The other large item of cost is that of expense for care and treatment of patients. Ninety cases were treated in hospitals for all or part of the time, as pay patients, half-charity, or full-charity cases. To meet these hospital expenses, $2,332.00 was paid to hospitals by full-pay patients themselves, and $1,834.50 was paid the hospitals by either individuals or charitable organizations for the care of half-pay patients, making the total cost of caring for 90 hospital patients $4,166.50. This is an understatement, because it omits the contribution of the hospitals themselves to the care of half-charity and full-charity patients. If figures were available, there should be added the amount represented by the difference in the money paid to hospitals and the actual cost of maintenance, presumably another $1,800.[11]
[11] Out of the 448 cases studied, twenty-four of the ninety cases treated in hospitals were as full charity patients and sixteen were taken as half charity cases; of the 358 cases treated at home, fifty received outside aid and ninety-six were compelled to incur a debt for all of their expenses, with no immediate prospects of being able to repay it. Moreover, many received sick benefits and others were a direct drain on the business interests of the city from the fact that their employers kept them on their pay-rolls during sickness, at half pay.
The expenses of the remaining 358 patients cared for in their homes amounted to $12,889.90 for doctors' bills, $1,965.50 for nurses, $2,640.60 for medicines and drugs; $1,810.10 for milk, $629.20 for ice, $861.50 for servants made necessary by the illness of those naturally caring for the home, and $1,204.45 for other expenses, of which the largest single item was the cost of a trip to Colorado and return at the doctor's orders, for a patient threatened with tuberculosis. The total of these expenses was $22,000.35.
The funeral expenses of the 26 patients who died, amounted to $3,186.00. It may be argued that sooner or later funeral expenses must inevitably be met, and that they should not, therefore, be charged against this account. Under the circumstances, however, these expenses were premature, and were directly chargeable to typhoid fever. Consequently, it has seemed fair from the point of view of this study, to include them. The grand total loss in wages and in expenses thus outlined was $56,252.50.
Further analysis shows that the average loss in wages per patient among the 187 wage earners was $126; that the average cost per patient in loss of wages and expenses for the 446 patients was $128; and that the average cost in loss of wages and expenses for each typhoid death among the 448 cases was $2,164.
Consider the losses in these wards in their bearing upon the city as a whole.
There were 5,421 cases of typhoid fever in Greater Pittsburgh in 1907. If the cost to each patient was $128, typhoid fever cost the city that year $693,888 in expenses and loss of wages alone. There were 622 deaths from typhoid fever in Greater Pittsburgh during the same period. If we put the value of these lives lost at so low a figure as $4,000, an additional loss of $2,448,000 was sustained. Or in round numbers $3,142,000 was the minimum economic loss to the community of Greater Pittsburgh, due to typhoid fever alone in the year 1907. This is a conservative estimate, in view of recent values placed on deaths from tuberculosis.[12] The two and a half million dollar death item might be doubled without overstating the case.
[12] Prof. Irving Fisher, of Yale, in a paper read at the International Congress on Tuberculosis in Washington last October, held that "the money cost of tuberculosis, including capitalized earning power lost by death, exceeds $8,000 per death." The average "expectation of life" lost through death from typhoid fever is not greatly different from that of tuberculosis.