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of actual cases notified baing therefore 11, equal to an incidence rate of 0*06
per 1,000 civil population.
Of the 11 cases, 5 died, the case mortality being 45.4 per cent.
Other statistical facts will be found on pages 15-17.

The cases were all in different homes, except that one ease in January
followed previous cases in the same family at the end of 1917. In two cases
the patients developed the illness in other parts of the country, arriving in
London already ill, and in two other cases the infection was contracted while
away on holiday and developed after returning to London. In the latter two
cases shellfish (oysters, mussels, and cockles) had been eaten and might have
been the source of infection. In the other six cases no source of infection
was traced. Of these six one was a hospital nurse (one of the cases developed
out of London was also a sick nurse); in two cases the diagnosis was somewhat
doubtful and not bacteriologically confirmed; and one case, where there
was a history of the illness beginning with abdominal pains and nausea
following the eating of some sausages on the same day, gave a positive
agglutinin reaction 1 in 200 with B. paratyphosus B, 1 in 50 with B.
typhosus, and negative with B. paratyphosus A.
ACUTE ANTERIOR POLIOMYELITIS.
Only one case of this disease was notified in 1918. The patient was a girl
aged 3½ (Ward 1, District N. 2), onset 25th August, notified 10th October.
The case was wrongly diagnosed as post-diphtheritic paralysis in the first
place. The paralysis affected both legs, especially the right leg from the
knee downwards, where it still persists. The patient was treated in a Metropolitan
Asylums Board Hospital.
EPIDEMIC CEREBROSPINAL MENINGITIS.
There was a reduction in the number of cases of this disease notified during
1918 as compared with 1915, 1916, and 1917, when it was unusually prevalent,
the numbers, however, still remaining higher than normal. The mortality
amongst the notified cases was very great, only one recovering.
13 cases were notified as suffering from the disease, but 4 were found to be
wrongly diagnosed, so that the total number of actual cases reported during
the year (all civilian) was 9, equal to an incidence rate of 0.05 per 1,000
civil population. The corrected number of cases for 19l7, 1916, and 1915
were 21, 20, and 37 respectively.
Of the 9 cases, 8 died, making a case mortality of 88.9 per cent. There
was one other death of a case notified during 1917, so that the number of
deaths for the year was 9, equal to a death-rate of 0 05 per 1000 (civil)
population.