of th lungs during the year 1910, excluding persons u
e
nder observa


1 Annual Repart for 1910, p. 88.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

149

tion, 1,470, or 49.5 per cen w treated w full su
t, ere
ith
ccess from an
econ ic point of view; 748, of 25.2 per cent, w partial success;
om
ith
and 25, or 0.8 per cen w unsuccessful; w
t, ere
hile 4 died.1 The total
expenditures am n to 1,152,813 m
ou ted
arks ($274,369), incurred on
accoun of 219,641 days of treatm
t
ent.
Of the 3,587 tu
bercu s w earn treated an cared for dur­
lou age
ers
d
ing 1910, 1,205 m
ales w provided for w treatm in the sana­
ere
ith
ent
torium at Friedrichsheim 1,049 fem
,
ales in the sanatorium at
Luisenheim an 551 m
, d
ales in N
ordrach colony, also 69 fem
ales in
N
ordrach village, the rem
ainder being distributed in a num of
ber
institutions w
hich do not requ d
ire iscussion in detail. The average
expenditure per patient per ca in all institutions w 309.28 m
se
as
arks
($73.61), an per patient per day, 5.20 m
d
arks ($1.24). The average
duration of treatm during 1909 w 83 days for patients of both
ent
as
sexes, or, respectively, 79 days for m
ales an 90 days for fem
d
ales.
TH E H AN SE T O W N S.

The territory of th Invalidity Insurance Institution of the H
e
anse
Tow includes the th free cities of B en, Ham
ns
ree
rem
burg, and Liib . The area of B en is 256 squ kilom
eck
rem
are
eters (98.8 squ
are
miles); that of H burg, 414 (159.8 sq are miles); and that of
am
u
Liibeck, 298 (115.1 squ m
are iles). In 1910 th population of B en
e
rem
w 298,736; that of H burg, 1,015,707; an that of L
as
am
d
iibeck,
116,533. The dom
icile of th in ran institution is at L
e su ce
iibeck. The
rate of annual in
crease in population during th last d e h b
e
ecad as een
2.82 per cen for B en, 2.77 per cent for Ham
t
rem
burg, and 1.85 per
cen for Liibeck, against an average annual in
t
crease for the G an
erm
Em
pire of 1.41 per cent The density of population is 1,165 per
squ kilom
are
eter (3,017 per squ m
are ile) for B en, 2,454 (6,356
rem
per squ m
are ile) for H burg, an 391 (1,013 per squ m
am
d
are ile) for
Liibeck. The free city of B en includes th port of B erhaven,
rem
e
rem
w
hich, in 1910, had a population of 24,140, the population of th
e
city of B en proper being 246,827.
rem
The average death rate of B en during the 10 years ending w
rem
ith
1909 w 16.5 per 1,000, the rate having d
as
ecreased from 18.1 in 1900
to 14.4 in 1909. The average death rate for the city of Ham
burg
during the sam period w 15.8 per 1,000, the rate having d
e
as
ecreased
from 17.4 in 1900 to 14.8 in 1909. The average death rate of the city
of L
iibeck during the sam period w 16.2 per 1,000, the rate having
e
as
d
ecreased from 18.2 in 1900 to 14.7 in 1909. The average death rate
from tuberculosis, of m
ales, ages 30 to 60, inclusive, during the year
1908, w 24 per 10,000 for the city of B en, 25 for the city of
as
rem
1 For 721 patients, or 24.3 per cent, the treatment was prematurely discontinued.
(See p. 96 o f the Annual Report for 1910.)




150

BULLETIN* OF THE BUREAU OF LABOR.

Ham
burg, and 18 for the city of L
iibeck. The corresponding tu
ber­
culosis death rates for fem
ales w respectively, 19 per 10,000 for
ere,
the city of B en, 15 for the city of H burg, and 13 for the city
rem
am
of L
iibeck. The tubercu
losis death rate for the total population
has d
ecreased in the city of B en from 39.7 per 10,000 in 1880 to
rem
15.1 in 1909, an in the city of H burg from 26.4 per 10,000 in
d
am
1890 (earlier data not being available) to 13.1 in 1909. For L
iibeck
the inform
ation is not available.
The actual m
ortality from tubercu
losis of the lungs in the city of
H burg has decreased from 1,314 in 1901 to 1,152 in 1910. The
am
im
portance of the d
isease from an econ ic point of view is em
om
­
phasized by the statem that in the d e ending w 1910 th
ent
ecad
ith
ere
w 12,294 deaths from tuberculosis. In the year 1910 the tuber­
ere
culosis death rate w 12.5 per 10,000 for the city proper, and 9.2
as
for the rural portions included w
ithin the territory of th H
e anse
Tow
ns. The death rates, by divisional periods of life, w distinc­
ith
tion of sex, in the urban an rural portions, are given in the table
d
following:
DEATH RATES FROM TUBERCULOSIS OF THE LUNGS IN THE CITY OF HAMBURG,
GERMANY, IN 1910, BY AGE PERIODS AND SEX.
[From the Annual Sanitary Report of the Medical Council of the City of Hamburg for 1910, p. 48.1
Death rates per 10,000 living persons.
Age period.

Urban territory.
Males.

Under 1 year..............................................
I to 14 years................................................
15 to 29 years..............................................
30 to 59 years...............................................
60 to 69 years..............................................
70 years and over........................................

12.9
2.3
13.0
22.3
22.3
19.2

Total.................................................

13.9

Females.
7.1
4.0
14.9
12.9

Rural territory.

City of Hamburg.

Males.

Males.

10.0

20.1

3.2
9.9
13.3
24.4

11.2

9.5

9.8

#

Females.
10.5
4.1

12.6

11.3
4.9
15.6

21.6

8.8

11.1

Females.

2.4
12.7

7.4
4.0
14.6

22.5
19.2

18.8
10.3

13.5

11.0

12.8

According to this table the m
ortality of m
ales w higher than
as
the m
ortality of fem
ales in both the urban and rural territories, but
the m
ortality of fem
ales w in excess of the corresponding m
as
or­
tality of m at ages 1 to 29, inclusive. At ages 30 to 59, inclusive,
ales
th m
e ortality of m
ales from tubercu
losis of the lungs w decidedly
as
in excess of the corresponding m
ortality of fem
ales.
Of the total m
ortality from tuberculosis, 32.8 per cent occu
rred at
ages 15 to 29, inclusive, an 16.4 per cent at ages 30 to 59. An
d
analysis by districts disclosed w variations in th in en of
ide
e cid ce
tuberculosis, the death rate having been as high as 2.3 per 1,000 in one
district an as low as 0.51 in an
d
other in 1910. Of the 1,151 death
s
from tuberculosis of the lungs in the city of Ham
burg 151 w
ere



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

151

persons w w com on laborers. The evid ce is qu conclu­
ho ere
m
en
ite
sive that the relative d
eath rate from tuberculosis w highest am
as
ong
th poor, as m red by th incom
e
easu
e
e-tax retu s. The details for th
rn
e
year 1910 are given in tabular form below:
DEATH RATES FROM TUBERCULOSIS OF THE LUNGS IN THE CITY OF HAMBURG,
ACCORDING TO TAXABLE INCOMES, FOR THE YEAR 1910.
Deaths from tubercu­
losis.
Taxable income.

Population.
Number.

$214 to $286..........................................................................................
$286 to $476..........................................................................................
$476 to $833..........................................................................................
$833 to $1,190.......................................................................................
$1,190 to $2,380....................................................................................
$2,380 to $5,950....................................................................................
$5,950 to $11,900...................................................................................
Over $11,900........................................................................................

47,371
91,449
32,598
11,044
9,565
5,382
1,806
1,335

241
389
74
23

Total.........................................................................................

200,550

744

1
2
4
1

Rate per
1 ,000.
0
50.9
42.5
22.7

20.8
12.6
7.4
5.5

37.1

Granting the lim
itations of the m
ethod of determ
ining the rela­
tion of tuberculosis to poverty on th basis of the incom
e
e-tax retu s,
rn
w
hich, of cou exclude the large proportion of the population not
rse,
paying taxes of this kind, the table con s th w
firm e idely accep con
ted ­
clusion that the m
ortality from tuberculosis of the lungs varies pro­
portionately to the m
aterial w
ell-being of the population.
During 1910 the n m of tuberculous patients treated in general
u ber
hospitals in the city of H burg w 3,330, and of this num 635,
am
as
ber
or 19.1 per cent, died. The n ber of h es disinfected on accou t
um
om
n
of tuberculosis during the year w 3,101.
as
In the experience of the Invalidity Insurance Institution of th
e
H
anse Tow th ratio of tubercu
ns e
losis of th lungs a a cau of in­
e
s
se
validity, according to the investigation of 1896 to 1899, w 24.4
as
per cent for m
ales, against 15 per cen for all in ran institutions,
t
su ce
an 8.3 for fem
d
ales, against a general average of 9.5 per cen The
t.
rate of insured p
erson treated and cared for on accou t of sick ess
s
n
n
from all cau by the Invalidity Insurance Institution of th H
ses
e anse
Tow during 1910 w 8.8 per 1,000 of th population subject to th
ns
as
e
e
in
suran law against 7.8 for the G an Em
ce s,
erm
pire as a w
hole. The
num of patients under treatm on accou t of tuberculosis of the
ber
ent
n
lungs during the year w 1,731, or 4.6 per 1,000 of the insured popu­
as
lation. This, how
ever, is only the n m of cases for w
u ber
hich the
treatm w com en
ent as
m ced and com
pleted d rin the year. The
u g)
am t expended on accou t of treatm an care during th year
oun
n
ent d
e
1910 for tuberculosis w 696,660 m
as
arks ($165,805), or an average
expenditure of 402.46 m
arks ($95.79) per case per an u .
nm



152

BULLETIN OF THE BUBEAU OF LABOB.

. The Invalidity InsuranceInstitution of the H
anse Tow m
ns aintains
th sanatoria for the treatm and care of its m bers—1 for
ree
ent
em
m
ales, established in 1897 at O
derberg, in the Harz M
ountains, w
ith
180 beds; 1 for fem
ales, established in 1901 at G
liickauf, also in the
Harz M
ountains, w 100 beds; and a convalescing h e at G
ith
om
rossHansdorf, in H
olstein, w an accom odation of 87 beds for m
ith
m
ale
patients.
The Invalidity Insurance Institution of the H
anse Tow w on
ns as e
of the first to actively in
terest itself in th system
e
atic institutional
treatm an care of tu
ent d
bercu s w earn
lou age
ers. Under the direc­
tion of the m
anaging director and privy councilor, Dr. Bielefeldt,
n m s reports have b
u erou
een prepared w
hich afford a m s for a
ean
thorough study of the m
ethods by w
hich the best obtainable
econ ic results have b
om
een secu . In addition to the annual
red
report for 1910, w
hich contains a w
ealth of statistical inform
ation,
a special souvenir volum for the 20-year period 1891 to 1911 w
e
as
published for the pu
rpose of presenting the results obtained, together
w a descriptive accou t of the sanatoria ow ed an m
ith
n
n
d aintained
by th institution. According to th annual report for 1910 the
e
e
institution granted 25,957 disability annuities, in conform to
ity
paragraph15 of the invalidity in ran law Of this num 3,790,
su ce
.
ber,
or 14.6 per cen w granted o accou t of tuberculosis of th lungs
t, ere
n
n
e
an 165 onaccou t of tubercu
d
n
losis of other organs, including scrofula.
The n m of applications for institutional treatm and care, in­
u ber
ent
cluding all cau in
ses, creased during 1910 to the extent of 13 per cen
t
over the n ber of ca con ered during th previous year. The
um
ses sid
e
total n ber of applications during 1910 w 6,218, of w
um
as
hich 3,396
w approved. Of the 3,396 approved applications, 1,693, or 49.9
ere
per cent, w on accou t of tuberculosis of the lungs, including 964
ere
n
m and 729 fem
ales
ales. The n ber of tuberculous m
um
ilitary recruits
brought to the attention of th institution during th year w 26.
e
e
as
In addition to the treatm an care of tuberculous m bers in
ent d
em
special institutions, th Invalidity Insurance Institution of the H
e
anse
Tow extends pecuniary aid to th five tuberculosis dispensaries, the
ns
e
am
ount provided for the city of H burg being 9,000m
am
arks ($2,142);
for B en, 2,000 m
rem
arks ($476); an for Lubeck, 1,500 m
d
arks ($357).
According to an investigation m in 1910, w a d e regard to
ade
ith u
the results of the occupation cen s of 1907, the num of in
su
ber
sured
persons in the H
anse Tow w estim
ns as
ated at 420,000, or 29.3 per cen
t
of the total population. The n ber of contributions per insured
um
m ber w 49.40 w
em
as
eekly paym
ents, am
ounting to 14.63 m
arks
($3.48) per an u .
nm




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

153

In appreciation of the intim relation betw housing conditions
ate
een
and th local in
e
cidence of tuberculosis, the Invalidity Insurance In­
stitution of the H
anse Tow w th approval of the im
ns, ith e
perial in­
su ce o
ran ffice, provided 1,000,000 m
arks ($238,000) for building pur­
p
oses for the year 1911.1
The num of disability annuities for all cau granted each year
ber
ses
su u t to 1891 is given in tabular form below:
bseq en
DISABILITY ANNUITIES GRANTED BY THE INVALIDITY INSURANCE INSTITUTION
OF THE HANSE TOWNS, 1892 TO 1910.
Year.
1892................
1893................
1894................
1895................
1896................

