Examination of 
 
 Employes for 
 
 Tuberculosis 
 
 Published by the Committee on Factories of the 
 
 Chicago Tuberculosis Institute 
 
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“Efficiency of the worker rests on health as its foundation” 
 
 Examination of Employes 
 
 for 
 
 Tuberculosis 
 
 Published by the Committee on Factories of 
 The Chicago Tuberculosis Institute, 
 Room 1351, Otis Building, 
 
 Chicago 
 
 “A system of medical examinations is an essential step in the preser¬ 
 vation of health and efficiency of a working force” 
 
I 
 
 
 
TUBERCULOSIS 
 PROBLEM 
 
 IN A WORKING PLACE 
 
 GROUPS OF WORKERS 
 
 GROUP Y 
 
 GROUP V 
 
 CONDITION 
 
 REMEDY 
 
 GROUP I "Open-Communicable Cases. 
 
 Juierca/ous , ' 
 
 GROUP IT -Disease JcifJe, Proeress/i/e. 
 
 Stibencu/oi/s. 
 
 GROUP 12 Disease-Inacf/iT 
 
 Titerevfaaj. 
 
 DerbcSc JCedfcaf CYaminafkns. 
 TJg/J Cb/sdiiio/zs J&r Cfe&e 
 Wcrb^Tp Jerce. | 
 
 Cducaf/on of Jill In /frtnp. 
 
 GROUP ET WorAea Wr/h tow Ppsfance. siapjfafiSaadkomm Tn&f- 
 
 GROUP Y ZDcrkfcs in Jherape JfeoIIh . men!Jbr (p/vi/psZbTcjparfofll. 
 
 RESULT 
 
 HIGHER STANDARD y HEAITH AND EFFICIENCY 
 
 Jar Copies of This Poster Jfrpfy b tie Committee 0/2 Jhcfories of 
 
 The Cbucago T/bcradoJis Insfifafe 
 
Digitized by the Internet Archive 
 in 2019 with funding from 
 
 University of Illinois Urbana-Champaign Alternates 
 
 https://archive.org/details/examinationofempOOunse 
 
Periodic Examination and Timely Repair 
 of Machinery as Conservation Measures. 
 
 Periodic examination of machinery is a part of the business 
 policy of all well-managed establishments. 
 
 Serious damage or even total destruction result from neglect 
 of timely repair. 
 
 Entailment of a small expense today means prevention of 
 larger expense, or, possibly, of total loss tomorrow. 
 
 In dealing with “inanimate” machinery, this principle is fully 
 recognized and universally applied as a matter of economy. 
 
 As a factor in conservation of “human machinery” the policy 
 of “periodic examination and timely repair” is still in need of fuller 
 recognition and wider application. 
 
 The Principle of 
 
 “Periodic Examination and Timely Repair” 
 
 Applied to “Human Machinery.” 
 
 Efficiency of the worker rests on health as its foundation. 
 
 As a measure of conservation, periodic examination of health 
 is of fundamental importance; without it “timely repair” is im¬ 
 possible. 
 
 The worker, the employer and the public are gainers by the 
 operation of a system of examinations rendering possible the timely 
 detection of “breaks” in the health of workers. 
 
 Periodic medical examinations tend to conservation of health 
 and efficiency of a working force. 
 
 Importance of Systematic Examination 
 of Employes for Tuberculosis. 
 
 In the detection of no other disease does the value of super¬ 
 vision of the health of workers stand out as prominently as in tuber¬ 
 culosis. 
 
 With its slowly developing group of symptoms and its grad¬ 
 ual, and, at first, imperceptible impairment of working power, tuber¬ 
 culosis, in a large number of cases, passes far beyond the curable 
 stage, before attracting attention. 
 
 5 
 
Its early detection in an employe is of great importance to 
 himself, his co-workers and his employer. 
 
 The chance of ultimate “cure” or “arrest” as well as restora¬ 
 tion of working capacity diminishes with the growth of the disease. 
 The possibility of infecting others grows with the gradual transfor¬ 
 mation of a “closed” incipient lesion into an “open” tuberculosis with 
 its swarm of tubercle bacilli in the sputum. The interests of the em¬ 
 ployer are alike vitally affected by the gradual diminution of the pro¬ 
 ductive capacity of the tuberculous employe and of those subsequently 
 infected. 
 
