37

H.-31

Statistics re Consumptives. Since January, 1903, 464 notifications of tuberculosis have been received. Particulars concerning the circumstances of these consumptives have been obtained in 209 cases. These particulars have either been obtained by an Inspector of the Department or from the special form on which medical practitioners fill in the particulars when notifying a case of consumption. I should like to take this opportunity of acknowledging the useful assistance that has been given by medical practitioners in obtaining this information. During the same period 366 deaths from consumption have been notified to this Department by the Registrars. One hundred and nineteen of these deaths were visited, and reported on by an Inspector. Notifications of 88 of these cases had been received previous to their death. This leaves 376 notified cases that are presumably still living. I expect that the probable explanation is that the notification of deaths to the Health Department is very incomplete, with the exception of the Christchurch District and one or two others, and that while the majority of the patients are doubtless alive, some proportion are dead and the deaths have not been notified. It is also worthy of remark that 254 cases died without being previously notified, which shows that the Department has very incomplete information about the numbers of cases from the notifications received. There are altogether 328 reports giving certain particulars in connection with these cases of consumption. The possibilities of the same case having been notified twice, and a second report having been made and the notification of death also received, have been carefully eliminated. When two or more cases have been notified, or have died in the same family, the case has only been treated as one for the purposes of these statistics. These statistics only deal with a comparatively small number of cases; and, although, from the somewhat indirect manner in many instances in which the particulars have been obtained, and from the necessity of taking other factors into consideration, the actual conclusions here set out should no doubt be to some extent discounted, I think they are in the main justified. Occupation. Of the 192 males the occupation is given in 156 cases. A sharp distinction cannot be drawn in all kinds of occupations between outdoor and indoor; but, taking outdoor to include all those occupations in which the workman would be exposed to the weather and to sudden changes of tern perature, such as working in freezing-chambers, &c, it is found that the majority (96) followed an outdoor occupation, while the remainder (60) followed an occupation which did not expose them to the above conditions. Among those following an outdoor occupation were 41 labourers, 7 farmers, 7 engine-drivers, 4 blacksmiths, and 3 sailors. Among those following an indoor occupation were 7 bootmakers, 6 cabinetmakers, 5 carpenters, 5 clerks, 4 plumbers, 3 tailors, and 3 drapers. The influence of an outdoor life and exposure to cold as a predisposing cause of consumption is not generally recognised by the public, as the modern outdoor treatment of consumption would give the impression that if a consumptive shop-assistant or clerk was able to follow an outdoor life, his chances of cure owing to change of occupation would be greatly increased. As a matter of fact some authorities at Home are very emphatic on the folly of expecting any good to follow from an indoor worker to change his occupation to an outdoor employment. The points to be emphasized are that the outdoor labourer could in many cases lessen his chances of " catching colds " by taking simple precautions, and that his home life is often lived under insanitary conditions, as the bedroom is usually small and badly ventilated, and the habit of sleeping with a window open is not common. The record of occupations followed by the 136 females does not show anything of great interest; the majority were naturally employed in domestic duties; 23 were employed in factories or shops, but there is no special occupation which seems to have any importance as a predisposing cause. Predisposing Causes. 1. Heredity. —A past history of consumption in the family has been taken to mean that a grandparent, parent, uncle, aunt, or cousin was affected with consumption, but does not include those cases in which brothers, sisters, or children were affected. In only 67 of the 328 cases was there any history of other members of the family having been consumptive. No history was obtainable in 37 cases; in the remaining 224 cases a statementwas obtained from the patient or relatives that there was no history of consumption in the family to their knowledge. From the 67 cases must be deducted 7 cases in which the patient became infected direct from a relative. In 42 cases only one member of the family had been affected previously, in 11 cases two members, and in 14 cases more than two members had suffered from consumption. It is obvious that from the law of averages one would expect to find a family history of consumption in a certain number of eases ; but so many factors have to be taken into account, and information on the matter is so incomplete, that it is useless to offer an opinion as to the percentage of families in which a history of consumption would normally be expected. The percentage must, however, be considerable, as about 10 per cent, of all deaths in New Zealand are due to tuberculosis. The general conclusion that 1 draw from the figures is that heredity might be assigned as a predisposing cause at the most in about 30 of the 328 cases, and that with fuller information about these 30 cases, it would probably be found in about 20 of them that more direct causes than heredity could be found to account for the development of consumption. Heredity is, therefore, of little importance as a predisposing cause of consumption. Further investigations and fuller information may confirm the theory that has already been put forward by an authority on consumption in England, that previous cases in a family cause an immunity from consumption rather than increase the risk of developing the disease.