Number.
104

20
2
418
623
637

Year.
1897................
1898................
1899................
1900................
1901................

Number.
904
1,209
1,408
1,587
1,852

Year.

Number.

1902................
1903................
1904................
1905................
1906................

2
,222
2,283
2,225
1,813
1,475

Year.
1907.............
1908...............
1909...............
1910...............

Number.
1,555
1,763
1,874
1,785

Since 1891 a total of 25,957 disability an uities have b granted,
n
een
the m
axim having b attained in 1903, w en th num w
um
een
h
e
ber as
2,283. Considering the in
crease in th insurable population, th de­
e
e
crease during recen years in the total n ber of disability annuities
t
um
granted w
ould seem to sustain the con
clusion that this result is, in
part at least, d e to th thoroughgoing m
u
e
ethods of treatm and care
ent
of invalid m bers, including a relatively large proportion of tuber­
em
cu s w earn
lou age
ers. The ratio of an uities granted for all cau in
n
ses
proportion to the n ber of applications m h varied consider­
um
ade as
ably, having b highest during the year 1892, w en32 per centw
een
h
ere
declined, and low in the year 1900, w en only 7.9 per cent w
est
h
ere
declined. The average for th period 1892 to 1910 w 17 per cent;
e
as
or, accurately, out of 36,687 applications for disability annuities, 6,250
w declined.2
ere
Of 16,301 disability annuities granted to m
ales by the Invalidity
Insurance Institution of the H
anse Tow up to D
ns
ecem 31, 1910,
ber
3,002, or 18.4 per cen w on accou t of tuberculosis of the lungs.
t, ere
n
The corresponding n m
u bers and proportion for fem
ales w 9,656
ere
disability annuities granted for all cau an 788, or 8.2 per cen for
ses d
t,
tuberculosis of th lungs. The n m
e
u bers and proportion by divisional
periods of life, for both sexes, are given in tabular form below
.3




1 Annual Report for 1910, p. 29.

2Id€m, p. 39.
8 Idem, pp. 50, 51.

154

BULLETIN OF THE BUREAU OF LABOR.

DISABILITY ANNUITIES GRANTED BY THE INVALIDITY INSURANCE INSTITUTION
OF THE HANSE TOWNS, 1892 TO 1910, ON ACCOUNT OF ALL CAUSES, AND TUBERCU­
LOSIS OF THE LUNGS, BY SEX AND AGE PERIODS.
Annuities granted to—
Females.

Males.
Age period.
Total
all causes.

On account of tu­
berculosis of lungs.

^Total
all causes.

Number. Percent.
20 to 24 years..............................................
25 to 29 years..............................................
30 to 34 years..............................................
35 to 39 years..............................................
40 to 44 years..............................................
45 to 49 years..............................................
50 to 54 years..............................................
55 to 59 years..............................................
60 to 64 years..............................................
65 to 69 years..............................................
70 years and over........................................

1,547
2,028
2,800
2,696
1,520

Total.................................................

16,301

427
920
978
1,009
1,156

12
,2 0

On account of tu­
berculosis of lungs.
Number. Per cent.

136
39

62.1
52.3
47.0
38.8
33.1
27.9
18.3
10.5
4.9
1.4

168
161
79
73
57
59
55
75
38
19
4

54.7
37.3
27.5
27.2
17.6
11.9
5.7
5.1
1.7

.8

307
432
287
268
324
497
958
1,485
2,233
1,752
1,113

3,002

18.4

9,656

788

8.2

265
481
460
391
383
340
283

22
1
1
2

1.1
.4

According to this m interesting an instructive com
ost
d
parison the
largest n m of disability annuities for all cau in the case of
u ber
ses
m w granted at ages 60 to 64, inclusive, but the largest n ber
ales as
um
granted on accoun of tuberculosis of the lungs w at ages 25 to 29,
t
as
or 52.3 per cen of the total n ber of disability annuities granted
t
um
at this period of life. For fem
ales the largest num of disa­
ber
bility annuities for all cau w granted at ages 60 to 64, in­
ses as
clusive, but the largest n ber granted on accou t of tuber­
um
n
culosis of the lungs w at ages 20 to 24, or 54.7 per cen
as
t
of th total num of disability annuities granted at this period
e
ber
of life. The table em
phasizes precisely the econ ic im
om
portance of
tuberculosis of th lungs as a cau of disability an the peculiar
e
se
d
interest w
hich invalidity in ran institutions have in th preven­
su ce
e
tion of the d
isease. It m be stated in this con
ay
nection that the
average value of the disability annuities granted in 1910 w 211.92
as
m
arks ($50.44) for m
ales an 161.85 m
d
arks ($38.52) for fem
ales.1
According to the experien data for 1892 to 1910, tuberculosis of
ce
the lungs w the cau of invalidity in the case of 18 per cen of the
as
se
t
m
ales favorably con
sidered an 8 per cent of the fem
d
ales; but for
1910 only, the proportion w 15 per cen for m
as
t
ales, rem
aining at
8 per cent for fem
ales. The great im
portance of tuberculosis of the
lungs as a cau of invalidity suggests the inclusion of th follow
se
e
ing
table, w
hich sh s th actual an relative dim
ow e
d
inutions in the n ber
um
of disability annuitants on accou t of this d
n
isease sin 1892.
ce




1
Annual Report for 1910, p. 57.

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

155

DISABILITY ANNUITIES GRANTED FOR ALL CAUSES, AND FOR TUBERCULOSIS OF
THE LUNGS BY THE INVALIDITY INSURANCE INSTITUTION OF THE HANSE,
TOWNS, 1892 TO 1910.

Year.

Number of disability annui­
ties granted on account of
all causes.
Males.

1892..........
1893..........
1894..........
1895..........
1896:.........
1897..........
1898..........
1899..........
1900..........
1901..........
1902..........
1903..........
1904..........
1905..........
1906..........
1907..........
1908..........
1909..........
1910..........

Females.

74
178
320
475
470
636
794
854
915
1,135
1,346
1,435
1,351
1,108
928
910
1,091
1,199
1,082

30
42
98
148
167
268
415
554
672
717
876
848
874
705
547
645
672
675
703

Total.
104

20
2

418
623
637
904
1,209
1,408
1,587
1,852

22
,2 2

2,283
2,225
1,813
1,475
1,555
1,763
1,874
1,785

Number of disability annui­
ties granted on account of
tuberculosis of the lungs.
Males.
5
25
80
127

10
2

138
151
149
174
227
282
243
237
178
194
154
168
182
158

Females.

2
1
0
17
1
2

19
34
27
42
51
60
57
74
62

6
8
58
58
81
56

Total.
5
27
90
144
132
157
185
176
216
278
342
300
311
240
262

22
1

226
263
214

Per cent of disability annui­
ties granted on account of
tuberculosis of the lungs.
Males.
6.67
14.04
25.00
26.74
25.53
21.73
19.02
17.45
19.02

20.00
20.59
16.93
17.54
16.06
20.91
16.92
15.40
15.18
14.60

Females.

4.76

1 .2
00

11.48
7.18
7.09
8.19
4.87
6.25
7.11
6.85
6.72
8.47
8.79
12.43
8.99
8.63

1 .0
20
7.97

Total.
4.81
12.27
21.53
23.11
20.72
17.39
15.30
12.50
13.61
15.01
15.39
13.14
13.98
13.24
17.76
13.63
12.82
14.03
11.99

Annual Report for 1910, p. 64.

According to this com
parison the m
axim percentage of dis­
um
ability annuities granted on accoun of tuberculosis of the lungs to
t
m w 26.74 in 1895, an the m um leaving out the first year,
ales as
d
inim ,
w 14.04 per cent in 1893. For fem th m
as
ales e axim w 12.43 per
um as
cen in 1906 and the m um4.76 per cen in 1893. For both sex
t
inim
t
es
com
bined, leaving out of consideration the year 1892, the m
axim
um
w 23.11 per cent in 1895, and the m um w 11.99 per cent in
as
inim
as
1910. The table, therefore, fully con s the conclusion that there
firm
has b a m
een
arked reduction in the actual num and relative pro­
ber
portion of disability annuitants on accou t of tubercu
n
losis of the
lungs during recen years, although th insured population or m ­
t
e
em
bership of the Invalidity Insurance Institution of the H
anse Tow
ns
substantially in
creased in th m
e eantim
e.
The m orial volum com em
em
e
m orative of the tw
entieth anniversary
of the Invalidity Insurance Institution of Ham
burg contains a
large am
ount of inform
ation, m of w
uch
hich, how
ever, is too techni­
cal to perm of extended consideration. The volum how
it
e,
ever, is a
treatise of exceptional value, an should be consulted by all w o de­
d
h
sire to obtain a thorough understanding of th m
e ethods and results
of G an invalidity in ran institutions in their efforts to provide
erm
su ce
adequ treatm an care for tubercu
ate
ent d
lous w earn
age
ers.
During th period 1891 to 1910, 30,748 applications w received
e
ere
on accoun of treatm and care of person suffering from tubercu­
t
ent
s
losis of th lungs, an of this num 17,057, or 55.5 per cent, received
e
d
ber
favorable consideration. The n ber of m applicants w 19,754,
um
ale
as
and th n ber favorably considered in this group w 10,338, or
e um
as



156

BU LLETIN OF TH E BUREAU OF LABOR.

52.3 per cen The n ber of fem applicants w 10,994, an th
t.
um
ale
as
d e
n ber favorably con
um
sidered w 6,719, or 61.1 per cen The inad­
as
t.
equacy of th present system how
e
,
ever, is best em
phasized in th
e
statem that 11,789 tubercu
ent
lous applicants could not receive treat­
m for various reason w
ent
s, hich do n requ to be con
ot
ire
sidered in
detail. The n ber of m applicants declined for treatm an
um
ale
ent d
care on accou t of tuberculosis of the lungs w 8,309, an the num
n
as
d
­
ber of fem applicants declined w 3,480.
ale
as
Special efforts have been m sin 1907 to im
ade ce
prove the diagnosis
of tuberculosis, an for this purpose a special tuberculosis station
d
w established at Gross-Hansdorf. It w ascertain that out of
as
as
ed
1,968 assu ed tubercu
m
lous patients, only 1,693, or 86 per cent, w
ere
tuberculous, th rem
e
aining p
erson being affected w nontubercular
s
ith
lung diseases. Obviously, the results of treatm
ent depend very
largely upon the accu
racy of the diagnosis, and for this reason th
e
establishm of a special station for the purpose of a thorough and
ent
qualified exam
ination is likely to prove a m valuable innovation.
ost
Out of 1,666 patients know to be tuberculous, th evidence of th
n
e
e
disease w determ
as
ined by m s of bacteriological exam
ean
inations in
23 per cen of the cases, by m
t
eans of physical exam
ination only in 19
per cen of th cases, and by m s of other m
t
e
ean
ethods, including th
e
tuberculin test, in 58 per cen of the cases. The average cost of
t
treatm an care on accoun of tuberculosis of th lungs during
ent d
t
e
1910 w 402.46 m
as
arks ($95.79) per patient per annum or 5.72
,
m
arks ($1.36) per patient per day. For m the cost of treatm
ales
ent
per patient per day w 7.01 m
as
arks ($1.67), an for fem
d
ales, 4.41
m
arks ($1.05).
The sanatorium for m patients at O
ale
derberg, in the Harz M
oun­
tains, is an institution of con
siderable m
agnitude, providing 180 b s.
ed
There are 14 room w 1 bed each 4 room w 2 beds each 7 room
s ith
,
s ith
,
s
w 3 beds each 9 room w 4 beds each 9 room w 5 bed each
ith
,
s ith
,
s ith
s
,
4 room w 6 beds each an 4 room w 8 beds each The per
s ith
, d
s ith
.
capita cost of m
aintenance has slightly d
ecreased or from 7.42 m
,
arks
($1.77) in 1908 to 6.50 m
arks ($1.55) in 1909 an 6.26 m
d
arks ($1.49)
in 1910. The average duration of treatm attained a m
ent
axim of
um
83 days in 1898, but by m
eans of rigid selection the average duration
h been gradually reduced to 55 days in 1910. It is explained that
as
this reduction in the average duration is d e entirely to the fact that
u
about one-fourth of the patients are treated in a prelim
inary w for
ay
th purpose of observation an study at the tuberculosis station at
e
d
Gross-Hansdorf.
An interesting statem is m
ent
ade w regard to th dism
ith
e
issals
on accou t of violations of rules, the proportion having b 5 per
n
een
cen in 1910 an as high as 10 per cent in 1906.
t
d



CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

157

The econ ic results h been very satisfactory, th proportion
om
ave
e
successfully treated having in
creased from 81 per cen in 1897 to
t
99 per cent in 1910. The im
provem in results is d e in part,
ent
u
how
ever, to a m careful selection of patients on adm
ore
ission. Leav­
ing out the year 1897 on accou t of sm n bers, the results, as
n
all um
m red by th proportion of patients still able to provide for their
easu
e
ow support, w 53 per cen in 1898, 55 per cen in 1899, 60 per cen
n
ere
t
t
t
in 1900, 57 per cen in 1901, 71 per cent in 1902, 63 per cen in 1903,
t
t
68 per cen in 1904, 55 per cen in 1905, and 61 per cen in 1906. Of
t
t
t
857 tubercu
lous patients treated in 1910,11 per cent w from 1 to 30
ere
days in the institution, 42 per cent from 31 to 60 days, and 47 per
cen from 61 to 90 days. According to ages on adm
t
ission, 60 per
cen w u
t ere nder 31 years of age, 33 per cen from 31 to 45 years, an
t
d
only 7 per cen w of ages 46 an over.
t ere
d
Of the 857 tubercu
lous patients, only 27 per cent had ren ered
d
full m
ilitary service, 56 per cent w disqualified for m
ere
ilitary
service, and in 17 per cen of th cases th point as to m
t
e
e
ilitary fitn
ess
had not been determ
ined. According to conjugal condition, 55
per cen of the patients w m
t
ere arried, 44 per cen single, an 1 per
t
d
cen w
t idow or divorced.
ed
The so-called “ B
rehm
er’sch ” taint w ascertained for 210 of
e
as
th 857tuberculous patients, or 24.5 per cen of the total. But, also, in
e
t
th case of the non berculou patients 15, or 26 per cent, w ascer­
e
tu
s
ere
tained to be last-born children, w
hich w
ould, therefore, according
to the report, w
arrant th con
e
clusion that the im
portance of the
so-called “ Brehm
er’sch ” taint w n substantiated.
e
as ot
A hereditary taint w ascertain w certainty in 24 per cen
as
ed ith
t
of th cases, an in 66 per cen th result w certainly in th nega­
e
d
t e
as
e
tive and in 10 per cen undecided. The hereditary taint w trace­
t
as
able to th father in 13 per cen of the cases, to th m
e
t
e other in 9
per cent, an to both parents in 3 per cen of th cases.
d
t
e
The com en en of th d
m cem t
e isease w alleged to have occu
as
rred
during a period of less than 6 m
onths in 53 per cen of th cases,
t
e
during from 7 to 12 m
onths in 19 per cent, during 1 to 5 years in 21
per cent, during 5 to 10 years in 5 per cent, an over 10 years in 2
d
per cent of th cases of tuberculosis treated during 1910. The aver­
e
age duration of illness, including 58 cases of n tu
on bercu s patients,
lou
previous to adm
ission w 1.6 years.
as
The duration of incapacity for w previous to adm
ork
ission w
as
up to 1 m
onth for 20 per cen of th cases, from 1 to 3 m
t
e
onths in 42
per cent, an from 3 to 12 m
d
onths in 11 per cen The rem
t.
ainder, or
27 per cen of th cases, w n incapacitated for w previous to
t
e
ere ot
ork
their adm
ission to the sanatorium
.



158

BULLETIN OF THE BUREAU OF LABOR.

C
lassified according to the Turban stage of th d
e isease, 64 per
cen w in the first stage on adm
t ere
ission, 33 per cen in th secon
t
e
d
stage, an 3 per cen in the third stage. A tuberculin reaction o
d
t
c­
curred in 514 out of 573 patients treated by the tuberculin m
ethod.
Of th 857 tubercu
e
lous patients 30 per cen had tubercle bacilli in
t
the sputum on adm
ission, 51 per cent had no bacilli in the sputum
,
and 19 per cen had no expectoration at all. On discharge 20 per cen
t
t
of th patients had tubercle bacilli in the sputum in 34 per cen
e
;
t
of the cases the result w negative and in 46 per cen there w n
as
t
as o
expectoration at all. In 35 per cen of th cases of patients having
t
e
bacilli in th expectoration on adm
e
ission the bacilli disappeared dur­
ing treatm
ent.
The average gain in w
eight during treatm w 5.8 kilogram
ent as
s
(12.8 pounds). In the case of 42 per cent of the patients the gain
w from 0.1 to 5 kilogram (0.2 to 11 pounds), in th case of 43 per
as
s
e
cen from 5.1 to 10 kilogram (11.2 to 22 pounds), an in the case of
t
s
d
12 per cen of the patients from 10.1 to 20 kilogram (22.3 to 44.1
t
s
pounds). The w
eight w stationary in 2 per cent of the cases an
as
d
d
ecreased in 1 per cen of the cases.
t
Of the 857 tuberculous patients 65 per cent w discharged in a
ere
m
aterially im
proved condition, 29 per cent in a fairly im
proved
condition, 5 per cen in about the sam condition as w en received,
t
e
h
and in only 1 per cent w the condition decidedly w
as
orse.
The econ ic results w satisfactory in 83 per cent of th
om
ere
e
cases—that is, the earning capacity w restored for a reason
as
able
period of time; the results w also fairly satisfactory w
ere
ithin th
e
m
eaning of paragraph 5 of section 4 and paragraph 15 of th
e
invalidity in ran law an in only 5 per cent of the cases w
su ce
s, d
ere
the patients discharged w their earning capacity not at least par­
ith
tially restored.
M the sam results, m
uch
e
edical an econ ic, w secu at the
d
om
ere
red
oth institutions m
er
aintained by the Invalidity Insurance Institution
of the H
anse Tow an it w
ns, d
ould serve no practical purpose to en
­
large upon the details, w
hich are conveniently available to an e
yon
w m desire to inquire further into the facts.
ho ay
The aggregate results are sum arized for the period 1893 to 1910
m
for m
ales, and for 1894 to 1910 for fem
ales, including in th form
e
er
10,067 patients under observation at least on year, an in the latter
e
d
6,485. The results are given in tabular form below show re­
,
ing
spectively the num of patients retaining their earning capacity
ber
for a stated period of tim of from 1 to 12 years.
e




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

159

ECONOMIC RESULTS OBTAINED BY SANATORIUM TREATMENT FOR TUBERCULOSIS
OF THE LUNGS AT INSTITUTIONS MAINTAINED BY THE INVALIDITY INSURANCE
INSTITUTION OF THE HANSE TOWNS, 1893 TO 1910.
[From Twenty Years’ Experience in the Treatment and Care of Tuberculous Wage Earners by the Invalid­
ity Insurance Institution of the Hanse Towns, 1891-1911, p. 179.]
Patients successfully treated and discharged, with earning capacity restored.

Years after discharge.

Number under ob­
servation.
Males.

1...............................
2...............................
3...............................
4..............................
5...............................
6...............................
7...............................
8...............................
9...............................
1 ...............................
0
1 ...............................
1
1 ..............................
2

8,353
7,556
6,726
6,069
5,333
4,105
1,450
1,077
715
481
208
32

Females.
5,554
4,923
4,320
3,916
3,432
2,626
796
579
367
204
69

6

Number still at
work.
Males.
8,060
6,196
4,718
3,792
3,065
2,193
660
446
287
175
60
5

Females.
5,461
4,313
3,391
2,859
2,379
1,755
490
339
215
124
35
3

Number not traced.
Males.

326
303
277
248
206
46
37
28
18
5

2

Females.

192
180
169
145
107
36
30
23

1
2
8

Per cent success­
fully treated.
Males.
96

8
6

73
65
60
56
47
43
42
38
30
17

Females.
98
91
82
76
77
70
64
62
63
65
57
50

This table sh s that of the 10,067 m patients under observation
ow
ale
at least on year during th period 1893 to 1910, 8,353 w discharged
e
e
ere
as successfully treated w the anticipation of a con u ce of
ith
tin an
earning capacity for a reason
able period of tim Of the 8 3 3
e.
^5
patients 8,060 w still at w at the en of the first year, or 96
ere
ork
d
per cen of the n ber of successful cases under observation, or 80
t
um
per cent of the total n ber treated an cared for.
um
d
The n ber of m patients under observation for tw years w
um
ale
o
as
7,556, and the n ber still at w at th en of this period w
um
ork
e d
as
6,196, excluding 326 for w
hom the inform
ation w not obtainable.
as
The percentage of m patients retaining their earning capacity for
ale
tw years, therefore, w 86 per cen of th successfully treated an
o
as
t
ose
d
69 per cen of the total n m of cases, including th u su
t
u ber
ose n ccess­
fully treated. In a sim m
ilar anner th results are traceable through­
e
out the entire exp
erien of 12 years, the percen
ce
tages becom grad­
ing
ually red ced to 73 for the third year cases, 65 for th fourth year,
u
e
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, an 17 for the tw
d
elfth year. For fem
ales
the results throughout are still better, but the facts can readily be
determ
ined by referen to the table. The table is subject to the
ce
correction that the num of not controlled cases requ to be d
ber
ires
e­
du
cted from th total num of su
e
ber
ccessfu cases, the p
l
ercen
tages
being calculated on the basis of th n ber of cases for w
e um
hich the
inform
ation for each year w ascertain
as
able.
The econ ic results obtained in the treatm an care of tuber­
om
ent d
culous w earn by the Invalidity Insurance Institution of the
age
ers
H
anse Tow are a su
ns
fficien in
t ducem t to believe in th accu
en
e
racy



160

BU LLETIN OP THE BUREAU OP LABOR.

of the theory that, in the long run, substantial financial gains m
ust
result from ad ate an effective m
equ
d
ethods of prevention an cu
d re.
It is, in any event, suggestive to fin that of the m patients treated
d
ale
during the period 1893 to 1910, th proportion treated successfully
e
at the outset w 83 per cen an for the fem
as
t, d
ales 86 per cen These
t.
results for tuberculosis of the lungs com
pare w som oth im
ith
e er ­
portant diseases, as follows: For an ia cases th proportion su
em
e
ccess­
fully treated at th outset w 90 per cen for m
e
as
t
ales an 91 per cen
d
t
for fem
ales; for nervous d
iseases, 83 per cen and 83 per cent, re­
t
spectively; for rheum
atism 80 per cen and 73 per cent; an for
,
t
d
other d
iseases, 79 per cen an 83 per cen
t d
t.
C
onsidering the perm
anent results as m
easured by a six-year
period, the com
parison sh s that for m patients the w
ow
ale
age­
earning capacity w retained in tuberculosis of the lungs in 43 per
as
cen of th cases; in anem in 48 per cent; in nervous diseases, in 46
t
e
ia,
per cent; in rheum
atism in 45 per cent; in sciatica, in 38 per cent;
,
and in other d
iseases, in 42 per cen For fem
t.
ales the respective
percentages as regards econ ic results to the en of the sixth year
om
d
w for tuberculosis of the lungs, 56; for anem 70; for nervous
ere
ia,
diseases, 54; for rheum
atism 41; for sciatica, 47; an for oth
,
d
er
diseases, 51.
A very im
portant analysis of the results, extending over a period
of from 6 to 15 years, h been m by Dr. F. R
as
ade
eiche in behalf of th
e
Invalidity Insurance Institution of the H
anse Tow by m s of a
ns
ean
m
edical reexam
ination of patients discharged from the sanatoria
during th period under observation. Of the m patients dis­
e
ale
charged in 1895,36 percen still retainedtheirw
t
age-earning capacity
to the en of 1910, but 8 per cen had undergone a su
d
t
bsequ t treat­
en
m in the m
ent
eantim Of th fem patients discharged in 1895,
e.
e
ale
the proportion retaining their w
age-earning capacity to th en of
e d
1910 w 67 per cen but 11 per cent had undergone a su u t
as
t,
bseq en
treatm
ent. C bining th results for patients discharged in 1895,
om
e
1896, an 1897, it w ascertain that ou of 245 m observed an
d
as
ed
t
ales
d
reexam
ined from tim to tim to the en of 1910, 52 per cent had
e
e
d
retained their full earning capacity an 4 per cen additional had
d
t
retained a lim
ited w
age-earning capacity. For fem
ales, the resp
ec­
tive percentages w 63 for full earning capacity an 18 for lim
ere
d
ited
earning capacity. Of th proportions, how
ese
ever, 20 per cen of the
t
m
ales an 24 per cen of th fem
d
t
e
ales w had retained their full or
ho
lim
ited earning capacity had u
ndergone a su
bsequ t treatm
en
ent.
Of the patients under observation from 1895 to 1904, excluding,
how
ever, all patients less than four w s in th institutions, the
eek
e
results, according to ages on adm
ission, w as follows: Of the m
ere
ale
patients adm
itted at ages 15 to 24, th proportion retaining their full
e



