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 RC311 .As7 Tuberculosis familie 
 
 RECAP 
 
 Tuberculosis Familie. .a 
 Their Homes 
 
 A Study 
 
 The ^Association of Tuberculosis J3inics 4. 
 
 and the 
 
 Committee on the Prevention of Tuberculosis 
 
 of the I 
 
 Charity Organization Society 
 
 New York City 
 
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Tuberculosis Families in 
 Their Homes 
 
 A Study 
 
 The Association of Tuberculosis Clinics 
 
 and the 
 
 Committee on the Prevention of Tuberculosis 
 
 of the 
 
 Charity Organization Society 
 
 New York City 
 
 iqi6 
 
0^1 
 
Foreword 
 
 THE present study was begun in 19 13, and continued inter- 
 mittently over a period of two years. The length of time 
 required for its completion and its final presentation has 
 been due to two causes : first, that the study was carried on sim- 
 ultaneously with the regular routine work of the Executive Office 
 of the Association, so that it was not possible to give full and 
 undivided attention to it ; second, to the unavoidable delay result- 
 ing from the necessity of submitting it for final approval to the 
 various workers more or less directly interested in it, either 
 through its conduct or because of their association with the agen- 
 cies caring for the families included in the study. 
 
 It is unfortunate that the general impression left by the study 
 as a whole is more or less pessimistic. Part II of the report deals 
 with avowedly "difficult families" more or less unhelpable from 
 the outset. Success could hardly be expected to follow in the 
 wake of the most expert social and medical care, all things con- 
 sidered. It is only fair to remind the reader that successful re- 
 sults zvere obtained by social and medical agencies with other 
 helpahle families under their care during the same period of time. 
 
 Unquestionably the technique of both medical and social 
 workers is improving from year to year, but the problem of the 
 apparently unhelpable family still remains unsolved. Whether 
 private agencies will ever be able to handle these families effec- 
 tively, or whether their care should be put directly up to the pub- 
 lic authorities, is a question that should receive more careful con- 
 sideration than it has in the past. 
 
 The report has been criticised as lacking in constructive sug- 
 gestions for the care of tuberculosis families generally. It should 
 be noted that the study was undertaken primarily to let a little 
 light, if possible, into dark places which are being encountered by 
 auxiliary organizations to the tuberculosis clinics of New York 
 City, and to bring home to them the futility of their attempting to 
 
handle these "difficult" families with the hmited facilities for in- 
 tensive social work at their command. It also attempted to point 
 out to them what might be considered a reasonable expenditure of 
 the not inconsiderable funds which they raise for tuberculosis 
 work. 
 
 Because of the possibly discouraging effect the report might 
 have on those whose background is insufficient to enable them to 
 properly interpret the reasons for the apparent failure in dealing 
 with the families included in this study, it has seemed wise to 
 limit its distribution to professional workers. It is offered to 
 them with the sincere hope that it may prove of some slight help 
 in meeting those difficult problems arising out of a combination 
 of chronic disabling disease and inherent lack of capacity. 
 
 As to the omission of broader constructive recommendations 
 regarding the care of dependent tuberculous families by social 
 agencies possessing all the necessary equipment for adequate fol- 
 low-up work, it would seem that their policy must be determined 
 largely by the attitude of the health authorities as to the degree 
 of control they are willing to exercise over the avowedly danger- 
 ous foci of infection, the active cases living under improper home 
 conditions. The final responsibility here undoubtedly rests with 
 the medical profession. Until they are willing to sanction the 
 wholesale segregation of dangerous tuberculosis carriers, as they 
 have sanctioned similarly the segregation of other infectious, pre- 
 ventable disease carriers, public authorities and private agencies 
 ahke can do little but mark time. The principles underlying the 
 control of tuberculosis, segregation, supervision and adequate re- 
 lief have been recognised for a decade. There has been lacking 
 only the willingness to follow the application of these principles 
 through to its logical conclusion, when this means for supervision 
 and relief, largely increased appropriations of either public funds 
 or private contributions, or for segregation, the readjustment of 
 our emotional outlook on the rights of the individual. 
 
Part I 
 
 A Comparative Study of 74 Relief Families 
 and 64 Non-Relief Families 
 
 NEW YORK CITY'S register of tuberculous individuals is 
 approximately 35,000. The annual crop of new patients 
 averages 22,000 each year. Twenty-seven thousand six 
 hundred and sixty-four of all these pass through the clinics ; 
 14,063 find their way in and out of the hospitals; 8,918 die. 
 
 Excluding the amount spent by subsidized private institutions 
 over and above the per capita payments made to them by the City, 
 we can summarize the annual cost ^ of the care of tuberculosis to 
 the city of New York as follows : 
 
 INSTITUTIONAL ( CHIEFLY MEDICAL CARE) 
 
 By the City $1,730,262.96 
 
 By private agencies 60,710.90 
 
 $1,790,973.86 
 
 HOME CARE ( MEDICAL AND SOCIAL 
 AND relief) 
 
 By the City . . ., $377,31 1.09 
 
 By private agencies 310,031.10 
 
 687.342.19 
 
 $2,478,316.05 
 
 This total of $2,478,316.05 represents a capital investment of 
 $49,566,321. Stated in other terms, if the annual cost of tuber- 
 culosis in dollars and cents were distributed upon a per capita 
 basis, EVERY MAN, WOMAN AND CHILD OF THE FIVE 
 MILLION AND MORE LIVING IN THE GREATER CITY 
 OF NEW YORK WOULD BE TAXED FORTY-SIX CENTS 
 YEARLY. 
 
 1 See Appendix, pages 76 and ']'], for detailed statement. 
 
 5 
 
The acid test for determining the value of this expenditure 
 for the care of tuberculosis is to be found in the death rate, 
 which, as we know, has steadily declined year by year, a greater 
 declination than has occurred in the general death rate during 
 the same time. 
 
 INSTITUTIONAL CARE VS. HOME CARE 
 
 For testing the relative value of the two methods of care we 
 have as yet no accurate measuring rod. Many factors combine 
 to invalidate morbidity statistics. The true incidence of tuber- 
 culosis cannot be definitely determined until we are sure of com- 
 plete registration returns. We are, however, pretty thoroughly 
 committed to the institutional form of treatment, and our chief 
 aim should be to use this method in the most intelligent and effi- 
 cient way in order to secure the best returns. 
 
 A certain amount of home care seems at present inevitable. 
 Some go further and say it is desirable. Funds to support this 
 home care come largely from private sources, either general re- 
 lief agencies or special tuberculosis funds. The general relief 
 agencies have to face tuberculosis as one of the complex factors 
 in the problem of dependence which they are trying to handle. 
 
 The wisest expenditure of the special tuberculosis funds is 
 still a matter for discussion. It was with the hope of throwing 
 some light upon the use of those special tuberculosis funds, raised 
 by auxiliaries to tuberculosis clinics, that the present study for 
 the Committee on Homes was undertaken. As we know, by far 
 the largest demands made upon these special tuberculosis funds 
 are for relief. The character of the homes into which such re- 
 lief goes is naturally of particular interest to the almoners of 
 these funds. 
 
 The various forms of institutional care of tuberculosis are 
 fairly well crystallized. There are hospitals, sanatoria, homes 
 and preventoria. Institutions in each class are graded according 
 to the medical and social type of case they are to receive, and 
 there is one admitting agency, the Flospital Admission Bureau, 
 which sets the standard to which each type must conform. 
 
There are as many forms of home care as there are agencies 
 furnishing it or individuals representing these agencies doing the 
 actual work. It is not the aim of this report to hold a brief 
 for either form of care, institutional or home, as opposed to the 
 other. To do so in our present stage of development would be 
 to court unanswerable arguments from either side proving that 
 €ach and both are indispensable under certain conditions. But 
 it is a plea for some concerted attempt to standardize the types 
 of home care on a basis which will recognize the fundamental 
 needs and limitations of these dependent families in which tuber- 
 culosis is a factor — or in these tuberculous families who have 
 become dependent, according to the point of view. 
 
 HOME CARE DEPENDENT ON HOME CONDITIONS 
 
 Admitting at the very start the thousand and one social and 
 economic threads with which the medical side of tuberculosis is 
 inextricably interwoven, we must nevertheless realize that the 
 prevention and control of tuberculosis is our particular task, just 
 as the prevention and cure of dependency is the task of organized 
 philanthropy, or the improvement of work conditions the task of 
 organized labor. In the long run we shall accomplish far more 
 by sticking to our last. At certain points where the tasks over- 
 lap (vide the home care of tuberculosis) we should at least base 
 our treatment on a common knowledge of fact, and a recognition 
 of mutual responsibility. 
 
 Home care, to be effective, presupposes a knowledge of home 
 conditions. If the elemental requisites for a decent home are 
 lacking, the time, effort and money expended upon home care of 
 tuberculosis cases cannot be expected to produce results. That 
 much of our laboriously raised tuberculosis funds have been spent 
 on makeshift families in makeshift homes is equally true, which 
 is chiefly responsible for the present-day discouragement of the 
 almoners of these funds. For, as the tuberculosis work has been 
 extended and new cases discovered, the demands for relief have 
 increased. Where it has not been possible to augment such a 
 fund it has been spread out a little thinner so as to include more 
 
recipients. After a time some have been dropped because they 
 would not respond, because they seemed hopeless, because nothing 
 could be done with them, or for them. 
 
 STUDY FOR COMMITTEE ON HOMES 
 
 Three years ago a joint "Committee on Homes" was ap- 
 pointed by the Committee on the Prevention of Tuberculosis and 
 the Association of Tuberculosis Clinics to make a study of homes 
 where there was tuberculosis. With medical records of clinics 
 going back for five years and social records of relief agencies 
 extending back indefinitely, it was felt that a study of these rec- 
 ords would bring to light facts regarding the social, economic 
 and physical background of these families which would help con- 
 siderably in arriving at a diagnosis of the underlying causes of 
 their condition of dependency and of the relation of tuberculosis 
 thereto. 
 
 Records of patients were taken from the active files of sev- 
 eral clinics. In the first group were included those who at any 
 time since admittance to the clinic had received aid through the 
 clinic or auxiliary relief fund. The second, or control group, in- 
 cluded those who had never received relief from the clinic or any 
 known relief agency. Eighty-one clinic patients were included in 
 the former group — seventy-nine in the latter. For the purpose 
 of this study, fractional families and single men and women were 
 excluded. By fractional families is meant other than normal 
 families of parent or parents and children, e. g., a man and 
 nephew, a deserted woman living with her mother's family. 
 
 There remained 74 families who were known to have re- 
 ceived relief and 64 who had never been known to receive relief, 
 and who will hereafter be referred to as non-relief families. 
 These 138 families were distributed amongst the various clinics 
 as follows : the 74 relief families were registered at the follow- 
 ing clinics: Bellevue, 26; H. D., Chelsea, 32; H. D., Harlem Ital- 
 ian, 16. The 64 non-relief families were registered at the follow- 
 ing clinics: Bellevue, 10; H. D., Chelsea, 2; Mount Sinai, 35,- 
 Presbyterian, 15; H. D., Stuyvesant, i; St. Luke's, i. 
 
 8 
 
The preponderance of relief families in certain clinics and 
 non-relief families in certain others should not be ascribed to the 
 racial character of the particular district covered or to the na- 
 tionality of the family studied, the detail of which appears later. 
 The relief cases at the clinics mentioned were selected for study 
 primarily because of the fact that organized women's auxiliaries 
 attached to these clinics had made possible more extensive relief 
 work for these particular cases. 
 
 The study of these relief families was arbitrarily discontin- 
 ued with the completion of 74 cases because of the large amount 
 of work involved. The selection of the 64 non-relief families 
 at various clinics was determined chiefly by the completeness of 
 the records available for such families and the length of time they 
 had been known to the clinics. 
 
 METHODS OF STUDY 
 
 A special record form was prepared which summarized and 
 classified all available information to be obtained from the rec- 
 ords of the clinic and the social or relief agencies. The housing 
 conditions past and present were noted, the physical conditions 
 past and present of each member of the family, also the physical 
 and mental defects, work-history and earning capacity and the 
 kind, source and extent of relief. 
 
 The information from the clinic record was obtained by the 
 assistant to the Executive Secretary of the Association of Tuber- 
 culosis Clinics, a graduate nurse of wide experience in the work 
 of the tuberculosis clinics and thoroughly familiar with the vari- 
 ous types of patients and their homes. vShe was thus capable of 
 interpreting the medical data on the clinic records and was 
 equally alive to the importance of noting accurately whatever 
 social and economic data were available at the clinic. 
 
 All records were then referred to the Social Service Ex- 
 change to learn what other agencies, if any, had known these 
 families, and records of the social agencies were obtained, addi- 
 tional information contained in them was added to the study rec- 
 ord, and an attempt was made to compare, collate and finally 
 
summarize for each family the facts contained in the records of 
 both medical and social agencies. This was done by three peo- 
 ple, each working on a separate group of relief families, the Sec- 
 retary of the Committee on the Prevention of Tuberculosis, a 
 member of the staff of the School of Philanthropy and the Execu- 
 tive Secretary of the Association of Tuberculosis Clinics. An 
 additional exhaustive study of the methods of social care was 
 made by the staff member of the School of Philanthropy for her 
 particular group of 35 relief families. It was not practicable to 
 extend this intensive study to the other groups of relief families 
 owing to the length of time required, but it seems reasonable to 
 conclude that the findings for this group are equally applicable 
 to the other groups. 
 
 Whatever conclusions are offered as a result of this study 
 are offered as indicating tendencies rather than as arbitrary 
 statements of fact. Some of the records, both medical and social, 
 afforded only the most meagre kind of information ; others were 
 obviously inaccurate; other voluminous ones, while extending 
 over a considerable period^ yet had long lapses of time, when the 
 family was lost sight of, and during which there was no recorded 
 information available. 
 
 Certain lines of inquiry had to be abandoned in the final 
 sum.mary because of the inadequacy or unreliability of the facts 
 noted or of their interdependence on certain other facts which 
 were not available. Thus the information as to the amount of 
 institutional care was of little or no value because it was so ob- 
 viously incomplete. In some instances depending solely on the 
 statement of the family, all the available information on this 
 point was complicated by the fact that the institutional sojourn 
 had not been continuous, patients going in and out of institu- 
 tions two or three or more times, so that the length of stay had 
 but slight bearing on the final outcome so far as the individual 
 patient or the involvement of his family was concerned. The 
 significant fact stood out boldly — the casualness of the institu- 
 tional care received by these people. 
 
 So the attempt to throw any light on the question of house 
 infection had to be abandoned because of the incompleteness of 
 
 10 
 
the records, few recording anything more than the number of 
 cases occurring in a given house, the individual apartment being 
 seldom noted. 
 
 The social and economic data regarding the non-relief fami- 
 lies were naturally scanty, the clinic record being the sole source 
 of information. As these families had never asked aid they 
 had been chary of giving information, and it had not been easy 
 for the clinic nurse to extract it along these lines. Thus again 
 the attempt to summarize for purposes of comparison the find- 
 ings of the two groups of relief and non-relief families was lim- 
 ited by the necessity of confining such a summary to facts 
 available for both groups. 
 
 OBJECTS OF THE STUDY 
 
 This inquiry had four objects: 
 
 First : To show the background, the constitution, the quality 
 of fibre, so to speak, of those families under clinic care who are 
 regarded specifically as tuberculous families, who are partially 
 or entirely dependent and for whom special tuberculosis funds 
 are being called upon to furnish material relief. 
 
 Second : To contrast with these dependent families other 
 families under clinic care who thus far have taken care of their 
 own tuberculosis, who have escaped the shoals of dependency, in 
 order to see in what way they dififer from the group of dependent 
 families. 
 
 Third : To point out deficiencies in both the medical and 
 social treatment of dependent families with tuberculosis. 
 
 Fourth : To suggest possibilities for the employment of 
 special tuberculosis funds which will bring in the largest ultimate 
 returns. 
 