 These conditions call for a system of medical examinations of 
 employes for tuberculosis in all working places, as a measure of great 
 importance to all concerned, the expense entailed in the maintenance 
 of such examinations being far outbalanced by the benefits derived. 
 
 Method of Detection of Cases of 
 Tuberculosis Among Employes. 
 
 The gradually growing appreciation of health as the greatest 
 asset of the worker points to the ultimate adoption by all industrial 
 concerns of the policy of periodic medical examinations of employes, 
 financed either by the employer, employes’ associations, the State, or all 
 three combined. 
 
 At the present time, provision for examination of employes is 
 in existence in comparatively few establishments, and this is either 
 limited to cases of sudden illness or accident, or is one of the condi¬ 
 tions of admission to employes’ benefit associations which generally 
 include only a part of the working force. 
 
 It is a matter of common experience in the majority of work¬ 
 ing places that under the present conditions little or no cognizance 
 is taken of a case of tuberculosis until the case is far beyond the 
 curable stage. 
 
 The plan of examination of employes described below is recom¬ 
 mended for adoption, first , because of the economy of its administra¬ 
 tion (as compared with the cost of periodic examinations of the entire 
 force) and hence greater possibility of its general acceptance; second, 
 because the operation of this plan draws the attention of the employer, 
 superintendent or foreman to the health of the individual workers, thus 
 tending to greater solidarity of interests, and hence greater efficiency 
 of the entire force. 
 
 6 
 
The details of the plan are as follows: 
 
 1. Physician to examine all suspicious cases. 
 
 In places with established medical service, this task may be as¬ 
 signed to the physician on the staff of the firm. In large establish¬ 
 ments a special “tuberculosis” examining physician may be necessary. 
 In either case, possession of special experience in the diagnosis of 
 tuberculosis is very important. 
 
 Duties of the physician: examination and diagnosis of cases; 
 disposition of those found tuberculous; instruction of the sick in the 
 essentials of treatment and of the “predisposed” in right living and in 
 measures tending to increase the general resistance; frequent noon or 
 evening talks to the entire working force on maintenance of health 
 and prevention of disease. 
 
 The hours of work of the physician are determined by the ex¬ 
 tent of the problem; one, two or more afternoons a week; or a 
 regular daily service. Compensation should be graduated according 
 to the amount of work and the individual qualifications. 
 
 2. Trained nurse to assist the physician. 
 
 Duties: to assist the physician during clinic hours; to visit and 
 study the homes and living conditions of employes pronounced “tuber¬ 
 culous” or “predisposed”; to instruct in the fundamentals of right 
 living and in the methods of care and prevention, by actual demon¬ 
 stration in the employe’s home; to gather in each individual case in¬ 
 formation essential to its right solution. 
 
 Compensation: that of a visiting tuberculosis nurse, regulated 
 by the responsibilities of the position and individual qualifications. 
 
 3. Classes of cases to be examined. 
 
 At a conference between the superintendent, the physician and 
 the nurse it is agreed that the working force is to be watched for 
 the following classes of cases: 
 
 (a) Employes in whom diagnosis of tuberculosis was previ¬ 
 ously made. 
 
 (b) Employes whose poor general condition (malnutrition, anae¬ 
 mia or weakness) in connection with other suspicious symp¬ 
 toms suggests the possible presence of the disease. 
 
 (c) Employes with histories of protracted (or recurring) cough 
 and expectoration. 
 
(d) Employes in whose families or homes a case of tuberculosis 
 exists or in which a death from tuberculosis occurred. 
 
 etc. 
 
 In large establishments, a circular letter may be sent, previous 
 to the conference, to all superintendents or foremen, calling attention 
 to the above mentioned classes of cases and explaining the object and 
 scope of the proposed examinations. 
 
 4. Tuberculosis Clinic. 
 
 With the compilation of a list of suspicious cases, a tuberculosis 
 clinic is established on the premises of the firm, in which all such 
 cases are subjected to a thorough medical examination. 
 
 Each individual case is classified, (a) according to diagnosis: 
 “tuberculous” or “non-tuberculous,” “active” or “non-active,” “open” 
 or “closed”; (b) according to necessity of change of occupation or dis¬ 
 continuance of work; (c) according to need of hospital, sanatorium or 
 home treatment. 
 
 The solution of each case is considered after a full analysis of 
 all its medical and social aspects. 
 
 At times some difficulty may be encountered in persuading an 
 individual member of the force to undergo the examination, but, as in 
 all matters, diplomacy and kindness will overcome all obstacles. 
 
