V.

SEX. In all the periods of duration, 60.75 per cent. CHAP. were males, and 39.25 per cent. females. It is elsewhere stated that phthisis tends more to extreme prolongation in males than in females; but in this Table the disproportion does not much increase in the cases of longest duration; instances of extreme chronicity not being included in it.

AGE. The age of the greatest prevalence of consumption in all its forms is from 20 to 30; next to which is the decade between 30 and 40; then the period under 20; and the least of all is that over 40.

RELATIVELY TO DURATION.-The largest number of Under 20. cases under 20 were found in the periods of duration of six months and one year, while the smallest number at this age appears in the four years column. This age is little favourable to chronicity; 17.74 per cent. only of the whole reached four years of duration. The more rapid and acute forms of phthisis prevail at this early period of life.

Between 20 and 30 years of age, which may be called 20 to 30. the great period when consumption is most common and most destructive, the numbers in the different periods of duration are nearly equal.

Between 30 and 40 the numbers in the short periods 30 to 40. decline, while those in the longer increase; age showing a very decided influence in lengthening the duration of the disease.

Over 40, 13 per cent. of all the cases occurred; 4.5 Over 40. per cent. of them reached a duration over four years.

STAGE.—In the 1,200 examined, the largest number Stage. were found to be in the third stage (415, or more than one-third.)

The first stage of the disease was found to exist in First. the greatest numbers in those who had attained one year of duration; next, in those of six months' duration. After four years, out of the 1,200, 7 per cent. remained still with evidence of unsoftened deposit in the lungs.

СНАР.

V.

Second.

Third.

One or

The numbers in the second stage were equally diffused over the four mentioned periods of duration; and after four years of illness, there were as many found so circumstanced as there were at six months. This shows the frequent occurrence of exceeding slowness in this stage.

The third stage was attained by 7.16 per cent. in six months. The greatest number of cases of this class was found to have been ill between one and two years, and at the end of four years as many as 117 out of 1,200, or 9.75 per cent., were found with the signs of cavity.

The deductions from the view thus exhibited in large numbers of cases, when analysed, as regards the stage of disease, will amply bear out the views advanced regarding the slowness of the progress of the greater number of cases of consumption. It will also show that stage 'per se' is not a measure of the danger of the case, nor of the chances of life for the patient.

ONE OR BOTH LUNGS.-In a nearly progressive ratio, both lungs. as the duration increased so did disease extend to the second lung. In 138 cases at six months this result was observed; yet, out of the 300 who outlived four years, as many as 139 (46.33 per cent.) were found with a single affection only. In the first instance, doubtless a more acute form of the disease had created very extensive local mischief, yet out of 589 who had both lungs affected, the large proportion of 161, or 27.33 per cent., reached the duration of four years.

Hæmopty

819.

This symptom occurred in 701 out of the 1,200 cases, 58.41 per cent. ; but of the 300 who reached the duration of four years, 66.66 per cent. had it; so that it cannot be considered as denoting in all cases a rapid progress of the disease. It was found in progressive frequency as the duration increased.

DIARRHEA. This symptom had occurred in 19.91 per cent. of all the cases. In those which had attained the duration of four years, 246 out of 300, or 82 per

cent., were found without it. Its absence is very im- CHAP. portant as an element of chronicity.

V.

LARYNX.-This part of the air-passages was affected in 8.66 per cent. of the whole number of cases; but of those who attained the duration of four years, only 19 (out of 300), 6-33 per cent., had symptoms of laryngeal irritation. The extension of disease to the organ of voice, although a much less frequent complication than diarrhoea, is a bad prognostic indication. HEREDITARY PREDISPOSITION. This is taken to imply Hereditary one or more members of the family of the patient.

The disease was hereditary in 30.16 per cent. of all the cases, and of those so circumstanced the numbers giving the first two periods of duration, viz. 96 and 95, closely approximate, while a like approximation will be seen to exist between the numbers exhibiting the two latter periods of duration (87 and 84).

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predisposi

tion.

EMACIATION. The degree of emaciation observed in Emaciacases of different duration was noted. A slight wasting tion. was marked 1; a more marked loss of flesh, 2; while 3 denoted a very great degree of marasmus. In observing the progress of chronic phthisis, this method proved useful, it being found impossible to weigh any but the more remarkable cases. A large number, as might be expected, were much wasted within the first six months of the attack, but a considerable proportion recovered from this so far as to regain a certain amount of flesh, yet below their former average; and it is remarkable that after four years' duration of illness, only 127 out of the 300 cases (42.33 per cent.) were wasted to the second, and 38 to the third or extreme degree. The inference is, that after the first onset of the disease and its customary reduction of weight, a certain rally is made when the case becomes chronic, although the patient never fully regains flesh. A condition of moderate emaciation seems essential to the long continuance of the tubercular disease. An explanation of this has been offered elsewhere.

CHAP.

V.

Hectic.

Vomiting.

Relative susceptibility to improvement by

HECTIC. This symptom, marked by the febrile access and sweatings, was found to exist in 53.09 per cent. of the cases examined when they first presented at the hospital, the patients naturally applying for advice during some increase of their symptoms. 16.50 per cent. had previously suffered in this way, while 30.41 per cent. could furnish no account of any distinct attack of hectic. It can scarcely be supposed that the disease had existed in a latent or quiescent form in all of these, and a certain deduction must be made for inaccuracies of memory or description; yet even with this reserve, it is evident that a large number had phthisis in its slow form without any febrile access of marked severity.*

VOMITING.This urgent symptom was present in severity in 12.33 per cent. of all the cases. In those who had already attained one year's duration it was found in the smallest proportion, and most marked in those between one and two years ill; while 12 per cent. had it among those who survived over four

years.

The actual state of the patient was carefully noted in all cases when he presented, and also on leaving, to show the result of treatment. When first examined, treatment. 85.25 per cent. were losing flesh and strength, and the greatest susceptibility to improvement was found in cases which were in the two years' class; and next to them, in the four year cases.

*Louis states that one-fifteenth of his cases were 'latent,' that is, had no cough; but naïvely adds, that fever was common in the latent period, a fact inconsistent with the English idea of 'latency.'

*It was found necessary to class a number of peculiar cases in this manner. They represent the usual indefinites met with in practice, and the averages of duration would have been incomplete without them.