 If, in our study of methods of treatment, undue emphasis 
 appears to have been put upon the social agencies' technique and 
 the medical agencies let off too lightly, it should be remembered 
 that we have been analyzing and criticising the professional work 
 of our medical agencies (or clinics) since the beginnings of the 
 
 11 
 
Association of Tuberculosis Clinics, and we shall continue to do 
 so. We know only too well where we compromise with our 
 ideals, where we fail. A certain social responsibility is also ours. 
 A knowledge of the experience, the mistakes, the responsibilities 
 of others will help us to a clearer vision of ourselves. 
 
 SCOPE OF THE STUDY 
 
 Information on the following points has been tabulated and 
 summarized for both the relief and non-relief families : 
 
 1. Nationality. 
 
 2. Housing Conditions. 
 
 3. Tuberculosis History. 
 
 4. Status of Wage-Earners. 
 
 5. Occupation and Wages. 
 
 6. Income. 
 
 For the relief families, the period covered by the record of the 
 social agency was noted as well as the character of relief given, 
 whether it was temporary, intermittent or continuous for any 
 length of time. 
 
 NATIONALITY 
 
 The nationality of the two groups of families studied ^ is 
 given as a matter of general interest, but it is not claimed that 
 it bears any relation to the general incidence of tuberculosis 
 throughout the city. The preponderance of certain nationalities 
 is easily traceable to the character of the district in which the 
 particular chnic was located from which the clinic records were 
 chosen. Thus the Irish and the American born characterize the 
 Chelsea clinic district on the middle west side. The Italians were 
 found chiefly in the northeastern portion of Manhattan, known 
 as Little Italy, and covered by the Harlem Italian Clinic, while 
 all three nationalities are to be found in Bellevue district. The 
 
 1 See Appendix, page 59. 
 
 12 
 
Russians were found principally in Mt. Sinai district, the uptown 
 Hebrew quarter. In the majority of instances both the father 
 and mother were of the same nationality ; where they were of 
 different nationality that of the mother was noted. 
 
 HOUSING 
 
 The relation of housing to tuberculosis, while generally 
 acknowledged, has not always been easy to define. We know 
 that bad housing conditions, overcrowding, insufficient light and 
 air, lower physical resistance and breed disease. We know that 
 the economic strain under illness breeds poverty and lowers the 
 standard of living. Cheaper rents usually mean poorer living 
 quarters, so that bad housing follows in the train of prolonged 
 sickness. Whichever be the prime factor, granted that bad hous- 
 ing and tuberculosis are both present in a given case, there can 
 be no question as to the danger of the infection spreading to 
 other members of the family. It is, therefore, pertinent to the 
 present inquiry to compare the housing conditions of the two 
 groups. 
 
 The 74 relief families comprise 425 individuals, of whom 164 
 are adults and 261 (61%) are children under 16. 
 
 The 64 non-relief families comprise 321 individuals, of whom 
 216 are adults and 105 (32^%) are children under 16. Rec- 
 ognizing how prone to infection are young children living in 
 contact with a tuberculous individual, the proper housing of the 
 group of relief families becomes doubly important in view of the 
 fact that there are proportionately nearly twice as many children 
 under 16 in this group as in the non-relief group. 
 
 But we find that over half of the relief families are living 
 in two- and three-room apartments, as against a little over a 
 fourth of the non-relief families who are similarly housed.^ The 
 consequent overcrowding undoubtedly falls heaviest upon the 
 children in the relief group. If horrible examples are wanted 
 they may be had. Thus we find in the relief group : 
 
 1 See Appendix, page 60. 
 
 13 
 
No. of No. of 
 
 Persons per Rooms in 
 Household Apartment 
 
 One family, Italian 8 2 
 
 Two families, Hungarian (living together) . . 10 3 
 
 One family, Italian 9 3 
 
 One family, Italian 9 3 
 
 One family, Italian 7 3 
 
 One family, Italian 7 3 
 
 One family, United States 7 3 
 
 One family, Italian 10 4 
 
 One family, Italian 10 4 
 
 One family, Irish 10 4 
 
 In the non-relief group : 
 
 One family, Russian 7 3 
 
 One family, Russian 7 3 
 
 One family, Russian 8 4 
 
 An attempt was made to note the number of so-called dark 
 rooms.^ The report of the home conditions was in every in- 
 stance made by the clinic nurse, who is usually unfamiliar with 
 the technical legal definition of a dark room. Her statement, 
 however, that a room was dark, or dim, means that these rooms 
 in her opinion were unfit for ordinary living or sleeping pur- 
 poses. As these reports were made by several nurses, variations 
 in standard due to the personal equation would balance each 
 other. 
 
 In the 70 homes of relief families there were 48 dark rooms 
 in 30 apartments. In the 63 homes of non-relief families there 
 were 52 dark rooms in 28 apartments. That is, 425^% of the re- 
 lief families were exposed to the danger of living in dark rooms, as 
 against 44% of the non-relief families. On the other hand, con- 
 sidering the total number of rooms occupied by each group, we 
 find that 20% of the rooms occupied by the relief families were 
 dark, as against 19% of those occupied by the non-relief families, 
 while the average person per room was for the relief families, 
 1.8, and for the non-relief group, 1.2. 
 
 1 See Appendix, page 61. 
 
 14 
 
Comparing the two groups according to the size of the apart- 
 ment occupied/ we find that over 50% of the relief famihes were 
 housed in 2- and 3-room apartments, 33% in 4-room apartments, 
 7% in 5-room apartments. On the other hand, only 25% of the 
 non-relief families were living in 2 and. 3 rooms, 43% were Hving 
 in 4-room apartments, 18% in s-room apartments, 10% in 6-room 
 apartments, 3% in 7-room apartments. Comparing the rentals^ 
 paid by the two groups for the same size apartment, we find that 
 the non-relief famihes were in many instances paying a higher 
 rental for the same size apartment, from which we may assume 
 that they were occupying a higher grade of apartments. 
 
 The general condition of the homes as regards their cleanli- 
 ness was classified as Good, Fair and Bad.^ Over one-fifth of 
 the homes of the relief families were characterized as Bad. 
 
 From the nature of things it was to be expected that self- 
 supporting families would be living under better housing condi- 
 tions than dependent famihes. But the living conditions of some 
 of the relief families are not only relatively less good, they are 
 positively bad. The futility of attempting to treat tuberculosis 
 in homes such as these would seem to be self-evident. 
 
 TUBERCULOSIS HISTORY 
 
 A comparison of the amount of known tuberculosis infec- 
 tion existing in the two groups of families * brings out several 
 significant facts : first, the much greater incidence of tuberculosis 
 in the relief families, amounting to 1.86, as against 1.17 in the 
 non-relief families ; second, the greater number of wage-earners 
 affected in the relief families, 31% of the total cases in these 
 families being adult males, as against 17.8% of the cases in the 
 non-relief group — or, comparing the number of wage-earners hav- 
 ing tuberculosis, living and dead, with the total number of wage- 
 earners in the group,^ we find that 58% in the relief group are 
 or have been tuberculous, compared with 21% in the non-relief 
 
 1 See Appendix, page 60. 
 - See Appendix, page 62. 
 
 2 See Appendix, page 63. 
 
 4 See Appendix, page 64. 
 
 5 See Appendix, page 65. 
 
 15 
 
group ; third, the proportionately larger number of women and 
 adult children with tuberculosis in the non-relief group; fourth, 
 the large number of children under i6 in the relief group who 
 have become infected, as contrasted with the negligible number 
 infected in the non-relief group. 
 
 But the story is only half told until we add the facts regard- 
 ing the thoroughness with which the physical examination of the 
 families has been made.^ 
 
 It would appear that the medical supervision over the relief 
 families is much closer than over the non-relief families, inas- 
 much as only 20% of the individuals in the former group have 
 not been examined, while 65^% in the latter group have not 
 been examined. Our previous assumption as to the extent of 
 tuberculosis in these families must therefore be modified by our 
 ignorance as to the real physical condition of these individuals 
 who have never been examined. Presumably, all definitely ill per- 
 sons were detected, but the amount of preventive work which 
 might have been done, particularly in the non-relief families, is 
 clearly evidenced by the large proportion of children under 16 
 who have never been examined. 
 
 EFFECT OF TUBERCULOSIS ON ECONOMIC STATUS 
 
 Classifying the families according to the tuberculosis con- 
 dition or status of the wage-earners^ we find that 35% of the 
 relief families were widows' families, as against 14% of the non- 
 relief families (including two families where the man was a 
 deserter). Coupled with this fact is the additional handicap un- 
 der which the relief families are laboring; viz., that in 43.7% of 
 the families where the man is living he is ill with tuberculosis, as 
 compared with 21.8% of the non-relief famihes where the man 
 is living. 
 
 Summarizing the work history of the members of the two 
 groups ^ we find that in the 21 relief families where the man is 
 living only 4 men are working at the same occupation with the 
 
 1 See Appendix, page 66. 
 ~ See Appendix, page 65. 
 3 See Appendix, page 67. 
 
 16 
 
same wage as formerly, while 7 are not working, and the remain- 
 ing 10 are working irregularly at less remunerative jobs; 17 
 women are supplementing the family income by doing unskilled 
 work, chiefly cleaning, at an average wage of from $4.00 to $6.00 
 weekly. Seven of these women are themselves tuberculous, as 
 are 3 of the remaining 4 who are not working. In the 12 non- 
 relief families where the man is living, 3 are not working and 3 
 are working irregularly. Information is too meagre to attempt 
 a comparison with their previous earning capacity for the remain- 
 ing 6. Only I woman in these 12 families is working as janitress 
 with rent free. Only i woman was tuberculous and she is dead. 
 In 5 of these families the income is supplemented by adult chil- 
 dren who are working, 2 of whom are tuberculous. 
 
 In the 22 relief families where the man is dead from tuber- 
 culosis, 15 women are working, 6 of whom are tuberculous. In 
 addition, 3 women who are not working are tuberculous. One 
 woman is dead from tuberculosis. Six of the families have 7 
 adult children working, while 3 children under 16 in these fam- 
 ilies are also contributing to the support of the family, i of whom 
 is tuberculous. In the non-relief families where the man has 
 died from tuberculosis, i woman is tuberculous and 2 adult chil- 
 dren are working, i of whom is also tuberculous. 
 
 In those families where the man is living and not tuberculous, 
 we find in the 27 relief families 19 of the women tuberculous, 2 
 of whom are dead. Fourteen are working, 9 of whom are 
 tuberculous. In 8 families the income is supplemented by the 
 children's work. 
 
 In the 43 non-relief families, all but 10 of the women are 
 tuberculous. Six only are working, 5 of whom are tuberculous. 
 In 18 families the income is supplemented by the children's work, 
 all adults with one exception. Five other adult children are 
 tuberculous and not working. 
 
 In the families where the cause of the man's death is un- 
 known or he has deserted, we find in the 4 relief families 3 of the 
 women, although tuberculous, are working; also i adult child 
 who is tuberculous. In the 8 non-relief families 4 of the women 
 
 17 
 
are tuberculous, 2 of whom are working. In 6 families, 13 adult 
 children are working, 5 of whom are tuberculous. Three other 
 adult children are not working and are tuberculous. 
 
 It would seem that the economic pressure is greatest upon 
 the women in the relief families, many of whom are tuberculous, 
 and upon the adult children in the non-relief families. In the 
 first instance, this means that the children in these families are 
 likely to suffer both physical and moral handicap because of their 
 exposure to infection and lack of proper care. In the second 
 instance, it means that adolescent children, young men and young 
 women, constitute the barrier between their families and semi- 
 dependency, and are enduring a strain under which some have 
 already broken and which may result in the ultimate break-down 
 of these others. 
 
 OCCUPATION AND WAGES 
 
 It would seem natural to suppose that a higher earning 
 capacity in the non-relief families had insured a standard of 
 living sufficient to enable them to take care of their own tubercu- 
 losis, but one of the most interesting and unexpected facts 
 brought out by a comparative study of the occupation and wages 
 of the relief and non-relief families is that both belong, generally 
 speaking, to the same wage-earning groups. 
 
 Classifying the families according to the wages of the man, 
 whether living or dead,^ we find that in over half the families 
 in either group the man earned less than $15.00 per week — in 
 63^/2% of the relief families, in 59% of the non-relief families. 
 In the former group, in 12% of the families the man earned 
 $15.00, in 9% over $15.00. For the remaining famihes (15%) 
 no information was available. In the non-relief group, one only 
 was said to have earned $15.00 per week; 9% were earning over 
 $15.00. In over one- fourth of the famihes (29%), no informa- 
 tion was available. Presumably their earning capacity was over 
 $15.00 per week. In four of these it is known that the men 
 were owners or part owners of stores or shops. The question 
 
 1 See Appendix, page 68. 
 
 18 
 
of regularity of employment has not been considered, owing to 
 the lack of sufficient data. That in many instances the income 
 from the man's work was neither regular nor sufficient may be 
 inferred from the large number of families with the man living 
 in which the income was supplemented by the work of women 
 and children under i6. 
 
 The income from the work of adult children ^ has evidently 
 contributed materially towards the maintenance of the economic 
 independence of 45% of the non-relief families. Thus we find, 
 out of a total of 64 adult working children living in 29 families, 
 31% are earning under $10.00, 21% earning from $10.00 to 
 $14.00, 5% earning $15.00, and 9% earning over $15.00. Twelve 
 per cent, who have formerly worked are no longer working, 
 seven of whom are tuberculous. Twelve of those who are 
 working are also tuberculous.^ No information was available 
 regarding 20% who are known to be working. 
 
 In 21 relief families, 25 adult children are working, 20 of 
 whom are earning under $10.00 per week. No information was 
 available regarding the remaining 5. Four of the adult work- 
 ing children in this group are also tuberculous. 
 
 The classification of occupations into skilled and unskilled 
 has been more or less arbitrary. Under the former classification 
 was included the various tailoring processes, the trades, such as 
 painters, carpenters, stonemasons, plumbers, horseshoers, fac- 
 tory hands, clerks and bookkeepers, chauffeurs, electricians, etc. 
 Under the latter was included peddlers, laborers, drivers, porters, 
 longshoremen, waiters, etc. 
 
 No attempt was made to classify the work done by women. 
 In the relief group 49 women, with few exceptions, were doing 
 laborious unskilled work — washing, office cleaning and janitress 
 work. The highest weekly wage was $9.00 for cleaning. The 
 average wage was from $3.00 to $6.00. One woman worked 
 on artificial flowers, earning $1.00 weekly; 3 on feathers, earn- 
 ing from $3.00 to $4.00 weekly; 5 worked in factories, earning 
 from $3.00 to $6.00. 
 
 1 See Appendix, page 68. 
 - See Appendix, page 67. 
 
 19 
 
In the non-relief group, only 9 women were working, 4 as 
 janitress, 2 at cigar-making, i as a milliner, i at photography 
 and I sewed, the highest weekly earnings amounting to $8.00. 
 
 Of the II children under 16 in the relief families who were 
 working, i with tuberculosis was working as a farm hand for 
 $1.00 a week and his board, another as an electrician at $4.00 a 
 week, I in a factory at $5.00 per week. This was the highest 
 wage earned in the group. The others were shining shoes, sell- 
 ing papers, or working as office or errand boys. 
 
 It is evident that the pressure of dependency has forced these 
 women and children to take up the burden of family support, 
 but nearly one-half of these women are themselves tuberculous. 
 In nearly 15% of these families, children under 16 are working. 
 They have been exposed to infection, their resistance to disease 
 has been impaired by unfavorable living conditions and they go 
 into a dead-end job for the sake of the $3.00 or $4.00 they can 
 earn to-day. From such sowing do we reap our harvest of 
 "cases" as the years go by. 
 