 Besides serving as a diagnostic station, the clinic maintains 
 continuous supervision over (a) employes classed as “predisposed”; 
 (b) employes returned to work, with disease “apparently cured” or 
 “arrested” by institutional or home treatment; (c) employes taking 
 “home treatment” and assigned to the clinic by the employer. 
 
 Since the submission of this plan to the Chicago Tuberculosis 
 Institute a year ago, a systematic campaign for its adoption by indus¬ 
 trial concerns in this city has been carried on by its Committee on 
 Factories. At present the plan is in operation in shops and offices of 
 the International Harvester Company; Montgomery, Ward & Com¬ 
 pany, and the Chicago Telephone Company, and has just been adopted 
 by Swift & Company. The firm of Sears, Roebuck & Company has 
 for some time given special attention to tuberculosis in their exami¬ 
 nation of employes. 
 
 8 
 
The campaign among employers of labor is being continued 
 by the Institute, and the prospects are bright for a more universal 
 adoption of the plan of examination as above outlined. 
 
 Some of the Problems Met in the Course 
 of Operation of the Above Plan. 
 
 Some of the important problems which will arise in the course 
 of operation of the plan are as follows: 
 
 (a) Insufficiency and inefficiency of the present institutional pro¬ 
 vision for the tuberculous in some of our cities. 
 
 The number of curable cases of tuberculosis in need of sana¬ 
 torium treatment in a community generally outnumbers the existing 
 sanatorium facilities. In addition to this, the administrative and medi¬ 
 cal standard of most of our hospitals for advanced cases is such as 
 not to appeal to the average workman unless driven there, as a last 
 resort, by the utter hopelessness of his condition or by absolute desti¬ 
 tution. This situation unavoidably results in the continuous infection 
 of homes by a large number of tuberculosis cases in which institu¬ 
 tional care would have best safeguarded the interests of the patient 
 and his family. 
 
 In submitting the above plan of examination of workers for 
 tuberculosis, the hope is entertained that with the gradual realization 
 on the part of the employers and employes of the extent and importance 
 of the tuberculosis problem, their influence will be exerted in favor 
 of more comprehensive and more efficient institutional care of the 
 tuberculous. 
 
 ( b ) Lack or insufficiency of financial provision for employes in case 
 of illness . 
 
 Excepting the provision connected with membership in em¬ 
 ployes’ benefit associations in a small number of concerns, or a policy 
 in an industrial insurance company, the average employe is generally 
 thrown on his own resources in case of illness. The attitude of some 
 industrial establishments has been very liberal in supplying funds for 
 the care of their employes in sanatoria and hospitals, and even for 
 the maintenance of the families during the illness of the wage-earners. 
 
 The interests of the employes as well as of the employers de¬ 
 mand, however, the further development and extension of the prin- 
 
 9 
 
ciple of “workmen’s sickness and disability insurance,” as but par¬ 
 tially realized at present in the employes’ benefit associations. 
 
 A system of examination for tuberculosis efficiently operated in a 
 working place will tend to materially reduce the financial burden im¬ 
 posed at present on a workman and his family by delayed diagnosis 
 of the disease, as early detection of tuberculosis, made possible by a 
 system of periodic examinations, shortens the necessary period of 
 treatment and increases the likelihood of “cure” and restoration of the 
 working power. 
 
 (c) Co-operation with the family physician, the city tuberculosis clinics 
 and other organisations in effecting efficient supervision and care 
 of cases of tuberculosis among employes . 
 
 Under the present conditions length of service or other per¬ 
 sonal considerations determine the active interest of an employer in 
 an employe stricken with tuberculosis. The employe may have no 
 resources of his own and the weekly allowance supplied by the benefit 
 association may be insufficient to carry him through the required 
 period of treatment and provide for his family during that time. Co¬ 
 operation with other organizations is frequently necessary in order to 
 effect the right kind of arrangement for the care of the employe and 
 his family. 
 
 As previously stated, diagnosis of all suspicious cases in a 
 working place is of great importance to the employe and employer. 
 A satisfactory arrangement by which the family physician of the 
 employe may co-operate with the firm in this respect should be put 
 into operation. If an employe is able to pay for medical care, a notice 
 of his illness should be sent, with his permission, to his family phy¬ 
 sician. 
 
