Public Health Reports, Vol. 38, No. 12, March 23, 1923.

(Courtesy of the Bureau of Tuberculosis, California State Board of Health.)

“alone" group had been in Colorado Springs less than three months and 34 per cent one week or less. Only 7 of the 106 had resided here over three years.

County records.-Unfortunately the county kept no records which could be consulted. The cases needing infirmary care were sent to St. Francis Hospital, a general hospital having a tuberculosis ward and conducted by Catholic sisters. Families were given outdoor relief, and homeless men not needing hospital care but unable to work were taken care of at the County Farm. Records for the year were obtained from St. Francis Hospital and the County Farm, and according to the Associated Charities' records about 40 families were noted as receiving additional aid from the county.

In general it may be said that the social agencies in Colorado Springs are exceptionally well organized for a place of that size, and that they cooperate most heartily in taking care of all cases.

Disposition of cases. - The best that could be done in this study was to give the disposition of the case as far as shown on the final record of the agency or agencies dealing with it. In addition, a search of death records in the board of health office was made to find out if any cases lost sight of by the agencies had subsequently died. In the majority of cases, of course, the present residence and status of the individual were not known. He had come under the supervision of the agency for a time, had been assisted according to his needs, and had not returned.

It may be said here that it is the policy of the Associated Charities and the county to furnish transportation to place of legal residence for any consumptive who is in an advanced stage of the disease and for whom recovery is impossible.

Our findings so far as they go are as follows: fifty-four had died, 45 had left town, 21 were known to be in institutions in Colorado Springs, 40 were known to be in Colorado Springs, and 225 were not reported.

Registration of cases. There is a State law in Colorado requiring the reporting of cases of tuberculosis to the State Board of Health. This law is not enforced and at the time of the study there were no facilities for enforcing it. Colorado Springs, however, has a city ordinance requiring such registration.

Copies of records were made for all cases of tuberculosis registered during the year from April 1, 1919, to April 1, 1920. There were 370 such records. The length of residence is not made a matter of record, but the place where the disease was developed is recorded. It is interesting to note that out of this 370 only 6 stated that the disease had developed in Colorado Springs. This indicates that at least 364 had gone there seeking health.

There had been 41 deaths among the 370 cases recorded in the year, 1 death for every 9 cases. It was supposed at the beginning of this investigation that the cases which would be discovered in this study would be, for the most part, registered. Therefore it was very surprising to find that only 100 of the indigent cases were recorded in the board of health office. That means that 285 were unrecorded. Probably some of those were the wanderers who stayed only a short time and did not come under a physician's care; but it is believed that this number is relatively small. The fact remains that many cases are not reported.

To the 370 cases which are registered should be added the 285 of our study which were not registered, making the known cases for that year 655, of which 59 per cent were indigent.

Significance of these figures.—The 1920 Census figures gave Colorado Springs a population of approximately 30,000. With a total of 655 known cases in a year, there is one case of tuberculosis to every 46 of the population, and one indigent consumptive to every 78 residents. The burden laid upon a community by such a situation is a heavy one.

The cost to the community.—What the community spends in bearing this burden can not be exactly computed. The budgets of the various relief agencies are, roughly, as follows: County relief.....

$42, 000 Associated Charities....

20, 000 Sunnyrest Sanatorium..

10,000 Tuberculosis Clinic....

3, 000 Visiting Nurse Association.

8,000 Total......

83, 000 The third and fourth items, totaling $13,000, are for the relief of tuberculosis only. It is estimated that at least one-third of the Associated Charities' budget goes for tuberculosis relief, and that one-fourth of the county's funds and one-fourth of the budget of the Visiting Nurse Association is used for the same purpose. The minimum amount expended by these agencies on tuberculosis relief would then be something over $32,000 in a year. This means a yearly tax of over $1 per capita for this purpose.

Tuberculosis death rate.-There were 225 deaths from tuberculosis in Colorado Springs in 1919. On the basis of a 30,000 population the tuberculosis death rate would be 750 per 100,000, as compared with 149 per 100,000 for the registration area of the United States.

Sources of migration.—The States from which most of the tuberculous came were, in order, Missouri, Kansas, Illinois, Oklahoma, Colorado, and Kentucky.


Extent.-Denver, the second largest city of the group, with a population of over a quarter of a million, was probably the earliest Mecca of health seekers to the Southwest. In fact, a large part of its population is composed of those who, having sought health there, have found it and are now its most enthusiastic citizens.

The proportion of indigent tuberculous to the population was in the ratio of 1 to 156, coming fourth in order among the six cities studied. The study made in Colorado Springs showed 1 indigent consumptive to every 78 residents, exactly twice as many in proportion to the population.

Sources of information.-Individual records were obtained from the following agencies: The Municipal Tuberculosis Dispensary, the City Bureau of Charities, the City Health Department, the Visiting Nurse Association, the Social Service Bureau, the Salvation Army, the Jewish Central Aid Society, the Ex-Patients' Home, Craig Colony, Sands's House, and the Sacred Heart Society.

Total number of cases. The agencies above noted which furnished records cared for a total of 1,635 tuberculous individuals during the year.

Length of residence. The first outstanding fact in regard to the entire group is that practically two-thirds are nonresidents. There is, in addition, a small group of 115 for whom length of residence was not stated on the records. These presumably were nonresidents, as they made application to agencies which deal mostly with nonresidents. Adding this number to the 1,036 known nonresidents, the total figure becomes 1,151 nonresidents out of the entire group of 1,635, or 70 per cent. If the term "nonresident” were restricted to those who had lived here less than one year, even then 62 per cent of the entire group would fall within this class, since those who had resided here between one and two years numbered only 136.

Forty-three made application for assistance on the day of their arrival in the city. Over one-half of the total nonresidents needed help before they had been in the city three months, and considerably over one-third when they had been there a month or less. Twentyeight per cent of the men, but only 8 per cent of the women, asked for assistance within a month after coming.

Only 369 out of the total of 1,635 assisted had lived in the city over three years at the time of contact with the agency. It


be cluded then that the burden imposed upon this community by the indigent tuberculous is largely one of migration.

Sources of migration.— The States of previous residence of the group of 1,036 “nonresidents” were in order of numbers, as follows: New York, Illinois, Missouri, Ohio, Michigan, Pennsylvania, Indiana, and

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