 In the 64 non-relief families only i child under 16 was work- 
 ing as an office boy and he was tuberculous. But 19, nearly 
 one-third of the 64 adult working children in this group, are 
 tuberculous, 7 of whom have already dropped out of the ranks 
 of active workers. The occupations and wages of the 12 who 
 continue to work are as follows : 
 
 Occupation Weekly Wage 
 
 Seamstress $4.00 
 
 Messenger 4.00 
 
 Factory Hand 6.00 
 
 Fur Worker ■ 8.00 
 
 10.00 
 
 Laborer 10.00 
 
 Bookkeeper 10.00 
 
 Unknown 14.00 
 
 Clerk 1 5.00 
 
 P. O. Clerk 18.00 
 
 20 
 
Occupation Weekly Wage 
 
 Operator Unknown 
 
 Factory Hand 
 
 Of the 7 who are no longer working: 
 
 Dentist's Ass't $5.00 
 
 Stenographer 10.00 
 
 Clerk 18.00 
 
 Stone Cutter Unknown 
 
 Silversmith 
 
 Factory Hand 
 
 Dressmaker " 
 
 One is at a loss whether to congratulate the relief families 
 on the earning capacity of their women and children, which 
 has not sufficed, however, to keep them from the shoals of de- 
 pendency, or to congratulate the non-relief families on their suc- 
 cess in escaping those same shoals ; albeit, in some instances the 
 price of escape is being paid in part by the work of tuberculous 
 young men and women. 
 
 INCOME 
 
 An attempt was made to compare the incomes of the two 
 groups of families. In the relief group 67% of the families 
 had an income of less than $15, of whom 16.4% were under $5. 
 For 26% the income was from $5 to $10, 24% from $10 to $15, 
 17.8% from $15 to $20, 5.4% from $20 to $25; for 5.4% the 
 income was not known. For the non-relief group the income 
 stated for 38% was under $15, for 14.3% from $15 to $20, for 
 14% from $20 to $25. Eleven per cent, showed an income be- 
 tween $25 and $30, 4.7% from $30 to $39, 2% over $50. For 
 14% no information was available. The detail of this com- 
 parison classified according to the size of the family will be found 
 in the table on page 69 of the Appendix. 
 
 21 
 
It should be borne in mind that the incomes stated are only 
 approximate. In the relief families they may be considered fairly 
 accurate. In the non-relief families it was naturally much more 
 difficult to obtain a definite statement of the families' resources, 
 when no financial aid was asked or desired. In some instances the 
 minimum income stated is manifestly inaccurate. No family 
 could live on such an income. No further information was 
 available, however. 
 
 The size of family includes only those living and being sup- 
 ported in the home — members of families in institutions are not 
 included. 
 
 This statement of income has been arrived at by adding the 
 wages of all working members of a family living at home, to- 
 gether with the amount received from lodgers and boarders. 
 There were, however, very few of the families supplementing 
 their income in this way, seven relief families and six non-relief 
 families in all. There was no available information regarding the 
 income of four relief families and eight non-relief families. For 
 the relief families where the income is stated as nothing, the fam- 
 ilies were receiving pensions from some relief agency, which is 
 also true of several families where the stated income was 
 ridiculously low. For the relief families it represents at most the 
 limit of their wage-earning capacity rather than their average 
 income, for this estimate takes no account of irregularity of em- 
 ployment and the complicating personal factors of alcoholism, 
 ill-health or inefficiency. 
 
 LENGTH OF SOCIAL HISTORY VS. LENGTH OF 
 TUBERCULOSIS HISTORY 
 
 Assuming that the beginning of the social and economic ills 
 of the relief families was coincident with their first application 
 to the organized relief agencies, an interesting comparison can 
 be drawn between the length of time covered by their tubercu- 
 losis history as shown by the clinic record and the period covered 
 by the history of their social maladjustment as shown by records 
 
 22 
 
of the social agency.^ It is also significant to compare the non- 
 relief families with the relief families as to the duration of their 
 tuberculosis clinic history. 
 
 Ten, or 133^%, of the relief families were unknown to the 
 organized relief agencies at any time. Whatever material relief 
 had been given to them had come either through the clinic or 
 from some private or personal source, such as the church, rela- 
 tives, foreign benevolent associations, etc. Of the remaining 
 86% no material relief had been given by organized relief agen- 
 cies to 8j4% ; 155^% had received temporary relief, 45% inter- 
 mittent relief, 31% continuous relief. 
 
 Nearly one-half, 48%, had been known to the organized social 
 agencies over 3 years, 12% had been known to these agencies 
 from 8 to 21 years. The tuberculosis history of 61^ % of these 
 families, however, covered a period of 3 years or less, another 
 25% had been known to the clinics from 3 to 4 years, while the 
 remaining 13% had been known to the clinics from 5 to 8 years. 
 
 Comparing the length of the tuberculosis history of the non- 
 relief families we find that one-fourth have been known to the 
 clinics under 6 months, 40% from 6 months to 2 years, 11% 
 from 2 to 3 years. Thus, 76% had been known to the clinics three 
 years or less as against 61% of the relief families who had been 
 known to clinics for a similar period. A still more significant 
 contrast is found in the number known to the clinics for a period 
 of one year or less, 42% of the non-relief families as compared 
 with 113/2% of the relief families. 
 
 As the burden of their tuberculosis extends through the years 
 to come, will these non-relief families join the ranks of semi- 
 dependency or will they continue to be saved therefrom by their 
 productive children? On the other hand, as the wage-earning 
 children in the relief families grow to maturity, will they re- 
 establish the economic independence of their families or are these 
 families permanently and irredeemably subnormal mentally and 
 physically ? 
 
 1 See Appendix, page 70. 
 
 23 
 
SUMMARY 
 
 Summarized briefly, the findings of the comparative study 
 of relief and non-relief families were : 
 
 1. That the relief families show : 
 
 a. Poorer housing conditions. 
 
 b. A longer tuberculosis history. 
 
 c. A greater incidence of infection. 
 
 d. A larger proportion of wage-earners with tu- 
 
 berculosis, both living and dead. 
 
 e. A larger proportion of women working and 
 
 tuberculous, 
 f. A larger number of children under i6 with a 
 proportionately greater number infected with 
 tuberculosis. 
 
 2. The two groups, both relief and non-relief families, 
 
 belong to the same wage-earning class with few 
 exceptions. 
 
 3. The non-relief group shows : 
 
 a. A much larger number of adult children in- 
 
 fected with tuberculosis, the majority of 
 whom are or have been working. 
 
 b. A larger income, due chiefly to the work of 
 
 these adult children. 
 
 4. Eighty-six per cent, of the relief families have been 
 
 known to various relief agencies for periods ex- 
 tending from 6 months to 21 years, of whom 81/2% 
 had received no relief, i5>^% had received tem- 
 porary relief, 45% intermittent rehef, 31% con- 
 tinuous relief. 
 
 AVe have thus accomplished, so far as was feasible, one ob- 
 ject for which the present inquiry was undertaken, namely, "to 
 contrast with dependent or semi-dependent families under clinic 
 care other families also under clinic care who thus far have taken 
 care of their own tuberculosis and have escaped the shoals of 
 
 24 
 
dependency in order to see in what way they differ from the 
 group of dependent famiHes." 
 
 The intensive study of thirty-five reHef cases which follows 
 has for its purpose the accomplishment of two other objects, 
 stated previously, as reasons for undertaking the inquiry : 
 
 First, "To show the background, the constitution, the quality 
 of fibre, so to speak, of those families under clinic care who are 
 regarded specifically as tuberculous families, who are partially, or 
 entirely dependent, and for whom special tuberculosis funds are 
 being called upon to furnish material relief." 
 
 Second, "To point out deficiencies in both the medical and 
 social treatment of dependent families with tuberculosis." 
 
 The accomplishment of the fourth object of the inquiry, 
 namely, "to suggest possibilities for the employment of special 
 tuberculosis funds which will bring in the largest ultimate re- 
 turns," will be made easier if predicated on the findings of the 
 inquiry as a whole. 
 
 25 
 
Part II 
 
 Intensive Study of Thirty-Five Relief Families 
 
 THIRTY-FIVE families receiving aid from the Woman's 
 Auxiliary of one of the Associated Clinics furnished the 
 basis for this study. These families had been selected by 
 the Auxiliary from among the individuals under clinic care as 
 most in need of relief to supplement their incomes. Families 
 unknown to other social agencies, families under care of social 
 agencies but not receiving adequate relief in the opinion of the 
 visiting clinic nurse, and cases in which the Auxiliary was co- 
 operating with some other agency in the matter of relief were 
 included. Not alone those with the smallest income but those 
 least efficient in meeting the problem of life and living are to be 
 found in this group. On the other hand, casual patients, drift- 
 ing in and out of the clinic, only to be lost sight of in the end, did 
 not come within the scope of the Auxiliary's work. We have, 
 then, a selected group, which includes, however, all the families 
 under Auxiliary care at a given time. 
 
 The 35 families studied include 31 normal families, i. e., 
 man, woman and children; 2 fractional families, one a deserted 
 woman and 4 children living with another man, and a woman 
 living with her mother and sister; also 2 single women. There 
 were 34 men, 37 women, 15 adult children and 131 children 
 under 16 comprised in the entire group. 
 
 Of these 35 families all but 3 are on the records of one or 
 the other of the large organized relief societies. Nineteen of 
 these families were known to social agencies before they came in 
 contact with the clinic. 
 
 Problems arising from ignorance of our language, our cus- 
 toms and the standards necessary for city life bulk large in the 
 task of social work with tuberculosis patients. The fact that 
 these problems are not featured in this study means only that in 
 the section of the city studied the families were predominately of 
 
 27 
 
American, German and Irish descent. The detail of the nation- 
 aHty of the 35 families studied is as follows : United States, 22 
 (i colored); Italian, 4; Irish, 6; English, i; Polish, i; and 
 Croatian, i. 
 
 Considering the occupation of the wage earners of these fami- 
 lies, the predominance of drivers and laborers has no relation to 
 their tuberculous condition, but rather reflects the fact that a 
 large proportion of men living in this particular section of the 
 city, the middle West Side, belong to' the lowest wage-earning 
 group and are either teamsters or laborers. 
 
 It is also worth noting that the people living in this district 
 are, according to New York standards, a fairly static group, fami- 
 lies remaining in this neighborhood from one generation to an- 
 other. When they do move the new home lies within a few blocks 
 of the old one. We may, therefore, expect to see the neighbor- 
 hood influences reflected in the lives of these families. The char- 
 acter of these neighborhood influences is vividly described in one 
 of the "West Side Studies, Boyhood and Lawlessness" : 
 
 "At first sight there are no striking features about the 
 middle West Side. Hand to mouth existence reduces living 
 to a universal sameness, which has little time or place for 
 variety. In street after street are the same crowded, unsani- 
 tary tenements, the same untended group of playing children, 
 the same rough men gathered around stores and saloons on 
 the avenue, the same sluggish women grouped on the steps 
 of the tenements and the' cross streets. The visitor will find 
 no rambling shacks, no conventional criminal's alleys — only 
 square, dull, monotonous ugliness, much dirt and a great 
 deal of apathy. The very lack of salient features is the su- 
 preme character of this neighborhood. The most noticeable 
 fact about it is that there is nothing to notice. It is ear- 
 marked by negativeness. There is usually a lifelessness 
 about the streets and buildings, even at their best, which is 
 reflected in the attitude of the people who live in them. The 
 whole scene is dull, drab, uninteresting, totally devoid of the 
 color and picturesqueness which give so many poor districts 
 a character and fascination of their own." 
 
 28 
 
STUDY BASED ON MEDICAL AND SOCIAL 
 RECORDS 
 
 The present study was undertaken jointly by a nurse and a 
 social worker. Unfortunately for the completeness of the study, 
 the medical data were largely collected before the social worker 
 began her work, and only in a few puzzling instances did it seem 
 worth while to go over the ground a second time. Thus some data 
 which might have been available in the medical records and which 
 seemed important to a social worker were not included in the tabu- 
 lation, usually because getting it would necessitate a great deal 
 of extra labor and extend the scope of the study too far to be 
 practicable. The information obtained was collected from many 
 different sources with infinite pains, e. g., from clinic records and 
 nurses (where verbal reports could be relied on to be fairly ac- 
 curate), from the Hospital Admission Bureau, and from the main 
 office of the Department of Health. 
 
 Theoretically, the records of each patient are centralized in 
 one place, but as the patient is sent from clinic to day camp, from 
 day camp to hospital or sanatorium and back, perhaps to a clinic 
 in a different section of the city, and finally is discharged, the con- 
 necting link between the various records is often broken, and be- 
 yond the clerical continuity there is none, each agency in turn 
 assuming responsibility. Often the clue to a part of the medical 
 history was found only by chance in the social record, and was 
 then traced and verified by applying directly to the agency or 
 institution mentioned. 
 
 In several of the clinics the records of the several members 
 of the family have been gathered together, so that if you know 
 that one child is under clinic care and get his record, you can 
 readily find out all about the other children as well as about the 
 mother and father; but unfortunately this method has not yet 
 been started in the clinic in which this study was made. 
 
 The filing systems in the various clinics differ, some being 
 by name, some by number, some by the day of the week the case 
 attends the clinic. A great deal of information, probably the 
 most valuable, is stored in the minds of physicians and nurses. 
 
 29 
 
The record-keeping of social agencies, on the other hand, is 
 fuller, more continuous, everything known of one family being 
 collected in one envelope, so that the social records were easier to 
 handle and more nearly a measure of the work actually done by 
 the agency. However, social data which seemed important soon 
 exceeded the provisions made for its tabulation on the printed 
 schedule prepared for use in connection with this study. An- 
 other form of tabulation was prepared which allowed for the 
 following additional classifications : 
 
 1. Calibre of family — Family history — Attitude. 
 
 2. Home surroundings — Healthful stimuli — Freedom 
 
 from mental strain. 
 
 3. Physical complications. 
 
 4. Emiployment. 
 
 5. Income vs. Budget. 
 
 6. Needs summarized. 
 
 7. Social treatment summarized. 
 
 8. Medical treatment. 
 
 9. Family's reaction under treatment. 
 
 10. Co-operation of clinic and social agencies — Occa- 
 sional reports — ^Joint plan — Separate treatment. 
 The roughness of these headings reflects the scrap-basket 
 nature of this schedule ; but in one way or another a great many 
 of the facts which were used in later tabulation could be noted 
 here, and also unclassifiable facts and even impressions which 
 would never reduce to statistics, but too telling to discard, could 
 be lodged in this scheme. 
 
 PHYSICAL DISABILITIES 
 
 Any consideration of the physical handicaps under which 
 these families were laboring would naturally give first place to 
 the amount of tuberculosis from which they were suffering. Out 
 of a total of 217 individuals, 54 (24.8%) were tuberculous, of 
 whom 20 (37%) were dead.^ Of these, five tuberculous children 
 registered in the social records but not in the clinic records, may 
 have died before the family came to the attention of the clinic. 
 1 See Appendix, page 71. 
 
 30 
 
It appears that the examination of other members of the family- 
 has been fairly well carried out, as only 38 (17.5%) were not 
 examined. 
 
 As regards other physical disabilities not directly connected 
 with or relating to the tuberculous infection of these people both 
 the medical and social records afford only the most meagre infor- 
 mation. Minor illnesses recorded in the social records, unless very 
 frequent or noted as symptoms of more serious conditions, were 
 not considered. These facts are brought out later in the sum- 
 mary of physical and social disabilities (page 37, part II). 
 
 An attempt was made to tabulate the general health condi- 
 tions under the headings Good, Poor, Not Stated, but it seemed 
 impracticable because of the slight evidence available. 
 
 SOCIAL DISABILITIES 
 
 The economic status of these families and its relation to their 
 tuberculous condition is evidenced by the information obtained 
 from the social histories regarding their condition of dependency. 
 Thus we find that of the 35 families : 
 
 Three were not known to organized charity ; 
 
 Nineteen were known to organized charity previous to 
 
 clinic care; 
 Five were known to organized charity subsequent to 
 
 cHnic care; 
 Eight were known to organized charity and to the clinic 
 
 at the same time. 
 
