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31
Report of the County Medical Officer—General.

Upon investigation it was found that of the 73 cases notified only 61 could be regarded as definite
cases of cerebro-spinal fever or of post-basic meningitis. During the same period 58 deaths were recorded
from cerebro-spinal or post-basic meningitis; these included a number of cases which were not certified
as cerebro-spinal or post-basic meningitis until after death. The 73 notified cases were classified as
follows—cerebro-spinal meningitis, 40 cases; post-basic meningitis, 19 cases; purulent basal meningitis,
2 cases; pneumococcal meningitis, 2 cases; doubtful, 11 cases. The age distribution of the 73 notified
cases was as follows *—
Under 1 year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 to 25 25 to 30 40 to 50
33 6 5 7 1 3 1 - 1 3 1 - -1 2 2 1 1 1 - - 1 3 1
In accordance with the agreed procedure, the borough medical officers furnished detailed information
for circulation to their colleagues in respect of 61 cases. This information may be summarised
as follows.—
Symptoms.—The symptoms most commonly associated with the course of illness in the 61 cases
recorded were headache, vomiting, muscular rigidity, drowsiness, delirium and coma. A variety of
other manifestations, particularly affecting the nervous system, were also noted in certain cases, e.g.,
Kernig's sign, extensor plantar response, hyperesthesia, retraction of head, photophobia, strabismus,
engorgement of retinal vessels and blurring of discs, and optic neuritis.
Recent illnesses of patient.—The information procurable with regard to recent illness was not very
detailed. In 36 patients no recent indisposition was noted. Eight gave a history of having recently
suffered from colds, in 4 cases bronchitis and in 11 instances otorrhæa or rhinorrhœa was present; of
the remainder there was a history of illness with no apparent bearing on the attack of cerebro-spinal
fever except possibly in one instance, in which the patient was said to have suffered from a prolonged
attack of influenza three months previously.
The possible association of influenza with cerebro-spinal fever during periods of epidemic prevalence
will be referred to later; during the non-epidemic period of 1914 such association was only
recorded in a single instance.
Health of other inmates of house.—In 44 instances nothing abnormal was observed with regard
to the health of other persons occupying the same house as the patient. In 4 cases influenza colds
or sore throat were noted ; in the remaining cases, although other persons in the house had been suffering
from various ailments, there was nothing to indicate that these bore any relation to the case of cerebrospinal
meningitis.
Details of housing accommodation.—In 27 cases there were less than two persons per room, in
15 cases from two to three persons, in 10 cases from three to four persons, in four instances there Were
from four to five persons per room, and in one family there were more than five persons to a room.
(а) See footnote (2) to table I, page 40.
(b) The deaths occurring in the 53rd week of the years 1890, 1896, 1902, 1908 and 1913, which are not
ihown, numbered 1, 14, 37, 16 and 22 respectively.