CASES OF FAMILY PREDISPOSITION.

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delicate, and taking cod-liver oil. Often subject to cough in the last three winters; now one since March, with yellow expectoration, and lately a little blood. Has been losing flesh and strength. Collapse, dulness, tubular sounds in left front and back. Bronchocele 6 months.-Oil ordered, with tonic.

March 29, 1864.-Took oil, and improved very much, having cough only in winter; but now has one lasting since Christmas, with yellow expectora tion, breath shorter. Oil has been discontinued on account of sickness, and no tonic taken. Dulness, tubular sounds and crepitation, in upper left chest, loose crepitation upper right.

CASE 11.-Miss V., aged 16, who had lost her mother and sister from consumption, was seen by Dr. Williams, March 22, 1859. Had cough and cold in December, which has continued, though to a slight extent, ever since, with opaque expectoration, and yesterday some blood. Breath short. Dulness, large tubular sounds, and gurgle in upper right chest, front and back. Oil ordered in tonic of phosphoric and hydrocyanic acids, with calumba and orange tinctures, the use of acetum cantharidis liniment, and a morphia linctus.

June 10, 1860.-Taken oil, &c., and much better. Last summer had measles; cough was violent for three weeks, but subsided under the use of oil, and has remained moderate since. Wintered at Cannes, and out much. Still decided dulness, and marked tracheal sounds in upper right chest. After measles, coarse crepitation there and below.

October 16, 1862.--Well, and free from cough till a month ago, when it was violent for two weeks, and subsided under oil and iodine paint. Now has no cough or expectoration. Hard dulness at and above right scapula, with loud tubular sounds. Back rounded.

1871.-Not seen since; but heard of as tolerably well, having passed a winter at Mentone.

CASE 12.—Mr. N., aged 42, consulted Dr. Williams, July 31, 1860. He had lost his father, mother, and a brother from consumption, and had been subject to cough for the last seven years. Two years ago he had hæmoptysis to ii. and breath has been shorter ever since. Cough has been constant for the last nine months, and hæmoptysis to amount of 3ss, has occurred once. Has taken oil regularly (3ss ter die) for nine months. Dulness and tubular sounds in upper right chest. Tubular sounds above left scapula.-Oil was ordered with phosphoric acid and tinctures of calumbo and orange; counterirritation with acetum cantharidis, and a morphia linctus.

April 5, 1867.-Has kept pretty well and stout, but breath has always been short, and he has cough with opaque expectoration, which has been less in last winter, but patient is hoarse. No oil taken last year.

Still dulness upper right, tubular sounds above scapula. Subcrepitus and weak breath below.-Ordered oil, with nux vomica, phosphoric acid and quassia.

June 8, 1868.-Tolerably well, but always has slight cough, and some hæmoptysis occurred last spring; oil taken last winter. Sputa opaque and tinged with blood. Some dulness at and above left clavicle with tubular sounds, but breath weaker above right scapula; crepitation down left front.

Here the strong family predisposition did not tell till comparatively late in life, and did not prevent the remedies used from having a beneficial effect. The patient has been about eight years under observation, and the disease seems to have diminished in right lung, though some increase has taken place in the left.

CASE 13.-Mr. R., aged 17, whose father had died of consumption, saw Dr. Williams, May 7, 1857. For three years he had had swelling and discharge from the cervical glands, and cough off and on for two years; lately has had cough for six weeks, accompanied in last fortnight by pain in the side, and short breath. The scrofulous sores in the neck are still discharging. Oil taken till two months ago. Dulness, obstructed breath, and much crepitation in front of left chest, mostly in upper portion and above the clavicle. Some dulness above right scapula.

Oil ordered in nitric acid and tincture of orange: a liniment of strong tincture of iodine.

April 13, 1864.-Took oil, and states that he got quite well in six months, and then omitted oil, except an occasional dose. Throughout last winter has had cough and expectoration, and three times brought up blood to the amount of 3ii. Has lost much flesh and strength. Dulness, cavern-ous sounds in upper half left chest, with obstruction sounds below.

What effect has family predisposition on the duration of phthisis? Is the duration curtailed by it? Do patients thus affected die earlier than other consumptive patients? These questions are of considerable importance in the prognosis of the disease; and we have attempted to answer them in the following statistical results, extracted from our tables :

:

PREDISPOSITION INFLUENCING DURATION.

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Here it is shown that the average duration among the 87 deaths of those affected with family predisposition was 7 years 5.8 months, an average not greatly differing from that of the cases free from this influence, or again from that of the total deaths. A difference of only a few months is noticeable, and does not indicate that family predisposition exercised any decided influence in shortening the duration of the disease.

The evidence of 397 living cases of family predisposition supports the same conclusion; for among these the average duration already reached was 7 years 11 months; that of all the cases free from predisposing taint being 8 years 7 months, and of the total living 8 years 2 months.

It would seem, therefore, that family predisposition, without reference to sex, exercises but a slight influence over the duration of phthisis.

Does it influence the duration of the disease in one sex more than another?

We have seen that the age of attack is influenced differently in the sexes, and also that phthisical females live a shorter time than phthisical males; and the following question should now be solved: Is the duration of the disease shorter among phthisical females affected with family predisposition than in others not so affected? This may be seen by a glance at the table below:

Relative Duration of Diseases in the two Sexes in
Family Predisposition.

The inspection of this table will show that the sexes

are equally influenced as to the duration of the disease, and that family predisposition exercises no particular influence-a conclusion which contrasts with that arrived at with reference to the age of attack; and is entirely at variance with the old views of hereditary phthisis being more rapidly fatal than acquired phthisis.

To this conclusion it might be replied, by those who still believe in the curtailing influence of hereditary taint, Perhaps family predisposition, as a whole, does not influence the duration of phthisis, but do not some of its various degrees do so? We had hoped to answer this point satisfactorily, but, unfortunately, lack of materials prevents our doing it completely. Such information as our cases afford is to be found in the following table:—

The evidence here furnished is chiefly of a negative kind, and must be viewed as proving that some forms of predisposition do not curtail the duration of the disease, and not as demonstrating what influence other forms may have on it. We see in 11 deaths where the mothers were consumptive the duration was 8 years, that 56 living patients similarly situated had lived 7 years 103 months. Among these few cases maternal influence had no effect in curtailing the duration, which in the 11 deaths was rather higher than ordinarily.

* Numbers too small to yield fair average.

FAMILY PREDISPOSITION ACCELERATES ATTACK. 127

In the case of brothers and sisters where the numbers, warrant our speaking more decidedly, what do we find?

In 44 deaths, the duration was 7 years 6 months, slightly below the whole average of deaths; while of 180 living cases in this category the mean duration was 8 years 2 months, about the same as the common average. Here again family predisposition seems to have exercised little or no influence. The other numbers are too small

to furnish even negative evidence.

Our last point to consider is the age which these patients affected with family predisposition live to. Do they die earlier than other consumptive cases? The grounds for determining this question have been already to some extent settled; the age of attack and the duration in these cases having been ascertained, and therefore the following result was easily arrived at:

Family predisposition, therefore, though it does not materially curtail the duration of the disease, has considerable influence in shortening the duration of life, such limitation amounting in males to more than six years and in females to not quite five years. But we must remember to assign this cutting short of the span of life to its proper cause-not to hereditary phthisis being more virulent and rapid in its progress, for that idea has been disproved-but to the fact that those who come of a consumptive stock are liable to be attacked earlier than others whose families are free from taint.