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42 TUBERCULOSIS.
disease was known not to be present on admission. Diagnosis is frequently particularly difficult
in lunatics, and in all the patients the disease was only known for very short periods
before death.
Duration of the Disease.—The information as to the lengths of institutional treatment
requires to be collated with that as to the duration of the disease, a question to which a good
deal of uncertainty attaches owing to the usually insidious character of the onset. In the tables
the approximate duration of the disease is given for 84 of the 112 cases tabulated. The
maximum durations recorded were 26 years for patients in Table II., and 21 and 15
years in Tables III. A and B, and the minimum 2 months, 3 months, and 6 months
respectively. Tables 27 and 28 show when the cases ending fatally during 1912 were reported
in summary form, the individual dates of the first reports (and the numbers of certificates
received during the lives of the patients) being given in Appendix Tables.
Family Histories.—The Staff are required to make inquiries as to known cases of or deaths
from tuberculosis in the patients. families, but many patients know little or nothing of the
medical histories of their relatives. In only 36 (out of 112) instances was any definite family
history of tubercle reported, and in 44 others the disease was definitely stated not to have been
present.
Civil Status.—The condition of 6 of the deceased persons could not be entered. Of the
other 106 persons, 36 were unmarried, 62 married (for periods ranging from 1 year to 39 years—
among the " home" and "infirmary" patients), and 8 were widowed. The age at death naturally
influences the proportions in each of these classes.
Removals.—Admitting the infectivity of pulmonary tuberculosis, the removal of a patient
from one house to another—in most cases tenement houses—means the transfer of a centre of
infection to a new milieu. Moreover, such removal only too often means that the patient is lost
for a longer or shorter period to the Department. Of the patients who died at their homes,
10 (18 5 per ) changed their homes after their cases had been reported; of those dying at
the Infirmary, 12 (27.2 per ); and of those dying in outlying institutions, 6 (42 8 per ).
In this connection the following analysis of the lengths of residence at the addresses given
when the patients were first notified is of some interest. The facts were taken out for the
patients dying at home and those dying in the Infirmary. The differences in the distributions for
the two classes are so small that it has not been thought necessary to show the results separately.
Length of residence. Patients. Length of residence. Patients.
Under 1 year 27 5—10 years 9
1—2 years 9 10—15 ,, 3
2—3 6 15—20 „ 4
3—4 „ 2 20 years and over 7
4—5 ,, 5 No permanent address 9
One other analysis of the housing of these patients has been made, viz., that to show on
what floor the patients in tenement houses were living at the time of the first inquiries. Where
the patient occupied two floors, he has been taken as occupying the upper, e.g., if occupying
rooms in the basement and the ground floor, his case has been placed among the occupants of
the ground floor. The appended analysis (see below) shows the housing of the patients dying at
home separately from that of patients dying in the Infirmary.
Part of House Patient Dying
occupied. At Home. In Infirmary.
Whole House 6 1
Basement 3 9
Ground Floor 13 7
First Floor 14 14
Higher Floors 15 6
Not Specified 3 7