TABULATION OF CASES. 293 As the duration of phthisis is such an important subject, we must crave the indulgence of our readers, if we give a considerable amount of preliminary information about the 1,000 patients, before stating the results of the statistics. The cases were extracted from the note-books of Dr. Williams, and arranged in tables containing twenty-five each, under the headings of Age. Family Predisposition.. Date of first Symptoms. Occurrence of Hæmoptysis. Date of first Visit. State of Lungs, as evidenced by Physical Signs. Result. Duration. The obituary of the newspapers has been closely watched, and where the patients had been lost sight of for several years without having been announced as dead, a correspondence was opened, either with themselves or their periods of observation. I wished to ascertain the power of nature, aided by art, to control or arrest the course of pulmonary consumption; and knowing the deep-seated and enduring nature of the disease, I distrusted all results not confirmed by time, and I rejected reports of temporary amendment or even cure, as unsatisfactory and inconclusive. Deaths were indeed conclusive, although not satisfactory; but the few deaths which did occur within that period were the issue of that degree and form of the disease, over which treatment never had, or is likely to have, any control. I already knew such cases to be hopeless-too rapid and overwhelming to be stayed by human power-therefore I put them out of calculation. I am quite content if our accounts are debited with the three or five per cent. which such deaths may be supposed to amount to; for although, as my son argues, the ten times more numerous improved and cured' cases may be set off' against them, yet this is balancing a certain against an uncertain quantity, which brings no definite result. But it cannot be fairly said, that our selection gives nothing but chronic cases, for many of the cases are acute at commencement, or in some part of their course, and are reduced to a chronic state by treatment. 6 friends, to ascertain whether they were alive and in what state of health-a correspondence which, when addressed, as it often had to be, to the individual whose life was suspected, sometimes evoked ludicrous answers. Reference to the various lists, the Army and Navy,' University,' 'Clergy,' and 'Law,' to the Court Guide,' and to the 'Peerage,' has often afforded valuable information; and on this point private practice has great advantages over hospital practice, for in respect of the former, by some means or other, patients can be traced through a number of years, whereas in the latter they are generally lost sight of when they quit the hospital. Nevertheless, a certain number of the tabulated cases could not be traced up to the present time; and of these the date when last heard of, with notice of their state, is registered. SEX. Of the 1,000 cases, 625 were males and 375 females, or 62.5 per cent. of the former, and 37.5 per cent. of the latter. This preponderance of males cannot be regarded merely as accidental, for it is closely in accordance with the evidence of the first report of the Brompton Hospital, where the percentage of males was 61, and that of females 39. Among Dr. Pollock's outpatients, 60.75 per cent. were males, and 39.25 females. AGE. The ages of the patients have been arranged in the following table. This table differs in one point from Age at Time of Attack of 1,000 Cases of Phthisis. Males Percentage Females Percentage Total Percentage Age at Time of Attack many similar records. Instead of the age at first visit, the age at first attack is tabulated; and this is arrived at by subtracting the history from the age at first visit. The date thus obtained is of far more consequence in estimating the duration of disease, and the conditions which modify it, than the age at first visit, which depends upon shifting circumstances; as, for instance, the feelings and opportunities of the patients, who may come under the observation of the physician either at the commencement of their disease, or many years after, near its termination. The record of their age at the time of the first visit would therefore afford us but slight information as to the time of attack or its duration. It may be objected, that it is difficult to arrive at accuracy as to the date of first symptoms. And undoubtedly this is true in the case of hospital patients, with whom it is necessary to pursue a system of close cross-questioning, in order to evoke the necessary information. Dr. Fuller' truly says on this point: The average duration of the complaint is ordinarily, I believe, very much understated, from the fact that the inferences respecting its duration are drawn from the statements of hospital patients, who pay little heed to the earlier, and, as they imagine, unimportant symptoms of the disease, and pertinaciously date their malady from the occasion on which they first experienced pain in the chest, or were frightened by the occurrence of hæmoptysis, or found themselves unequal to their daily work.' Private patients, with whom we have now to deal, hardly err on this side, for the upper classes generally remember and narrate, almost too fully for the physician, every symptom, early or late, of their illness. The results of this table accord with the commonly received opinion as to the period of attack. Taking the sexes collectively, 41 per cent. were attacked between 1 Op. cit. p. 413. 20 and 30; about 25 per cent. between 30 and 40; 19.5 per cent. under 20; and 13 per cent. above 50. When we examine the relative liability of the two sexes in the various decades, we find some important differences to exist. Between 20 and 30-the most common period of attack for both sexes-about 7 per cent. more females were attacked than males; and again, between 10 and 20, 11.8 per cent. more. On the other hand, after 30 the reverse was the case. Between 30 and 40 the males attacked exceeded the females by 11.68 per cent., and above 40 by 6 per cent. These results may be said nearly to agree with those of the first Brompton Report. The average age of attack was-for the males 29.47, and for the females 26.06. Family Predisposition.-The results under this head have already been given in Chapter XV., to which the reader is referred. This feature was traced in 48.4 per cent. of the 1,000 cases. Origin and First Symptoms.-In 385 cases the disease came on without any antecedent illness, and was characterised by the usual group of symptoms, more strongly marked in some cases than others, and it pursued its course free from complications, besides the ordinary ones of phthisis. In 315 cases it either originated in, or followed closely after, other diseases, as the subjoined table will show : Phthisis was preceded by Pleurisy and Pleuro-pneumonia in 149 Cases. The number arising from pleuro-pneumonia and bronchitis is very large, reaching a total of 267, or more than one quarter of the whole, and deserves attention as showing statistically the influence of these diseases as direct sources of consumption. It is well known to physicians connected with hospitals for diseases of the chest, how often a neglected case of pneumonia or bronchitis becomes, under depressing causes, one of consumption; but statistics proving this frequency are rare, if not wanting. This number, 267, or 26.7 per cent., is high, considering that it is taken in a class which has opportunities of protecting itself from many depressing conditions; but high as it is, it is probably much below a correct estimate for hospital patients, among whom the prevention or rapid cure of these diseases is much more difficult, and therefore less common than among their wealthier brethren. In the cases of phthisis arising from pleuro-pneumonia (pneumonic phthisis), the course of events was generally what was painted in the examples given in Chapters VIII. and X. After the attack, some portions of the lungs remained consolidated or compressed by dense pleuritic adhesions, or both these lesions existed, and tended to cripple the lungs for their respiratory work. The breath remained short; the patient seldom or never lost the cough, which a fresh cold or some disordering influence caused to increase, muco-purulent expectoration and sometimes hæmoptysis accompanying it. Signs of softening were detected in one or both lungs, followed by those of excavation, and the case assumed a consumptive aspect. |