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Physical Disability of New York
City School Teachers

A Study of 3,877 Records of Absence During the
School Year 1914-1915

BY

LOUIS I. DUBLIN, Ph.D., Statistician
Metropolitan Life Insurance Company, New York
1916

[Reprintedfrom SCHOOL AND SOCIETY, Vol. IV., No.
93, pages 564-569, October 7 ; and No. 94, pages 602607, October 14, 1916]

PHYSICAL DISABILITY OF NEW YORK CITY
SCHOOL TEACHERS.
A STUDY OF 3,877
RECORDS OF ABSENCE DURING
SCHOOL YEAR

1914-i5

SCHOOL teachers are subject to especially low

death rates. They share with clergymen the
distinction of having the most favorable mortality in a list of representative occupations.
With reference to physical disability, however,
there appears to be considerable divergence of
opinion. In view of the lack of decisive evidence, opinion has been swayed to one side or
the other, depending upon preconception or
even upon certain practical ends which writers
have wished to further. There is, therefore,
room for a disinterested study of the amount
and character of physical disability occurring
among teachers. Such an investigation is
especially called for because of the peculiar
position that the teacher occupies in our social system. The health of the teacher is an
index of the sanitary condition of our school
plants in which our children spend so many
of their waking hours. The health of the
teacher determines the character of the instruction given. There is finally the demand
of the community to know whether those who
train the young are themselves of good health;
for there is the belief that none but such can
transmit to children under their care ideals
of physical well-being and of complete development.
The following report is an attempt to contribute to the discussion of the subject with
especial reference to the teachers in the New

1F

5371

York City schools. It has grown out of an
effort to analyze the problem made by the
Brooklyn Teachers Association Committee on
School Problems.' The report of this committee issued in September, 1915, contained a
number of far-reaching conclusions regarding
the effect of teaching on the health of the
teachers. New York City teachers, it was suggested, suffer from a high sickness rate and
this rate is concentrated in four so-called
"occupational" diseases, namely, diseases of
the respiratory system, infectious diseases, diseases of the nervous system, and diseases of the
digestive system. In view of the importance
of the subject and of the limited facilities of
the teachers' committee to give full consideration to all the technical requirements of the
study, it was clear that further and more detailed investigation should be made. To this
end, conferences were held with Dr. Oswald
Schlockow, chairman of the Committee of
Teachers. The writer's best thanks are due
this gentleman for his helpful cooperation in
arranging for the present study. It is a pleasure also to acknowledge at this point the many
courtesies extended by former President
Churchill, of the Board of Education, by Dr.
Gustav Straubenmiiller and Dr. Edward B.
Shallow, associate city superintendents of
schools, who placed at our disposal the necessary records of the department.
RECORDS USED

As in the previous study, the basic records
used were the applications submitted by teachers for refund of salary deducted because of
absence due to illness. During the school year
1914-15 there were available 3,969 such appli1 Schlockow, Oswald, "Ad-interim report of an
investigation of the absence of New York City
school teachers during the school year, 1913-14."
Brooklyn Teachers Association, Committee on
School Problems. Brooklyn, N. Y., September,
1915, pp. 12.

2

cations. Each was transcribed upon a separate slip and such facts as the age, sex, period
of teaching, the disease or condition, the duration of illness, together with certain registration items identifying the school and the case
were abstracted. Illnesses which were continuous, but which were reported separately two
or more times for salary refund were identified
and combined on one slip and were henceforth
considered as one case. By this means duplication of illnesses was obviated as far as possible. Two or more different illnesses of the
same teacher were separately treated in the
analysis. There were on this basis, 3,703 distinct cases of illness to be considered. To
make our basic materials as complete as possible, 174 records of illness involving leaves of
absence in this year were transcribed and
added to the above. There was accordingly a
total of 3,877 cases of continuous illness. The
study is entirely limited to a consideration of
these cases. It is realized that these records
do not cover all the cases of illness that occurred, since refund of salary is limited by the
regulations of the department to cases of illness of at least three days' duration. As we
shall see later, a few cases whose duration was
less than three days were recorded in our list;
but it is safe to, say that they formed only a
small fraction of the total that occurred. Our
report is, therefore, in effect limited to physical disability lasting three days or more.
MAIN RESULTS OF THE INQUIRY

