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the cerebrospinal fluid showed the presence of the pneumococcus and
not of the diplococcus intracellularis.
There was no spread of the disease from any of the notified or
unnotified cases, so far as known ; and it is evident that the infectivity
of cerebro-spinal fever in London during the past year was of very low
degree, if it existed at all in the ordinary sense.
In London during the year, 136 cases of cerebro-spinal fever were
notified, notification having commenced in the second week in March ;
and 24 deaths were registered in London as being due to this disease
in a similar period. The case-mortality is, therefore, only 17.7 per cent.
for the year; but it seems probable that many of the notified cases
were not in reality true instances of the disease with which the
meningococcus of Weichselbaum is associated, as this form of the disease
is excessively fatal, no specific or serum treatment being as yet generally
available. The serum prepared by Dr. Flexner, pathologist to the
Rockefeller Institute of New York, has been used in Belfast during the
past year, where the disease has been prevalent, with very gratifying
results, the mortality case-rate in the Fever Hospital having been
reduced to 27 per cent. in serum-treated cases, as compared with 80
per cent. prior to its use in the same institution.
Voluntary Notification of Phthisis.—During 1907, 10 cases of
pulmonary tuberculosis were notified by medical practitioners, as against
20 in 1906, and 24 in 1905. Only four medical practitioners notified
cases in 1907. There were altogether 110 deaths from phthisis in
Chelsea in 1907, of which number 78 died in public institutions, so
that the 10 cases, voluntarily notified, form 31 per cent. of the 32 cases
that terminated fatally at the patients' own homes.
The sputa of 2 patients were sent to the Lister Institute for bacterioscopic
diagnosis, results confirmatory of the presence of the tubercle
bacillus being obtained in one case only.
The Master of the Chelsea Workhouse has continued to supply
information as to cases of phthisis leaving the Workhouse and Infirmary
for their homes in the Borough; and cases of the disease have also
been notified by the Lady Almoner of St. George's Hospital, and by the
Chelsea Branch of the Charity Organisation Society. The cases were
visited at their homes by the Lady Sanitary Inspector, and leaflets of
precautions, pocket spittoons, disinfectants, and fibre handkerchiefs
were distributed where considered necessary.
Since October, 1903, when voluntary notification of phthisis commenced,
167 cases of this disease have been inquired into by means of
visits and revisits at the homes of patients. Of this number, 82 cases
were reported by medical practitioners, and the remaining 85 cases
were brought to my knowledge by other agencies.
Of the 167 cases, fairly full information as to previous history and
habits was obtained in 146; of the remaining 21 cases, in 7 a wrong
address had been given, and the case could not, be traced, and in 14 the
information obtainable was too slight or dubious to be reliable.