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No connection between the cases and no source of infection was found. They were
treated in the Middlesex Hospital, the Hampstead General Hospital, the Woolwich institution
above mentioned, and Great Ormond Street Children's Hospital.

ENCEPHALITIS LETHARGICA.
In 1921 eight patients were notified as suffering from this disease, of which two cases
(treated in the M.A.B. hospitals) were afterwards found not to.be suffering from encephalitis,
the actual number of cases being 6. Two of these 6 cases were fatal. (The number of deaths
from the disease registered in 1921 was 3; one of these was a case notified in 1920.)
The particulars of the cases were as follows:—
L.J., male, aged 32. Ward 1 (D). Horsekeeper. Onset 4th December, 1920. Initial
symptoms—giddiness, impairment of vision, diplopia, difficulty in opening eyes, headaches,
delirium, drowsiness, some facial paralysis, and constipation. Admitted to St. Pancras Hospital,
14th December, 1920. Temperature subnormal; lethargy very marked (only answered questions
after lumbar puncture and after stryclnine); squint marked, but disappeared after lumbar
puncture; urine incontinent; B.O. with enemata; reflex on tapping for knee-jerk was a flexor
response instead of a kick; speech— whispers only; hemorrhage from gums, with pyorrhœa
and dirty mouth; tendency to bed sores. Notified 1st January, 1921; died 5th September, 1921.
P.M. showed no signs of recent encephalitis.
E.A.F., male, aged 50. Ward 3 (G). Painter. Onset 24th December, 1920. Initial
symptoms—headaches, dimness of vision, diplopia, loss of energy and lethargy. Admitted to St.
Pancras Hospital, 1st January, 1921. Evening temperature of 99° or 100° for two or three days
after admission; afterwards generally 97°; lethargy; marked ptosis and no squint; incontinence
of urine and fæces; spoke very lowly when roused. C.s. fluid 4th January—albumen 0.008 per
cent., globulin slight excess, dextrose present, very few leucocytes and no organisms seen. In
hospital seven months. On 28th August—At work, tendency to sleepiness since discharge, but
gradually improving; more talkative than before illness memory good; eats and sleeps well;
no headaches; bowels regular; eyesight normal; some weakness of the arms at times.
M.S., female, aged 34. Address and occupation not known. Found wandering by the
police; drowsy condition and thought to be under the influence of alcohol or drugs; admitted
to St. Pancras Hospital, 7th December, 1920. Temperature in the early stages frequently 97°
and never over 99° except once; lethargy marked; for one week would not eat except at the
commands: "Open your mouth; shut your mouth; swallow"; plantar response (?) extensor for
14 days. C.s. fluid—under slight pressure—no other definite abnormality. Became troublesome
and was kept in the mental ward from 23rd December to 5th January. Notified 13th January,
1921. February. 1921—Slight hemorrhage from lungs with crepitations and dulness at bases;
sputum occasionally blood-stained for some months. July, 1921—Intention tremor of hands, no
abdominal reflex, knee-jerks +, ankle clonus, plantar reflex flexor, right lateral nystagmus and
slight internal strabismus. August, 1921—General joint pains and evening pyrexia 99° to 100°.
Discharged 10th March, 1922, complete recovery; no mental sequelae.