Table I. below gives the main results of our
inquiry. The 3,877 cases of illness when considered in relation to the 20,421 teachers on
the active list during the year, give a rate of
187.2 cases of sickness per thousand teachers
exposed. Exclusive of leaves of absence the
rate is 178.8 per 1,000 teachers. In other
words, 18.7 per cent. of the teachers reported
sick during the school year. This figure is
slightly lower than that reported by the
3

Schlockow Committee, namely, 20.5 per cent.
for the school year 1913-14. The difference
may be due in part to the slightly different
conditions in the later year, but also to the
fact that the number of cases of illness were
reduced by our effort to remove duplications,
a process not attempted by the school teachers' committee. It must be pointed out also
that the figures of the two reports are limited
to the school year of the teacher, which is 41
weeks. The rates, therefore, are not a measure of the amount of illness occurring during
a full fiscal year. We shall later consider the
limitations of the data in making comparison
with other studies of disability resulting from
sickness and accidents.
The rates of sickness vary with sex. Of the
total number of cases 231 were contributed by
male teachers and 3,646 by female teachers.
For the men there were 88.5 cases of physical
disability per 1,000 employed during the school
year. The corresponding rate for women
teachers was 201.5 per thousand. In relation
to the number employed there were, therefore,
228 cases of illness among women for each 100
cases registered among men.
If we exclude "leave of absence cases" for
which neither age of teacher nor duration of
disability were available upon the original
records, we find the average period of disability for work to be 16.1 days per case for all
teachers disabled. The differences in this figure by sex are not significant, the average
period being 15.9 and 16.1 days for men and
women, respectively. The earlier report gives
an average duration per case of illness as 16.5
days. This agreement in the two sets of figures is, of course, gratifying.
Considered in terms of the individual
teacher, whether sick or not, the average number of days of physical disability was 2.88 days.
For men, including leaves of absence, the
average duration was 1.34 days per teacher

TABLE I

Number of Cases of Physical Disability; Rate per
1,000; Days of Absence from Work per
Case and per 100 Teachers, School
Year 1914-1915
Cases of
Disability
Sex
Number

Per
1,000

Teachers

Days Absent from Work

Number

Per
Per Per Year
Case of Per 100
TeachDisability
ers

Both sexes:

Including
Leaves of ab-

sence....... 3,877 187.2

Excluding
Leaves of absence...... 3,703 178.8 59,681

16.1

288.2

15.9

134.0

Males:

Including
Leaves of absence.......
Excluding
Leaves of absence.......

231

88.5

220

84.3

sence....... 3,646

201.5

3,500

Females:

Including
Leaves of abExcluding

Leaves of ab-

sence....... 3,483

192.5 56,181

16.1 | 310.5

and for women 3.11 days per teacher. Again,
we find the average period of disability more
than twice as long among females as among:
males.
PHYSICAL

DISABILITY CONSIDERED

BY AGE

PERIOD'

The age factor in sickness and accident disability is a most important one and is espe
cially so in the present investigation. For our
purposes the average number of men and
women teachers employed throughout the
school year 1914-15 was distributed in accordance with the actual findings of the census
taken by the Mayor's Commission on Pensions
as of June 30, 1914. Physical disability was
then measured in terms of the approximate

number of men and women school teachers
exposed to risk of sickness and accident at
each age period.
The following table and graph give the
principal facts of physical disability by age:
TABLE II

Physical Disability Rates per 1,000 Teachers Exposed Classified by Sex and by Age Period
Men Teachers

Women Teachers

Age Period

All ages
(Inc. leaves of ab2 .
.....
sence) ...... ...

r4

2,611231 88.5 18,096 3,646 201.5

(Exc. leaves of absence) ............... 2,611 220 84.3 18,096 3,483 192.5
15-19.........

