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Of the 146 cases in which fairly full information was obtainable
in 57, or 39 per cent, there was a previous history of consumption in
the family, one or more near relatives having previously died of the
disease. In 14 cases, or 9.6 per cent. of the total, there had been
personal association with another case of consumption previous to the
onset of the disease; but in some of these cases there is merely a
history of illness from phthisis of a relative, with whom the patient
might have been more or less in association, but no definite account of
prolonged or continuous contact, such as is involved in the nursing of
or sole care of a sick person. It seems very doubtful as to what precise
value as a causative agent is to be attached to association with a person
suffering from phthisis. It appears probable that some few cases of
the disease may arise in this way—by what may be regarded as personal
infection—but in the majority of cases investigated it has not been
possible to trace out any history of infection by personal contact.
The question as to which is the more important as a causative
agent in tubercular disease—the seed or the soil—the bacillus of
tubercle or the capacity of the bodily tissues to receive, harbour and
nourish the bacillus—is still full of uncertainty, and will probably not
be satisfactorilly decided until our knowledge of the intimate pathology
of tubercle rests on much firmer ground than is at present the case.
Puerperal Fever.—Four cases of this disease were notified in
Chelsea in 1907, as against eleven in 1906. Under an arrangement
made with the London County Council, the authority for administering
the Midwives' Act, means are now provided by the Chelsea Public
Health Department for disinfecting the clothing aud instruments of any
certified midwife that may be in attendance on a case, as well as the
bedding and room occupied by the patient. Instructions are also given
to the midwife as to when she is at liberty to resume her avocation.