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33
Report of the County Medical Officer—General.

It will be observed that the average age of attack during 1915 was higher than in former years; the
average age in 1915 being nearly fifteen, as compared with five in 1914.
As increase in the incidence of the disease became clearly marked towards the end of February,
the Local Government Board on 22nd February circulated a memorandum among sanitary authorities
throughout the country recommending that certain administrative and other measures should be
taken to prevent the spread of the malady. The memorandum gave advice with regard to bacteriological
aids to diagnosis in suspected cases and made reference to the desirability of making arrangements
for the swabbing of contacts. In this connection the Council, at the request of the Local Government
Board, addressed a circular to the Metropolitan Sanitary Authorities with a view to securing co-operation
between the County Medical Officer and the Medical Officers of Health of the several metropolitan
boroughs. It was arranged that the services of the Council's medical officers should be available for the
purpose of examining suspected cases, by lumbar puncture where necessary or by making postmortem
examinations, and in particular arrangements were made for the bacteriological examination of
material in the Council's Public Health Laboratory, the investigations being placed in charge of Dr.
J. A. H. Brincker, assisted by Dr. J. G. Forbes and Dr. E. H. Ross.
During the first three months of the operation of the scheme a considerable amount of work
was done and the services of the Council's experts were placed at the disposal of local Medical Officers
of Health and medical practitioners. Furthermore, close co-operation was maintained between the
Council's Public Health Department and the Army Medical Service when there was known association
between military and civil cases. Up to the end of May, 1915, 51 persons who were regarded as
possible subjects of cerebro-spinal fever were visited by the Council's medical officers both with a view
to assisting in diaguosis and for removing cerebro-spinal fluid or other suitable material for bacteriological
examination. In some of these instances the disease had already proved fatal, at the time of the visit,
and post-mortem examinations were conducted.
Analysis of the 51 suspected cases shows that material was collected for bacteriological examination
in 40 cases. In 28 of the 40 specimens the organism commonly associated with the disease, viz., the
particular kind of Gram negative diplococcus known as the meningococcus was found; in 12 cases
meningococci could not be identified. Throat cultures were also taken from three persons who had been
discharged as cured after having suffered from cerebro-spinal meningitis, and two of them were found
still to be carrying the meningococci in the throat, although in one case a second culture taken a week
later gave a negative result; in the other case, that of a soldier, the second examination proved positive,
but a third gave a negative result. In this latter case, the soldier was in the infirmary suffering from
cerebro-spinal fever from 3rd March to 1st April; his sister, aged 4 years, was taken ill on 29th March
(prior to the soldier's discharge from the infirmary) and died the next day. The child did not see her
brother during his illness.
The following information is available concerning the twelve cases in which no evidence of
meningococci could be detected in the cerebro-spinal fluid or other material examined:—
Case No. 1.—Proved to be cerebro-spinal meningitis at post-mortem examination.
Case No. 2.—Not cerebro-spinal fever. Patient a soldier with doubtful symptoms; his
throat was examined at request of a consultant.
Case No. 3.—Notified as cerebro-spinal fever on clinical evidence.
Case No. 4.—Pneumococcus identified. Case of pneumococcal meningitis.
Case No. 5.—Not cerebro-spinal fever. Died probably as result of shock following upon
extensive burns.
Case No. G.—Notified as cerebro-spinal fever on clinical evidence.
Case No. 7.—Pneumonia certified as cause of death.
Case No. 8.—Examination of the cerebro-spinal fluid indicated that case was one of acute
poliomyelitis.
Case No. 9.—Clinically the case appeared to be one of cerebro-spinal meningitis, but the
result of lumbar puncturc indicated that it was probably poliomyelitis. This was subsequently
confirmed in hospital.
Case No. 10.—Examination of cerebro-spinal fluid showed that there was no meningitis.
The child improved and is now quite well, and the conclusion arrived at was that the child
suffered from intestinal toxaemia.
Case No. 11.—Although the cerebro-spinal fluid was normal, the clinical features of the
case justified notification as cerebro-spinal fever.
Case No. 12.—Examination of cerebro-spinal fluid during life showed that the case was
not one of meningitis. The patient died and the cause of death was certified as " toxaemia
from abdominal infection."
With regard to the remaining 11 patients, in 8 cases lumbar puncture was not performed ; of
these, the patient was too ill to justify an operation being performed in one case, one proved to be a case
of poliomyelitis, in six cases no meningeal symptoms were present; of the last-mentioned group three
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