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52
family was previously known to be suffering from the disease, were mostly examples of this
nature.
Considering now the type of disease in the original case, it will be seen that nearly threequarters
of the infecting ' cases are either living cases of pulmonary tuberculosis with positive
sputum or cases which have succumbed to pulmonary tuberculosis within the immediately preceding
five years. It is known that over 90 per cent, of pulmonary tuberculosis deaths five years
after residential treatment are T.B. plus cases. It might almost be said, therefore, that where
previous contact with the disease is found, in almost three-quarters of such instances the primary
case was a positive sputum sufferer in the family either alive or only recently dead.
It may be of interest to note finally that, where there is previous tuberculosis in the family,
in 28 per cent, of instances there were two or more " original " cases of the disease ; or, in other
words, there was more than one contact in over one-quarter of the cases in which important
contact was noted.
The following conclusions may be drawn from this investigation:—
(1) Contact with a previously diagnosed case of tuberculosis in the family is of
sufficiently common occurrence in the history of new patients to stimulate examination of
contacts in the attempt to find early cases.
(2) Thus in the age groups 16 to 30, 22 per cent, of new male positive sputum cases
and 27 per cent, of similar female cases arise from families in which there has been a recent
previously known case in parent, husband or wife, brother or sister, or child.
(3) Approximately three-quarters of such previously known cases are themselves
sufferers with positive sputum disease.
(4) Every effort therefore should be made to examine and supervise, over a considerable
period of time, contacts, especially young adult contacts, of living positive sputum cases
or of those recently dead from the disease.