 That is, 19 families had a previous history of social de- 
 pendence, although not necessarily receiving relief. In eight 
 families social dependence developed at the time of physical 
 breakdown. Five families were able to meet the problem for a 
 time with the help of the clinic, but later needed social care. 
 Three families have so far been helped solely by the clinic. Doubt- 
 less a much larger proportion, of whom we have no record be- 
 cause they do not come within the scope of this study, carry the 
 
 31 
 
burden of sickness with no help from either organized charity 
 or the chnic. 
 
 These figures are suggestive in showing in how few famihes 
 the cHnics try to carry the relief problem alone. Of three fam- 
 ilies in this group, one was a normal family, with both parents 
 and three children. There are indications that the problem was 
 predominantly a health problem. The man, a watchman, was in 
 the habit of making $17 per week. There are no mental or 
 moral disabilities recorded, and relatives are helping the family. 
 The danger signals indicated are that it is the man, the wage 
 earner, who is ill and incapacitated for work. His condition is 
 progressive and he is in the hospital. The relatives are "unable 
 to help much." The family is unwilling to attend clinic. So far 
 it is apparently a family meeting its own problem, although not 
 entirely satisfactorily. 
 
 The other two included in this group are single women, one 
 of whom is taken care of by the community through a sana- 
 torium. The other lives with a sister and their old mother, appar- 
 ently managing with very little help. These would seem to be 
 less urgent cases from a social point of view. 
 
 That eight families did not come to social agencies until the 
 time of illness and five families not until some time after, sug- 
 gests that in these families a fair degree of normality may be 
 expected, and the chief element, and therefore the chief respon- 
 sibility, is probably the health problem. Other things being equal, 
 a reconstruction of their health will set them on their feet, pro- 
 viding the previous state of normality has not been impaired 
 during the strain of illness. 
 
 The largest number, 19 families, or 55%, belong to the 
 group which has been socially dependent prior to having tuber- 
 culosis or prior to the discovery of it. In these families the social 
 factors must be closely considered in any program of care for the 
 existing tuberculous condition. 
 
 In as far as these figures are suggestive, they show that the 
 clinics' relief program is of inconsiderable size, and used to sup- 
 plement rather than take the place of other forms of organized 
 charity. 
 
 32 
 
Reclassifying these 35 families in an attempt to relate their 
 economic dependenc}^ to their tuberculous condition, we find that : 
 
 (a) Prior to tuberculous infection. 
 
 Twenty-one families were apparently self-sup- 
 porting ; 
 Eight families were occasionally dependent ; 
 Six families were chronic dependents. 
 
 (b) After tuberculous infection. 
 
 One family still apparently self-supporting (re- 
 ceived sanatorium outfit only). 
 
 Twenty-seven families received occasional relief ; 
 
 Seven families were chronic dependents (i. e., re- 
 ceived som.e regular allowance, which was main 
 support of family). 
 
 MEN'S WORK 
 
 The records of ^2 wage earners were studied and the infor- 
 mation summarized as follows : ^ 
 
 All belonged to a low-wage group ; that is, wages varied 
 from $6 to $21 per week. One was a telegraph operator working 
 regularly and earning good wages, but the amount was not stated. 
 Four whose wages were too irregular to tabulate were alcoholic, 
 inefficient or physically disabled (other than by tuberculosis) to 
 such an extent that they were practically unemployable. The 
 lowest tabulated wage, $6, was the estimated earnings of a peddler. 
 Twenty-four out of 32 earned not over $15 weekly; 18 out of 32 
 worked irregularly. 
 
 Physical disability other than tuberculosis, alcoholism, ineffi- 
 ciency and trade irregularity are factors in these cases. Any at- 
 tempt to secure an adequate income which will protect the family 
 from the living conditions which were favorable to the outbreak 
 of tuberculosis must deal with these factors. 
 
 Considering the effect of tuberculosis on the economic effi- 
 ciency of these 32 wage earners, we find that 1 1 were dead, as a 
 result of tuberculosis, 10 were living and tuberculous. Of these 
 
 1 See Appendix, pages 72 and y2>- 
 
 33 
 
lo, two are working at the same occupation; one a laborer at $13 
 a week, one a flagman at $10 a week. Three others showed a 
 reduced earning capacity since their tuberculous infection. One, 
 who formerly earned $15 as a laborer, now earns $10 a week as 
 a porter. Another, who earned $13 as a teamster, now earns $12 
 as a laborer. The third, who formerly earned $15 as a painter, 
 is now working as a janitor for his rent plus $15 monthly. Five 
 of the 10 are not working. 
 
 One factor in this reduced earning capacity may lie in the 
 casual character of the occupation, but the physical disability 
 resulting from their tuberculous infection has undoubtedly played 
 a large part in reducing the wage-earning capacity of this group. 
 The fact that these men are allowed to drift into any occupation 
 on their return from an institution frequently accounts for their 
 subsequent relapse and death. It would seem the better part of 
 economy to continue such cases under observation and to sup- 
 plement their income, rather than to sever relations because the 
 "man is back at work and able to support his family." 
 
 WOMEN'S WORK 
 
 An attempt was made to summarize the available informa- 
 tion regarding the work and wages of the wives of these 32 
 wage earners as follows : ^ 
 
 Information available as to their previous occupation was 
 too vague to be used as a basis for any conclusion, except as to 
 the number of women who were previously employed in gainful 
 occupations. In this low wage group many women had been 
 working even previous to the death or illness of the husband. 
 In six families only the woman was not helping with the financial 
 burden when tuberculosis developed. 
 
 Subsequently i woman died. Six wives still do only house- 
 work. The occupation of 3 others was not known. Twenty- 
 two of these women have taken up the burden of support. 
 
 A large number of women did only home work after the out- 
 break of disease. The women tend to go into unskilled work 
 that takes part time, largely cleaning and laundry work, because 
 
 1 See Appendix, pages 74 and 75. 
 
 34 
 
they have children to care for. In 14 cases part time work only 
 was being done. 
 
 When the wage earner is afflicted, women are driven into 
 industry, either to supplement the reduced earnings of the hus- 
 band or to undertake the entire support of the family. Wages 
 and hours are entirely irregular, but in no instance are the earn- 
 ings sufficient to maintain a decent standard of living unless 
 supplemented by children's earnings and relief. 
 
 In II families where the man is dead, 2 families have chil- 
 dren over working age ; otherwise the woman has to carry the 
 full burden of support unless supplemented by some form of 
 relief. The weekly wage earning capacity of these 11 women 
 is as follows : 
 
 One woman earns $9.00 
 
 Three women earn 6.00 
 
 One woman earns 5.00 
 
 One woman earns 3.50 
 
 One woman earns 2.50 
 
 Two not known 
 Two dead 
 
 In the 10 families where the man is living but tuberculous, 2 
 women are not working; in one instance because the man still 
 holds his job, in the other because grown children are working. 
 Four women are the only wage earners for their families. 
 Their occupation and earning capacity per week are as follows: 
 
 One factory worker $5.00 
 
 One janitress and cleaning, rent plus 4.50 
 
 (Woman not only supporting children but 
 sick husband as well.) 
 
 One laundress 4.50 
 
 One factory worker 4.25 
 
 In the group in which the man is living and either not 
 tuberculous or not examined, therefore supposedly working and 
 
 35 
 
supporting family — 4 women are at home and 4 are supplement- 
 ing the family income. 
 
 CHILDREN'S WORK 
 
 Out of 32 families only 8 famiHes have children of working 
 age, 14 years or over, 13 of whom are or have been working, 
 4 among families where wage earner is not affected by disease. 
 
 The kind of work done by these 13 working children and 
 their weekly wage was as follows : 
 
 One ofhce boy $6.00 
 
 One candy packer 6.00 
 
 One elevator boy 5-00 
 
 One errand boy 4.50 
 
 One factory hand : 4.50 
 
 One electrician's helper 4.00 
 
 One laundry worker 4.00 
 
 One farm hand (tuberculous boy supporting only 
 
 himself) 
 
 One, employment unknown 
 
 Three, odd jobs 
 
 One not working at present 
 
 In addition, in i family 2 children under age were working 
 at selling newspapers. They had repeatedly been caught beg- 
 ging. Including these 2 children, the employment of 8 children 
 appeared entirely unsatisfactory. Of the remaining 7 not enough 
 is known to judge; but only i (an electrician's helper) was 
 learning a skilled trade. One candy packer and i office boy 
 were brother and sister whose parents had died of tuberculosis. 
 The record shows that neither can hold any job very long, the 
 girl being indifferent and apathetic and the boy rather wild. 
 
 HOUSING CONDITIONS 
 
 Little definite information is available regarding the housing 
 conditions of these famiUes. It was known that 8 of the homes 
 
 36 
 
of the 35 families were dirty and ill-kept. In 6 families the 
 ratio of individuals to a room was over 1.5. Six families had 
 a record of frequent moving. Thus : 
 
 One family moved five times in seven years. 
 
 One family moved fifteen times in ten years, seven months. 
 
 One family moved seven times in three years. 
 
 One family moved seven times in four years. 
 
 One family moved fourteen times in nine years. 
 
 One family moved ten times in three years. 
 
 CONCLUSIONS AS TO PHYSICAL AND SOCIAL 
 STATUS OF FAMILIES STUDIED 
 
 Of the 217 individuals included in the 35 families studied, 
 20 (9.2%) were dead as a result of tuberculosis, 34 (15.6%) 
 were living and tuberculous. In addition to this physical handi- 
 cap, the data obtainable show that complicating personal and 
 individual factors are keeping these families below standard. 
 The following tabulation is an attempt to summarize both the 
 physical and social disabilities from which these individuals were 
 suffering : 
 
 34 Men: 
 
 Physically below par (other than tuberculosis) .... 20 
 
 Industrially below par 18 
 
 Cruel and abusive 4 
 
 Indifferent 7 
 
 Alcoholic 9 
 
 Deserter 2 
 
 37 Women: 
 
 Physically below par (other than tuberculosis — may 
 
 include childbirth) 22 
 
 Inefficient (in the home) 8 
 
 Indifferent 5 
 
 Alcoholic 4 
 
 Immoral 4 
 
 Mentally defective i 
 
 37 
 
146 Children : 
 
 Physically below par (other than tuberculosis) 19 
 
 School irregular , 2 
 
 Below grade i 
 
 Mentally defective i 
 
 Unruly 4 
 
 Child labor 2 
 
 Begging 2 
 
 Inadequate home care ' 2 
 
 This is all that can be said as the information is so meagre. 
 Absence of comment may mean that conditions were good or it 
 may mean that the social worker failed to recognize the presence 
 of bad conditions. The outstanding defects seem almost like 
 mountain peaks that succeed in obtruding themselves above the 
 surface of the prevailing low standard. The industrial difficul- 
 ties are most quickly noted. The housekeeping disabilities seem 
 next in importance. Further investigation would, without doubt, 
 show a maze of disabilities all reacting on each other. The 
 records as a whole are amazing in their haphazard appreciation 
 of these people's difficulties. 
 
 Of the 35 families studied many have young children. In 
 8 families there are children over school age. The children's 
 needs seem to have been disregarded altogether unless we may 
 assume that, except in the few cases noted, these children were 
 attending school regularly, were up to grade and were well cared 
 for at home. Of the 15 children who are working, 2 are under 
 age, 8 are working under conditions entirely unsatisfactory. Of 
 the remaining 7 not enough is known to judge as to their work 
 condition, but i only, an electrician's helper, is learning a skilled 
 trade. The general physical level is low, but how many are 
 actually in robust health and how many have physical disabilities 
 not related to their tuberculous condition is not known. 
 
 It is noteworthy that relatives figured so little in the lives of 
 these families, at least, that is the impression one gets from the 
 social records. Financially we would expect them to do very 
 little, as the probabilities are that they themselves are near the 
 
 38 
 
margin of dependence. In 8 cases relatives gave some material 
 assistance. It was very little. 
 
 Other natural resources of helpfulness were not very suc- 
 cessfully tapped. The church gave financial help in five in- 
 stances. In one instance this wa.s estimated as at least $ioo. 
 Employers in no case gave relief and, again judging from the 
 records, it does not appear that they were ever approached on 
 this subject. Adequate pensions were given in three cases with 
 educational supervision, otherwise relief was meagre, intermit- 
 tent and inadequate during the period of the wage earner's ill- 
 ness, thus letting the burden fall too heavily on the wife. In 
 17 instances the woman subsequently developed tuberculosis or 
 was otherwise physically disabled. As the institutional care was 
 short and intermittent, the greater strain on the family came 
 during illness which often lasted for several years. All of the 
 families belong to the low wage earning group and therefore had 
 little or no chance to save for time of sickness. 
 
 The industries of the men were largely unskilled. In 18 
 cases the work history was irregular. In 5 cases this was due 
 to the irregularity of trade itself, in the other 13 cases to com- 
 plicating factors of physical incapacity, alcoholism, inefficiency 
 and indifference. 
 
 Previous to the history of tuberculosis infection a large pro- 
 portion of women have done housework only, subsequently 6 
 only are recorded as doing housework, from which it appears 
 that not only the death of the wage earner but illness throws the 
 burden of support on the woman and drives her into industry. 
 Hours and wages for women's work are most irregular. Four- 
 teen of the 20 women working were doing part-time work. 
 Every tendency is to go into unskilled work, largely cleaning and 
 laundry work. 
 
 The most evident thing is that very little was known of the 
 background of these families and tentatively one would conclude 
 that relatives play a very small part in their lives ; that the 
 church connection has been largely lost as far as any vital con- 
 nection is concerned; that with employers the relationship is 
 
 39 
 
temporary, shifting and in no case does it mean more than a 
 work relationship so far as the social records can show. The 
 neighborhood background can only be concluded by one's knowl- 
 edge of the West Side. The records never, except by the most 
 meagre comments, take the neighborhood life into consideration. 
 To sum up, as far as the testimony of the records go, the 
 majority of the families studied were deficient in the elements 
 essential to social welfare in health, industrial efficiency, recre- 
 ation, education and spiritual vigor. In so far as this same tes- 
 timony goes, the tuberculous condition seemed deeply imbedded 
 in these social disabilities and could hardly have been treated 
 separately. The records fail to give a clear-cut idea of the 
 strong and weak points in each family or any measure of the 
 permanent progress made in treating these families. Judging 
 from the repeated re-openings of the cases, the harmful forces 
 are too deep-rooted and persistent to be removed by the social 
 treatment given. 
 
 METHODS OF TREATMENT 
 
 We come now to a consideration of a third object for which 
 the present study was undertaken, namely, to point out the "de- 
 ficiencies in both the medical and social treatment of dependent 
 families with tuberculosis." 
 
 That the problem of the tuberculous patient is not met by 
 treating him alone, but must take in his whole family in its oper- 
 ation, seems an established principle in the care of tuberculosis. 
 That inadequate incomes, accompanied by underfeeding, bad 
 housing and worry, are obstacles in the way of the physician 
 which must be considered in any program of care, is also show- 
 ing itself in the prevalent practice of clinics in supplementing 
 the incomes of their neediest patients, either through their own 
 organizations or by referring them to some "relief society." But 
 whether medical care plus relief can satisfactorily meet the 
 problem of these families, or whether effective care must in- 
 clude "social treatment," has not yet been clearly proven. 
 
 Tentatively we may define social treatment as "action under- 
 
 40 
 
taken to secure for a family the ability to insure its own general 
 well-being," or, more specifically, the endeavor to secure for a 
 family resources in health, employment, education, recreation 
 and spiritual vigor. 
 
 Are there families under clinic care who are deficient in this 
 ability to "secure their own general well-being," and if so, can 
 their tuberculous condition be treated separately? Or is their 
 tuberculosis simply one manifestation, one symptom of general 
 below-par-ness which may break out in any of a score of differ- 
 ent ways, and which will always be liable to break out again until 
 the deep-rooted causes can be diagnosed and treated? 
 