-

-

--

20-24.........
25-34 .......
35-44.........
45-54........
55-64.........
65-69........

166
1,075
827
369
146
22

13 78.3
88 81.9
57 68.9
40 108.4
15 102.7
4181.8

70 and over...........
Not stated. ...........
Leaves of absence2..

6

2333.3
1 11 -

3187.5

16

3,353 425 126.8
7,328 1,288175.8
4,656 975 209.4
2,087 550 263.5
602 174 289.0
50 14280.0
4

54 163 -

The sickness rate among school teachers increases steadily with age. This is especially
so for the group, as a whole, irrespective of
sex. Thus, in the age period 20-24, the rate
is 126.3 per 1,000 cases. From this period
onward until the age period 55-64 inclusive is
reached the rates increase without exception
with each 10-year period. In the period 55-64,
the rate is 256.0 or slightly over twice the rate
in the first period.
The rates for the males are not regular in
their increases by age, the number of cases
being often too small to give reliable figures.
Among female teachers, on the other hand, the
rates are increasingly higher with advancing
age except at the very earliest and most ad2

Neither age nor duration of disability stated.
6

Qbases of 5icfln3 Per 1 ,00OOExposed
Thvolvinc3 Di5@bi1I±hj For W\orS

New

or

botcp'I~oo

Ctr1
Q
Y~c Y

4-

j'hooITec~cy(

q

RI

q15

5.

vanced ages, when the number exposed is also
small. The highest sickness rate registered
for female teachers was found in the period
55-64; the highest reliable rate for male teachers in the period 45-54.
In connection with the rates for female
teachers it is of interest to note the smoothness of the curve with reference to age. In
other groups of females for which sickness statistics are available it is usually found that irregularities exist in the age period 25 to 44.
This is due to the inclusion of puerperal conditions. These do not exist in the data for
New York City school teachers apparently because of the small number of married women
employed by the board. During the school
year 1914-15 only 30 leaves of absence were
granted to teachers on account of maternity.
This is not a sufficiently large number to modify the rates, but unfortunately the cases
could not be included in our table because no
age statements could be obtained.
The disparity between the rates for men and
women is marked at all age periods, but becomes especially so with advancing age. In
the period 35-44, for example, the rate for
women teachers is over three times as great
as that for the men. From 45 to 54 the female
rate is two and one half times as great as the
male rate. Beyond this period, comparisons
are not permitted because of the small number
of male teachers exposed at these ages.
DURATION

OF DISABILITY

As pointed out above, there is little difference in the average duration of disability by
sex, the average case of illness lasting about
16 days in both sexes. Sixty-one and six
tenths per cent. of the cases lasted two weeks
or less on the basis of five school days to the
week; 18.3 per cent. had a duration of between
two weeks and four weeks; and 20.2 per cent.
over four weeks. Table III. shows the per
8

cent. distribution of the durations by days,
under one school week, and by weeks and
months thereafter:
TABLE III

Cases of Disability Classified by Duration Period
Duration Period

5

Number of Cases Per Cent. of Total

100.0

All durations............3,703
.170
Under 3 days..........
3 days...........185
4 days...........266
5 days...........627
6- 10 days............1,033
11- 15 days..........417
16- 20 days...........259
21- 40 days...........380
.359
41-120 days..........
7
121-180 days.............