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

161

earning capacity to th en of 1910 w 63 per cent, and a lim
e d
as
ited
earning capacity w retained in 7 per cen of the cases. The re­
as
t
spective percentages for fem
ales w 69 an 14. For m patients
ere
d
ale
at ages 25 to 49 on adm
ission, a full earning capacity w retain
as
ed
to the en of 1910 in 52 per cen of the cases an a lim
d
t
d
ited earning
capacity in 9 per cen of th cases. For fem
t
e
ales, th respective per­
e
centages w 57 an 18. The n bers at ages over 50 are very sm
ere
d
um
all,
bu of th m
t
e ales 19 per cen had retained their full earning capacity,
t
and of the fem
ales 5 per cen It is show therefore, that th
t.
n,
e
econ ic results are m favorable in the case of m and w en
om
ost
en
om
adm
itted for treatm at ages u
ent
nder 25.
Considering the results by duration of d
isease previous to adm
is­
sion, it is sh n by the investigation referred to that of th m pa­
ow
e ale
tients from 1 to 6 m
onths u
nder treatm 62 per cent retained their
ent
full w
age-earning capacity to the en of 1910; w a stay of from
d
ith
6 to 24 m
onths the p
ercen
tage w 56; w a stay of from 2 to 6
as
ith
years it w 44; from 6 to 12 years it w 49; and over 12 years it
as
as
w 44 per cen For fem
as
t.
ales the econ ic results w as follows:
om
ere
For a duration of th d
e isease of from 1 to 6 m
onths the percentage
w 73; from 6 to 12 m
as
onths it w 62; from 2 to 6 years it w 64;
as
as
from 6 to 12 years it w 65; and for over 12 years it w 49 p
as
as
er
cen It is therefore sh n that the econ ic results w m sat­
t.
ow
om
ere ost
isfactory in th ca of patients w a com
e se
ith
paratively short duration
of the d
isease previous to adm
ission.
The econ ic results did not vary m
om
aterially for patients w or
ith
w
ithout a family taint of tuberculosis, having been 54 per cen
t
for m patients having a fam history of tuberculosis, an 57
ale
ily
d
per cen for those not having a family history of the d
t
isease. For
fem patients the respective p
ale
ercen
tages w 63 and 66.
ere
Finally, it m b stated that th Invalidity Insurance Institution
ay e
e
of th H
e anse Tow loaned 8,075,400 m
ns
arks ($1,921,945) in the form
of building loans for w earn h es, an it m also b stated
age
ers’ om
d
ay
e
that in appreciation of the social service rendered by th institution
e
a dock laborer by th n e of G
e am
ustav K
iissner, w o had sin Ju e
h
ce n
3, 1897, been in receipt of a disability annuity, left at th tim of his
e e
death, on M
arch 26, 1904, th su of 3,700 m
e m
arks ($881) a a legacy
s
to the institution for w
elfare pu
rposes to be u at its discretion. It
sed
is clearly sh n by the adm
ow
irable analysis of the results, statistical or
otherw that the aim an efforts to advan in the m im
ise,
d
ce
ost portant
directions the w
ell-being of w
age earn insured w th Inva­
ers
ith e
lidity Insurance Institution of th H
e anse Tow have b realized.
ns
een
49397°— 12----- 11




162

BU LLETIN OP TH E BUREAU OF LABOR.

APPENDIX I.— TREATMENT OF TUBERCULOUS WAGE
PUBLIC INSTITUTIONS, 1902 TO 1904.1

EARNERS IN

During the present year the Im perial Board o f Health has pub­
lished a supplementary report on the results o f sanatorium treatment
for the period 1902 to 1904, which confirms in all essentials the ex­
perience data for 1896 to 1901. The results o f this supplementary
investigation are briefly summarized, as follow s:
1. The statistical investigation includes 34,071 male and 12,632
female patients treated and cared for on account o f tuberculosis o f
the lungs, with an average duration o f treatment fo r males o f 86.6
days and for females o f 95.8 days.
2. The cost o f treatment was provided for by social insurance insti­
tutions in the case o f male patients to the extent o f 85.4 per cent and
o f female patients to the extent o f 75.7 per cent.
3. O f the male patients 44.3 per cent and o f the female patients
59.3 per cent were o f the age period 20 to 29 years, and o f the male
patients 31.8 per cent and o f the female patients 18.8 per cent were
o f the age period 30 to 39 years.
4. A parental history o f tuberculosis was ascertained in the case o f
25.2 per cent o f the male patients and o f 36.7 per cent o f the female
patients. Tuberculosis among brothers and sisters was ascertained
in the case o f 19.6 per cent o f the male patients and o f 24.4 per cent
o f the female patients. In addition thereto, in the case o f 2.6 per cent
o f the male patients and o f 2.9 per cent o f the female patients,
respectively, the w ife or the husband was ascertained to be tubercu­
lous. The proportion o f families with tuberculous children was only
0.5 per cent in the case o f male patients and only 0.4 per cent in the
case o f female patients.
5. About two-thirds o f the patients, or 61.9 per cent fo r males and
64.7 per cent for females, entered the sanatorium during the year in
which the disease first became apparent. In the case o f 16.9 per cent
o f the male patients and o f 12.3 per cent o f the female patients
receiving institutional treatment, a previous treatment had been had
in sanatoria, in hospitals, or in air-cure establishments.
6. The nutrition o f the patients on admission for institutional
treatment was ascertained to be good in the case Of 19.1 per cent o f
the male patients and o f 18.9 per cent o f the females. For 51.2 per
cent o f the males and for 50.5 per cent o f the females the condition
as regards nutrition was considered average, and in 29.7 per cent o f
the male patients and in 30.6 per cent o f the female patients the
condition as regards nutrition was bad. An improvement in the
bodily condition took place in the case o f 95.9 per cent o f the male
patients and o f 94.1 per cent o f the female patients during treatment,
1 Tuberkulose-Arbeiten aus dem Kaiserlichen Gesundheitsamte. Deutsche Heilstatten
fiir Lungenkranke. Verlag yon J. Springer, Berlin, 1912. 13. hft.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

163

and the average gain in weight was 6.6 kilograms (14.6 pounds) for
males and 5.8 kilograms (12.8 pounds) for females.
7. The general condition o f patients on admission was apparently
good in the case o f 23.1 per cent o f the males and o f 20.7 per cent o f
the females. The condition was average in the case o f 49.5 per cent o f
the males and o f 42.6 per cent o f the females, and the condition was
bad in the case o f 27.4 per cent o f the males and o f 36.8 per cent o f the
females. An improvement in the general condition during the period
o f institutional treatment took place in the case o f 64.2 per cent o f
the males and o f 66.1 per cent o f the female patients.
8. On admission the proportion o f patients with cough and expec­
toration was 92 per cent for males and 65.9 per cent for females. The
proportion o f dry cough was 3.3 per cent for males and 17.6 per cent
for females. O f the patients with cough and expectoration 26.3 per
cent o f the males and 32.7 per cent o f the females were relieved there­
from entirely, and a partial result was obtained in the case o f 14.3
per cent o f the males and o f 7.7 per cent o f the females. O f the male
patients 69.9 per cent were relieved from dry cough as the result o f
institutional treatment and o f the female patients 66.1 per cent.
9. The bacilli o f tuberculosis was bacteriologically ascertained to be
present in the case o f 35.1 per cent o f the male patients and o f 21.8
per cent o f the female patients. As the result o f treatment 33.4
per cent o f the male patients and 29.4 per cent o f the female patients
were free from bacillary evidences on discharge.
10. Fever was present on admission in the case o f 14.5 per cent o f
the males and o f 14.9 per cent o f the females. On discharge 71.9 per
cent o f the male patients and 57.3 per cent o f the female patients were
free from fever.
11. Night sweats on admission were present in the case o f 25.4 per
cent o f the male patients and o f 18.3 per cent o f the female patients.
O f the males 91.7 per cent were free from night sweats on discharge
and o f the females 85.8 per cent.
12. O f the male patients on admission 37.3 per cent were in the
first Turban stage o f the disease, 46.2 per cent in the second, and 16.5
per cent in the third. O f 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 o f 23.3 per cent o f the male patients and o f
25.8 per cent o f the female patients only one lung was affected with
the disease on admission. The right lung only was affected in the
case o f 67.5 per cent o f the male patients and o f 65.7 per cent o f the
female patients.
13. A complete cure was obtained on discharge in the case o f 4.5
per cent o f the male patients and o f 6.7 per cent o f the female patients.
An improvement in the condition o f the lungs was secured in the case
o f 86.7 per cent o f the male patients and o f 81.7 per cent o f the female
Digitized forpatients, and o f these, in the case o f 27 per cent and 23.1 per cent.
FRASER


164

B U LLETIN OF TH E BUBEAU OF LABOR,

respectively, the improvement was so decided that there was a change
to a more favorable Turban stage o f the disease. In only 6.3 per
cent o f the male patients and in only 8.8 per cent o f the female pa­
tients was there no change in the condition o f the lungs during treat­
ment. The proportion o f deaths during treatment was only 0.3 per
cent for male patients and only 0.2 per cent fo r female patients.
14.
A complete economic result—that is, restored wage-earning
capacity—was obtained in the case o f 53.9 per cent o f the male
patients and o f 60 per cent o f the female patients. But, in addition
thereto, in the case o f 28.6 per cent and o f 24.2 per cent, respectively,
a fairly satisfactory economic result was secured—that is, restored
wage-earning capacity o f lim ited extent for a reasonable period o f
time.
The comparative statistical facts for the investigations o f 1896 to
1901 and 1902 to 1904 are conveniently summarized below :
COMPARATIVE RESULTS OF TREATMENT FOR TUBERCULOSIS IN GERMAN PUBLIC
SANATORIA.1
1896 to 1901
Males.
NmnhAr of nationts.....................................................................
Average duration of treatment.................................
Ages on admission:
Under 20 years...................................................
20 to 29 years......................................................
30 to 39 years.......................................................
40 years and over................................................
Tuberculous parents.................................................
Tuberculous brothers and sisters..............................
Previous duration of disease less than 1 year...........
Previous sanatorium treatment of at least 6 weeks...........do___
Good nutrition on admission.................................... ........ do___
Average nutrition on admission................................
Poor nutrition on admission.....................................
Gain in weight..........................................................
Average increase in weight......................................
Physical condition on admission:
Good...................................................................
Average.............................................................. ........d o....
Poor............................................................................do___
Physical condition during treatment:
Improved.................................................................... d o....
Unchanged........................................................ ......... d o ....
Worse................................................................ .
Cough and expectoration on admission.....................
Cough only.............................................................. ......... do___
No cough and expectoration on discharge.............. ......... d o....
Bacillary diagnosis positive on admission......................... do___
Bacillary diagnosis negative on discharge......................... d o ....
Fever on admission........................................................... do___
No fever on discharge.............................................. ......... d o....
Night sweats on admission...................................... .
No night sweats on discharge................................... ........d o ....
Turban stage on admission:
First...................................................................
Second................................................................
Third..................................................................
One lung affected..................................................... ......... do___
Condition of lungs on discharge:
Improved.................................................................... d o....
Stationary.......................................................... ........ do___
Worse................................................................ .
_
Deaths................................................................_ ..do___

Females.

Males.

Females.

15,869
89.2

4,008
94.4

34,071
86.6

12,632
95.8

10.5
44.0
30.1
15.4
26.4
16.5
54.4
9.8
17.9
48.9
33.2
93.6
13.0

20.4
57.8
17.6
4.4
36.7
21.2
54.6
8.2
* 18.0
44.6
37.5
92.3
11.5

8.5
44.3
31.8
15.4
25.2
19.6
61.9
16.9
19.1
51.2
29.7
95.9
14.6

16.6
59.3
18.8
5.3
36.7
24.4
64.7
12.3
18.9
50.5
30.6
94.1
12.8

32.9
36.8
30.2

28.2
31.7
40.1

23.1
49.5
27.4

20.7
42. 6
36.8

57.5
40.1
2.4
91.1
4.5
122.8
45.3
234.4
13.8
8 68.6
29.8
<90.7

59.0
38.4
2.6
65.7
18.5
126.2
30.0
225.0
19.4
863.3
27.3
<85.2

64.2
34.0
1.8
92.0
3.3
126.3
35.1
233.4
14.5
8 71.9
25.4
<91.7

66.1
32.4
1.5
65.9
17.6
132.7
21.8
229.4
14.9
8 57.3
18.3
<85.8

31.3
52.9
15.8
25.0

28.4
58.4
13.2
19.7

37.3
46.2
16.5
23.3

51.0
37.4
11.6
25.8

84.2
10.3
5.1
0.4

75.7
17.0
7.1
0.2

91.2
6.3
2.2
0.3

88.4
8.8
2.6
0.2

1 Of those having cough and expectoration on admission.
* Of those showing positive bacillary diagnosis on admission.
* Of those having fever on admission.
<Of those having night sweats on admission.




1902 to 1904

CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

165

APPENDIX II.—MEMORANDUM ON TUBERCULOSIS.
[Compiled and published in English by German Imperial Board of Health at Berlin.]
A. WHAT IS TUBERCULOSIS?

Tuberculosis 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 numerous. Every third person who dies between the
ages of 15 and 60 years succumbs to tuberculosis.
Tuberculosis is caused by the tubercle bacillus discovered by Robert Koch.
This is a minute creature of the lowest scale, visible only when very highly
magnified. It thrives best at blood temperature (about 98° F.) and multiplies in
the interior of the body. It reaches the outer world chiefly in the sputum of
sick persons and in the milk of diseased animals.
Every person 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.1
Everyone must therefore be prepared for battle with this enemy.
The tubercle bacillus is most efficiently destroyed by burning, boiling, or
steaming. It can not long resist the action of sunlight. Other means of
disinfection, such as cresol water, a solution of carbolic acid, formaldehyde,
require a special previous knowledge for safe and effective use.
B. HOW DOES THE INFECTION TAKE PLACE?

