HENRY F.

VAUGHAN

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132.2 per 100,000), Grand Rapids (137.9), Bay City (133.8), Jackson (118.6), Kalamazoo (127.6), Saginaw (126.6), Escanaba (252.3), Ish.peming (146.3), Muskegon (134.0), Pontiac (110.3), Sault Ste. Marie (122.4), Traverse City (213.6), Benton Harbor (164.1), Coldwater (112.6), Holland (122.7), Mt. Clemens (168.8), St. Joseph (169.1), and Wyandotte (221.2).

TABLE 19.-The prevalence of tuberculosis in urban and rural localities in Michigan,

in 1904.

*This footnote is below Table 16, on a preceding page. †Not including Calumet, which, for the purposes of this study, is classed with urban localities having corresponding populations.

THE SEASONAL FATALITY OF TUBERCULOSIS.

As a rule, tuberculosis in the early stages is not recognized, and consequently the time of its inception is not generally known or reported. This, coupled with the fact that regular reports of the progress of many cases are lacking, renders it difficult to determine, with any degree of accuracy, the seasonal prevalence of the disease. Table 20 is therefore designed to take the place of a table showing the seasonal prevalence. The months of greatest fatality, named in the order of greatest numbers of deaths, were May, April, March and December; the months of least fatality being from June to September, inclusive.

TABLE 20.-The seasonal fatality from tuberculosis in Michigan, as shown by the average numbers of deaths from this disease in each month in the eleven years, 1894-1904.

Months.

Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec.

Average numbers of deaths..

147 145 158 162 164 137 128 131 129 149 142

156

REPORTED SOURCES OF CONTAGIUM.

While dealing with but a small portion of the cases which occurred in 1904, Table 21 serves to indicate the manner in which tuberculosis is generally spread. Not including the eighty cases, said to have inherited the disease, 316 cases, or about 61 per cent of all the cases in which the source of contagium was stated, were reported as traced to personal contact or association with tuberculous persons, principally relatives. Though not definitely traced to their source, an additional 41 cases, or 8 per cent of the whole number, are believed to have originated in the same manner as the 316 cases. Members of a family in which there is a case of tuberculosis are necessarily and constantly exposed to the danger of infection unless the sputa are carefully and effectually disposed of. For this reason it should be the constant aim of physicians and health officials to educate the families of those suffering from the disease in the very simple methods for preventing its spread.

TABLE 21.-Reported sources of contagium in tuberculosis in 1904.

PREDISPOSING INFLUENCES AND PREMONITORY SYMPTOMS.

Table 22 may well be studied in connection with Table 11 in the article on the subject of pneumonia, on a preceding page, the tables indicating that the principal predisposing influences are practically the same in tuberculosis as in pneumonia. Both tables emphasize the necessity for the "ounce of prevention" in prompt and thorough treatment of a cold or cough, or in an attack of influenza or bronchitis, and in restrictive and preventive measures in typhoid fever, measles and whooping-cough.

Five items in Table 21,-heredity, insanitary surroundings, dust, handling turpentine and paints, and cigarette smoking-reported as sources of contagium should properly be considered in connection with Table 22, because per se they are nothing more than predisposing influences.

Disease began with or followed:

TABLE 22.-Predisposing influences and premonitory symptoms in tuberculosis, in the eight years, 1897-1904.

INFLUENCE OF OCCUPATION IN TUBERCULOSIS.

What has been said in the preceding article, relative to the influence of occupation in pneumonia, will apply equally to tuberculosis, as a comparison of Tables 14 and 23 will show.

TABLE 23.-Occupations of tuberculous persons in the ten years, 1895-1904.

CONSUMPTIVE RELATIVES OF CONSUMPTIVES.

Table 24 may serve to indicate, in some measure, the influence which a consumptive member of a family may exert upon other members of the same family, in respect to the spreading of the disease.

It will be noted that the numbers of male members were invariably less than the female members, of corresponding relation, thus: Sister, 1,045, brother, 688; mother, 778, father, 504; aunt, 275, uncle, 181;

daughter, 187, son, 89; wife, 120, husband, 105; and so on down the list. This may be accounted for by the fact that of all the cases reported to this Department, in which the sex was stated, 56 per cent were females and but 44 per cent males. In this connection attention is again directed to Table 23, in which it is shown that those engaged in housework (women) are more susceptible to tuberculosis than any other class of persons.

TABLE 24.-Showing the relation between tuberculous persons and other tuberculous members of the same family, in Michigan, during the ten years, 1895-1904, arranged in order of the greatest number of times the relationship was mentioned in the reports from health officers.

INFLUENCE OF NATIONALITY IN TUBERCULOSIS.

Table 25 indicates that, of all those persons who suffered from tuberculosis in this State in the seven years, 1897-1903, about 61 per cent were native born and 39 per cent of foreign birth. Comparing these per cents with the ratio of native to foreign born residents of the State (about 78 per cent native born and 22 per cent foreign born), it will be seen that tuberculosis was most prevalent among those of foreign birth.