 If we find conditions generally accepted as lowering resist- 
 ance to tuberculous infection operative in a majority of tubercu- 
 lous families, upon further analysis do we not find the cause 
 of these conditions imbedded in the social forces of the family 
 and the community? Can we not demonstrate that, as long as 
 we allow these primary causes to go untreated, the same symp- 
 toms are apt to manifest themselves and that any treatment of 
 one symptom only is temporary and uneconomic? If this is 
 true, how can the treatment of the social needs of the tuberculous 
 best be correlated with the work of the physician and nurse? 
 Is there as yet a technique of social treatment to deal with these 
 "primary causes?" Is this technique effective in all cases? If 
 not, where does it fail and why? 
 
 Again, what can be expected under present conditions from 
 the clinics? Certainly social workers should know their point 
 of view, know the handicaps under which they work, where 
 there are gaps in their routine, where an extra effort in the 
 same direction will help their work, and how much can rightfully 
 be expected from them for the families in which social workers 
 are equally interested. If these points can be fixed fairly in 
 mind and the method of social work is flexible enough to adapt 
 itself to these conditions, social workers should be more ready 
 to work harmoniously at the joint medical and social problems 
 of tuberculosis or to face squarely certain issues which have 
 seemed to be irreconcilable. 
 
 41 
 
MEDICAL TREATMENT 
 
 Before proceeding to a detailed consideration of the methods 
 of treatment in vogue in the tuberculosis clinics and the relation 
 of these methods to the scheme of social treatment as carried 
 out by the social agencies which are also in touch with these 
 families, it may be well to see what effect institutional care and 
 treatment have had upon the tuberculous condition of these fam- 
 ilies. 
 
 Thirty-five cases, in each instance the first member of the 
 family who had applied to the clinic for care, were studied for 
 the history of their institutional care, which is shown in the 
 following tabulation: 
 
 Length of Care No. of Cases 
 
 Under one month 6 
 
 One to three months 7 
 
 Three to six months 4 
 
 Six months to one year 6 
 
 Over one year 3 
 
 No institutional care 9 
 
 Total 35 
 
 In 8 of these cases the care recorded was intermittent, 
 that is, included two or more admissions to institutions. Of 
 these 35 cases, 13 died, 6 are progressive, 11 improved, 5 ap- 
 parently cured. Day camp care was noted in 3 cases, but in- 
 formation was lacking as to the length of their attendance or its 
 regularity. 
 
 Fourteen subsequent cases in these families also received 
 institutional care as follows: 
 
 Length of Care No. of Cases 
 
 Under one month i 
 
 One to three months 2 
 
 Three to six months 3 
 
 Six months to one year i 
 
 No institutional care 7 
 
 Total 14 
 
 42 
 
Thus in 35 families, out of a total of 49 cases of tuberculosis 
 with whom the clinic had been working, 16 (32.6%) received 
 no institutional care. 
 
 It was not possible to arrive at any definite conclusion as 
 to the results obtained by the institutional care received for the 
 following reasons : 
 
 1. The number of cases in each group was so small. 
 
 2. Definite information as to the condition of the patient 
 
 on admission is lacking. 
 
 3. Insufficient data as to whether care had been inter- 
 
 mitten or consecutive, i. e., whether the patient's 
 stay in an institution had been for a consecutive 
 number of weeks or months, or whether he had 
 been admitted and discharged several times. 
 
 While this intermittent care may be due to lack of enforce- 
 ment of the powers of forcible detention, it is probably true that 
 in many instances a continuous stay in the institution could be 
 secured voluntarily : 
 
 1. If the patient were convinced that his family was 
 
 being properly cared for. 
 
 2. If institutional life were made more attractive 
 
 by eliminating just grounds for the repeated 
 complaints regarding overcrowdng, failure to 
 classify patients according to their social char- 
 acteristics, unattractive dietaries, etc. 
 
 Likewise we are unable to arrive at any conclusion as to the 
 effect of institutional care of the first case on the subsequent 
 infection of other members of the family for the following rea- 
 sons: 
 
 1. The length of infection previous to admission to the 
 
 clinic could not be shown. 
 
 2. It was not possible to know definitely whether the 
 
 case first registered with the clinic was the first 
 infection in the family. 
 
 43 
 
From the information available for the 33 cases who did 
 enter institutions, it seems that institutional care played only a 
 small part in the program of care worked out for these families. 
 In man}^ cases it was too short to have any effect except pos- 
 sibly in giving the patients some training in hygienic methods 
 of living. 
 
 The fact that institutional care plays such a small part in the 
 history of these tuberculous people should be realized and a more 
 adequate technique of home care should be developed. 
 
 As regards clinic care, the regular routine provides for 
 periodic re-examination, for home visits by the clinic nurses and 
 for day camp care in a small number of cases. There is no 
 record of the adequacy of any of these measures or of the 
 methods employed to bring into line ignorant or indifferent 
 patients. In other words, the ground is covered extensively 
 by the clinics, but there appears to be need for far more intensive 
 individual case work if results are to be obtained in the home 
 care of these cases. 
 
 CO-OPERATION BETWEEN MEDICAL AND SOCIAL 
 
 AGENCIES AS AFFECTED BY WORK 
 
 METHODS OF EACH 
 
 Before proceeding to a detailed criticism of the methods of 
 work of the two groups of agencies it should be noted that these 
 criticisms have been gleaned from personal interviews with indi- 
 vidual workers, from attendance at conferences and from the 
 reading of reports, rather than from any analysis of case records, 
 where disagreements are seldom recorded, although the basis for 
 the criticism of relief agency methods are illustrated in the 
 records. 
 
 The criticisms made by the social agencies of the clinics' 
 methods of work can be summarized briefly as follows : 
 
 I. That the tuberculosis specialist sees only the medical 
 problem, ignoring the effect of his plan of treat- 
 ment on other phases of the patient's develop- 
 ment ; that the giving of relief is on a sentimen- 
 
 44 
 
tal basis not determined by any broad social 
 policy; that relief is given without regard as to 
 whether the right use of it is made, e. g., if the 
 patient actually consumes the special diet pro- 
 vided ; that the tuberculosis nurse's policy of 
 "handouts" spoils the later relationship of the 
 family and the visitor for the social agency ; that 
 the clinic often gives relief w^hen the giving of 
 it makes the continuation of a socially dangerous 
 situation possible. 
 
 2. That there is inexcusable delay in getting patients to 
 
 hospitals and sanatoria. 
 
 3. That forcible removal is not often enough enforced. 
 
 4. That home supervision is inadequate. 
 
 5. That disputed diagnoses often keep the patient on ten- 
 
 terhooks and finally discourage his attendance at 
 the clinic. 
 
 6. That the physical examination is too short and super- 
 
 ficial to be reliable, especially for the detection of 
 other dangerous symptoms. 
 
 7. That the clinic does not make sufficient effort to fol- 
 
 low up patients who do not attend regularly, or 
 lapse altogether, or to secure examination of the 
 entire family. 
 
 8. That having diagnosed the need of other medical 
 
 treatment, e. g., removal of tonsils and adenoids, 
 there is no assurance that this is carried out. 
 
 9. That clinic records are not full enough, accurate 
 
 enough, up-to-date enough, available enough. 
 
 The first of these criticisms of the clinics' work relates to 
 action on the part of the clinic which involves a broader question 
 than the medical aspect of the cases under consideration. Relief 
 as a therapeutic measure may be within the scope of medicine, 
 but relief as it contributes to the family's activity as a self- 
 dependent, economic and social entity may need other than medi- 
 cal consideration. Policies of relief-giving as well as those in- 
 
 45 
 
volving the maintenance or breaking up of a family group must 
 be settled by fundamental considerations of the greatest total good 
 to the family and community, which both nurse and social worker 
 are seeking. We have come to realize that this cannot be done 
 without some technical knowledge of social problems^ which very 
 few nurses have as yet acquired. If the problem is to be solved 
 by the division of the field between the social worker and the 
 nurse, then the nurse must realize the validity of the social 
 worker's principles in regard to the social problem of a tuber- 
 culous family. More and more, however, nurses are adding the 
 training in these principles to their equipment, and they will be 
 increasingly ready to handle the whole problem, weighing the 
 medical and social needs of a patient so as to reach the best ad- 
 justment, or better still, the harmonious solution of his problem. 
 In the meantime, social worker and nurse should get together for 
 a reasonable conference on each case as it comes up, reminding 
 themselves often of their common aim in securing the welfare of 
 the individual, and defining what this welfare consists of. It is 
 worth while remembering that there may also be an advantage 
 in the intensity with which each specialized agency regards the 
 special need it is meeting. 
 
 When social workers wish to suggest modification in the 
 medical treatment given to a man because they believe that not 
 merely his sickness but also his status as father, wage earner 
 and citizen needs consideration, they have all the disadvantages of 
 the youngest member of the fam.ily of professions — in measuring 
 up their tentative, pragmatic and still largely unformed technique 
 against the older one of medicine. If they would only remem- 
 ber to keep it tentative and pragmatic ! Do we know yet, for 
 instance, on scientific — not dogmatic — grounds what is a "socially 
 dangerous situation"? Every step which can be taken toward 
 increasing the firmness and soundness of social treatment will 
 win social workers a better hearing with the medical specialists. 
 
 The second point, about inexcusable delay, also needs further 
 analysis. Is it not sometimes due to the clinic being more con- 
 scious than social workers of the inadequate facilities, the other 
 
 46 
 
more urgent cases pressing for attention, of the unattractiveness 
 of institutions which makes them so unendurable to the patients 
 who are sent? We need to differentiate pretty fairly between 
 lack of community resources and the apparent indifference of the 
 cHnic in order to put pressure in the right place. Forcible re- 
 moval is another point at which the health authorities have had 
 to be wary — to go no further than public opinion would sustain 
 them in the exercise of so drastic a measure. 
 
 The objections about inadequate home supervision, hasty 
 medical examinations and failure in follow-up work have a fa- 
 miliar ring to social workers. They raise the question as to 
 whether an attempt to cover fully the field in some shape is as 
 valuable as to establish standards in a limited field which can be 
 used as a basis of education and extension. 
 
 The better correlation of the work of the tuberculosis clinics 
 with other medical clinics is especially important, in order to insure 
 specialized treatment when morbid conditions other than tuber- 
 culosis are present. It is equally necessary, in order to secure 
 treatment for physical defects contributory to tuberculous infec- 
 tion, when the special tuberculosis clinic is not equipped to give 
 such treatment. In immigrant families, in indifferent but socially 
 dangerous cases, with children, we cannot afford to leave this 
 correlation to the initiative of the patient. 
 
 The question of disputed diagnoses seems to lie so wholly in 
 the medical field that we cannot do more than mention it and to 
 recall to the physicians as tactfully as may be the hardship it 
 entails on a family. When all is said, an unsound snap judgment 
 may bring greater and more unnecessary hardship. 
 
 As to the clinic records, they have been in the past scrappy, 
 inaccurate, often out of date and badly organized. Nurses know 
 it, and sadly confess that the most valuable information is in the 
 heads of the physicians. While the clinic record shows the date 
 of the patient's visit to clinic, there is no way of knowing whether 
 this attendance met the mxcdical requirement of individual cases, 
 as the recommendation of the physician in this matter is not re- 
 corded. While other physical defects are noted, there is seldom 
 
 47 
 
information available as to whether treatment for these defects 
 has been secured. Seldom do they note the reason for a patient's 
 discharge from an institution or reason for his not going when 
 institutional treatment seems to be indicated. Occasionally the 
 medical record indicates if the family is hard to deal with, other- 
 wise no comment is made as to the success of home supervision. 
 No distinction is noted on the medical record between lodgers 
 and boarders who share food. In recent years there has undoubt- 
 edly been a considerable improvement in both the medical and 
 social records kept at tuberculosis clinics. 
 
 Judging from the cases studied, the clinics can be trusted 
 to cover the field extensively — to get in all the members of the 
 patient's family, if moral suasion will bring them; to do good 
 preventive work with children ; to visit the home periodically, but 
 not enough ; to secure attendance at the clinic, which does not 
 necessitate very persistent follow-up work; finally, to supply 
 relief, indiscriminately or not, as the case may be, until the relief 
 agencies do the job so well that they must recognize their motives 
 and methods as the best available. 
 
 The indictments of the relief agencies by the clinics may be 
 summarized as follows : 
 
 1. That adequate relief in nourishment, good housing, 
 
 freedom from worry are indispensable therapeu- 
 tic measures, and that the relief agencies give 
 meagrely, defer the giving too long, refuse in 
 cases where it should be given, and give irregu- 
 larly; that the tuberculosis nurse, owing to her 
 medical relationship, has the family's confidence 
 more completely, and is therefore a better judge 
 as to when and how much relief is needed. 
 
 2. That organized charity, having learned the one fact 
 
 that institutional care is desirable for tuberculous 
 people, tries to force this method of treatment 
 through in every case ; and where institutional 
 care is not possible it is apt to drop further action, 
 whereas in some cases home care is not a great 
 
 48 
 
menace, and the existing menace is increased by 
 withholding adequate nourishment — that it is nec- 
 essary to consider individual prejudices and to 
 temporize often. 
 
 3. That organized charity investigation antagonizes the 
 
 patient and leads to nothing in the way of con- 
 structive treatment. 
 
 4. That organized charity has no hold on the family but 
 
 relief. 
 
 5. That organized charity does not succeed in rehabili- 
 
 tating the majority of its families, and therefore 
 its efforts are more or less futile. 
 
 Considering in detail the criticisms made by the clinic nurses 
 of the work of the social agencies for the families in whom they 
 are interested, social workers can afiford to be frankly severe with 
 themselves. 
 
 It is true that in all but a few of the cases studied (three 
 pension cases notably) relief was meagre, irregular and long in 
 coming; that an entirely inadequate conception of the necessary 
 standards of nourishment, sleeping arrangements, rest and out- 
 door recreation was evident. The criticism that at present they 
 seem unfit to judge what is needed in such matters has some 
 foundation. 
 
 The length of time many of these families have been known 
 to organized charity without ever having been affected in the 
 slightest degree by their relationship is startling. That the rela- 
 tionship between organized charity workers and the family hangs 
 on the question of relief, and that only, seems also true almost 
 invariably, and because there is no other lever, withdrawing relief 
 is used frequently by the visitor to get the family to take a de- 
 sired action ; that this fact must bias the sort of information given 
 the visitor, and that therefore the nurse is apt to have a franker 
 relationship is obvious. If there were no question of withdraw- 
 ing relief except in the most extreme instances, and if there had 
 been numerous other ties established between visitor and family, 
 
 49 
 
these could be used to get a family to follow advice. The effort 
 should be to bring about a change in the family's point of view, 
 rather than to make them go through certain actions from fear 
 of losing relief. 
 
 Organized charity workers need, above all, to develop the 
 art of second best plans — when institutions are overcrowded, 
 urging further admissions only aggravates the conditions in the 
 institutions, which make patients hate to go and unwilling to stay. 
 At present it is necessary to select the most urgent, or most 
 helpable cases, in the meantime never ceasing to agitate for more 
 adequate accommodations, but meanwhile developing a technique 
 of home care for cases that can't get in, for cases that are wait- 
 ing, for cases that won't go, for cases that can very well profit by 
 home care. There are instances in which a father must be allowed 
 to die at home, and the best we can do to safeguard the children 
 is to feed them well, keep them out of doors, even if it takes a 
 daily visit, and so show our vital interest that the family will 
 believe in the good faith of our advice. 
 
 These human reasons for the failure of the best plan are 
 much more quickly understood and appreciated apparently by the 
 nurses than by the social workers. Again, social workers are con- 
 stantly getting irritated at and condemning a patient's state of 
 mind, while a nurse realizes that frequently the mentality of a 
 tuberculous patient is affected by the toxic action of his disease. 
 
 The criticism about investigation applies to any sort of case 
 work. If we could only make our services as real to the mind 
 of the public as our investigation, it might be possible to connect 
 the two in their minds, although in the thirty-five cases studied 
 the connection is not clear in the records and the criticism seems 
 justified. 
 
 The waiting game, before a definite plan is decided upon, is 
 one of the social worker's habits which calls forth the condemna- 
 tion of the nurse ; but in the cases studied up to the record of the 
 last two or three years, the whole game was a waiting game, and 
 there were no plans. The recent records do show improvement 
 on this head. 
 
