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In Bermondsey 7 cases were notified by medical practitioners.
During the last three quarters of the year, i.e., after the notification of the disease came
into force, inquiries were made into all cases of meningitis in which tubercle or some other
special cause was not stated on the death certificate. In this way twelve were inquired
into and in one of these the disease was found to be tubercular in character. One death
not included in the above was certified by the Coroner to be due to cerebro-spinal meningitis,
but this on subsequent examination of the fluid was found to be tubercular. This leaves eleven
cases which died of meningitis, the nature of which still remains uncertain. They all presented
some symptoms of cerebro-spinal fever, but as there was no post-mortem or bacteriological
examination in any of them it is impossible to say how many of them may or may not
have been tubercular. The difficulty of diagnosing the two forms is very great since each may
present symptoms of the other, and all that could be said about these cases, after consultation
with the medical attendant, was that they were probably meningitis but did not belong to the
epidemic form.
The following are the particulars of the notified cases: —
(1) E.E.M.D., 8 years, female, of New Church Street, notified 23rd April. The
child attended the infants' department of East Lane School. Her father was a casual
labourer. This patient was, to outward appearance, in perfect health up to Tuesday
night, 16th April, and attended school on that date. On Wednesday forenoon she
complained of headache, and had several attacks of vomiting, so that she was unable to
go to school. The mother thought it was simply a bilious attack, and, thinking she would
be able to attend school in the afternoon, had her dressed with the view of sending her
there. She remained quite sensible up to 2 o'clock in the afternoon, but gradually got
worse, and had what was thought to be a fit about 2.30. She rapidly became insensible
alter this, and the coma gradually increased until she died at 3.30. There was no
eruption Two doctors were sent for, but they happened to be out, so that no doctor saw
the patient before death. The rapidity and severity of the symptoms at once aroused the
suspicions of the medical practitioner called in, and he immediately communicated with
the Coroner. He ordered a post-mortem examination to be made and this revealed the fact
that the child died of cerebro-spinal meningitis. This was confirmed by bacteriological
examination. On reporting the matter to the Committee I stated: —There is no doubt
that this child died of acute cerebro-spinal meningitis, but whether it should be considered
the epidemic form of the disease it is difficult to say. There was no apparent source of
infection. There had been no previous cases of illness of any kind in the house : there was
no history of consumption suggesting that the disease might be tubercular, and the whole
circumstances were extremely obscure.
(2) C.L., 4 years, female, of The Grange, notified 28th April. The father was a
carman. The patient did not attend school. The illness began suddenly on 10th April
with feverishness and dyspnoea. On the morning of the 11th she had twitching of hands
and face, refused food, and was sick. Later on the same day she seemed drowsy with
slight bulging of the anterior fontanelle. On the 12th, slight retraction and rigidity of the
lower limbs. On the 26th she developed slight squint with greater rigidity of arms and
legs. On the 29th the squint became more marked and converged towards the right side,
and on the 30th she became comatose; no Kernig's sign or tache cerebrale. There was no
eruption of any kind.
The diagnosis was confirmed by bacteriological examination.
This patient recovered.
(3) E.P., 2 years, female, Tranton Road, notified on 17th May. The father was
a casual labourer. The illness began suddenly on 13th May with convulsions and delirium
which developed into coma towards the end. Tache cerebrale was marked, and muscular
rigidity marked on the right side, with paralysis of the left leg and external rectus of the
left eye. Pietraction of the head and Kernig's sign were both present. There was a slight
eruption in the shape of two haemorrhages, one over buttock and one higher up. This
patient died on lfith May, and on bacteriological examination a double infection was found
of meningococcus and pneumococcus.
(4) L.A.G., 1 year 8 months, female, of Guinness Buildings, Pages Walk, notified
on 6th July. The father was a porter. The patient was ill first on Sunday morning,
30th June, with drowsiness and vomiting. Convulsions came on at 5 p.m. on Ist July
followed by coma and death at 7.30 p.m. The child was dead when the doctor was called
in. There was no definite information as to the presence of other symptoms. There was
no eruption. The post-mortem examination showed death to be due to cerebro-spinal
meningitis. The bacteriological examination was unsatisfactory as there were no microorganisms
of any description present.
(5) D.L., 55 years, male, of Collett Road, notified on 31st July. The patient was
a casual labourer but had not been at work since Christmas. He was taken ill suddenly
on 30th July with giddiness and unconsciousness. His head was retracted and drawn to
the left side. Tache cerebrale and muscular rigidity were marked; exaggerated knee
jerks; vomiting of bloody fluid ; no eruption. Post-mortem examination confirmed the
diagnosis of cerebro-spinal meningitis, but no micro-organisms were found on bacteriological
examination of the fluid.
(6) G.T., 3½ years, female, of St. James' Road, notified on 8th August. She was
taken ill on 2nd August with severe and uncontrollable vomiting. During this time she