4.6
5.0
7.2
16.9
27.9

11.3
7.0
10.3
9.7
.2

The average number of days of disability
for work per case varies irregularly with age.
No consistent relation between the duration in
days per case and the age of the teacher is
observed.
On the other hand, age is apparently an important factor in determining the average
duration of illness per 100 teachers employed.
Table IV. gives the number of days absent
per school year per 100 men ond women
teachers according to age period :
TABLE IV

Days Absent per School Year per 100 Teachers
Classified

by Sex and by Age

Period
Days per 100

Age

PriodTeachers
Men

134.0
All ages (excl. leaves of absence) ...
15-19..................................20-24 ............................... 125.3
25-34 ............................... 117.6
35-4.................130.6

Women

310.5
143.8
161.1
287.4
323.2

479.8

45-54 ...............................

169.9

65-69 ...............................

190.9 980.0

55-64............................... 156.2 511.6

70 and over..........166.0
3 One hundred and seventy-four leave of absence cases are not included because the duration
period is unknown.

The average duration of absence per teacher
markedly increases with age for both sexes except where the number of cases is too small to
give reliable figures. The increase, however,
is much more regular for women than for men.
We find, for example, that in the earliest ages,
20-24, the average number of days absent per
year per teacher is not very different between
the two sexes, namely, 1.25 and 1.61 days for
males and females, respectively. In the age
period 45-54, however, the averages are 1.70
and 4.80 per teacher for the two sexes respectively. Between 55 and 64 the average duration is over five days per female teacher and
in the period 65-69 it is close to ten days per
female teacher.
DISEASES AND CONDITIONS CAUSING DISABILITY

The diseases and conditions causing disability were those registered by physicians on the
applications submitted for excuse of absence.
These were classified for our study under the
titles and in accordance with the rules of the
International List of Causes of Sickness and
Death as modified by the Bellevue Hospital
Manual. The resulting statistics will be comparable in form with figures published by hospitals and other statistical offices. It should
not be overlooked, however, that their reliability is conditioned by the accuracy of the diagnoses stated by the physicians in attendance
upon the teachers. We shall see later that these
statements of diagnosis are, unfortunately, not
always to be taken on their face value.
The leading causes of disability among men
school teachers were influenza (48 cases-20.8
per cent.) and tonsillitis (16 cases-6.9 per
cent.). There were in addition 6 cases of pulmonary tuberculosis and 7 cases of neurasthenia and nervous exhaustion. The other causes
were scattered throughout the entire list and
even where the number of cases was noteworthy they were without particular scientific
interest. Among women teachers the principal
10

diseases and conditions identified were influenza (739 cases-20.3 per cent.), tonsillitis
(396 cases-10.9 per cent.), neurasthenia and
nervous exhaustion (321
per cent.),
acute and chronic bronchitis (249 cases-6.8
per cent.), accidents, injuries or other external
causes (138 cases-3.S per cent.), gastritis and
other diseases of the stomach (134 cases-3.7
per cent.). The following table gives a statement for each sex of the principal diseases
and conditions found in the analysis :

cases-8.8

TABLE V

Diseases and Conditions among New York City
School Teachers, Number4 and Per Cent.
of Total by

SexZ
L

Males

I

Disease or ConditionrI
a

)4Eo

ZaU

4r

100.0 3,646 100.0

All diseases and conditions..

20.8
Influenza ........................
Tuberculosis of the lungs....
2.6
Acute articular and chronic
rheumatism combined.......
4.3
Neurasthenia, nervous exhaustion 7 3.0
Diseases of the heart ............
7 3.0
3 1.3
Laryngitis.......................
Acute bronchitis ................
4 1.7
1
.
Chronic bronchitis .............
.4
Pneumonia (broncho-, lobar, etc.) 5 2.2
16 6.9
Tonsillitis......................
2
Diarrhea and enteritis .........
.9
INonvenereal diseases of the
system and annexa...
6 2.6

geni-

tourinary

Z
Females

739 20.3
32
.9
90 2.5
321 8.8
58 1.6
82 2.2
100 2.7
149 4.1
54 1.5
396 10.9

107

2.9

119 3.3
.8
30
7 3.0 138 3.8
All other diseases and conditions. 109 47.2 1,231 33.8

Maternity .....................
External causes ................