Hereditary tuberculosis is rare.
Tubercle bacilli enter the human body mainly by the respiratory organs and
the digestive system.
Tubercle bacilli are taken up—
1. By inhaling 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 on 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, first through unboiled milk, also, in case of unsatisfactory
inspection of meat through the flesh of tuberculous animals, which, admitted
in trade, was not afterwards thoroughly cooked before being eaten.
3. By means of unclean hands and unclean utensils, e. g., in the case of chil­
dren crawling on the floor, seizing soiled objects (clothing, handkerchiefs, and
the like) and immediately afterwards putting the fingers into the mouth
(sucking fingers, 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.
Tubercle 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,
tubercular excrescences, voluntary limping), the cerebral membrane, etc. In
the case of adults infection by inhalation predominates and leads to tuberculosis
of the lungs, more infrequently of the larynx (consumption). Through absorption1
1 One-fourth of the corpses o f persons who have died from other diseases show internal
traces o f tuberculosis that had been overcome.




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BU LLETIN OF TH E 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 TUBERCULOSIS?

Each person, even the weakest and poorest one, will highly contribute to
guarding himself against tuberculosis by merely combining judgment with selfcontrol.
I.

M easures a g a in s t c o n tra c tin g 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 sputum
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 short intervals by disinfecting methods. 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
drinking 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 the
dwelling room, the work place, and on the street should be avoided whenever
possible. 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 before being
eaten; the boiled milk should be covered and kept as cool as possible.
3. The hands, including the nails, the teeth, and mouth, should be cleansed
frequently and thoroughly. Putting the fingers into the mouth or nose and *
also scratching the face should be discontinued. Every sore 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—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) from 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; 1
keeping the stalls clean.
1Many large dairies now heat all the milk before manufacture so that all danger Is
removed.




CABE OP TUBEBCULOUS WAGE EABNEBS IN’ GEBM ANY.

167

I I , M easures f o r s tre n g th e n in g th e body .

It will be impossible to extirpate all tubercle bacilli, therefore it is indis­
pensable so -to strengthen and harden the body that the absorbed germs can not
take hold upon it. The principal means1 are:
Plain and wholesome 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
than in the heart of the 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
warmer than in that of someone frequently in motion; discarding the follies of
fashion that hamper the free movement of the body, e. g., the corset and belts.
Only after defraying the necessary costs of dwelling, eating, and clothing,
other expenses may be considered.
Let order and cleanliness have the first place in the whole conduct of life.
Wash the whole body daily with moderately cold water or rub it vigorously
with a rough, damp cloth, 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
clean. Breathe through the nose keeping the mouth shut; the former is the
natural filter for impure and injurious substances. If breathing through the
nose is difficult, be examined by a physician; it is often easy to remove the
impediment.
Seek to perform your work in accordance with your health. Take advantage
of prescribed measures for protection. Avoid a bent position in intellectual
work. 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 strengthening 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
the open air in unfavorable weather. Change wet clothing and shoes. Gym­
nastic exercises—especially when out of doors—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.
Go 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 moderately strong coffee or tea, a cigar—enjoyed at
the proper time—injure the normal adult body as much as every intemperance
injures it.
Finally, 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 especially 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 with a flat
1 Further particulars are contained in the “ Gesundheitsbiichlein,’’ compiled in the Kais.
Gesundheitsamt. 13. Ausgabe, Berlin, J. Springer, 1908.




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B U LLETIN OF TH E BUREAU OF LABOR,

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 workmen, or playmates) or in consequence of their own sickness
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 sickness, from measles, whooping cough, influenza, and gen­
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 corresponding 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 precau­
tion in every place where people assemble in large numbers through their occu­
pation or from other causes (in schools, boarding schools—corresponding con­
duct of tuberculous teachers—factories, hotels, poorhouses, orphanages). Neg­
lect of tuberculosis by individuals endangers the general public.
E. ADVICE TO DISEASED PEBSONS.

If symptoms appear that arouse the suspicion of a not merely transient dis­
ease of the respiratory passages, repeated coughing (dry or with sputum), fre­
quent pains in the throat, breast, or back, lasting depression 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 anticipation.
Especial attention should be paid to the sputum; it should neither be cast
upon the floor nor swallowed, but rather be vented 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



CAEE OF TUBERCULOUS WAGE EARNERS IN GERM ANY.

169

not too short a sojourn (not under 3 months), the obedient and attentive pa­
tient often regains not only his health, but appropriates to himself also the
rules of living necessary to avoid relapses.
To poor consumptive people advice and help is given free of charge by the
information and care offices recently so often established (Auskunfts- und Fiirsorgestellen) and by dispensaries for tuberculous people.
APPENDIX m .—DEFINITION OF GERMAN TERMS RELATING TO TREAT­
MENT AND CARE OF TUBERCULOUS WAGE EARNERS.
1. Heilbehandlung: This term has been interpreted as “ treatment and care.”
There is no exact equivalent of this term in the English language.
2. Heilverfahren: This term has been interpreted as “ systematic institutional
treatment and care.” There is no exact equivalent of this term in the
English language.
3. Landes-Versieherungsanstalt: 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
old age.
4. Fursorge: 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 been interpreted as “ permanent economic re­
sults of treatment and care,” but in actual practice the observed results
are generally 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
sanatorium.
6. Walderholungstatte: This term has been interpreted as “ forest day and
night camps,” and on some occasions as “ forest convalescent homes.”
7. Invalidenpensionen: This term has been 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
members provided with accommodation in homes of this kind pay for
their support by means of their invalidity or disability annuities.
8. Erwerbsfahigkeit: 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 daily 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. Volksheilstatten: 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.
11. Privatheilanstalten: This term has been 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
duced rates.



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B U LLETIN OF TH E BUBEAU OF LABOB.

12. Kinderheilstatten: 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, anemic, or
otherwise impaired in health.
13. Schulsanatorien: This term is practically the equivalent of No. 12 (Kinder­
heilstatten), except that the accommodation is limited to tuberculous
school children.
14. Waldschulen: This term has been interpreted as “ open-air” or “ forest”
schools. In the strict interpretation of the term the schools are open-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. Landliche Kolonien: This term has been interpreted as “ agricultural col­
onies” which provide treatment and care for convalescing tuberculous
wage earners, together with possibilities for light outdoor work under
medical supervision.
16. Invalidenheime: This term is the equivalent of No. 7 (Invalidenpensionen).
17. Genesungsheime: This term has been interpreted as “ convalescing homes,”
but the meaning is somewhat indefinite and the accommodation may be
for tuberculous as well as nontuberculous wage earners, chiefly, however,
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 patients’ condition
and to safeguard against the admission of the nontuberculous to institu­
tions provided for the treatment and care of tuberculous wage earners.
19. Folikliniken: This term has been translated “ tuberculosis clinics,” usually
conducted in connection with hospitals and medical schools.
20. Auskunfts- und Fursorgestellen: This term has been translated as “ infor­
mation bureaus and tuberculosis dispensaries,” in clear distinction to
polyclinics and tuberculosis clinics, which provide medical treatment and
medicines, which is not 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 official patronage and subsidized by
State and municipal contributions, or the financial aid rendered by inva­
lidity insurance institutions, sick funds, etc.
22. Deutsches Zentral-Komite zur Errichtung von Heilstatten Lungenkranker:
This term has been translated, briefly, as “ The German Central Commit­
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 financially 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. 518 of the miscellaneous section of diplomatic and
consular reports and reprinted in Bulletin of the Bureau of Labor, No. 91.




CARE OF TUBERCULOUS WAGE EARNERS IN GERMANY.

APPENDIX IV.— LEGAL PROVISIONS REGARDING TREATMENT
ACTUAL OR PROSPECTIVE INVALIDS.

171
OF

The special treatment o f actual or prospective invalids was pro­
vided for in section 18 o f the German Invalidity and Old Age In­
surance Law o f 1899,1 as follow s:
S ection 18. If an insured person is so ill that incapacity to earn a livelihood
is to be apprehended as a consequence of the illness, which would constitute a
claim to a pension, 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 institution 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 has a household of his own, or if he is a member of the household
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 be paid to such persons as are dependent upon
the insured person, and for whose maintenance the insured person has hitherto
provided 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 fourth of the standard daily wages of ordinary day laborers in
the locality of his last employment 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 o f the invalidity insurance institution and the
sickness insurance association in connection with the special treat­
ment o f invalids was provided for in section 19 o f the law, as follow s:
S ection 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 burden is thereby imposed on the funds which exceeds the
extent of the provision to be 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 person; 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
so far as greater expenses are not proved.

The cooperation o f industrial accident associations was provided
for in section 21 o f the law, as follow s:
S ection 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
prevented by the curative course, and, at the same time, a burden to the person
upon whom the cost of indemnification in cases of accident 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
1 For text of this law see Bulletin of the Bureau of Labor, No. 91, p. 966 et seq.




.172

B U LLETIN OF TH E BUREAU OF LABOR.

against 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 week after the accident oc­
curred, can not be claimed.

It was further provided by the law o f 1899, under section 22, that:
S ection 22. If the insured in consequence of the illness becomes incapable of
earning a livelihood, he can, in cases where he has 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 livelihood is the result of his
own conduct.

Under section 45 o f the law o f 1899 authority was granted to the in­
validity insurance institutions to advance loans for the establishment
o f sanatoria or to erect such sanatoria on their own account. The
section follow s :
S ection 45. By unanimous decision 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 dependents
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 longer suf­
fices to permanently cover their obligations.

In addition to the above provisions the follow ing articles o f the
W orkm en’s Insurance Code o f July 19, 1911, provide fo r medical
treatment for the prevention o f in validity:1
V. MEDICAL TREATMENT.
A rticle

1269.

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
medical treatment.
A rticle 1270.
P a r a g r a ph 1. The insurance institute may in particular place the insured
person in a hospital or in an institution for convalescents.
Par. 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.
Par. 3. In the case of a minor person, his consent shall be sufficient.
A rticle

1271.

The relatives of the sick person whose support he has either wholly or prin­
cipally defrayed out of his earnings shall, during the course of treatment (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 shall amount to
one-fourth of the local wage for an adult day laborer. If, however, up to the
1 For text of this law see Bulletin of the Bureau of Labor, No. 96, p. 514 et seq.




CARE OP TUBERCULOUS WAGE EARNERS IN GERM ANY.

173

assumption 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 pension may be either
wholly or partly refused for the duration of the course of treatment. The
house 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.
A rticle

1272.

If the sick person without legal or other reasonable ground declines to receive
the medical treatment (art. 1269) and if the invalidity could probably have
been prevented through the medical treatment, then the pension may, for the
time being, be refused either wholly or partly if the sick person has been noti­
fied of this consequence.
A rticle 1273.
In regard to controversies which have not been settled on the determination
of the pension, the superior insurance office shall decide finally upon the appeal.
A rticle

1274.

With the approval of the supervisory authority, the insurance institute may
expend its funds to promote or to carry out general measures for the preven­
tion of premature invalidity among insured persons or improve the health con­
ditions of the population subject to the insurance. Approval may also be
granted for the expenditure of lump sums.
APPENDIX V.—BIBLIOGRAPHY.
American Sanatorium Association: Tuberculosis Nomenclature and Classifica­
tion, A Committee Report approved by the American Sanatorium Associa­
tion. (Journal of the American Medical Association. Sept 25, 1909,
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Amsterdam. Bureau van Statistiek: Statistiques DSmographique des Grandes
Villes du Monde pendant les Annies 1880-1909. Bureau municipale de
Statistique d’Amsterdam. Amsterdam, 1911. (Statistische Mededeelingen, No. 33.)
Austria. Statistisches Zentral-Kommission: Die Gemeinniitzigen Kleinwohnungs-Anlagen in den in Reichsrate vertretenen Konigreichen und Landern nach den Ergebnissen der Erhebung vom 17. April, 1909. Zusammengestellt von dem Bureau der K. K. Statistischen Zentral-Kommission.
Briinn, 1910. 124 p.
Baer, Otto: Statistische Beitrage zur Beurteiling des Wertes der Heilstattebehandlung bei Lungentuberkulose, von Otto Baer. Zweibriicken, Buchdruckerei Hermann & Otto Hallazy, 1909.
Basse & Selve, Firm, Altena, Westphalia: Dwellings for Workmen with Pul­
monary Disease of the Firm Basse & Selve in Altena in Westfalia. [n. d.]
Bender, A : Gewerbliche Gesundheitspflege, von Dr. A. Bender. Stuttgart, E. H.
Mortiz, 1906.
Bielefeldt, Alwin: Die bisherigen Leistungen der Heilstatten, von A. Bielefeldt. Sonderabdruck aus den Yerhandlungen der 11. General-Yersammlung des Deutschen Zentral-Komitees zur Bekaempfung der
Tuberkulose, 23. Mai, 1907.
Die Heilbehandlung der gegen Unfall und Invaliditat versicherten Arbeiter
in Deutschland. Im amtlichen Auftrage fur die Weltausstellung zu Paris,
bearb. von Bielefeldt. Berlin, A. Asher & Co., 1900. 56* p.



