Work done by tuberculosis patients

160

Work Done by Tuberculosis Patients By WILLIAM D. GRAY District Tuberculosis Officer, Durham County Council

The Disabled Persons Employment Act (1944) has turned the attention of Tuberculosis Officers to the question of the employment of thelr patients. In the past many patients have been able to obtain employment, usually by concealing their disability. This has led to many of them being placed in quke unsuitable jobs. Registration under this Act now provides the machinery for closer co-operation between the Tuberculosis Officer, the Ministry of Labour's Disablement Rehabilitation Officer, the patient and the employer. However, despite the Quota system, the D.R.O. finds the greatest difficulty in obtaining work for anybody disabled by tuberculosis. The employer will take any other type of disabled person first. The lay public fails to recognize the difference between the actively infectious case, who should only be employed in work under sheltered conditions, and the quiescent or arrested case who is quite able to work among others, and will often prove to be a most conscientious worker. Previous published surveys have shown quite high proportions of patients on Tuberculosis Registers able for work:--Uxbridge investigation (Tubercle, August I946) found 68 per cent, England in Oxfordshire (Tubercle, December 1946) 6o per cent, and Hardy in Hull (Tubercle, January I948) 46 per cent of their male pulmonary cases were working. It is suggested by England that these good results are not well enough known by the lay public and I believe that if they were it would not be so difficult to place tuberculous persons on an employer's quota. In this paper I have made a survey of the male cases on my Register otx January I, I948, in order to find out what they were doing, and how many of them were in need of help from the D.R.O. The figures relate to a mixed colliery urban and rural area in south-west Durham, with a population of approximately I37,ooo.

Table I

(See page z61)

From this table it is seen that 138 males (35 per cent of all males on the Register) are working, not including the 5 men doing handicrafts at home. This is not so good a proportion as in Uxbridge (57 per cent of 1,o58 males and females), Oxfordshire (6~ per cent of 288 males) or HulI (47 per cent of 7~4 males). 58 (63 per cent) out of 92 sputum negative cases (Hull 70 per cent), 42 (30 per cent) of the 141 sputum positive group (Hull 37 per cent, Oxfordshire 51 per cent) and 38 (67 per cent) of 57 nonrespiratory cases are working. It is obvious that the pulmonary group presents a much greater problem than the non-pulmonary. T h e next table examines the former group in a little more detail. TAm.I~ II Not

Groups I~ Sputum Sputum 3) Sputum 4-) Pleurttl

Working morkit,g

persistently positive .. converted . . . . . . negative . . . . (including mixed types) Total

~ ~o9 ~6 o~

52 37 3~ 4

ioo

133

Out of 233 cases classified as suffering from respiratory tuberculosis, I4I (60 per cent) belong to Class RB. Out of 75 cases still with positive sputum, 13 (I7.~ per cent) are working (Hull 17 per cent). Out of 66 cases now sputum converted, ~9 (44 per cent) are working (Hull 69 per cent). Out of 66 sputum-negative cases, 36 (54 per cent) are working (Hull 7~ per cent). Out of 26 pleural cases 2e (85 per cent) are working (Hull 67 per cent). 19 men over 55 are unemployed, that is 15 per cent of all male pulmonary cases who are unemployed (Hull I8 per cent). Only one of these is considered fit for work and one could do home work but is over 65. 6 cases in the RB group are over 65 . 216 (55 per cent) out of 390 are in the younger age groups (i5-44) and of these 76 (35 per

July

161

TUBERCLE

1948

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July 1948

TUBERCLE

162

cent) are workillg (()xlbrd 62 per cent, Uxbridge 57 per cent, Hull 4.7 per cent). IO cases or the RB group (7 per cent) are fit but unemployed and so are 6 cases (6~ per cent) of the RA group, or I6 out of" 233 (nearly 7 per cent). Another Io cases (7 per cent) of the RB group are fit for some measure of home work, and 7 (5 per cent) are fit for work under sheltered conditions only. In all there are 33 puhnona:ry cases out of 233 (14 per cent) and 6 out of 57 (Io~ per cent) non-pulmonary cases needing Belp fi'om the Ministry or Labour to fincl suitable work; in other words Io per cent of all males on Register; (Hull I8 per cent). 3o of the pulmonary cases are hi age groups I5"44, As at I:-Iendcm (l:lall, Tubercle, November 1!14(~), the mnnerical problem racing the D,R.O. is small; tlmre it was fimnd that he had to place three men xdth positive sputum in sheltered employment, and find home work For i'a men. The discouraging figure in my investigation is that dealing with tllose who are fit fbr normal work but are unemployed .......t Ci men. These men are being rejected by emph)yers merely because of their past history, and tiffs discourages Other patients Ii'om registering at all. They will prercr to find possibly unsuitable jobs for themselves as in. the past. Out of Ioo cases working, only 4 were placed by tile D.R.O. In art attempt to find out what patients can do, I have attempted to tabulate types of work being done by those pulmonary cases at work. TABLE I I I RA

Type of W o r k

RB

Outdoor Indoor Outdoor Indoor

Manuah Heavy . . . . Medium ,. Light . . . .

5 xo :4

9 6 ~~

3 5 3

-5 m

T , tal

x8

'~7

xI

x5

..

~

9

i

3 !)