 Abuse of medical charity should be avoided in any arrangement 
 the firm makes for the care of its tuberculous employes. Under the 
 present conditions, however, a large proportion of working people find 
 themselves, unfortunately, with inadequate means, when confronted 
 with a chronic disease; this necessitates close co-operation between the 
 tuberculosis clinic in a working place and the municipal tuberculosis 
 clinics, as well as tuberculosis associations, in order to assure proper 
 supervision and care of all discovered cases. 
 
 10 
 
Disposition of Various Groups of Cases Discov¬ 
 ered in the Course of the Examinations. 
 
 The question is frequently asked what disposition should be 
 made of the various groups of active and inactive cases of tuberculosis 
 discovered in the course of examinations. An answer to this question 
 is very important, as the laity is under the impression that sanatorium 
 treatment is the only solution in all cases of tuberculosis, no matter 
 how slight are the suspicious physical signs or how inactive is the 
 disease. Such a procedure is of course impossible, with our present 
 limited institutional facilities and, fortunately, is unnecessary under 
 any conditions. 
 
 To make this clear, we shall consider, in a general way, the 
 various groups of cases encountered in a working place and suggest a 
 policy to be followed in each group: 
 
 1. “Open” cases of tuberculosis (tubercle bacilli in the sputum). All 
 stages of the disease. Unless under control, this group is a prolific 
 source of infection. 
 
 Hospital or sanatorium treatment of the majority of cases of 
 this group is the ideal solution from every standpoint. Treatment at 
 home should never be attempted unless conditions permit absolute 
 control of infection. While the majority of “open” cases are beyond 
 the incipient stage, “arrest” of the process and full or partial restora¬ 
 tion of working power takes place, with proper treatment, in a con¬ 
 siderable proportion of this group. 
 
 Discharged hospital or sanatorium patients, in possession of 
 sufficient working power, but still “carriers” of infection (bacilli in 
 the sputum) may be given light outdoor employment. Indoor work 
 is permissible in very few cases of this kind and then only under the 
 condition of perfect control of the infection on the part of the worker, 
 in well-ventilated rooms and not in contact with other employes. 
 
 Consideration of the welfare of the entire working force de¬ 
 mands detection and control of the group of “open” cases, as the 
 first step in any system of medical examinations established in a work¬ 
 ing place. 
 
 2. “Active” cases of tuberculosis, without tubercle bacilli in the spu¬ 
 tum (“closed ”). Chiefly incipient, favorable cases (exception: 
 a small number of cases reaching the advanced stage, without 
 bacilli in the sputum). Unless given timely and efficient treat¬ 
 ment, a large percentage of these cases pass into group 1 (become 
 “open,” communicable). 
 
 11 
 
Sanatorium treatment is the most efficient method in dealing 
 with the majority of these cases. Home treatment may be attempted 
 in surroundings affording all the essentials of sanatorium life and with 
 patients possessing the necessary power of self-control. A large per¬ 
 centage of this group recover health and working capacity and con¬ 
 tinue to maintain it under proper conditions. 
 
 When “cure” or “arrest” is attained, decision as to proper occu¬ 
 pation in each individual case should be based on a thorough study 
 of all its conditions. Arduous labor, insufficient night rest, lack of air 
 (day or night) and insufficient nourishment lead to “breakdowns,” 
 but with avoidance of unhealthy occupations and proper regulation of 
 home life (plenty of rest, air and food), maintenance of health is pos¬ 
 sible in the majority of these cases if discovered and treated in the 
 early stages. It is the function of the physician and the nurse em¬ 
 ployed by the concern to guide these men and women in the essentials 
 of proper living and in the avoidance of all injurious influences. 
 
 While from the standpoint of safety of a working force the 
 division of all cases of tuberculosis into “open” and “closed” is of 
 the greatest importance, the chances of recovery in the individual case 
 are influenced by other factors, equally important, viz.: extent and 
 activity of the process, degree of constitutional disturbance, general 
 condition, etc. The more recent the disease, the smaller its extent and 
 the less active the process, the more favorable is the prospect of 
 ultimate recovery. Hence, “early diagnosis” should be the slogan in all 
 examinations for tuberculosis. 
 
 In arranging institutional treatment for employes showing signs 
 of “active” tuberculosis (“open” or “closed”) the institutional re¬ 
 sources of the city are drawn upon and any expense connected with 
 treatment in private hospitals or sanatoria is borne according to con¬ 
 ditions, either by the employer, the employe, employes’ benefit associa¬ 
 tion or some other organization. 
 
