EPILOGUE THE SPIRIT: You have seen our pageant marching through the thorny ways of sickness. You have visioned our great leaders who have broken paths to light. You have watched the Crusade gathering in the wise, the old, the young. And my spirit leads them onward to the goal of Health and Joy, to a world of Happiness where Illness may not dwell, to a land where Tuberculosis, man's most merciless enemy, will dare not lurk in hiding to pounce out on weak and strong. Our Crusaders cannot prosper nor be victors in their quest until all the people living have joined in to do their parts. So I beg you, oh, all persons, be you well or be you sick, rich, poor, good, bad-or big or little-will you march with us and work with us, be conquerors with us in our Search for Blessed Health? THE END The Indigent, Migratory Tuberculous in Certain Cities of the Southwest* By JESSAMINE S. WHITNEY, Statistician, National Tuberculosis Association, New York INTRODUCTION Scope and Purpose of the Present Report The present report covers. a first hand study in the following cities: Colorado Springs, Denver, El Paso, Phoenix, Los Angeles and San Antonio. The purpose was to get actual facts and figures concerning the number of indigent tuberculous being cared for by social agencies in a single year in these cities of the southwest. Following the 1920 annual meeting of the National Tuberculosis Association in St. Louis, an experimental study was made in Colorado Springs to see if the method used in the present studies was a feasible one. As a result of that survey, the Colorado Tuberculosis Association wished to have a similar study made in Denver, and obtained from the National Tuberculosis Association the services of the writer for the last four months of 1920. During this period the Denver study was completed, being financed by the Denver Tuberculosis Association. In December, 1920, the chairman of the Committee on Indigent Migratory Consumptives, thinking that further studies were advisable, asked the National Tuberculosis Association to continue the work in other cities. On a favorable vote of the Committee, the National Tuberculosis Association consented to this, and the other studies were financed by the National Association and by the states visited. The El Paso records were obtained by Mr. George Granger in July, 1920, when he was field secretary for the Texas Public Health Association. The record forms which he used were similar to the ones used in the other studies, and the tabulation of them has been included with that of the other cities, although they were obtained at another time and by a different person. Since the gathering of data was not completed until April 10th of this year, the present report can be only a summary of the salient points disclosed by the survey. It is planned to make a more detailed report for each city when time permits. Sources of Information It should be understood at the outset, that the data used were taken entirely from records of social agencies, therefore, only that information could be obtained which had been made a matter of record by the agency. The figures for San Antonio, Los Angeles and Phoenix, cover the calendar year 1920, and include all individuals who were cared for in any way by social agencies during that year. The figures for Denver, having been collected during the latter part of 1920, were for the year just preceding, namely, from September 1, 1919, to September 1, 1920. The Colorado Springs figures cover the year from April 1, 1919, to April 1, 1920; the El Paso figures were for the year June 1, 1919, to June 1, 1920. In every case where the year covered was not the calendar year 1920, the period taken was the year just completed at the time the study was made, so that the figures might be current. Completeness of Study It is undoubtedly true that some tuberculous individuals have been cared for by community agencies during the year covered who were not included in the study. It is also probably true, that in covering many thousand records of various agencies, a few records of tuberculous individuals may have been inadvertently omitted. On the whole, however, the figures presented are believed to be fairly complete and representative of the extent of the indigent consumptive probblems in these various cities. It should be borne in mind, of course, that all duplicate records in each city have been eliminated, and that the figures presented are the actual number of individuals, and not the number of records. Read at the seventeenth annual meeting of the National Tuberculosis Association, June 14-17, 1921. Degree of Indigency "Indigent," as defined by the Committee on Indigent Migratory Consumptives, is a person who is not able to finance himself completely during the period of his cure. It is with this meaning that the word is used in this report. The degree of indigency of course varied greatly. Some persons needed only free medical or nursing care; others were in need of temporary aid; while many were dependent almost entirely upon the community for their living and care. ANALYSIS OF FINDINGS Total Number of Cases In the six cities there was a total of 7319 tuberculous individuals cared for, wholly or in part by the municipal agencies. This means, on an average, one indigent tuberculosis person to every 155 of the entire population of those cities. The proportions, according to cities, vary greatly, those cities having the smallest population, of course, bearing the greatest burden. Phoenix, with the smallest population, 29,053, has the greatest number of indigent tuberculous persons to the population, namely, 1 to every 58. Compare this with Colorado Springs, which is practically of the same size, 30,105, which has 1 indigent tuberculous to every 78 of the population. El Paso has 1 to every 71 of the population; Denver, 1 to 156; Los Angeles, 1 to 186; and San Antonio, 1 to 264. Unfortunately we have no similar figures of other cities, east or west, with which to compare them. Length of Residence There was a large group for which the length of residence was not stated in the records. This comprised nearly one-fifth of all the individuals recorded. The greater part of this group was from Los Angeles, where the county hospital record showed only the length of residence in the