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83
the infirmary. Out of 328 cases, there was a clear history in 157
households of other previous cases—that is a definite family
history of infection was obtained in 48 per oent. of the cases
where the information was obtainable. In each of three families
there had already been five deaths from phthisis, in each of four
others, 4 deaths, and in four families 3 deaths, in sixteen families
2 deaths, and in seventy-five families one death. In addition to
the above records, there were seven cases of phthisis still living
in one family, six cases living in one family, four cases living in
each of two families, three cases living in each of sixteen families,
and two cases living in each of thirty-five families. This list
bears witness to the destruction wrought by this disease and to
the way in which it passes from one member to another in the
same household.
Presumed Source.—In most families where this fact was
fairly well established, the father was marked out as the chief
or only primary infecting agent. Next to the father in order of
occurrence came the mother. In both instances the children
were infected. Other presumed sources in order of frequency
were the husband, the brother, the sister, the wife, the son, the
uncle, aunt, cousin, sister-in-law, and grandmother. In many
instances, especially in model buildings, the presumed source was
a case in a tenement on the same landing as the case under
investigation, in other examples the origin was a known case in
the same block of buildings pr in the same street, with whom
the patient concerned used to play, or whom he used to visit and
accompany.
One patient was a lodger in a family where there were 5 cases
living and 4 dead. He contracted the disease.
What First took the Patients to the Doctors.—The
early signs which first induced the patients to seek medical advice
are annexed:—
Prolonged cough or prolonged cold on the chest, 205; cough
associated with pain in the back, side, or front of the chest, 19;
cough associated with difficulty of breathing, 5; cough and