The interest in such diseases as occur among
school teachers appears to be fairly concentrated in a few titles. These we shall discuss
in some detail.
INFLUENZA

Influenza alone accounted for over one fifth
of all the cases reported for both men and
women teachers. The 48 cases for men gave

4 Includes

leave of absence cases.

11

a rate of 18.5 per thousand employed and the
739 cases for women gave a rate of 40.8 per
thousand. These cases cover a large variety
of grippal conditions, from slight indispositions lasting only one or two days, to the graver
complications involving the respiratory, circulatory and nervous systems. The largest
number of cases occurred in the age period
25 to 34. It is in this period also that the
highest rate for the condition is found. Seventy-eight per cent. of the influenza cases had
a duration of less than ten days or two school
weeks. The average duration per case of influenza among the teachers was 8.9 school
days.
The figures for influenza confirm the findings of Todds5 for the Teachers Provident Society of England (1905-06) and indicate a
high incidence of the disease among teachers.
The element of uncertainty in the diagnosis
in some of the cases makes a comparison with
the frequency of the disease in other occupations difficult. Such figures as are at hand,
for example, those for a large group of clerical
employees, indicate a decidedly lower rate and
proportionate distribution for this latter
group than that found among teachers. Influenza may well be considered a disease
which is especially incident to work in a class
room.
TONSILLITIS

A large number of cases of tonsillitis was
registered, 412 or a rate of 19.9 per 1,000. A
large proportion of the cases (42.2 per cent.)
occurred in the age period 25 to 34. Considerably more than one half of the cases involved disability for work for periods from
five to ten school days. The average duration
per case was 7 days. The frequency with
5 Todds, Walter, "Some Prevalent Diseases Incidental to the Profession of Teaching in Elementary Schools," Transactions, International Congress on School Hygiene, London, 1907, Vol. III.,
p. 853.
12

which this condition is confused with infections of the respiratory passages makes comparisons with othei data impossible.
NEURASTHENIA

AND NERVOUS

EXHAUSTION

In the present investigation 328 cases of
neurasthenia and nervous exhaustion were recorded, the rate for the two sexes combined
being 16.1 per thousand exposed. This condition seems to be confined chiefly to the women
teachers, the number of cases among men being only seven. Among the women teachers,
the rate increased with age up to the period
45 to 54. The average duration of disability
per case among females is also considerable,
about 30 days. Over 41 per cent. of cases were
more than one month in duration. In addition to neurasthenia and nervous exhaustion,
there were 92 cases of neuralgia and neuritis
and 49 cases of other nervous disorders. Together they make a total of 469 cases affecting
the nervous system, excluding the organs of
special sense, or 12.1 per cent. of all cases
reported.
Again we find very close correspondence between the figures for nervous ailments in our
investigation and those of Todds and other
writers on the subject, first with reference to
the lower incidence among males as compared
with females and second with reference to the
relative proportion of the cases to total.6
Comparison of our data with that for other
groups is admittedly difficult because of the nature of the diagnosis. Neurasthenia and nervous exhaustion are often but symptoms of
other important primary causes and conditions. In a large group of female clerical employees, fully 10.per cent. of all the cases of
disability lasting over seven days were due to
nervous disorders. The proportion is as high
if not higher than that found among teach6 See proceedings of Section III., Second International Congress on School Hygiene, London,
1907.

Transactions, Vol. III., p. 849 et seq.