............ '~

i. I,

Total

I

J~

~

x4

Grand Total

HI

39

I23

~[1

dVon-mamlal: Heavy Medium Light

it used to be ron lnlon advice to a tnbercuIons patient tlmt he should go and get a light job in tb.e fi'esh air. Table l l I shows that I9 men (33 per cem) of tim RA group are working mahfly outside and 39 (67 per cent) inside, ht the RB group 13 (31 per cent) are outside and 29 (69 per cent) inside. In the RA gr(mp, '25 (4.3 per cent) are doing light work, I.~) (33 per cent) medium work and 14, (24 1)er cent) heavy work. In the RB group '29 (69 per cent) are doing light work, ~o (~4 per cent) medium wm'k and only 3 (7 per cent) heavy work. [t is interesting to set: what tile I)ersistently positive sputum cases are doing. 5 are doing clerical work, i is ;t mete, r c(dle(:tor, i a [)us driver, I an ettgine driver, i a |llet'l(~tlliC repaMn.g roal-('utting machines, r a ra.retaker in a clul), [ has a smallh(ddlng, I is a joiner's htl)(mrer, and t is a general labourer. Stone of' these jobs are, obviously unsuitaMe, Th.c taMe shows that th,e majority or l)oth groups are working indoors, that light work is lltvoured by a lttz'gc: rn@)rity of the RB group, bttt tl:lat less than half of tlm RA grott l) are so engaged, The next table slmws the total number of years ill, mid the total numl)er ()[' years worl(ed by each group, TAm.v. I V

Years worked Group x (Sputum a l w a y s positive) G r o u p ,2 ( S p u t u m converted) .. G r o u p 3 (Sputun:t ahvays negative) Group 4 (Pleural - - i n c l u d i n g all types) . . . .

36 yrs. 7 m .

Years ill 6I yrs.

~ j ears worked

3 m.

60%

8'a yrs. a m .

~79 yrs. i ~ m .

,t,6~

9" yrs. 6 m.

Ll.5 yrs.

I m.

64~

50 yrs, 8 m.

Itll yrs.

9 m.

50%

These figures seem rather anomalous, in that they show that with the exception of the sputum converted group, all groups worked more than half of the time since they became ill. The explanation of the po(wer figure for the sputum converted group may be the hmger period of' Sanatorium treatment they may have undergone, in order to have their sputum converted by collapse thera.py. The good showing of the sputum persistently

July

TUBERCLE

1948

163

positive group is possibly due to the fact Nearly half of these, i6, could be placed in that this group is made up of thegood chronic light jobs in industry if employers would cases, some of whom have little or no co-operate. 3~ of them are under 45 years of institutional treatment at all, and carry on age, with many years of productive work with their work against advice. The rather ahead of them. (3) There is a small but definite need for poor slmwing of the pleural group is explained by the inclusion in this group of a provision of work in the home, and for work patient who had multiple bone and joint in sheltered workshops for the persistently disease and urogenital tuberculosis lasting positive sputum case. Some of those working for 20 years 6 months, who has only just witl~ a positive sputum should not be in their started work two months ago. This man present jobs, but should be in such special incidentally is now working in a furniture workshops. (4) Few patients find the mythical light factory, feeding a steel press, using a foot pedal. He obtained the job as a disabled job in the .fresh air, but 48 per cent of cases person, without telling his employer that he working are doing light work indoors. (5) The prejudice of employers against had tuberculosis. The point l wish to emphasize is that tuberculosis cases, and the difficulty extuberculous patien.ts can do usdhl work for perienced by the D.R.O. in placing them in years, anti I tl~ink that if employers knew jobs, is becoming known to Dispensary this they wonld be more willing to accept patients, and is discouraging them from Registration as Disabled Persons. sucl~ cases on their quota. (6) Employers should be taught to accept Summary and Conclusions medical advice about the fitness of tubercu(z) A survey of the male cases oa a Tubercu- lous patients for work. High percentages of losi.s Register is made, showing the state of the more favourable groups are able to employment in the different clinical groups. work, some cases for many years. I should llke to express thanks to Dr C. A. The results approximate more closely to those of Hardy in Hull than to those of O'Neill, Clfief Clinical Tuberculosis Officer other investigators, where larger percentages to Durlaam County Council, for permission of cases working were found. This may be to publish this paper, to the Disablement due to the type of industry in the north, Rehabilitation Officer at Bishop Auckland where coal mining and iron and steel pre- for his help in classifying types of work and dominate, and ttmre are few light industries. to the Heatth Visitors on the County Staff The percentage working in each clinical who have helped me to collect much of the group varies inversely as the severity of the information required. disease, the smallest percentage working References being found in the persistently positive Uxbridge investigation, Tubercle, z946 , xxvIb z ~4. sputum group. England, N. J., ibid., z946 , xxwb ~o 7. (2) 33 (z4 per cent) of the pulmonary Hardy, R,, ibid., i948, xxzx, 8. cases are unemployed but fit for work. Hall, Stephen, ibid,, z946 , xxvzz, z9z.

TUBERCULOSIS--ENGLAND AND WALES STAFF SHORTAGES IN INSTITUTIONS

Dee. 3~, z 9 4 6 Dee. ,3J, ~947.

Patients having treatment

Waiting list

Beds provided

Beds empty chiefly because of staff shortage

26,a26 27,680

7,o25 8,269

32,o65 32,590

4,912 3,757