county, but not in Los Angeles proper. The material relief in that city, as well as the free hospital care, is financed jointly by city and county, so that the length of the city residence is not separately entered. In the six cities 63 per cent. of all the tuberculous, for whom length of residence was known, had resided there less than two years at the time they applied to the agency. Residence less than two years has been used to define a so-called "non-resident" in this report. Of course any division is arbitrary. I am inclined to think that any person who has resided less than three years should be classed as a migrant. If this division is made then 75 per cent. of all cases can be classed as "non-residents." In the Denver study, even among the 484 classed as residents (i. e., having resided two years or over) all but 73 had come originally as health seekers, or with a member of their family who was ill. The proportion of non-residents varied from 83 per cent. in Phoenix to 36 per cent. in San Antonio. Los Angeles and Denver were about even with 64 per cent. and 68 per cent. respectively. El Paso is low with 47 per cent. Both the Texas cities have a small proportion of non-residents, so called. This is due to the fact that there are, in both places, a large number of Mexicans who constitute a big problem from a tuberculosis standpoint, but who have lived over two years in those cities, and must be classed as residents. Five hundred and forty-five, or 16 per cent., of all non-residents made application for aid within a week after arrival, and onethird before they had been there a month; 50 per cent. before they had been resident three months, and nearly 90 per cent. when they had been there one year or less. The women are either better provided for at first, or are more resourceful in placing themselves, since 38 per cent. of the men asked for assistance within a month after coming, and only 19 per cent. of the women. Age Periods The largest group is at the age period 25 to 29-1000 or about one-sixth of all cases being of those ages-although the ten-year age period, 40-49, comprises almost as many, 975. More significant is the proportion of tuberculous children in the various city groups. In all cities together, one-tenth were children under 14, and 10 per cent. of these were under 4 years of age. In San Antonio and Los Angeles, nearly 15 per cent. were children under 14, while in El Paso, only about 1 per cent. In Denver and Phoenix, 4 per cent. were children. Country of Birth Only one-half (51 per cent.) of all the cases recorded were born in the United States, about 7 per cent. of them being Negroes. Twenty per cent. were Mexicans, found almost entirely in El Paso, San Antonio and Los Angeles. The largest proportion of Mexicans were in San Antonio, where they constituted practically one-half of all cases. In El Paso they comprised about 45 per cent., and in Los Angeles about 20 per cent. In addition to the Americans and Mexicans nearly every country of the world was represented among the remaining 29 per cent., the Russian Jews being the only large group, constituting 9 per cent. of the total number. All these were found in the two cities, Los Angeles and Denver. Both have national institutions for Jews, although the one near Los Angeles is small. The two located at Denver, however, are large institutions. Sex Seventy-two per cent. of all non-residents were men, and 28 per cent. women, showing that it is the men primarily who roam in search of health. Alone or with Family But more significant than the fact that the large majority are men, is the fact that the men migrate alone, and the women more often with their family. Only 29 per cent. of the non-resident women came alone, while 70 per cent. of the non-resident men came without their family. The "homeless man," therefore, becomes the biggest part of the problem numerically. He was more in evidence in Denver, El Paso and Phoenix, while not so numerous proportionately in Los Angeles, San Antonio and Colorado Springs. However, the extent of the added burden to these communities by the presence of other members of the family is not to be minimized. Taking all classes together, residents and non-residents who were with their families, there were 9315 other members of the immediate family living in the household, 5347 or 57 per cent. of whom were children under 16. The non-resident group alone added 3238 other persons to the community, 1752 of whom were children. Sources of Migration We are able quite definitely from this study to fix responsibility for much of this migration. A few states are responsible for most of it. They are in order, Illinois, New York, Missouri, Ohio, Pennsylvania and Michigan. In the next group to the big six come Indiana, Kansas, Nebraska, Oklahoma and Minnesota, which, together with those already mentioned, furnish half of the migration to the southwest. Texas and California were also given as legal residence in a large number of cases, but the latter only in the Los Angeles records and the former for the Texas cities, so that in the case of both these states the migration was purely intra-state. One-fourth of the migration to San Antonio was from other points in Texas. San Antonio also got more migration from the southern states, and also more Negroes than any other city. Reasons for Migration How The only two cities in which the reasons for migration were made a part of the social agency records were Denver and El Paso. Of course records in this regard were not complete even for these two cities. ever, in Denver all the non-residents, comprising 1036, said they had come seeking health in all but 38 cases. Even among the 484 in Denver classed as residents, all but 73 had originally come either as health seekers themselves, or with a member of their family who was ill. Considerably over onehalf were advised to come by physicians. In El Paso 61 per cent. of those for whom this information was recorded had come defi nitely on the advice of a physician. All but 84 of the 422 non-residents came seeking health. Stage of Disease The findings in this respect are not very accurate, as most of the records consulted were not medical. It must be remembered in regard to these figures that they do not represent the stage of the disease at the time