13

ers. We must, therefore, be cautious in interpreting the above figures to indicate a
deleterious effect of teaching upon the nervous
constitution of teachers. While the work is
admittedly exacting in its demands upon the
supply of nervous energy, it is quite possible
that some of the cases of neurasthenia and
nervous exhaustion may be traceable to the
nervous constitution of teachers and not especially to the work which they perform. Our
statistics suggest rather than answer an inquiry. We must wait for the production of
exact figures for similar conditions in other
occupational groups before a definite conclusion may be drawn.
PULMONARY

TUBERCULOSIS

Pulmonary tuberculosis is frequently considered in discussing the health of the teacher.
In our data, only 38 cases were reported during the school year, of which 18 were among
the active force and 20 among those who had
received leaves of absence. The rate of pulmonary tuberculosis per thousand exposed is,
therefore, very low and if the figures are accepted as reliable it may be assumed that the
New York City teacher is singularly free from
tubercular infection. Unfortunately, the findings of other investigations and the internal
evidence of this study both make it very questionable whether the 38 cases of pulmonary
tuberculosis represent all the active cases for
the teachers of New York City. We must note
the existence of 150 cases of chronic bronchitis, which condition may have been given
as an excuse for absence to disguise the existence of pulmonary tuberculosis. Teachers are
prone to withhold the admission of pulmonary
tuberculosis because of its possible effect on
the retention of their places in the school system. Under the circumstances we can only
conjecture the true rate for pulmonary tuberculosis among the teachers of New York City.
But even if all the cases of chronic bron14

chitis be called tuberculosis, the resulting rate,
9.1 per thousand, is lower than is found in
other occupied groups which have recently
been examined. Less than one per cent. or
nine per thousand is not a high rate for tuberculosis at the main working ages. It is, therefore, important to call attention to a fallacy
which has arisen in the literature on the
health of teachers. Certain authors, and especially Terman, 7 would make the rate for pulmonary tuberculosis extraordinarily high.
They have confused the high proportionate
mortality from pulmonary tuberculosis which
does occur among teachers with the true
sickness and death rate for this condition.
These writers have overlooked the fact that
the death rate from all causes among teachers
is extremely low, as we shall show later. The
proportion of cases of pulmonary tuberculosis
to all cases is, therefore, correspondingly increased. They have also overlooked the fact
that teachers are concentrated in the early
working period of life at which time pulmonary tuberculosis is always an important cause
of death whatever the occupation. The result
of these two factors, i. e., the low general death
rate and the low average age of teachers, is to
make the proportionate mortality from tuberculosis appear exceptionally high. This is by
no means indicative of a high death rate from
this cause. In spite of the high proportion of
pulmonary tuberculosis, the actual rate in relation to the number employed is in all probability as low, if not lower, than that found in
other professional groups of corresponding
ages. Thus, in our series for the year 19141915, of 74 deaths which occurred, 10, or 13.5
per cent., were returned as pulmonary tuberculosis. If this number be increased by the
deaths from other respiratory conditions
which could by any possibility have been associated with tuberculosis, the total rate would
7Terman, Lewis M., "IThe Teacher's Health,"
p. 21. Houghton Miflin Company, Boston, 1913.
lb

still be less than 1 per thousand teachers.
This rate is less than two thirds of the rate
prevailing among females in the community
at large at the ages 15 and over.
OTHER IMPORTANT CAUSES OF PHYSICAL DISABILITY

Record should be made of 52 cases of
measles, scarlet fever, whooping cough and
diphtheria occurring among teachers during
the school year. Twenty-five cases of mumps,
chickenpox and German measles should also
be noted. Together, the number of cases of
the acute infections other than those of the
respiratory tract and typhoid fever are indeed
too few to call for any special comment. This
is, indeed, as might be expected from the ages
of the teachers, many of whom are already immune to the attacks of the infectious diseases
of childhood. On the other hand, the few
cases that do occur indicate that teachers are
not particularly endangered by their association with their pupils in the close relation of
the class room.
Attention has already been directed to the
150 cases of chronic bronchitis and to the possibility that a considerable number of them
are really masked cases of tuberculosis of the
lungs.
Accidents and injuries and other causes external to the body were responsible for 145
cases or 7.0 per 1,000 exposed. Eleven cases of
poisoning by food, 14 contusions, 40 fractures
and dislocations and 31 sprains were observed
in this group of causes.
Gastritis and other diseases of the stomach
were diagnosed in 143 cases, at a rate of 6.9
per 1,000. The particular diseases registered
were 16 cases of "ulcer," 13 cases of "indigestion," 43 of "gastritis" and 71 of other diseases of the stomach.
Diarrhea and enteritis was recorded in 109
cases. Appendicitis, with and without operation, was observed in 112 instances. For this
disease the periods of disability in the largest
16