 50 
 
There are additional criticisms Avhich are suggested by a 
 study of these cases. 
 
 We are not sufficiently aware of the strain on the other mem- 
 bers of the family. Our energies seem to flag when the family 
 is examined, more or less adequately relieved, and the patient 
 has applied for admission to an institution. In a great propor- 
 tion of this group of cases the patient was the man. It should 
 be carefully considered how much work the wife could wisely 
 do while she is caring for her husband and even after he has gone. 
 
 According to the social records, natural resources of help 
 are lacking in many cases, and are very meagre where they 
 do exist in these city families. The records show so little 
 study of background that it is almost impossible to say finally 
 that these families have not the normal connections which the 
 case worker largely depends on to make her work successful. But 
 if further study proves this true, does it not indicate that we must 
 use artificial levers more largely to jack these families up? 
 
 We must keep in mind that under present conditions no force 
 can be exercised to keep the average patient in an institution, and 
 repeatedly our half-hearted way of caring for his family has 
 brought a man home to attempt to take up the burden himself, 
 thus jeopardizing his cure. It is sure failure to our treatment to 
 close the case when the cured or arrested patient returns. Only 
 special interest and advice^ constant supervision and readiness to 
 help share the burden of support can insure a man's not relapsing. 
 This policy was not apparent in any case, and relapses and subse- 
 quent deaths occurred. 
 
 SUMMARY 
 
 When we have made all these adjustments there still remain 
 the knotty problems of : 
 
 1. The man who is able but refuses to support his family. 
 
 2. The family which it is eugenically criminal to keep 
 
 together. 
 
 3. The hopeless family who are so unteachable that 
 
 effort and money seem misspent because they do 
 not touch the situation. 
 
 51 
 
4- The non-sufficient family which will have to be helped 
 along- indefinitely to maintain a decent standard, 
 without any prospect of its becoming self- 
 sufficient. 
 In the records of cases studied, the social treatment given 
 seems to have been slight, casual and limited almost solely to 
 times of financial stress — a sort of "lend a hand" policy which 
 may tide a normal family over an emergency. It shows little 
 evidence of the adequate handling of a case having the elements 
 of normality, but demanding intensive work in physical rebuild- 
 ing, re-education of habit and careful readjustment of environ- 
 ment. Unavoidably it has failed with the group where the very 
 mainspring of life seems never to have existed. 
 
 Even to define the social problem of tuberculosis treatment 
 to this extent, to dififerentiate treatment accordingly, would be 
 a step forward. Are we not ready to distinguish between cases 
 we can help and those which we have no power to help, and there- 
 fore do not dare to handle? Furthermore, are social workers 
 prepared to say that these latter cases should become the respon- 
 sibility of the community, which should have larger powers of 
 legal compulsion and take over the care of these cases for its 
 own protection? 
 
 Again, social workers have assumed exclusive skill in the 
 problem of handling relief, and therefore all the odium and the 
 hazards of relief-giving are heaped upon them. They need to 
 define their field of work to themselves and to limit their intake 
 accordingly. They need to dare to say when they do not know 
 or when they think a problem hopeless. They need records that 
 will be some index to the normality and helpability for the fam- 
 ily. If this be done they will have given validity to their conten- 
 tions in cases involving co-operation with other agencies. 
 
 As the best means of securing a workable basis for such 
 co-operation might be suggested : 
 
 I. A broader study of the problem of family welfare 
 involved in a particular case, and in the light of 
 additional knowledge to see if the ultimate prob- 
 lem is not the same for both agencies. 
 
 52 
 
2. A better definition of the scope of each agency's 
 
 work. 
 
 3. A better understanding of the p^irpose of the detailed 
 
 processes or methods of work of each agency. 
 
 4. An appreciation of the Hmitations imposed upon each 
 
 agency by lack of community resources, legal 
 restrictions, limited finances. 
 
 5. A better organized machinery for securing more fre- 
 
 quent conferences between the two groups of 
 agencies on problems in which both are inter- 
 ested. 
 
 6. The exertion of pressure on each organization to 
 
 cause it to square its methods with its professed 
 ideals. 
 
 In snap judgments we are apt to attribute most of the mis- 
 takes we think we see to a failure in this last named particular, 
 whereas they may be due to either more excusable or improvable 
 causes. If this is true, we may be ready to face more easily 
 those issues in which our differences seem to be irreconcilable. 
 Perhaps we may be able to face facts still harder to admit, 
 namely, that there are people whom, with our present equip- 
 ment of skill and technical knowledge, we are not able to help, 
 people who so far as we are concerned are unimprovable. 
 
 53 
 
Conclusions and Recommendations 
 
 Returning to a consideration of the objects for which the 
 present study was undertaken as stated in Part I of this report, 
 there still remains to be considered the fourth object, namely, 
 "to suggest possibilities for the employment of special tubercu- 
 losis funds which will bring in the largest ultimate returns." 
 
 Let us recapitulate the findings of the comparative study of 
 the relief and non-relief families, which were as follows : 
 
 1. That the relief families show: 
 
 a. Poorer housing conditions. 
 
 b. A longer tuberculous history. 
 
 c. A greater incidence of infection. 
 
 d. A larger proportion of wage earners with tubercu- 
 
 losis, both living and dead. 
 
 e. A larger proportion of women working and 
 
 tuberculous. 
 
 f. A larger number of children under i6 with a pro- 
 
 portionately greater number infected with 
 tuberculosis. 
 
 2. The two groups, both relief and non-relief families, be- 
 
 long to the same wage earning class with few excep- 
 tions. 
 
 3. The non-relief group shows : 
 
 a. A much larger number of adult children infected 
 
 with tuberculosis, the majority of whom are 
 or have been working. 
 
 b. A larger income due chiefly to the work of these 
 
 adult children. 
 
 4. Eighty-six per cent, of the relief families have been 
 
 known to various relief agencies for periods extending 
 from 6 months to 21 years, of whom 8^% had re- 
 ceived no relief, 15^% had received temporary relief, 
 45% intermittent relief, 31% continuous reHef. 
 The intensive study of 35 relief families, which is given in 
 Part II of the report, strongly indicates that our present tech- 
 
 54 
 
nique for handling a large proportion of these families is not 
 adequate to secure results. In other words, that we are unable 
 to rehabilitate families in which "the very mainspring of life 
 seems never to have existed." In view of the limited facilities 
 at our disposal we are urged "to define our field of work, differ- 
 entiate our treatment, and to limit our intake accordingly." 
 
 On the basis of these findings we therefore offer the fol- 
 lowing recommendations for the employment of special tubercu- 
 losis funds, particularly with reference to those funds raised 
 by organizations auxiliary to tuberculosis clinics : 
 
 First: To furnish the necessary equipment for taking the 
 "cure," such as sanatorium outfits ; provisions for sleep- 
 ing arrangements which may be necessary to continue 
 the "cure" at home. 
 
 Second : To provide loans : 
 
 a. To discharged sanatorium cases, either to relieve 
 
 the economic pressure during the necessary 
 period of convalescence or to permit the es- 
 tablishment of these sanatorium graduates in 
 business. 
 
 b. To supplement family incomes in order to enable 
 
 the adult tuberculous children who are con- 
 tributing thereto, to cease work and take the 
 "cure." 
 Third : To provide increased facilities for preventive work 
 with children, such as : 
 
 a. Country homes for continuing care of physically 
 
 sub-normal children exposed to infection. 
 
 b. Summer vacation homes for children of tubercu- 
 
 lous families. 
 
 c. Temporary homes for children under four whose 
 
 mothers may need institutional care. 
 
 d. Educational classes, i. e., corrective exercise 
 
 classes, cooking classes. 
 
 Finally, if we have the courage, whether we be social 
 workers or medical workers, let us admit frankly our failures, 
 
 55 
 
recognizing that some were unavoidable considering the material 
 upon which we have been working and the limitations of our 
 present technique, but that others have been due to our own 
 imperfections, our lack of tolerance, of experience, of skill, of 
 knowledge. And if our admitted failures are still with us in 
 the flesh, a broken family that we have not mended, a temporary 
 dependent whom through mistaken kindness we have confirmed 
 in his dependency, let us not trj^ to shift the burden elsewhere, 
 but rather do our best to meet the responsibility created by our 
 own mismanagement in the past. 
 
 56 
 
APPENDIX 
 
NATIONALITY OF FAMILIES STUDIED 
 
 Nationality 
 
 Relief 
 Families 
 
 Non-Relief 
 Families 
 
 United States 
 
 30 
 25 
 12 
 
 2 
 
 8 
 
 Italy 
 
 5 
 
 Ireland 
 
 4 
 
 Austrian 
 
 3 
 
 German 
 
 2 
 
 Hungarian 
 
 6 
 
 English 
 
 1 
 
 Roumanian 
 
 2 
 
 Polish 
 
 
 Bohemian 
 
 5 
 
 French 
 
 1 
 
 Russian 
 
 27 
 
 
 
 Total 
 
 74 
 
 64 
 
 
 
 59 
 
HOUSING— APARTMENTS CLASSIFIED ACCORDING TO NUMBER 
 OF ROOMS PER APARTMENT 
 
 No. OF Rooms in Apartment 
 
 Relief Families 
 
 Non-Relief Families 
 
 
 No. 
 
 Per Cent. 
 
 No. 
 
 Per Cent. 
 
 2 
 
 12 
 28 
 24 
 5 
 1 
 
 4 
 
 16 
 
 37.5 
 
 33 
 
 7 
 
 1.4 
 
 '5 
 
 2 
 15 
 
 27 
 
 11 
 
 6 
 
 2 
 
 1 
 
 3 
 
 3 
 
 24 
 
 4 
 
 43 
 
 5 
 
 17 
 
 6 
 
 9H 
 3 
 
 7 
 
 No infnmna.tinn 
 
 
 
 
 Total 
 
 74 
 
 
 64 
 
 
 
 
 60 
 
l-H 
 
 O 
 
 s 
 
 fc. o 
 
 o o 
 
 6« 
 
 00 Cs 
 r— 1 T- 
 
 
 ►J y, 
 < o 
 
 H a} 
 O « 
 
 PU 
 
 lO 1-1 
 ^ CO 
 
 m 
 S 
 O 
 O 
 
 « 
 
 Q 
 
 5? 
 
 o a> 
 
 6 
 :z; 
 
 GO (N 
 
 
 CO CO 
 
 K 
 
 » 
 < 
 
 ^ 
 
 
 d 
 
 O 00 
 CO <M 
 
 
 O CO 
 1> <© 
 
 s 
 
 fa 
 
 O 
 
 A< 
 in 
 
 
 "a 
 
 1 
 
 •F- 
 
 "a 
 
 d 
 o 
 
 
 61 
 

 ^ 
 
 
 
 
 
 II 
 
 
 
 1 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 0? 
 
 1-1 
 
 
 
 t)< r-i 
 
 C<J 
 
 1— 1 
 
 •>* 
 
 
 
 
 
 CO"* 
 
 000 
 
 
 ;^s 
 
 
 
 
 
 
 
 
 
 
 
 
 
 T-l '^ 
 
 
 ^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ,^ 
 
 
 
 (N 
 
 
 
 
 
 
 
 
 (MM 
 
 
 
 li. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 T3 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 S 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1— 1 
 
 
 iH 
 
 1-1 
 
 
 fO>o 
 
 
 Sl^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e© 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 •* 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 (N 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 as 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 CO 
 
 
 
 
 
 
 
 
 1—1 
 
 
 
 
 
 
 -S 
 
 
 IN 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 m 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 T— 1 
 
 
 
 
 
 
 1-1 
 
 1—1 
 
 
 
 CO"! 
 
 
 N 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e# 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 
 
 
 
 
 
 T-( 
 
 
 
 
 ^s 
 
 
 IN 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e© 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 
 1— 1 
 
 1—1 
 
 I— 1 
 
 
 r-l 
 
 
 iHrH 
 
 CO 10 
 
 
 fN 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 >3 
 
 ^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 
 T-H 
 
 
 (N 
 
 
 
 
 
 CO "5 
 
 <! 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 «© 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 00 
 
 
 
 
 
 
 •* 
 
 C^ 
 
 1—1 
 
 
 
 
 ^^ 
 
 '^^ 
 
 P3 
 
 as 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 JH 
 
 + 
 
 
 
 
 
 (M 
 
 1— 1 
 
 
 
 
 i-H 
 
 
 ^-^ 
 
 C<IM 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 a 
 
 EH 
 
 « 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 1— 1 
 
 (M 
 
 
 
 
 1—1 
 
 
 1—1 tH 
 
 CO "5 
 
 ^; 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e© 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 10 
 
 
 
 
 
 CO 
 
 TJH 
 
 T-H 
 
 1—1 
 
 
 
 
 TiHtO 
 
 -^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e» 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 
 7-1 
 
 C<l 
 
 
 
 1— 1 
 
 
 
 1—1 1-1 
 
 coo 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 »» 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 1— 1 
 
 10 
 
 (N 
 
 
 
 
 
 
 <S>ai 
 
 (MM 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 a» 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 
 
 10 
 
 rH 10 
 
 (N 
 
 
 
 
 
 
 1—1 ^ 
 
 CO 10 
 
 + 
 
 
 
 CO 
 
 Cq (N 
 
 10 
 
 
 
 
 
 
 kOl> 
 
 •^ilj 
 
 
 ,-H 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 <« 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 cc 
 
 T- 
 
 lO 
 
 (M (M 
 
 1—1 
 
 
 
 
 
 
 ■* 
 
 rUto 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 e© 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 r- 
 
 ^ 
 
 CO 
 
 r-( 
 
 
 
 
 
 
 
 iOt> 
 
 -2^ 
 
 
 m 
 
 
 
 
 
 
 
 
 
 
 
 
 
 + 
 
 '^ 
 
 H 
 
 
 
 (M 
 
 
 
 
 
 
 
 (Nt- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 •a 00 
 
 f 
 
 5 
 
 CO 
 
 CO 
 
 
 
 
 
 
 
 CO ® 
 
 CO"^ 
 
 
 t) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 |i( . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 « 
 
 r^ 
 
 t- 
 
 GO 
 
 TlHfN TfH^ 
 
 l>- ro 
 
 lO t^ 
 
 1—1 00 
 
 tH .-h 
 
 COO 
 
 
 00 
 
 (MO 
 
 °l 
 
 
 H-l C^ 
 
 )C0 c^M< 
 
 ,-iOi (MM 
 
 (M-* 
 
 
 I— 1 "-I 
 
 
 i-l 
 
 CJ 
 
 * '"' 
 
 COO 
 
 z-^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 j^ 
 
 
 
 
 Ul 
 
 
 tt-i 
 
 
 ,:^ 
 
 ^ 
 
 
 =4-1 
 
 
 
 C 
 
 J 
 
 
 
 CD 
 
 
 03 
 
 
 
 
 
 
 03 
 
 
 
 3 «« 
 
 
 
 ^, 
 
 
 
 e<-i 
 
 
 
 <--l 
 
 
 
 3 c 
 
 
 
 
 
 
 
 03 
 
 
 
 03 
 
 
 w g 
 
 "7 
 
 ^, p 
 
 5 ^> 
 
 « 
 
 03 
 
 P4 
 
 i1 
 
 rt 
 
 OJ 
 
 Pm ;^ 
 1 
 
 p: 
 
 ^ 
 
 P? 
 
 £^ 
 
 p: 
 
 H ^ 
 
 ? f^ 
 
 S 
 
 rt 
 
 ^ 
 
 rt 
 
 PI 
 
 
 P4 
 
 *^ 
 
 c 
 
 P^ 
 
 § 
 
 
 
 ^ 
 
 
 ^ 
 
 
 ^ 
 
 
 ^ 
 
 
 ^ 
 
 ^ 
 
 
 ^ 
 
 
 
 
 
 
 
 03 
 
 
 IB 
 
 
 a; CO 
 
 
 
 ^^s 
 
 
 -a 
 
 CO 
 
 a 
 
 
 TfH 
 
 a 
 
 
 10 
 
 a 
 
 
 
 
 g ^1 
 
 03 
 
 o3 
 
 
 02 
 
 <; 
 
 
 2 
 
 
 
 
 
 
 
 
 rH 
 
 
 
 
 
 
 ;-< 
 
 1 
 
 ^ 
 
 Eh 
 
 H 
 
 62 
 
HOUSING— GENERAL CLEANLINESS 
 
 
 Relief Families 
 
 Non-Relief Families 
 
 
 No. 
 