the patient came to the city. It would be very illuminating to have such figures showing whether the climate was selected as a last resort, or whether patients were coming during the earlier and hopeful stage of the disease. However, the records from which this study was made usually gave only a single diagnosis. These may have been made shortly after the patient came, after he had been here a considerable time, or whenever he could be induced to have an examination. Unfortunately, the records, except a few of the dispensary ones, did not show progressive diagnoses, so that we can learn nothing of the effect of the climate on the patient. Wherever a definite diagnosis of stage of the disease was entered on the record, it has been no noted in this study. Usually no such specific record was made. About 3 per cent. had tuberculosis, other than pulmonary. Of the pulmonary cases, nearly one-fifth were entered as third stage. These were evidently those cases which were so far advanced as to be obvious at the first clinic call. For The first fact which you will note is that the majority of them are lost sight of by the agencies concerned. Where and how do they live, and what do they do? These are questions that cannot be answered. those who have resided over two years, and can be classed as residents of the cities, the query is the same as for those who are of a distinctly migratory group. Fifty-four per cent. were lost sight of, 13 per cent. had died, 10 per cent. were known to have moved out of the city, and 23 per cent. were still in the city at the end of the year studied, Cost to the Community The financial burden borne by these various cities cannot be exactly measured. As far as possible, however, the cost of all tuberculosis activities has been ascertained in each of the cities cited. The results show that the highest cost per capita is in Phoenix, where the annual tax for each member of the community, man, woman and child, was $1.75 for the support and relief of the tuberculous. It is impossible of course in figuring expenditures to separate the cost of non-residents from that of residents. The per capita yearly expenditure varies from $.22 in San Antonio to the amount mentioned above, $1.75, in Phoenix. El Paso and Denver carry approximately the same financial burden, the former being $.45 per capita, and the latter $.50. Colorado Springs being smaller, like Phoenix carries a proportionately larger financial burden, the cost per capita there being $1.00. The cost in Los Angeles is $.31. Facilities for Caring for the Tuberculous None of these cities has anything like adequate provision, medical, relief, or institutional, for caring for the tuberculous, whether resident or r non-resident. From what can be learned from the records, it would seem that there is no attempt at a coördinated policy or program of rehabilitation of the tuberculous anywhere. The ma T terial relief facilities of these cities are incapable of meeting, adequately, the problem of the indigent migratory consumptive. Confirmation of Findings It is of more than passing interest to note that the findings of all the cities taken together are very similar to those for the city of Denver, which has been worked out in greater detail. The proportion of non-residents in Denver was 66 per cent., and for all the cities together, 63 per cent. The same six states furnish the most migration to Denver, as well as to all the cities taken together. The largest group according to age period is from 25 to 29, both in Denver and in the group of cities taken together. Slightly more than half were born in the United States, both in the single city and in the group. Seventy per cent. of the men were alone, and thirty per cent. of the women, both in Denver and in the six cities taken together. In Denver the ratio of deaths was 1 to every 7 cases; in the group the ratio is 1 to 8. In both Denver and the group taken together the same proportion of non-residents were men, namely, 72 per cent. These similar findings in a single city and in all the cities taken together seem to show that there is a definite problem which follows certain definable laws. A Home-Made Window Tent By T. B. KIDNER, Institutional Secretary National Tuberculosis Association HE accompanying drawings and the following notes were prepared in response to a request from a subscriber to the JOURNAL OF THE OUTDOOR LIFE for advice on making for himself a window tent which would allow of his sleeping with his head in the open air, while his body was in the warm room. It was also required that the device should exclude cold air from the room. In the drawings, two pieces of simple framing are shown: (A), which forms the top of the tent, and (B) which forms the end. These frames should be covered with wall-board, of which there are several makes on the market, all much alike. The piece marked D is screwed to the face of the window frame and A rests upon it. Piece C is nailed on the face of the frame, to receive the heavy cloth which forms one side and the back of the tent. The filling piece F is cut in to fit snugly between the stop heads of the sash, and may either me held in place by friction or fastened to the framing A. If the latter plan be adopted, felt will be needed only on the outer edge of the filling piece. Should the outer, unsupported corner of the frame B have a tendency to sag, it should be supported by a wire from the upper part of the window frame. Piece B is fastened to the window by being nailed or screwed against a quarter-round fillet (see elevation). By the exercise of a little ingenuity, the top and end framing might be hinged, but it is recommended that the tent be a fixture. The bed is shown with its foot towards the left of the window, but, obviously, it would be easy to arrange that the bed be in the opposite direction by fixing the frame B on the lefthand side of the window. It will be noted that the frame B extends to within an inch and a half of the top of the bed frame, between the mattress and the head of the bed. Heavy woolen cloth, preferably double blanketing, should be tacked to the edges of the two frames, and to the strip E, as shown in the conventional perspective drawing. The cloth should be divided vertically, but should overlap at least six inches at the division. |