proportion of the cases were two weeks or more
in extent. Considered by age these appendicitis cases occurred mostly between the ages
25 and 54.
DEATH RATE OF TEACHERS

There were 74 deaths registered in the
school year 1914-15 in our series. This number includes deaths occurring among teachers
on the active list as well as those on leave of
absence. In relation to the total number of
teachers exposed, the crude death rate is 3.6
per thousand, at all ages. The rate is extremely low when the average age of the
teacher is considered. Fortunately, the figures are confirmed by the statistics prepared
by the Mayor's Commission on Pension Funds
of New York City. We find therein that over
a period of 6 years a total of 362 women and
56 men died in the active service, or a total of
418. This is an average of close to 70 per year,
which indicates that the number quoted above
for the year 1914-15 is not unlike that for
previous years. The mortality rate of both
men and women teachers according to the commission is very low at all age periods and the
rate of disability is likewise among the least
which the commission determined for the several departments of the city service. These
findings are like those for other groups of
teachers which have been reported on. The
death rates are consistently among the very
lowest recorded for any occupation.
While it is not to be assumed that a low
mortality rate is an unfailing index of a low
sickness rate, it is nevertheless to be expected
that the two sets of figures are closely related.
The evidence, such as exists in the report of
the Mayor's Commission, clearly corroborates
our own findings.
GENERAL CONCLUSIONS

Consideration of the facts brought to light
in this survey warrants the conclusion that the
occupation of teaching has no very deleterious
17

effect upon the vitality of the teachers. The
death rate is undisputably low. The sickness
rate among teachers is likewise low. Among
males, less than 9 per cent. of those exposed
report cases of illness during the school year
and the average loss from disability per male
teacher is only about one and one third school
days. These figures must be compared with
the usual rate of about 40 per cent. of the
membership and eight or nine days of disabling sickness per member found in the experience of the German and other sickness societies of Europe. Of the women teachers we
find that 20 per cent. report sick with an average of three days illness per teacher against
35 per cent. and 8 days in the general experience of industrial groups.
TABLE VI

Comparison of Sickness ates in a Representative
European Sickness Insurance Fund with
Data of Group of New York City
School Teachers
Males
Age Period

Females

N.Y.C.
Sch.
Tchrs.

Leipzig

N.Y.C.
Sch.
Tchrs.

38.0
44.3
51.7
60.2

8.2
6.9
10.8
10.3

50.2
55.3
54.3
54.9

17.6
20.9
26.4
28.9

21.2
25.0
28.9
35.3

14.4
18.9
15.7
15.2

28.3
30.1
31.1
35.7

16.4
15.4
18.2
17.7

Leipzig

8

Cases per 100
members

25-34
35-44
45-54
55-64
Days of sickness
per case
25-34
35-44
45-54
55-64

Days of sickness
per member
25-34
8.1
1.2
14.2
2.4
35-44
11.1
1.3
16.6
3.2
45-54
14.9
1.7
16.9
4.8
55-64
21.2
1.6
19.6
5.1
S"Leipzig" figures relate to physical disability
for work in the "Ortskrankenkasse fir Leipzig
und Umgegend," experience of years 1887-1905.
18