174

B U LLETIN OF TH E BUREAU OF LABOR,

Bielefeldt, Alwin—Continued.
Invalidenversicherung und Volksgesundheit, von A. Bielefeldt. (VII. Intemationaler Arbeiterversicherungs-Kongress, 17-23, Sept. Wien, 1905.
In French issue of the same: CongrSs International des Accidents du
Travail et des Assurances Sociales. Septieme session, tenue & Vienne du
17 au 23 Sept., 1905, v. 2, p. 35-55.)
Die Krankheit und die Arbeitsunfahigkeit (Invalidity) an und fiir sieh
und in ihren gegenseitigen Beziehungen in Hinsicht sowohl auf die
Verhiitung als auf die Versicherung, von M. A. Bielefeldt. (Congrfcs
International des Assurances Sociales. 8me session, Rome, Octobre, 1908.
Rome, 1909. v. 2, p. 495-517.)
Bremer Vereip zur Bekampfung der Tuberkulose. Siebenter Jahresbericht des
Bremer Vereins zur Bekampfung der Tuberkulose. Bremen, 1911.
Das Deutsche Reich in gesundheitlicher und demographischer Beziehung.
Puttkammer & Muelbrecht, Berlin, 1907.
Deutscher Verein gegen den Missbrauch geistiger Getranke. Was sollen LungenGefahrdete und -Kranke vom Alkohol wissen? Deutscher Verein geg. d.
Missbrauch geistiger Getranke. Berlin.
Deutsches Zentral - Komitee zur Bekaempfung der Tuberkulose, Berlin.
Anweisung fiir die Bekampfung der Tuberkulose in kleinen Landgemeinden, von Prof. Dr. Nietner, Generalsekretar. Berlin, 1909.
Beilage zum Geschaftsberieht, 1911.
Kurze Ubersicht tiber die Tatigkeit des Central-Komitees in den Jahren
1896 bis 1905 und Geschaftsberieht fiir die Generalversammlung am 31.
Mai, 1906, von Dr. Nietner, Generalsekretar. Berlin, 1906.
Der Stand der Tuberkulose-Bekampfung in Friihjahre 1908,1909,1910,1911,
von Prof. Dr. Nietner, Generalsekretar. Berlin, 1908-1911.
Tuberkulose und Wohnungsfrage. Verhandlungen des Zentral-Komitees
in der Generalversammlung am 11. Mai, 1910. von Prof. Dr. Nietner.
Berlin.
Verhandlungen des Zentral-Komitees. 1907-1909,1911, von Prof. Dr. Nietner,
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Wie konnen die Miitter ihre Kinder vor der Tuberkulose, dem krgsten
Feinde der Volksgesundheit, schiitzen? [Berlin.]
Deutsches Zentral-Komitee zur Errichtung von Heilstatten fiir Lungenkranke,
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Jan. 1900. Berlin, 1900.
Verhandlungen, Marz, 1901; Mai, 1906. Berlin, 1901-1906.
Engelmann: Results of the Open Air Treatment of Consumption. Report by
Regierungsrat Dr. Engelmann. Berlin, J. Springer, 1901.
Ernest Ludwig-Heilstatte, Sandbach i. O .: Geschafts-Bericht der “Ernst
Ludwig-Heilstatte ” bei Sandbach i. O. fiir das Jahr 1910. LandesVersicherungsanstalt Grossherzogtum Hessen.
Florschiitz, G .: Die friihzeitige Feststellung des Vorhandeseins einer Veranlagung zur Tuberkulose, insbesondere zur Lungentuberkulose, von Prof.
G. Florschiitz, Gotha. (IV. Internationaler Kongress fiir VersicherungsMedizin zu Berlin 11. bis. 15. September, 1906.)
Frankel, Bernhard: Asyle fiir Tuberkulose, von Geh.-Rat Prof. Dr. B. Frankel,
Berlin, [n. d.].
Frankel, Carl: Die Lungentuberkulose, ihre Entstehung, Verhiitung und
Heilung, von Prof. Carl Frankel, Halle a. S. Verein zur Bekampfung
der Schwindsucht in der Provinz Sachsen nnd dem Herzogtum Anhalt



CAEE OP TT7BEBCULOTJS WAGE EABNEBS IN GEBMANY.

175

German Workingmen’s Insurance. A Conspectus of its Work issued on the
Occasion of the International Exhibition of Hygiene at Dresden and the
International Exhibition of Manufacturers and Trades at Turin, 1911.
Germany. Gesundheitsamt: Medizinal-statistische Mitteilungen aus dem Kaiserlichen Gesundheitsamte. 14. Band, 2. Heft. Berlin, 1911.
Deutsche Heilstatten fur Lungenkranke. (Tuberkulose-Arbeiten aus dem
Kaiserlichen Gesundheitsamte. Berlin, J. Springer, 1904-12. 2., 4., 5.,
6., 13 Hft.)
Statistik der Ursachen der Erwerbsunfahigkeit (Invaliditat) nach dem
Invaliditats- und Altersversicherungsgesetz. (Amtliche Nachrichten Beiheft. Berlin, 1898.) 1 p. 1., xvi, 227 p.
Germany. Laws: Invalidenversicherungsgesetz. Vom 13. Juli, 1899. [Berlin,
Reichsdruckerei, 1899] p. 393-462. (Reichsgesetzblatt, 1899, nr. 33.)
Translated in United States Bureau of Labor Bulletin No. 91, pp. 965-

1002.
Reichsversicherungsordnung. Vom 19. Juli, 1911. [Berlin, Reichsdruckerei, 1911] pp. 509-860. (Reichsgesetzblatt, 1911, nr. 42.) Translated
in United States Bureau of Labor Bulletin No. 96, pp. 501-757.
Versicherungsgesetz fiir Angestellte. Vom 20. Dezember, 1911. [Berlin,
Reichsdruckerei, 1911] pp. 989-1061. (Reichsgesetzblatt, 1911, nr. 68.)
Translated in United States Bureau of Labor Bulletin No. 107.
Germany. Reichs-Versicherungsamt: Statistik der Heilbehandlung bei den
Versicherungsanstalten und zugelassenen Kasseneinrichtungen der Invalidenversicherung ftir die Jahre 1909-1910. (Amtliche Nachrichten,
1905-1911. Beihefte: 1905, No. 1; 1906, No. 2 ; 1907, No. 1 ; 1908, No. 1;
1909, No. 2; 1910, No. 2; 1911, No. 1. Berlin, 190&-11.) 7 v.
Statistik der Ursachen der Erwerbsunfahigkeit (Invaliditat) nach dem
Invaliditats- und Altersversicherungsgesetz fiir die Jahre 1896 bis 1899.
(Amtliche Nachrichten, 1903. 2. Beiheft. Berlin, 1904.) xxiii, [1], 231,
[1] P.
Ubersicht iiber die am 1. Januar 1910 bei den Tragem der Invalidenversicherung gemass, sec. 164, art. 3 des Invalidenversicherungegestzes zum
Zwecke der Arbeiterwohnungsfiirsorge und fiir andere, insbesondere
gemeinniitzige Zwecke verfiigbar gewesenen und von ihnen aufgewendeten Beitrage. (Amtliche Nachrichten. Nr. 3,15. Mhrz, 1911, 27. Jahrg.
pp. 337-339.)
Germany. Statistisches Amt: Bevolkerung des Deutschen Reiches am 1. Dezem­
ber, 1910. (Vierteljahrshefte zur Statistik des Deutschen Reiches. 20.
Jahrg., 1911, 1. Heft Berlin, 1911.)
Bewegung der Bevolkerung im Jahre 1909. (Statistik des Deutschen
Reichs, Band 236. Berlin, 1911.)
Statistisches Jahrbuch fiir das Deutsche Reich. 32. Jahrg., 1911. Berlin,
1911.
Germany. Statistisches Amt: Abteilung fiir Arbeiterstatistik: Die Arbeiterversicherung in Europa nach dem gegenwartigen Stande der Gesetzgebung in den verschiedenen Staaten. (Sonderbeilage zum ReichsArbeitsblatt, Nr. 7, Juli, 1910.)
Wohnungsfiirsorge in deutschen Stadten. Bearbeitet im Kaiserlichen
Statistischen Amte. Abteilung fiir Arbeiterstatistik. Berlin, C. Heymanns Verlag, 1910.
Gemeinniitzige Vermogensanlage der Trhger der Invalidenversicherung.
(Reichsarbeitsblatt, 9. Jahrg., April, 1911, Nr. 4, pp. 299-300.)
Die Heilbehandlung in der Invalidenversicherung. (Reichs-Arbeitsblatt,
March, 1911, pp. 203-210.)




176

B U LLETIN OF TH E BUREAU OF LABOR.

Gocke, Theodore: Die Lungenheilstatte der Landes-Versicherungsanstalt
Brandenburg in der Cottbuser Stadtforst bei Kolkwitz, in ihrer baulichen
Anlage und Einrichtung, beschrieben von ihrem Architekten Theodore
Gocke.
Gottstein, A : Die friihzeitige Feststellung des Yorhandenseins einer Yeranlagung
zur Tuberkulose, insbesondere zur Lungentuberkulose, von Sanitatsrat
Dr. A. Gottstein. (IV. Internationaler Kongress ftir Versicherungs-Medizin du Berlin 11, bis 15. September, 1906.)
Great Britain Local Government Board: Supplement in Continuation of the
Report of the Medical Officer from 1905-1906, on Sanatoria for Con­
sumption and certain other Aspects of the Tuberculosis Question. Lon­
don, 1908. xii, 670 p.
Hannoverscher Provinzialverein zu Bekampfung der Tuberkulose. Verwaltungsbericht 1909 des Hannoverschen Provinzialvereins zur Bekampfung
der Tuberkulose. Hannover, 1910.
Hanseatische Yersicherungsanstalt, Liibeck. Ratschlage fiir Lungenkranke,
zusammeugestellt von der Hanseatischen Yersicherungs-Anstalt in Liibeck. Hrsg. von der Yereinigung zur Fiirsorge fiir kranke Arbeiter zu
Leipzig, 1905.
Die Heilstatte Heidehaus bei Hannover, [n. d.]
Heilstatte Albertsberg bei Auerbach i. Y. Verhaltungsmassregeln fiir Lungen­
kranke bei der Entlassung aus der Heilstatte Albertsberg bei Auerbach
i. V., 1908.
Heilstatte Holsterhausen, Werden, Essen-Ruhr.
Heilstatte Nordrach-Kolonie. II. Jahresbericht der Heilstatte Nordrach-Kolonie
fiir das Jahr 1910. Landes-Versicherungsanstalt Baden.
Heydweiller-Liidenscheid: Ueber Bekampfung der Tuberkulose durch Wohnungsfursorge, von Landrat Dr. Heydweiller-Liidenscheid. Sonderabdruck aus den Yerhandlungen der Jahresversammlung des Deutschen
Zentral-Komitees, 23. Marz, 1901.
Kehl: Die Forderung des Wohnungsbaues durch die deutsche Arbeiterversicherung, von Geheimen Regierungsrat Kehl. Berlin, 1909.
Koch, Robert: Epidemiology of Tuberculosis, by Robert Koch. (In Smithso­
nian Institution Annual Report, 1910. Washington, 1911. pp. 659-674.)
“ Translated from Zeitschrift fiir Hygiene, Leipzig, 1910. v. 67, pt. 1,
pp. 1-18.”
Koehler, F .: Die Lungenheilstatten im Lichte der historischen Entwicklung der
Tuberkulosebekampfung, von Chefarzt Dr. F. Koehler, Heilstatte Hol­
sterhausen, Werden bei Essen Ruhr.
Krupp’sche Gussstahlfabrik, Essen-Ruhr. Fiihrer durch die Wohlfahrtseinrichtungen der Gussstahlfabrik. [n. d.]
Landes-Yersicherungsanstalt Baden. Jahresbericht der Heilstatten Friedricbi
heim und Luisenheim fiir das Jahr 1910. Landes-Versicherungsanstalr
Baden, [1911]
Landes-Versicherungsanstalt Berlin. -Die Heilstatten Beelitz und sonstige Einrichtungen der Landes-Versicherungsanstalt Berlin im Kampfe gegen die
Tuberkulose. Berlin, 1908.
Heilverfahren der Landes-Yersicherungsanstalt Berlin im Jahr. 1909. Ber­
lin, Druck von W. & S. Loewenthal, [1910]
Landes-Versicherungsanstalt Brandenburg. Auszug aus dem Verwaltungsberieht des Yorstandes der Landes-Yersicherunganstalt Brandenburg fiir
das Geschaftsjahr 1910 betreffend die Lungenheilstatte Cottbus bei
Kolkwitz.



CARE OP TUBERCULOUS WAGE EARNERS IN GERMANY.