 Ppr Cent. 
 
 No. 
 
 Per Cent. 
 
 Good 
 
 29 
 
 22 
 
 15 
 
 4 
 
 41 
 31 
 21 
 
 35 
 21 
 
 6 
 
 56 
 
 Fair 
 
 33 
 
 Bad 
 
 
 Not Stated 
 
 9>^ 
 
 
 
 Total 
 
 70 
 
 
 62 
 
 
 
 
 63 
 
CO 
 
 w. 
 O 
 
 O 
 
 H 
 
 Em 
 O 
 
 H 
 O 
 
 Q 
 
 
 H o 
 
 (N 
 
 § 
 
 
 a 
 5 
 
 
 
 
 » CO 
 
 <s ^ 
 
 
 
 i 
 
 o 
 
 
 C<5 
 
 S 
 
 
 CO 
 
 S 
 ^ 
 
 
 
 O 
 > 
 
 13 
 
 s 
 
 n 
 O 
 
 1 2 
 
 CO® 
 
 
 1 «5 
 
 
 2^ 
 
 in 
 
 IN 
 
 s 
 
 1 
 
 o 
 
 
 O 
 
 1 
 
 
 CO 
 
 e 
 ^ 
 
 o "* 
 
 03 
 
 J 05 
 
 §^ 
 
 HO 
 
 00^ 
 
 28 
 
 
 1^ 
 
 i^ 
 
 
 
 
 IS 
 
 t4~ 
 
 .i 
 p: 
 
 
 3 
 
 64 
 
< 
 
 H 
 O 
 < 
 
 O 
 in 
 
 H 
 < 
 
 < 
 < 
 
 03 
 
 H 
 K 
 W 
 
 W 
 
 Q 
 
 
 
 C<) 
 
 CO 
 
 a 
 w 
 Q 
 
 
 
 
 g 
 
 
 -1 l? 
 
 
 'a 
 
 
 !>. 
 
 > 
 
 
 CO 
 
 CO ^ 
 
 
 1— I t-^ 
 
 0:i ^ 
 
 
 GO 
 
 10 
 10 
 
 O S 
 
 
 ^ 
 
 
 
 
 Si 
 
 
 
 Pi 
 
 
 
 PJH 
 
 c 
 
 
 65 
 

 < 
 
 O 
 
 O 
 I— I 
 
 Eh 
 <! 
 
 < 
 O 
 n 
 
 OQ 
 >^ 
 W 
 P4 
 
 
 ^ 
 
 
 ^ 
 
 
 ^ 
 
 
 <N 
 
 
 
 
 M 
 
 
 ai 
 
 
 
 
 ^. K 
 
 
 
 
 
 
 
 
 P3cO 
 
 
 »o 
 
 
 Q'-i 
 
 iX 
 
 O 
 
 
 dp3 
 
 CN 
 
 T-H 
 
 
 a H 
 
 
 
 
 ^g 
 
 
 
 
 !D 
 
 
 
 
 ^2; 
 
 ^^ 
 
 a 
 
 
 
 f Si> 
 
 ■* 
 
 
 K 
 
 s 
 
 (M 
 
 
 H 
 ^ 
 
 ^•" 
 
 
 
 « 
 
 
 
 
 fH H 
 
 
 
 
 
 
 
 
 P 
 
 c< 
 
 t^ 
 
 
 ad 
 
 cc 
 
 t- 
 
 
 o 
 
 
 
 
 H 
 
 ^^ 
 
 
 
 •A 
 
 ^ » 
 
 
 
 n 
 
 
 CO 
 
 
 m 
 
 -^cc 
 
 Ti^ 
 
 
 
 ^"'■ 
 
 
 
 m 
 
 
 
 
 s 
 
 (N 
 
 Ci 
 
 
 & 
 
 cr. 
 
 CO 
 
 
 Q 
 
 
 rH 
 
 
 <^ 
 
 
 
 
 
 H 
 
 
 
 
 
 z 
 
 
 Q 
 
 
 
 
 (^ 
 
 
 g 
 
 
 rH 
 
 
 H 
 
 
 
 
 PL, 
 
 
 
 
 
 ►; 
 
 
 
 
 
 ?i 
 
 IC 
 
 i— 1 1 
 
 
 H 
 
 C^ 
 
 (N 1 
 
 
 H 
 
 Tt- 
 
 CO 
 
 
 
 J . 
 
 
 
 
 
 ^a 
 
 "* 
 
 ■* 
 
 
 5^ 
 
 1> 
 
 o 
 
 
 !" 
 
 
 
 
 
 J 
 
 
 
 
 
 
 
 
 
 ^ 
 
 f^ 
 
 
 
 
 m 
 
 < 
 
 
 
 
 ^ 
 
 fe 
 
 
 'oS 
 
 
 
 
 H 
 
 X 
 
 'q3 
 o 
 
 5^ 
 
 H 
 
 a 
 
 
 p: 
 
 ^ 
 
 1 
 
 
 *S2 
 
 
 t— 1 
 
 CO 
 
 (M 
 
 5i^ 
 
 
 »o 
 
 cr. 
 1—1 
 
 
 CD 
 CO 
 
 1—1 
 
 CO 
 
 C 
 
 5 -co 
 
 o-g<M 
 
 ^■2 
 
 C5 
 
 o 
 o 
 1—1 
 
 i-( 
 
 rH 
 
 CO 
 
 p: 
 
 
 o 
 
 
 CD 
 
 
 1 
 
 
 
 :^ 
 
 
 I^S 
 
 o 
 
 
 CO 
 
 
 
 
 
 
 
 
 &--^ 
 
 
 
 
 
 
 
 
 
 
 
 
 ^-^ 
 
 
 
 1—1 
 
 CO 
 
 
 '^ 
 
 1> 
 
 
 "eS 
 
 
 
 S^<= 
 
 1—1 
 
 
 ^tc 
 
 1> 
 
 
 i,-?^ 
 
 
 
 
 
 
 CO 
 
 ko 
 
 
 1— ^ 
 
 "O 
 
 
 'e w 
 
 ^ 
 
 
 
 o 
 
 
 ■"^c^ 
 
 IQ 
 
 
 6^3 
 
 
 
 oc 
 
 CO 
 
 
 (M 
 
 00 
 
 
 l=.-c 
 
 ^ 
 
 
 
 s 
 
 
 ^-^ 
 
 
 
 »r: 
 
 T-4 
 
 
 oc 
 
 l-( 
 
 
 Tt 
 
 rt< 
 
 
 1> 
 
 CD 
 
 Q 
 
 
 
 
 H 
 
 
 
 
 02 S 
 
 
 
 
 1^ 5 
 
 aw 
 
 t 
 
 '% 
 
 11 
 
 'a 
 
 
 pn 
 
 l:z 
 
 1 
 
 ^ 
 
Adult 
 Children 
 
 NOT 
 
 Working 
 
 ■qx 
 
 
 
 
 
 
 
 
 
 LO 
 
 
 cq 
 
 
 t^ 
 
 
 leiox 
 
 
 
 
 
 
 lO 
 
 
 CO 
 
 
 r/:i 
 
 
 
 g 
 3 
 
 K 
 O 
 
 y-, 
 
 w 
 
 K 
 
 a 
 a 
 
 3 
 O 
 
 o 
 c 
 
 t3 
 
 ■qx 
 
 
 
 ^ 
 
 
 1-H 
 
 1-\ 
 
 
 
 (M 
 
 1— 1 
 
 I^^ox 
 
 (M 
 
 
 CO 
 
 
 lO 
 
 I— 1 
 
 T— I 
 
 
 1—1 
 
 T-H 
 
 T-l 
 
 
 ■qx 
 
 
 N 
 
 
 1—1 
 
 CO 
 
 Tt< 
 
 1—1 
 
 lO 
 
 Th 
 
 I— 1 
 
 i^^ox 
 
 CO 
 
 
 
 I> 
 
 (M 
 
 O) 
 
 1—1 
 
 CO 
 
 1—1 
 
 CO 
 
 1—1 
 
 10 
 
 C5 
 
 CO 
 
 ONraaOjVV NaaaiiHO 
 HXLVi saniwv^ T^iox 
 
 lO 
 
 10 
 
 
 
 T— 1 
 
 GO 
 
 GO 
 
 1— ( 
 
 IM 
 
 <o 
 
 1—1 
 
 
 
 CO 
 
 ■ax avaa NaiiOAi 
 
 
 -H 
 
 -- 
 
 
 (M 
 
 
 
 
 CO 
 
 1—1 
 
 
 •qx 
 
 CO 
 
 
 CO 
 
 I— 1 
 
 00 
 
 CO 
 
 (M 
 
 tH 
 
 (M 
 
 lO 
 
 1—1 
 
 CO 
 
 I'B^OX 
 
 ^ 
 
 
 
 T-H 
 
 
 
 I— 1 
 
 T— 1 
 
 CO 
 
 1—1 
 
 CO 
 
 
 10 
 
 II 
 
 ■qx 
 
 t^ 
 
 
 
 
 
 01 
 
 »o 
 
 CO 
 
 05 
 
 10 
 
 i> 
 
 l^^ox 
 
 1— I 
 
 I— ( 
 
 1—1 
 
 
 ^ 
 
 
 
 CO 
 
 IM 
 
 C5 
 
 C5 
 
 ONIAiq 
 NHIMOAi. ^vxox 
 
 T-H 
 
 Y— 1 
 I—I 
 
 
 - 
 
 
 CO 
 
 ^ 
 
 00 
 
 1—1 
 1> 
 
 CO 
 
 
 aNisaOj^ iON Nai/\[ 
 
 I> 
 
 fO 
 
 
 
 TjH 
 
 
 
 
 1—1 
 1— ( 
 
 CO 
 
 o 
 g 
 
 M 
 H 
 O 
 
 aSBj^ ssaf]; 
 
 o 
 
 1— 1 
 
 CO 
 
 
 
 
 
 
 
 
 
 83-B^ axn^g 
 
 tH 
 
 CO 
 
 
 
 
 
 
 
 
 
 l^^ox 
 
 1— 1 
 
 C5 
 
 
 
 CO 
 
 CO 
 
 
 
 CO 
 
 01 
 
 LO 
 
 sniait; xai\[ iviox 
 
 T-H 
 
 1-i 
 
 
 
 t^ 
 C^ 
 
 CO 
 
 
 
 ^ 
 t- 
 
 -+1 
 
 CO 
 
 sarimvj iviox 
 
 T-H 
 
 (M 
 
 
 T-l 
 
 
 CO 
 
 ^ 
 
 CO 
 
 
 CO 
 
 
 < 
 
 o 
 g 
 Eh 
 
 
 p 
 
 U 
 M 
 
 P 
 H 
 
 Q 
 -..1 
 
 
 
 
 Man Dead from Tuberculo- 
 sis: 
 
 Relief 
 
 
 1 
 
 
 
 Man Living — Not Tubercu- 
 lous: 
 
 Relief 
 
 
 
 Man Dead — Other Causes 
 OR Deserting: 
 
 Relief 
 
 I 
 
 a 
 
 
 °a3 
 
 
 'Z. 
 Pp 
 
 C 
 
 c 
 
 
 67 
 
O 
 
 o 
 u 
 o 
 
 
 iVO|vi ONiaaoAi ■ioni 
 
 
 
 
 
 
 
 00 
 
 
 00 ■ SIS HHAO iiaVTCJlS 
 
 -asj^ ins KLAiONg; iojvj 
 
 ^2 
 
 2- 
 
 
 1—1 (M 
 
 o 
 
 5 
 
 T^'iOX 
 
 ^f 
 
 
 
 coSS 
 
 C3 
 
 aaTiiHSK]^ 
 
 1-H 
 
 
 
 
 aaTiisg 
 
 o 
 
 CO 
 
 
 CO 
 
 o 
 o 
 
 avxox 
 
 C»?q 
 
 ^!! 
 
 
 co^' 
 
 aaTirasKfi 
 
 (N 
 
 
 
 
 aaTiisg 
 
 t^ 
 
 1— 1 
 
 
 CO 
 
 1 
 
 iviox 
 
 
 
 
 
 aaTiiHSN_i 
 
 
 (M 
 
 
 1— 1 
 
 aaiiisg 
 
 I> 
 
 1—1 
 
 
 CO 
 1—1 
 
 s 
 
 o 
 
 C3 
 
 S 
 
 a 
 
 avxox 
 
 CO-w 
 
 05^ 
 
 §1 
 
 
 aaTiissKi 
 
 o 
 
 CO 
 
 T— 1 
 
 o 
 
 aaiaisg 
 
 -* 
 
 o 
 
 CO 
 
 Ttl 
 
 avxoi 
 
 1> 
 
 CO 
 
 
 CO 
 
 S3I1IKVJ ^VXOi 
 
 -# 
 t^ 
 
 CO 
 
 1—1 
 
 C2 
 
 1 
 
 < 
 O 
 
 a 
 
 Q 
 
 Q 
 
 Z 
 
 
 p: 
 c 
 
 
 Z 
 
 1— ( 
 
 > 
 
 « 
 O 
 
 1— ( 
 
 si 
 
 
 
 Q 
 
 
 'Z 
 
 p: 
 1 
 
 c 
 
 
 68 
 
o 
 o 
 
 SI 
 
 
 
 
 1-H 
 
 
 1-) 
 
 i-( 
 
 (N 
 
 (N 
 
 (M 
 
 
 1—1 
 
 1—1 
 
 
 
 !N 
 
 
 
 
 
 
 
 TJH 
 
 in 
 
 o: 
 
 "=1 
 
 Ǥ 
 
 go 
 
 
 
 1 
 
 
 
 
 
 
 
 i-< 
 
 
 
 
 
 
 
 
 I-l 
 
 
 
 
 
 
 CO 
 
 o o 
 
 CO CO 
 
 
 
 
 
 
 i-H 
 
 
 1—1 
 
 
 
 : 
 
 
 
 
 
 rH 
 
 1—1 
 
 
 
 
 ^^ 
 
 CO^ 
 
 
 
 
 
 
 
 
 
 (M 
 
 
 CO 
 
 
 
 
 
 1—1 
 
 I— 1 
 
 
 
 1—1 
 
 1—1 
 
 
 
 
 o 
 
 o o 
 
 o o 
 
 • o ■ 
 
 O H^ 
 
 
 
 
 
 
 1—1 
 
 
 <M 
 
 1—1 
 
 (M 
 
 1—1 
 
 i 
 
 • 1—1 
 
 CO 
 
 1-1 
 
 1—1 
 
 
 • 
 
 
 
 
 
 
 
 o o 
 
 3 S5 
 
 
 
 I— 1 
 
 1— 1 
 
 1-1 
 
 CO 
 
 
 T-( 
 
 T-l 
 
 1-1 
 
 CO 
 
 
 (M 
 
 CO 
 
 CO 
 
 
 (M 
 
 
 
 
 
 
 CO~ 
 
 1-1 1> 
 
 
 o o 
 3 s 
 
 
 
 
 Tfl 
 
 
 <M 
 
 1—1 
 
 (N 
 
 O 
 
 Tt< 
 
 00 
 
 (N 
 
 1—1 
 
 (N 
 
 
 i-l 
 
 (N 
 
 
 
 i-( 
 
 
 
 r^° 
 
 ^?^ 
 
 o o 
 
 O qO 
 
 
 
 T-l 
 
 
 ^ 
 
 (N 
 
 CO 
 
 1-1 
 
 CD 
 
 CO 
 
 kO 
 
 T-H 
 
 
 
 
 
 
 
 
 
 
 
 1—1 o 
 
 ^2 
 
 «o 
 
 Bo 
 • 
 
 ■r-l 
 
 
 rH 
 
 
 ^ 
 
 
 ^ 
 
 
 (N 
 
 
 
 
 
 
 
 
 
 _ 
 
 
 
 
 
 1—1 o 
 
 
 m 
 S 
 
 o 
 
 H 
 
 n 
 
 a 
 
 
 T-) 
 
 
 rH 
 
 i-H 
 
 lO 
 
 (N 
 
 1> 
 
 CO 
 
 lO CO 
 
 lO 
 
 : 
 
 
 
 1-1 
 
 
 1-1 
 
 
 
 
 
 
 CD 
 
 Ci 
 
 
 
 
 (M 
 
 lO 
 
 rh 
 
 CO 
 
 <M 
 
 00 
 
 <M CO 
 
 1-( T-4 
 
 I— 1 
 
 Tfl 
 
 lO 00 
 
 '^ 
 
 lO 
 
 -* 
 
 <M 
 
 1—1 
 
 1—1 
 
 1—1 
 
 
 !> 
 
 •* 
 
 
 g 
 o 
 
 1-H 
 
 
 ffO 
 
 CD 05 
 
 o 
 
 1—1 
 
 o 
 
 1—1 
 
 t- CD 
 
 1—1 1-1 
 
 1—1 
 
 TfH 
 
 »o 
 
 00 
 
 lO 
 
 lO 
 
 lO 
 
 (N 
 
 r-4 
 
 1—1 
 
 1—1 
 
 
 CO 
 * 
 
 CO 
 
 CO 
 
 3 
 
 O 
 
 9 
 
 
 ;=! 
 