The foregoing table presents a comparison
of the main facts of our study with those for
the men and women insured in the large sickness society of Leipzig:
To be sure, these two sets of figures are not
immediately comparable and no effort is made
to push the comparison. The German figures
are quoted because they are the most authoritative extant and because they cover the largest group of workers available. They must be
taken as fairly representative of large masses
of employed men and women. The figures for
teachers are, however, subject to many qualifying restrictions. First, the period, covered
in the school year is not the same as in most
other work. If we consider the average work.
ing year in industry as 300 days, that of the
teacher is less than 200. The rate is at once
affected by this difference in the working
period. The long summer's vacation of ten
weeks is not a source of any cases of sickness
in our record, although cases of illness certainly occur during this period, even if their
number is small. In view of the many difficulties involved we are not justified to attempt
an adjustment of the data to make the two
sets of figures comparable. The element of
uncertainty is too great. But it must be obvious that our figures such as they are indicate
a condition of marked healthfulness for the
New York City teachers.
The crux of the whole question is whether
we may consider our returns a reliable index
of the amount of illness actually occurring
among teachers. It may be questioned whether
the records upon which our study is based give
all the cases which occurred during the school
year. No refunds of salary for absence due to
illness were made by the authorities during
the year 1914-15. In view of the fact that
there was no certainty of the payment of benefits, have all teachers entitled under the bylaws of the Board of Education to a refund
for illness made application for such refund?
19

The writer has made many inquiries among
those qualified to know and he has invariably
been informed that teachers have continued to
make applications in the usual manner in the
event of illness. School principals and teachers agree that no serious source of error in the
registration of sickness exists because of the
present inactivity of the fund. This conclusion is likewise confirmed by the general agreement existing between the figures obtained in
the two studies, namely, the present one and
that of the school teachers committee already
referred to.
Another disturbing and perhaps more serious factor is the possibility that the non-payment of refunds for illness may cause some
teachers who are in reality sick, to continue at
their work or to return to work from illness
before they are really in fit physical condition
to do so. This, unfortunately, may be an important element in the low disability rates, but
it is impossible to determine how serious its
effect is.
In conclusion, our findings point to the desirability of the following prophylactic action
on the part of the Board of Education for the
protection of the teacher:
1. The careful inspection of school plants to
determine whether conditions of ventilation,
heating, light, cubic air content, etc., are in
accordance with the standards determined upon
by the best technical information now available. This is all the more required in view of
the suggestive findings of our study for such
conditions as influenza, tonsillitis and other
respiratory conditions. Improvement in the
school plants will safeguard the health of the
pupils as well as that of the teachers.
2. A selective physical examination of applicants for employment with especial reference to neurotic tendencies, deficiency in form
and function of vocal apparatus and other
physiological details particularly important in
the hygiene of teaching.
20

8. The periodic physical examination of all
school teachers to detect initial lesions of the
respiratory, cardio-vascular, nervous and allied
tracts to make possible early remedial measures.
4. The rehabilitation of the Teachers Retirement Fund with provision for the payment
of benefits during illness so that teachers may
not be tempted to continue at work while sick.
Such refund of salary, properly safeguarded
by the authorities, should insure adequate
medical treatment and nursing care during illness. This will moreover serve to shorten the
period of disability. It is assumed that the
pension fund will make provision for the care
of teachers during illness, however short the
duration of service in the school system, even
if this require a larger contribution on the
part of the teachers than has heretofore prevailed in order to insure the solvency of the
fund.
5. The continued study and keeping of records by the Board of the facts of absence of
teachers. It is hoped that the department will
furthermore analyze these records annually to
determine the causes which impair the health
of the teaching staff and to discover such new
administrative measures as will control causes
of physical disability. Such a plan would, indeed, be as desirable a means of protection for
the pupils of the school system as for the
teachers, and would be, moreover, in agreement
with modern ideas of business administration
of the schools for the joint welfare of pupils,
teachers, and the general public.
Louis I. DUBLIN
STATISTICIAN,
INSURANCE

METROPOLITAN
COMPANY,

NEW YORK CITY

21

LIFE

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