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He had no definite convulsions, but occasionally the arms and
legs became quite rigid for two or three minutes at a time.
During the next two days he became more comatose, and continued
to vomit repeatedly ; the retraction became more marked.
The temperature throughout only varied from 100-102, being
generally at the higher level.
On the morning of the 6th December, two or three drops only
of turbid yellow fluid were removed for bacteriological examination.
Unfortunately, the tube containing the fluid was broken
during transit to the laboratory, and the child died on the same
day before a second specimen could be obtained. The temperature
just before death was 100.6 deg. On the second day an
indefinite purplish erythema was noticed on the legs, but this
disappeared subsequently, and was barely discernible at any time.
The diagnosis in this case was made entirely on clinical
grounds, but there does not appear to have been much doubt as
to the nature of the disease, and the case would seem to be of
the "fulminating" type of infection, occurring sporadically.
Cerebro-spinal Fever has not, fortunately, made much headway
in London or in the country generally since the outbreaks in
Belfast and Glasgow during 1907. The precaution taken by the
London County Council in making the disease notifiable is a wise
one, having regard to the history of past epidemics and the uncertainty
that exists as to the degree of virulence and the channels
through which the disease is spread.
In the County of London 85 cases of Cerebro-spinal Fever
were notified during the year 1908.
Measles.
As Measles is not a notifiable disease, we are dependent on
the school returns and the death returns for our knowledge of its
prevalence and severity. During 1908 there were 47 deaths recorded
from the disease, or 46 below the average for the ten years
1898-1907, as compared with 72 in 1907 and 44 in 1906.
The death rate was 0.25 per 1,000 population, as compared
with 0.52 per 1,000, the mean death rate for the preceding ten