177

Landes-Versicherungsanstalt Hannover. Bericht des Vorstandes der LandesVersicherungsanstalt Hannover iiber die Verwaltungdersecbs Genesungsh&user in den Jahren 1904-07, nebst drei Bericbten iiber die Krankenfiirsorge in den Badern Oynhausen, Nenndorf und Rehburg sowie in St.
Andreasberg. Hannover, Buchdruckerei Friedrich Culemann (M. Leonhardt), 1908.
Forderung des Baues von Arbeiterwohnungen bis 1. Jan., 1906. Sonderbericht der Landes-Versicherungsanstalt Hannover. Hannover, 1907.
Landes-Versicherungsanstalt der Hansastadte. Ergebnisse des von der LandesYersicherungsanstalt der Hansastadte eingeleiteten Heilverfahrens bei
Lungenkranken Versicherten bis Ende 1903. Hamburg, Luetcke & Wulff,
Senats Buchdrucker, [1904]
Die Beteiligung der Landes-Yersicherungsanstalt der Hansastadte an der
Bekampfung der Tuberkulose. Liibeck, 1904.
Heilbehandlung von Versicherten und Fiirsorge fiir Invalide bei der LandesYersicherungsanstalt der Hansastadte, 1909. Liibeck, 1910.
Landes - Versicherungsanstalt Sachsen - Anhalt: Lungen - Heilstatte Schielo.
Landes-Versicherungsanstalt Sachsen-Anhalt.
Landes-Versicherungsanstalt Schlesien. Arzt und Invalidenversicherung, bearbeitet im Auftrage des Vorstandes der Landes-Versicherungsanstalt Schle­
sien, von Landesrat Dr. Gerber und Sanitatsrat Dr. Legal, Vertrauensarzt der L.-V.-A. Schlesien. Breslau, 1910.
Landes-Versicherungsanstalt zu Weimar.
Das Invalidenheim der Thiiringischen Landes-Versicherungs-Anstalt zu Weimar. 1911.
Libawski [Richard]: Eine Answeisung fiir Krankenpflegesehwestem, [von Dr.
Med. R. Libawski. Breslau.]
Die Tuberkulose als Volkskrankheit und ihre Bekampfung, von Dr. Richard
Libawski. Schlesischer Provinzialverein zur Bekampfung der Tuber­
kulose.
Magdeburger Verein zur Bekampfung der Lungenschwindsucht. Verwaltungsbericht des Magdeburger Vereins zur Bekampfung der Lungenschwind­
sucht, fiir die Zeit vom 1. April-31, Marz, 1910.
Mayet: 25 Jahre Todesursachenstatistik; hierzu 4 Tafeln mit Diagrammen.
Referent: Regierungsrat Professor Dr. Mayet. (In Germany. Statistisches Amt. Vierteljahrshefte zur Statistik des Deutschen Reichs. 12.
Jahrg. 1903, Nr. Ill, p. 162-168.)
Meirerei O. Bolle, Berlin: Bekampfung der Tuberkulose, durch die Einrichtungen der Meierei C. Bolle, Berlin, [n. d.]
Meyer: Finanzielle und rechtliche Trager der Heilstattenunternehmungen, von
Landesrat Meyer in Berlin. Halle a. S., Buchdruckerei des Waisenhauses, 1899.
National Association for the Study and Prevention of Tuberculosis, Committee
on Clinical Nomenclature. Report of the Committee on Clinical Nomen­
clature. (In National Association for the Study and Prevention of
Tuberculosis. Transactions of the Second Annual Meeting, Washington,
D. C., May 16-18, 1906. Lancaster, Pa., 1906, p. 291-296.)
Nietner: Die Tuberkulose als Volkskrankheit und ihre Verhiitung, von Prof.
Dr. Nietner, Generalsekretar des Deutschen Zentral-Komitees zur Be­
kampfung der Tuberkulose. Berlin, 1911.
Nietner, and Lorentz, Fried.: Wesen der Tuberkulose als Volkskrankheit und
ihre Bekampfung durch die Schule, von Prof. Dr. Nietner, Generalsekre*
taer des Deutschen Zentral-Komitees zur Bekaempfung der Tuberkulose
und Fried. Lorentz, Lehrer. Berlin, 1909.
49397°—12-----12



178

B U LLETIN OF TH E BUREAU OF LABOR.

Flitter, Ernst: Die Bekampfung der Tuberkulose innerhalb der Stadt, ein
Beitrag zur Wohnungsfrage, von Ernst Putter. Berlin, Yerlagsbuchhandlung yon Richard Schotz, 1907.
PUtter, and Kayserling, A .: Die Errichtung und Yerwaltung yon Auskunfts- und
FUrsorgestellen fUr Tuberkulose, von PUtter und Dr. A. Kayserling.
Berlin, August Hirschwald, 1905.
PUtter, [Ernst]: German Information Bureaus and Dispensaries (Auskunftsund FUrsorgestellen) for Consumptives in Berlin.
Reiche, F .: Die Erfolge der Heilstattebehandlung Lungenschwindstichtiger, von
Dr. F. Reiche. Leipzig, Georg Thieme, 1899.
Rheinischer Verein ftir Kleinwohnungswesen. Jahresbericht des Rheinischen
Vereins ftir Kleinwohnungswesen ftir 1909 und 1910. DUsseldorf, Druck
von August Bagel, 1911.
Rosatzin, Th.: FUrsorgestelle ftir Lungenleidende in Hamburg. Jahresbericht
ftir 1910, von Dr. Th. Rosatzin, II. Schriftfuehrer.
Rumpf, E .: Beitrag zur Bewertung der Heilstattebehandlung Lungenkranker
von Direktor Dr. E. Rumpf. Separatabdruck aus der Mtinchener medizinischen Wochenschrift. [n. d.]
Sachsischer Volksheilstatteverein, Auerbach. Bericht des Sachsischen Volksheilstattevereins auf das Jahr 1910. Auerbach, 1911.
Schlesischer Provinzialverein ftir Lungenkranke. Was kann der Einzelne tun
im Kampfe gegen die Tuberkulose? [Dieser Vortag ist auf Anregung des
Schlesischen Provinzialvereins ftir Lungenkranke 1908 ftir die Zoeglinge
des Schles. Seminare geschrieben worden.]
Schlesischer Provinzialverein zur Bekaempfung der Tuberkulose. Was sollt Ihr
in der Heilstatte gelernt haben? Schlesischer Provinzialverein zur
Bekaempfung der Tuberkulose. Breslau, 1907.
Schmidt, C .: Die Aufgaben und die Tatigkeit der deutschen Invalidenversicherungsanstalten in der Arbeiterwohnungsfrage, von C. Schmidt,
Doctor der Staatswissenschaft. Coin, Paul Neubner, 1905.
Schmidt, L. F. Karl: Die Kleinwohnungsbauten des Yerbandes Sachs. Industrieller, bearbeitet von L. F. Karl Schmidt, Oberbaurat in Dresden.
Schon, Max: Die Invalidenversicherung des Deutschen Reiches im taglichen
Leben, von Max Schon. Grunewald-Berlin, Yerlag der Arbeiter-Yersorgung, A. Troschel, 1906.
Schtirmann, Fr.: Die Bedeutung der deutschen Lungenheilstatten ftir die
Bekampfung der Tuberkulose als Volkskrankheit, von Dr. Schtir­
mann, Stadtassistenzarzt in Dtisseldorf. Berlin, August Hirschwald.
Siefart, H .: Der Begriff der Erwerbsunfahigkeit auf dem Gebiete des Versicherungswesena 3d ed., Berlin, 1908.
Statistique D^mographique des Grandes Yilles du Monde pendant les Annies
1880-1909. Johannes Mueller, Amsterdam, 1911.
Thtiringische Landes-Yersicherungs-Anstalt, Weimar. Die Invalidenpflege der
Thtiringischen Landes-Versicherungs-Anstalt zu Weimar.
Tuberkulose-Merkblatt, bearbeitet im Kaiserlichen Gesundheitsamte
Tuberkulose-Merkbuch. Schlesischer Provinzialverein zur Bektimpfung der
Tuberkulose und Breslauer Yerein zur Ftirsorge ftir unbemittelte Lungen­
kranke.
Ulrici, H .: Das Krankenmaterial und die Therapeutischen Leistungen der
Lungenheilanstalten, von Dr. H. Ulrici, Chefarzt der Heilstaette Muellrose. Sonderabdruck aus “ Reichs - Medizinal - Anzeiger,” Jahrg. 1910.
[Nr.] 14 & 15.
Vaterlandischer Frauenverein zu Cassel. Der Neubau (FrauenabteUung) der
Heilstatte zu Oberkaufungen, bearbeitet vom Vorstand der Sektion YII
(Heilstatte zu Oberkaufungen) des Yaterlandischen Frauenvereins zu

Cassel. Cassel, 1911.


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179

Verband der Vaterlandischen Frauen-Yereine der Provinz Schlesien. Bericht
liber die siebenzebnte General-Yersammlung des Yerbandes der Vater­
landischen Frauen-Yereine, der Provinz Schlesien am 3. September, 1907.
Breslau, 1907.
Yerband Rheinischer Baugenossenschaften. Die Frage der Geldbeschaffung
fiir den Kleinwohungsbau. Bericht liber die VIII. Generalversammlung
des Yerbandes Rheinischer Baugenossenschaften am 5. November 1910.
Diisseldorf, 1910.
Yerein fiir Kinderheilstatten an den deutschen Seekiisten. XXI. Jahresbericht
des Vereins fiir Kinderheilstatten an den deutschen Seekiisten. Berlin,
1911.
Verein fiir Volksheilstatten in Oberbayern. XY. Bericht des Yereins fiir
Volksheilstatten in Oberbayern, 1910. Mtinchen, 1911.
Verein zur Bekampfung der Schwindsucht in Chemnitz und Umgebung: Merkblatt zum Schutz gegen Schwindsucht. Eigentum des Yereins zur Be­
kampfung der Schwindsucht in Chemnitz und Umgebung.
Verein zur Bekampfung der Schwindsucht in Chemnitz und Umgebung. Ratschiage fur die Haltung und Reinigung der Wohnungen Tuberkuloser
zur Verhiitung der Ansteckung. Eigentum des Vereins zur Bekampfung
der Schwindsucht in Chemnitz und Umgebung.
Verein zur Bekampfung der Schwindsucht in der Provinz Sachsen und dem
Herzogtum Anhalt. Die Kinderheilstatte Herzogin Marie bei Oranienbaum in Anhalt. Yerein zur Bekampfung der Schwindsucht in der Pro­
vinz Sachsen und dem Herzogtum Anhalt.
Die Yereinigung der Flirsorgebestrebungen in einer Gemeinde. Verlag, Norddeutsche Verlagsgesellschaft m. b. H., Berlin.
Vereinigung zur Flirsorge fur Kranke Arbeiter, Leipzig. Belehrung liber die
ersten Anzeichen beginnender Lungenschwindsucht und Mahnung zu
deren Beachtung. Vereinigung zur Flirsorge fur kranke Arbeiter, Leipzig.
Bestimmungen fiir die Erholungsstatten Leipzig-Stotteritz der Yereinigung
zur Flirsorge fur kranke Arbeiter zu Leipzig.
Einiges liber die Walderholungsstatten fur Lungenkranke in Leipzig-Stot­
teritz. Yereinigung zur Flirsorge fiir kranke Arbeiter, Leipzig.
Die Staubkrankheiten der Arbeiter und die Mittel zu ihrer Verhiitung.
Vereinigung zur Fursorge fur kranke Arbeiter. Leipzig, 1908.
Vogt, Gustav. Die Vorteile der Invalidenversicherung und ihr Einfluss auf die
deutsche Volkswirtschaft, von Gustav Vogt. Grunewald-Berlin, Verlag
der Arbeiter-Versorgung, A Troschel, 1905.
Weicker-Gobersdorf: Beitraege zur Frage der Volksheilstaetten, von Dr.
Weicker-Gobersdorf. Berlin, Medizinischer Verlag G. m. b. H., 1905.
Westphalia: Die Invaliden- und Altersversicherung in der Provinz Westfalen
von 1891-1908. Sonderabdruck aus der aniasslich der 50. Tagung des
Westfaiischen Provinzial-Landtages herausgegebenen Festschrift: Die
Provinzielle Selbstverwaltung Westfalens.
Wezel: Katalog der Sondergruppe Tuberkulose der Internationalen Hygieneausstellung Dresden 1911, bearbeitet von Stabsarzt Dr. Wezel. Dresden,
Verlag der Internationalen Hygieneausstellung, 1911.
Windscheid, Franz: Innere Erkrankungen mit besonderer Beriieksichtigung der
Unfallnervenkrankenheiten, von Dr. Med. F. Windscheid. Jena, Gustav
Fischer, 1905. viii, 204 p. (Handbuch der Sozialen Medizin; Achter
Band. Der Arzt als Begutaehter auf dem Gebiete der Unfall- und Inva­
lidenversicherung. Erste Abteilung.)