 0) 
 
 o 
 
 Cm 
 
 o 
 
 «4-i 
 
 p^ 
 
 
 1 
 
 o 
 
 .2h 
 P^ 
 
 h 
 o 
 
 
 Pj? 
 
 o 
 
 
 Cm 
 
 p:? 
 
 1 
 
 o 
 
 
 "a; 
 o 
 
 ■.sH 
 
 P^ 
 
 CD 
 
 1 
 
 o 
 
 
 o 
 
 1 
 
 03 
 
 o 
 
 2; 
 
 "a 
 
 
 c 
 2 
 
 
 
 5S 
 2^ 
 
 
 H 
 
 (> 
 
 ) 
 
 O' 
 
 3 
 
 T 
 
 ri 
 
 i^ 
 
 3 
 
 c: 
 
 3 
 
 ^ 
 
 - 
 
 G« 
 
 
 
 c 
 
 :> 
 
 c 
 
 3 
 -1 
 
 
 ■1 
 
 o 
 H 
 
 
 1 
 
 
 p _~ 
 
 >- r. ^ 
 
 3 3_ 
 03 rt ^ 
 
 a =33 
 
 rzz 
 
 69 
 
LENGTH OF RECORDS COMPARED FOR SOCIAL AND MEDICAL 
 
 AGENCIES 
 
 Length of Record 
 
 Under 6 months . . . 
 6 months to 1 year 
 
 1 year to 2 years. . . 
 
 2 years to 3 years. . 
 
 3 years to 4 years. . 
 
 4 years to 5 years. . 
 
 5 years to 6 years. . 
 
 6 years to 7 years. . 
 
 7 years to 8 years. . 
 
 8 years and over. . . 
 No Social History. . 
 
 Total 
 
 Relief Families 
 
 Social History 
 
 % 
 
 7 
 
 10 
 10 
 9 
 7 
 9 
 2 
 1 
 9 
 10 
 
 74 
 
 9 
 13J^ 
 IBM 
 12 
 
 9 
 12 
 
 2M 
 1.3 
 12 
 
 13M 
 
 100% 
 
 Tuberculosis 
 Clinic History 
 
 4 
 
 5 
 21 
 15 
 
 19 
 2 
 5 
 
 74 
 
 % 
 
 5 
 
 28 
 20 
 
 251^ 
 
 W2 
 
 6M 
 
 Non-Relief 
 Families 
 
 Tuberculosis 
 Clinic History 
 
 16 
 11 
 
 15 
 7 
 3 
 7 
 2 
 1 
 1 
 1 
 
 64 
 
 % 
 
 25 
 17 
 23 
 11 
 
 11 
 
 2^ 
 
 IM 
 IM 
 
 100% 
 
 70 
 
AMOUNT OF TUBERCULOSIS 
 
 35 FAMILIES STUDIED IN PART II 
 
 
 Total 
 
 Tuberculous 
 
 Not 
 Tuberculous 
 
 Not 
 Exam- 
 ined 
 
 Dead 
 
 
 Dead 
 
 Living 
 
 Dead 
 
 Living 
 
 Cause 
 
 Not 
 Known 
 
 Men 
 
 34 
 
 *12 
 
 til 
 
 
 3 
 
 8 
 
 
 Women 
 
 37 
 
 3 
 
 12 
 
 
 tl5 
 
 t 7 
 
 
 Adult Children 
 
 15 
 
 
 2 
 
 
 6 
 
 7 
 
 
 
 
 Children under 16 
 
 131 
 
 5 
 
 9 
 
 5 
 
 92 
 
 16 
 
 4 
 
 Total 
 
 217 
 
 20 
 
 9.2% 
 
 34 
 
 15.6% 
 
 5 
 
 116 
 
 38 
 
 17.5% 
 
 4 
 
 * Includes first husband of one woman, 
 t Includes one relative (man's brother), 
 j Two relatives in fractional family. 
 
 71 
 
^ o 
 
 1—1 '-t! 
 
 :g:e:Ss§ 
 
 
 Dead of 
 Dead of 
 Dead of 
 Not exa 
 Tb. In 
 
 Laborer 
 Dead of 
 Not exa 
 Dead of 
 Liv.; tb. 
 Dead of 
 Dead of 
 
 o tc j.< a) 
 
 rt bC 03 S 
 K fl 02 c5 
 
 ^ <u 
 
 p c3-^ 
 
 O O- 
 
 -7:3 -^3 
 
 o3 o3 t^ tJ 
 CD OJ >^ ^ 
 
 QP33 
 
 !^ o3^ P 
 
 X'iS PI X O 
 > O > > O <D 
 
 02 fl 
 
 o a; 03 
 O S3 
 
 lO I— I IC CO lO 
 
 1-1 '^ O LO 1> tH ^ 
 
 I CO 05 1>C0 ^^ i-O Tt< 
 
 O 
 
 M 
 
 CO 
 
 O 
 p 
 
 -*^ • fab 
 
 O 02 QJ 
 
 73 
 
 faC O 
 
 g^ 
 
 _T3 
 
 
 -S^ 03 
 
 faC 
 
 
 ^^^1 
 
 q; 0^ CD ^ CO c3 
 k^ v^ K> o3 c 
 
 Tl T! T3 • - o a 
 
 O O O d o rt 
 IS 
 
 t-1 CQ 
 
 c3 <U 
 
 T3 o 
 S ^^• 
 
 It 11 
 
 fill 
 
 fab faB fab p_i 
 
 g fab 2 g fab fab"^ 
 
 •7^ "^ 1^ "^ "^ "^ r^ 
 O O (D (1) O) CD . ^ 
 
 o o o o o 3 o 
 
 T3 
 
 r^ '^ 
 
 faC fcyO faD 
 <B O CU 
 " ^-1 !-i 
 
 5C 
 
 ■^ !^ u -ii 
 
 .^.^.^ ^ 
 
 « a; o 
 
 c3 c3 o3 f^ 
 
 fH >H f-( ,j3 _ 
 
 -•^ +^ -^^ P, 1-^3 
 
 >><! 
 
 !^ ^ !-i 
 
 3 .3 -S t.( 
 
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THIRTY-TWO WAGE-EARNERS' WIVES 
 I. HusBAiirDs' Earnings too Ikregular to State 
 
 Case 
 No. 
 
 Previous 
 
 Present 
 
 Remarks 
 
 32 
 
 43 
 
 51 
 47 
 35 
 
 Housewife 
 
 Cleaner $3.50 
 
 Housewife 
 
 Housewife 
 
 Glove fact $5.00 
 
 Furs 10.00 
 
 Restaurant 5 . 00 
 
 (Womanand children 
 serted.) 
 
 Cleaner, part time. .$5.00 
 
 Janitress, cleaning part 
 
 time Rent, $3.50 
 
 Sewing part time 
 
 Chocolate fact $5 .00 
 
 living with man, father of 
 
 Ale; indiff. 2 child, 
 sell newspapers. 
 
 Phys. disabled — tb. 
 
 Ale. Dead of tb. 
 
 children having de- 
 
 
 II. Husbands 
 
 ' Earnings Under $12.00 per Week 
 
 Case 
 No. 
 
 Previous 
 
 Presen 
 
 r 
 
 Remarks 
 
 63 
 
 Housewife 
 
 Cleaning and wash- 
 ing. . . $6.00 
 
 Housewife 
 
 Housewife 
 
 Phys. disab. 
 Tb. 
 
 36 
 41 
 
 Same 
 
 Housewife 
 
 Dept. H. MUk 
 part time .... 
 
 ...$6.00 
 
 Depot, 
 
 . . .$2.50 
 
 37 
 
 Cigar fact 
 
 
 
 Housewife 
 
 Housewife (andclean- 
 er after man's 
 death) $4.50 
 
 Liv. tb. 
 
 55 
 56 
 
 Cleaner 
 
 ...$5.00 
 
 Phys. disab. 
 Tb. 
 
 62 
 
 Housewife 
 
 Cleaner 
 
 ...$9.00 
 
 Phys. disab. 
 
 III. Husbands' Earnings $12-$15 per Week 
 
 Case 
 No. 
 
 Previous 
 
 Present 
 
 Remarks 
 
 46 
 
 Housewife 
 
 
 Dead of tb. 
 
 53 
 39 
 
 31 
 
 Housewife 
 
 Janitress and fact.. 
 (During husband's 
 
 Housewife 
 
 Housewife 
 
 Cleaner $6.00 
 
 Factory, part time . . $4 . 25 
 
 illness.) 
 
 Housewife 
 
 Tb. 
 
 57 
 
 Cleaning 
 
 Tb. (1 son electrician, 
 
 61 
 
 Housewife 
 
 
 $4). 
 Dead of tb. 
 
 52 
 50 
 
 Janitress and rent 
 
 $1.80 
 Housewife 
 
 Laundress $4 . 50 
 
 Artificial flowers. . . .$1 .00 
 
 (1 child fact $4.50) 
 
 Factory $6.00 
 
 Cleaner, part time 
 
 1 child tb. 
 
 54 
 33 
 
 Factory $6.00 
 
 Cleaner $5.00 
 
 Phys. disab. — tb. 
 Ale; indiff. 
 
 74 
 
IV. Husbands' Earnings $15 
 
 Case 
 No. 
 
 Previous 
 
 Present 
 
 Remarks 
 
 38 
 34 
 
 CL, washing.. .$6.00 
 (During man's illness) 
 Housewife 
 
 Folds envelopes 
 time 
 
 Cleaning 
 
 Janitress and c 
 rent + 
 
 Dept. H. Milk 
 part time 
 
 part 
 .$6.00 
 .S6.00 
 eaning 
 .$4.50 
 depot, 
 .$2.50 
 
 Indiff.; tb. 
 
 44 
 60 
 
 Washing $3.00 
 
 Housewife 
 
 
 
 Housewife 
 
 Phys. disab.; indiff. 
 
 42 
 
 Housewife 
 
 Phys. disab. (1 child 
 farmhand; keep, $1.00 
 per wk.) 
 
 Phys. disab.; ale; indiff. 
 
 Phys. disab. 
 
 40 
 
 Housewife 
 
 Crochet 
 
 Washing 
 
 .$2.00 
 .$2.50 
 
 45 
 
 Washing and janitress. 
 Rent + $5 (1st 
 husband died of tb. 
 Driver, $8, irreg. ; 
 ale; indiff.) 
 
 V. Husbands' Earnings Over 
 
 Case 
 No. 
 
 Previous 
 
 Present 
 
 Remarks 
 
 64 
 
 48 
 
 49 
 
 Housewife 
 
 Housewife 
 
 Housewife 
 
 Housewife 
 
 Washing (?) part time. 3 
 
 grown sons work irreg. 
 
 Housewife 
 
 
 
 
 
 
 75 
 
ESTIMATED ANNUAL EXPENDITURES FOR 
 TUBERCULOSIS 
 
 The City spends : ^ 
 
 For Institutional care of tvtberculosis pa- 
 tients $1,715,485.46 
 
 For Home Care : 
 
 a. Clinic treatment, visiting nursing 277,311.09 
 
 b. Public School Fresh-Air Classes.... 100,000.00 
 For Laboratory 14,777.50 
 
 $2,107,574-05 
 Private Institutions and Agencies 2 spend : 
 
 For Institutional Care 60,710.90 
 
 For Home Care 310,031.10 
 
 $370,742.00 
 
 $2,478,316.05 
 
 The expenditures for Institutional Care from private sources include : 
 
 Hospital and House of Rest for Consump- 
 tives $45,401.87 
 
 Bedford Sanatorium (Brooklyn Tuberculosis 
 
 Committee) 8,000.00 
 
 Bellevue Settlement House, annual cost (Belle- 
 
 vue Women's Auxiliary) 5,623.16 
 
 Summer Home for Children of Tuberculous 
 Families, annual cost (Presbyterian 
 Hospital) 1,685.87 
 
 Total $60,710.90 
 
 The expenditures for Home Care by private agencies include : 
 Private Institutions, for clinic nurses' and physicians' 
 
 salaries $20,000.00 
 
 Philanthropic Agencies 290,031.10 
 
 United Hebrew Charities $45,404.00-!- 
 
 Hebrew Sisterhoods (estimated) 20,642.00-!- 
 
 C. O. S. (estimated) 25,000.00 
 
 A. I. C. P.: 
 
 In patients' homes $15,738.00 
 
 In Home Hospital 45,102.78 
 
 Outside contributions for Home 
 
 Hospital 1,629.92 
 
 62,470.70 
 
 Joint Tuberculosis Committee 43,433-00 
 
 Auxiliary Funds, to Tuberculosis Clinics.... 44,555.40 
 
 1 1914. 
 
 - Last fiscal year's figures available at time report was prepared. 
 
 76 
 
Bellevue (1915) $8,827.80 
 
 Relief $6,567.17 
 
 Salaries 2,161.88 
 
 Sundries 98.75 
 
 Health Department (1915) 18,275.56 
 
 (Includes Day Nursery, $6,905.34) 
 
 N. Y. Hospital 275.00 
 
 Presbyterian Hospital 7,848.48 
 
 (Includes salaries, $2,700) 
 
 St. Luke's 7S3-00 
 
 Vanderbilt 8,575.56 
 
 (Includes salaries, Day Camp and Clinic) 
 
 Brooklyn Bureau of Charities 30,026.00 
 
 Brooklyn Jewish Charities 18,500.00 
 
 Total $310,031.10 
 
 Excluding the amount spent by subsidized private institutions over 
 and above the per capita payments made to them by the City, we can 
 summarize the annual cost of the care of tuberculosis to the City of New 
 York, contrasting the amount spent on Institutional Care with the amount 
 spent on Home Care as follows : 
 
 Institutional (chiefly medical care) : 
 
 By the City $1,730,262.96 
 
 By private agencies 60,710.90 
 
 $1,790,973.86 
 
 Home Care (medical and social and relief) : 
 
 By the City $377,3ii.09 
 
 By private agencies 310,031.10 
 
 687,342.19 
 
 $2,478,316.05 
 
 77 
 
THE TROW PRES 
 NEW YORK 
 
DUE DATE 
 
 Ar' 
 
 -ir^^ 
 
 )] ^ihiiJ 
 
 - Oct'[l^Qo^ 
 
 ir 
 
 HY 
 
 "it the 
 wing, 
 il ar- 
 
 Printed 
 in USA 
 
COLUMBIA UNIVERSITY UBRARIES 
 
 0022318917 
 
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