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headache, followed in a large proportion of instances by interference with the nervo-muscular system of
the eve, resulting in a variety of eye manifestations, such as ptosis, squint and nystagmus ; in others
there was an interference with the nervo-muscular system of the face, producing a characteristic masklike
appearance, or later a varying amount of permanent paralysis of the face or neck muscles. A predominant
feature was involvement of the lumbosacral enlargement producing constipation and retention of urine.
Other features of nervous origin such as delirium, tremors, vomiting, sweats, rashes, were also frequently
observed. The symptoms in many of the instances were mild and it may be assumed that a number of
cases missed identification. Of the 49 which came under observation by the Council's medical officers,
12 died within 14 days of the date of onset. In severe cases, owing to extensive injury or destruction
of nervous tissue, recovery was very slow, in some cases the illness lasted six weeks or even longer. The
paralysis observed in the more severe cases remained permanent even after recovery. The chief
characteristics of the cerebrospinal fluid taken from the 49 cases were as follows:—The fluid was usually
quite clear and colourless and was contained in the canal under considerable pressure. The albumen
content was usually very small and the fluid reduced Fehling's solution very slightly. The centrifuged
deposit contained very few cells, mainly lymphocytes, and no micro-organisms were demonstrated
either microscopically or by culture.
The monthly distribution of the 49 cases which presented the characteristic group of symptoms
was as follows. As the disease was not at the time notifiable the dates of onset of illness have been selected
for the purpose of this table. No cases came under observation between August and the end of the year:—
Month .. .. February. March. April. May. June. July. August.
Number of cases 1 8 14 19 6 — 1
On 19th December the Local Government Board issued an Order requiring the compulsory
notification of cases of encephalitis lethargica under regulations which came into force on 1st Januarv,
1919.
Poliomyelitis
During the past two years the prevalence of poliomyelitis and polioencephalitis has been the lowest
recorded since these diseases were made notifiable in 1911. viz.. 53 in each of the two vears

Of the 53 cases notified in 1918, four proved subsequently not to be poliomyelitis, reducing the
total to 49. Detailed particulars Were received from borough medical officers respecting 47 of these
cases and were circulated for information.

B.—Administration.
Certain statistical information available is summarised in Table II., see page 21.
Tuberculous Milk.—L.C.C. (General Powers) Act, 1904, Part V., and 1907, Part IV.
The Council's inspectors obtained 654 samples from churns of milk consigned from the country
to the various London railway termini, and these were submitted to the Lister Institute for bacteriological
examination. The milk was sent to London from 33 counties. Of the 620 completed examinations, 46,
or 7'4 per cent., yielded tubercle bacilli, as against 10 3 per cent, in 1917, 8'7 per cent, in 1916, and
6'5 per cent, in 1915. In connection with these samples the veterinary inspector visited 50 farms and
examined 1,839 cows. It was found that 36 cows, i.e., 2 per cent., showed signs of tuberculosis in one
or more of its forms, or were otherwise unhealthy. In the case of each cow suffering from tuberculosis,
the farmer undertook to have the animal slaughtered and meanwhile not again to use the milk. In
addition, the inspector re-visited 182 farms and inspected 7,781 cows ; all the animals examined at these
re-visits were found to be in a satisfactory condition with the exception of 15 which appeared to be
tuberculous. In each instance the owner undertook to have the animal removed.
During the period 26th November, 1917, to 25th November, 1918, there were three inspections
of the cows in the 132 London cowsheds. In all, 5,466 examinations were made. No cases of tuberculosis