number before the sixth day; and the next, between the tenth and sixteenth days. Of the non-fatal cases, the greatest number of recoveries, both male and female, took place between the tenth and twenty-first days. The per cents of deaths and recoveries, both male and female, in five day periods, are shown in Tables 9 and 10. TABLE 9.—Exhibiting, by sex of patient, the duration (in days) of fatal cases of sickness from pneumonia, in Michigan, in 1904. TABLE 10.—Exhibiting, by sex of patient, the duration (in days) of non-fatal cases of sickness from pneumonia, in Michigan, in 1904. In reply to the question, "Did this disease begin as a 'bad cold,' influenza, bronchitis, or as pneumonia?" 1,074 cases were reported to have begun as a "bad cold;" 167 cases following exposure; 166 cases following influenza; and 120 cases following bronchitis. These, and other predisposing influences, are shown in Table 11. In this connection it may be stated that in seven instances a second attack occurred in the same person in periods ranging from 1 to 5 years, and in one instance a third attack occurred in the same person within 5 years. TABLE 11.-For the year 1904, in 1,619 instances, pneumonia was reported to have begun The information contained in the reports of health officers relative to the sources of the contagium in pneumonia is very meagre, probably on account of the difficulty met with in tracing cases of this disease to their source. Out of 64 cases, about the source of which definite statements were made, 39 were reported as contracted while nursing, or otherwise coming in contact with pneumonia patients. Other reported sources of contagium are shown in Table 12. TABLE 12.-Reported sources of contagium in 72 cases of pneumonia, in Michigan, in 1904.* Contracted while nursing, or otherwise coming in contact with pneumonia patients.. Probably from a former case.. From outside jurisdictions.. Atmospheric influence... Insanitary surroundings Debilitated condition. Old age.. Result of an operation... Probably from infected house.. Handling mail.. Myocarditis.. Paralysis... Following lodgment of a timothy head in bronchial tube By small kernel of corn in trachea... Contracted tonsillitis from mother and eleven days later contracted pneumonia... 39 7 5 4 3 3 2 2 1 1 1 1 1 1 1 *In a large majority of instances the source of the contagium was not stated, or reported as unknown. PERIOD OF INCUBATION. By reason of the difficulty experienced in locating individual sources of contagium, and, by this means, the time of exposure to the disease, the period of incubation is not easy to determine. As indicating the probable average period of incubation in 1904, it may be stated that, in the majority of instances, the time which elapsed between certain cases and recent previous cases in the same families was seven days. The periods of time between the occurrence of seventy-six cases of pneumonia in 1904 and previous cases in the same families is shown in Table 13. TABLE 13-The reported periods of time which elapsed between the occurrence of seventysix cases of pneumonia in 1904 and previous cases in the same families.* *In addition to these 76 cases, three cases were reported as having occurred at the same time as other cases in the same families, and twelve cases as having occurred in the same families at periods ranging from 6 to 26 years previously. In ten instances the time was not stated. In two instances a second attack in the same person. [In one instance, a second attack in the same person; and in one instance, a third attack in the same person in the five years. INFLUENCE OF OCCUPATION. The occupations of pneumonia patients in 1904 were given in 1,561 instances, and of this number at least 1,189 were engaged in occupations which, it is believed, exposed them, or rendered them susceptible, to this disease. Heading the list are those engaged in housework-housewives, housekeepers and domestics-to the number of 559, many of whom spend a considerable portion of their time in ill ventilated and dust laden rooms. Dirt-often contaminated with infected sputum-carried into the home on the shoes and skirts, and disseminated throughout the rooms by air currents, or by the periodical sweeping and dusting, is generally believed to play a very important part in the spread of pneumonia, and other diseases of the respiratory organs. Next in order are the farming class, to the number of 371, who, though naturally a hardy race, and living under conditions which tend to health and vigor, seem to be very susceptible to this disease. A possible reason for this anomalous condition may be found in the statement made by Robert Hessler, A. M., M. D., of Logansport, Indiana,* and based upon observations extending over many years, that people living in the country, and who are healthy during the greater portion of the year, often become suddendly ill from what he has termed "Dust disease," after going to town and inhaling the sputum contaminated atmosphere of the streets, the frequency and violence of the attacks being greatest in the spring and fall, especially during high winds and when sprinkling of the streets is not being carried out. Next in order are the laboring class, with 179 cases, and next to them the student class-principally young children of school age-with 80 cases. The methods and media by which pneumonia is spread being substantially the same as in the case of tuberculosis, it can scarcely be considered a remarkable coincidence that the occupations before-mentioned are found to head the list-practically in the same order of occupations of persons sick with tuberculosis in each of the nine years, 1896 1904. A complete list of the occupations of pneumonia patients, as reported in 1904, may be found in Table 14. *American Medicine, October 1, 1904. TABLE 14.-Occupations of pneumonia patients reported in 1904, in 1,561 instances. RESTRICTIVE AND PREVENTIVE MEASURES. By reference to Table 15 it will be seen that of the total number of cases of pneumonia in 1904, but 698, or 18 per cent, were isolated from all persons except nurses and attending physicians; in 1,191 instances, or 31 per cent of the whole number, the sputa was disinfected or destroyed; and in 987 instances, or 26 per cent of the whole number, the rooms occupied by pneumonia patients were disinfected. In very many instances, isolation and disinfection were neglected because of the failure of the attending physician or householder to notify the health officer until too late to be of service. |