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32
Annual Report of the London County Council, 1914.
With regard to the recorded number of persons in the patient's family, in 40 cases there were
six persons or less in family, in 9 cases there were seven in family, in 3 cases eight persons, in 6 cases
nine persons, and in 3 instances there were as many as ten persons in the family.
Enquiries as to the number of families occupying the patient's house showed that in 44 cases there
were either one or two families occupying the premises, six of which were tenement houses. In 9 cases
there were three families, and in 5 cases four families in the house.
The number of persons occupying each house attacked ranged between 4 and 20, and the average
number to each house was 9 persons.
Sanitary condition of house.—Only in 6 cases was the condition of the house from a sanitary point
of view referred to as "bad"; in 16 cases the sanitary condition was "fair," and in 21 instances the
state of the premises was " good." In 9 of the cases enquired into the premises were verminous.
Hospital or Institutional treatment.—In 46 of the 61 cases investigated the patient was removed
to a hospital or institution for treatment.
Duration of illness.—It has been possible to calculate approximately the duration of illness in
the cases of 39 of the 61 patients concerning whom particulars were furnished. There appears to have
been considerable variation in the length of the periods between the dates of onset and death, which
ranged from one day to nearly three months.
Bacteriological examinations.—In 29 cases, or nearly 50 per cent, of the total number of those
concerning which enquiries were made, bacteriological examinations were stated to have been conducted.
In 26 of these examinations Gram negative diplococci were identified, and in another case polymorphonuclear
cellswere present, although the cultures Were sterile; in this case post-mortem examination showed
diffuse meningitis over the posterior part of the base of brain and pus in both lateral ventricles; the
results in the remaining two cases were indefinite.
Post-mortem examinations.—Post mortem examinations were recorded in 23 of the fatal cases
registered. In 21 cases the post mortem investigations confirmed the original diagnosis of cerebrospinal
or post-basic meningitis; one case proved to be tuberculous meningitis and the remaining case
was found to be one of meningitis secondary to disease of the middle ear.

Evidence of the increasing prevalence of the disease was primarily observed in certain camps,
and in particular an outbreak at the Crystal Palace, Royal Naval Division Depot, specially directed
attention to the disease. The appearance of cerebro-spinal fever in camps and barracks has always
been the subject of comment and is probably due to the fact that "the population at risk" in camps
consists largely of young adults who on account of the prevailing conditions must be regarded as especially
susceptible persons. This population is exposed to important predisposing causes of the disease
among which close aggregation in huts, etc., with accompanying deficient ventilation, should be especially
mentioned.