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k

I N D E X
Page.
Administrative control of tuberculosis____________________________________________ 98-116
Agricultural colony at Stilbeckshorn for tuberculous wage earners.________ 111, 112
Building loans by invalidity insurance institutions__________________________ 114-116
Dispensaries and information bureaus_________________________________________ 99-111
Housing reform---------------------------------------------------------------------------------------------- 112-114
Sanatorium treatment, limitations of__________________________________________ 98,99
Town planning and sanitary progress--------------------------------------------------------------116
Admission to, and discharge from, sanatoria of tuberculous patients according to
Turban stage of disease, statistics of-------------------------------------------------------------------- 84-87
Agricultural colonies and forest homes for tuberculous patients----------------------------37
Agricultural colony at Stilbeckshorn for tuberculous wage earners---------------------- 111, 112
Annuities, disability, granted on account of tuberculosis by invalidity insurance
institutions:
118
Berlin__________________________________________
Hanse Towns________________________________________________________________ 153-155
Rhenish Prussia-----------------------------------------------------------------------------------------------132
Army recruits, rejection of, on account of tuberculosis, report of, to invalidity in­
surance institutions required-------------------------------------------------------------------------------66
Augsburg, tuberculosis dispensary in____________________________________________ 109,110
Baaen, Invalidity Insurance Institution of, experience data of__________________ 143-149
Berlin, Invalidity Insurance Institution of, experience data of__________________ 117-125
Berlin invalidity insurance institutions, per cent of disability annuities granted by,
on account of tuberculosis, 1910________________________________________________
118
Berlin, tuberculosis dispensaries in------------------------------------------------------------------------102-104
Bibliography----------------------------------------------------------------------------------------------------------- 173-179
Board of Health, Imperial, at Berlin, memorandum on tuberculosis by__________ 165-169
Building loans made by invalidity insurance institutions to aid in control of
tuberculosis____________________________________________________________________114-116
Children, tuberculous, measures for treatment and care of, advised by German
Central Committee_______________________________________________________________
36
Cost of treatment and care of tuberculous patients:
Distribution of________________________________________________________________ * 39
Per capita_____________________________________________________________ 75, 76, 78-80
To specified territorial and employees* insurance institutions, 1910------------------25
Deaths from tuberculosis:
18
German cities and American cities compared, 1880 to 1909----------------------------Germany_______________________________________________________________________ 11-15
Hamburg-------------150,151
Kingdom of Wurttemberg-------------------------------------------------------------------------------138
United States, registration area, 1900 to 1909-------------------------------------------------- 16,17
Disability annuities granted on account of tuberculosis by invalidity insurance
institutions:
Berlin________________________________________________________________________
118
Hanse Towns________________________________________________________________ 153-155
Rhenish Prussia______________________________________________________________
132
Discharge from, and admission to, sanatoria of tuberculous patients according to
Turban stage of disease, statistics of-------------------------------------------------------------------- 84-87
Dispensaries and information bureaus, control of tuberculosis through___________ 99-111
Dispensaries and informationbureausinstituted by German Central Committee______35, 36
Dust and fumes as predisposingcauses of tuberculosis_______________________________ 41,42
Earning capacity, restoration of, through treatment___ 26-32, 55, 84-89, 96,124,129,159
Economic loss (estimated loss of earning power) from tuberculosis in United
States__________________________________________________________________________ 18,19
Economic value, estimated, of sanatorium treatment in Germany__________________ 20-22
Employment, suitable, of tuberculous patients______________________________________
78
Experience data of representative invalidity insurance institutions in treatment and
care of tuberculous wage earners,1910__________________________________________ 117-161
Baden______________________________________________________________________ 143-149
Berlin___________________________________________
117-125
Hanse Towns________________________________________________________________ 149-161
Rhenish Prussia_____________________________________________________________130-136
Westphalia__________________________________________________________________ 125-130
Wurttemberg_________________________________________________________________ 136-143
Family support, contributions to, during treatment of wage earners in public sana­
toria_________________________________________________________________________________ 68,69
Forest homes and agricultural colonies for tuberculous patients___________________
37
Fumes and dust as predisposing cause of tuberculosis-----------------------------------------------41,42




181

182

INDEX.

Page.
German Central Committee for the Prevention of Tuberculosis, organization and
activities of______________________________________________________________________ 34-38
Dispensaries and information bureaus-------------------------------------------------------------- 35, 36
Forest homes and agricultural colonies------------------------------------------------------------37
Homes and institutions for advanced cases------------------------------------------------------37
Sanatoria_____________________________________________________________________ 36, 37
36
Treatment and care of tuberculous children__________________________________
Work of the organization, conclusion as to__________________________________ 37, 38
German Imperial Board of Health at Berlin, memorandum by, on tuberculosis— 165-169
German invalidity insurance institutions, in treatment and care of tuberculous
wage earners, experience data_____________________________________________________58-98
Army recruits, rejection of, on account of tuberculosis, notice of, required-----66
Cost and duration of treatment------------------------------------------------------------- 75, 76, 78-80
Employment, suitable, of tuberculous patients------------------------------------------------78
Expenditures on account of treatment and care--------------------------------------------- 61-65
Family support, provisions for. during treatment of wage earner in sanatorium. 68, 69
Financial aid given in campaign against tuberculosis-------------------------------------67
Loans by, for the erection of public sanatoria_________________________________ 77, 78
—
Methods of treatment and care------------------------------------------------------------------- • 69-75
Patients treated, number of, by sex__________________________________________ 60, 61
Proportion of insured population treated in 1909_____________________________
65
Proportion of patients tieatod, by selected States___________________________
65, 66
____________________________76, 77
Sanatoria owned by, financial statistics of________•
Sanatorium treatment, general conditions as to value of_____________________ 96-98
Sanatorium treatment, nostdischarge results of______________________________ 87-94
Sanatorium treatment, successful and unsuccessful, financial statistics of-------- 94-96
Treatment, effect of premature discontinuance of_____________________________
81
Treatment, statistics of readmission for_______________________________________ 81-83
Turban-Gerhardt method of classifying tuberculous patients_________________83, 84
Turban stage of disease, statistics of admission and discharge of patients ac­
cording to____________________________________________________________________84-87
German terms relating to treatment of tuberculous wage earners, definition of— 169,170
Hamburg, death rate from tuberculosis in_______________________________________150,151
Hamburg, tuberculosis dispensaries in___________________________________________ 105,106
Hanse Towns, invalidity insurance institutions of, experience data of___________ 149-161
Homes and institutions for advanced cases of tuberculosis-------------------------------------37
Hospital and sanatorium treatment, comparative results of______________________ 33, 34
114
Housing reform, control of tuberculosis through__________________________________ 112—
Imperial Board of Health at Berlin, memorandum on tuberculosis by-----------------165-169
41
Indoor and outdoor workers, proportion of, among tuberculous patients-------------Information bureaus and dispensaries instituted by German Central Committee------ 35, 36
Institutional and noninstitutional treatment of tuberculous patients, comparative
results of---------------------------------------------------------------------------------------------------------------- 32, 33
Institutions and homes for advanced cases of tuberculosis_________________________
37
Invalidity insurance institutions. (S e e German invalidity insurance institutions.)
Invalidity insurance institutions, treatment and care or tuberculous patients by,
legal sanction for-------------------------------------------------------------------------------------------------- 22, 23
Legal provisions regarding treatment of actual or prospective invalids__________171-173
Leipzig, tuberculous dispensaries in------------------------------------------------ ---------------------106,107
Mortality from tuberculosis:
German cities and American cities compared-------------------------------------------------18
German Empire-------------------------------------------------------------------------------------------------- 11-15
Hamburg____________________________________________________________________150,151
Hospitals and sanatoria compared_____________________________________________33, 34
United States, registration area________________________________________________ 15-17
Munich, tuberculosis dispensary in_______________________________________________ 107-109
Occupational conditions of tuberculous patients------------------------------------------------------- 42, 43
Outdoor and indoor workers, proportion of, among tuberculous patients___________
41
Patients treated for tuberculosis. ( S e e Tuberculosis, statistics of patients treated
for.)
Public institutions for treatment of tuberculous wage earners, experience data of_^8-^58.
Causes, predisposing or complicating, in tuberculosis__________________ 41, 42, 44, 45
Condition of patients, changes in, during treatment----------------------------------------49-52
Condition of patients on admission------------------------------------------------------------------ 47, 48
Cost of treatment, provisions for defraying___________________________________
39
Occupational conditions of patients-----------------------------------------------------------------42
Previous duration of disease------------------------------------------------------ 1
---------------------- 45, 46
Previous sanatorium treatment________________________________________________
45
Patients with family history of tuberculosis_____________________ i
____________ 43, 44
Patients treated, proportion of indoor and outdoor workers----------------------------41
Patients treated, age, sex, and conjugal condition of----------------------------------------40, 41
Sanatorium experience, 1896 to 1901, summary of------------------------------------------- 56-58
Social condition of patients___________________________________________________
43
Treatment, duration of_________________________________________________________ 52, 53
Treatment, economic results of--------------------------------------------------------------------------- 54, 55
Treatment in incipient stage of disease, importance of---- ----------------------------------55, 56
Treatment, medical results of__________________________________________________ 53, 54
Treatment of tuberculosis in relation to gain in weight of body--------------------- 48, 49
Treatment of tuberculosis in relation to stage of disease______________________ 46, 47
Prussian-Hessian railways peusion fund, average membership of, tuberculous
patients treated, cost, etc----------------------------------------------------------------------------28
Rhenish Prussia, Invalidity Insurance Institution of, experience data of____ 130-136
Sanatoria experience data:
German,invalidity insurance institutions_______________________________________ 58-98
Public institutions for treatment of tuberculous wage earners_________________38-58




INDEX,

183

Page.
Sanatorium treatment of tuberculosis, Germany:
Comparative results of, with treatment at home_______________________________32, 33
Comparative results of, with treatment in hospitals__________________________ 33, 34
Cost of, per person, in 1010___________________________________________________ 24-26
Earning capacity of wage earners, restoration of, resulting from_____________ 26-32
Economic value of---------------------------------------------------------------------------------------------- 20-22
Legal sanction for, to invalidity insurance institutions------------------------------------ 22, 23
Limitations o f ________________________________________________________________ 98, 99
Results of______________________________________________________________________ 87-98
Wage earners treated, 1910, number of----------------------------------------------------------- 23, 24
Sanitary progress and town planning, control of tuberculosis through-------------------116
Silesia, tuberculosis dispensaries in------------------------------------------------------------------------109
Tuberculosis, administrative control of------------------------------------------------------------------ 98-116
Tuberculosis, memorandum on, by German Imperial Board of Health at Berlin__ 165-169
Tuberculosis, special institutions for treatment of, owned by invalidity insurance
institutions, number, financial, and other statistics of------------------------------------------- 71-74
Tuberculosis, statistics of patients treated for, in German institutions:
Age at discharge, number and per cent of patients of each classified___________
123
Cost of treatment per day and per person--------------------------------------------------------- 80, 96
Cost of treatment, Prussian-Hessian railways pension fund------------------------------28
Cost of treatment, total and per capita amount of, by districts_______________
25
Days of treatment in each year, 1897 to 1900, number of____________________
80
Duration of disease previous to admission, patients admitted in each speci­
fied year of------------------------------------------------------------- 1-------------------------------------46
Earning capacity restored, patients having_______ 28, 55, 86, 88, 89, 96,124,129,159
Expenditures on account of treatment_________________________________________ 62, 64
Expenditures per day for board and drink of patients, special institutions-----76
Expenditures per day for board of patients, itemized__________________________
119
Mortality of patients in hospitals and in sanatoria compared-------------------------33
Patients discharged as cured, number and per cent of, Dy sex and by age on
admission___________________________________________ :______________________
54
Patients treated, number of, etc_____________________________ 24, 28, 40, 60, 61, 70, 96
Readmissions for treatment after discharge, number of______________________ 82, 83
77
Sanatoria, general, financial, and other statistics of___________________________
Treatment lasting each classified number of weeks, patients discharged after
receiving________________________________________ __________________________ 52,133
Treatment, sanatorium, comparative results of, for two specified periods_____
164
Turban stages of the disease, sanatoria patients in each of the—
admitted, number of______________________________________________________
47
bacilli in sputum, number having________________________________________
51
discharged, with and without earning capacity restored, number of____ 55, 86, 87
Tuberculosis. (S e e a lso Deaths; Mortality.)
Turban-Gerhardt method of classifying tuberculous patients________________________83, 84
United States and Germany, comparative mortality from tuberculosis in___________ 15-18
United States, estimated economic loss in, from tuberculosis______________________ 18,19
Wage earners, tuberculous, treatment and care of, experience data:
German invalidity insurance institutions_______________________________________58-98
Public institutions_____________________________________________________________38-58
Westphalia, Invalidity Insurance Institution of, experience data of_____________ 125-130
Westphalia, tuberculosis dispensaries in__________________________________________ 110-111
Wurttemberg:
Invalidity Insurance Institution of, experience data of_____________________ 136-143
Mortality from tuberculosis, by age, 1908____________________________________
138
Population in each age group, per cent of, insured------------------------------------------138
Tuberculosis of lungs, disability rate from___________________________________
139




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