 3. “Inactive” cases of tuberculosis (signs of “healed” or “arrested” 
 lesion revealed by examination; no symptoms). A portion of these 
 cases come from tuberculous families. 
 
 4. Workers predisposed to tuberculosis (by malnutrition, anaemia or 
 
 any debilitating condition). 
 
 12 
 
Cases belonging to the last two groups (particularly group 4) 
 form not an inconsiderable part of any working force. 
 
 Most effective work can be done among this class of employes 
 by the physician and nurse, with the co-operation of the employer. 
 Contrary to the method applied to the first two groups (cessation of 
 work followed by institutional treatment), the majority of employes 
 of the last two groups may continue to work under certain conditions. 
 Attention should be given to the character of work, and place of resi¬ 
 dence of the employe (very laborious or dusty trades should be avoided 
 as well as work in poorly ventilated quarters). Education in right 
 living (sufficient amount of rest, air and food, avoidance of all injurious 
 influences) will tend toward the improvement of the state of resistance 
 in the majority of these cases and is bound to reflect itself in the atti¬ 
 tude of the entire working force toward the problem of health. 
 
 The work of the physician and nurse should be to a great ex¬ 
 tent educational, extending beyond the factory, office or store, right 
 to the home of the employe, where their guidance should be in the 
 direction of better health with the resulting greater efficiency. 
 
 Conclusion. 
 
 The aim of the proposed plan of examination of employes for 
 tuberculosis is, first, detection and suppression of sources of infection 
 in the working place; second, detection of cases of the disease in the 
 curable stages; third, guidance of all employes predisposed to the dis¬ 
 ease and of those who are re-employed after having recovered their 
 health by sanatorium or home treatment; fourth, guidance of all em¬ 
 ployes in right living and methods of prevention. 
 
 The watchwords should be: education, detection, control. 
 
 The hand of the engineer is on the throttle of the manufacturing 
 machinery; the hand of the physician should be on the health of the 
 working force; a higher standard of health means greater efficiency. 
 
 13 
 
f 
 
 1 
 
The Chicago Tuberculosis institute 
 
 THE CENTRAL HEADQUARTERS 
 OF THE ANTI-TUBERCULOSIS PROPAGANDA IN CHICAGO 
 
 Room 1351, Otis Building, Madison and LaSalle Streets. 
 
 Officers and Members of the Board of Directors : 
 
 Henry B. Favill, M. D., 
 
 President. 
 
 Frank Billings, M. D., 
 
 First Vice-President. 
 
 Robert H. Babcock, M. D., 
 
 Second Vice-President. 
 
 Charles L. Allen. 
 
 Robert H. Babcock, M. D. 
 Frank Billings, M. D. 
 
 Nathan S. Davis, M. D. 
 
 George R. Durgan. 
 
 Mrs. E. C. Dudley. 
 
 William A. Evans, M. D. 
 Henry B. Favill, M. D. 
 
 Miss Annie Fitzgerald. 
 
 David R. Forgan. 
 
 Henry N. Foster. 
 
 Miss Harriet Fulmer. 
 
 Ethan A. Gray, M. D. 
 
 James Alexander Harvey, M. D. 
 Mrs. James L. Houghteling. 
 
 David R. Forgan, 
 
 Treasurer. 
 
 Sherman C. Kingsley, 
 
 Secretary. 
 
 Frank S. Johnson, M. D. 
 Sherman C. Kingsley. 
 
 O. W. McMichael, M. D. 
 
 Mrs. Jessie L. Moss. 
 
 Rev. Peter O’Callaghan. 
 George W. Perkins. 
 
 George A. Ranney. 
 
 John Ritter, M. D. 
 
 John A. Robison, M. D. 
 Julius Rosenwald. 
 
 Edwin W. Ryerson, M. D. 
 Theodore B. Sachs, M. D. 
 
 John C. Shaffer. 
 
 Miss Laura A. Shedd. 
 
 George W. Webster, M. D. 
 
 Committee on Factories: 
 
 Theodore B. Sachs, M. D., Chairman. 
 
 Henry B. Favill, M. D. Sherman C. Kingsley. 
 
 Telephones : 
 
 Franklin 2562, Franklin 2563. 
 
 James Minnick, 
 
 Superintendent. 
 
 Arthur J. Strawson, 
 
 Assistant Superintendent. 
 
f • 
 
 V 
 
 
UNIVERSITY OF ILLINOIS-URBANA 
 614.542 C432E C002 
 Examination of employees for tuberculosi