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37
Report of the County Medical Officer—General.
however, to the "selected" group of 462 sufferers from cerebro-spinal fever we find that not 2 or 3,
but as many as 27 give a recent history of influenza attack. This latter number (27) compared with
the "expected" is so large as to afford strong ground for the belief that some relationship exists between
the two diseases. This presumption is materially strengthened when regard is paid to the large number
of cases of cerebro-spinal fever giving a history of contact with sufferers from influenza.

Diagram (W) shows the monthly distribution of cases m London during 1914.

The borough medical officers supplied detailed information on special forms in respect of 77 cases
during the year. The severity of attack in the cases which came under observation varied considerably.
It was noted that pain was a marked feature of the illness in 32 cases ; there was an eruption in 9 cases,
and symptoms of meningitis supervened in one case. In only one instance was there any record of
two cases in the same house.
The increased knowledge, obtained as a result of the wider study of epidemiology of the disease
since compulsory notification was introduced in London, indicates that though cases of this malady
occur at all seasons of the year, the numbers notified are greatly increased during the late summer
and autumn months. A similar increase of yearly prevalence is observed in the case of cerebro-spinal
meningitis, but this increase occurs during the winter and spring months. In the case of influenza
the seasonal maximum usually occurs in the winter or very early spring; but occasionally epidemics
have been recorded in which the maximum has been reached during the summer.

The period comprising the 18 weeks from 6th June to 26th September 1914, was that in which
the disease was prevalent in East London, and it may be stated that information as to 31 cases was
received from the boroughs of Stepney (21 cases), Poplar (a cases), and Bethnal Green (5 cases). This
incidence is at the rate of 54 per million in East London (including Stepney, Poplar and Bethnal Green)
as compared with 5 per million for the rest of London north of the Thames and 7 per million for
South London.
This exceptional incidence in East End was made the subject of investigation by Dr. Brincker,
who instituted inquiries at the various East End hospitals. It was noteworthy that 18 of the 31 cases
were notified from the London Hospital during the above-mentioned period. These cases were under
treatment at the hospital, and whenever death occurred the diagnosis was confirmed by post-mortem
examination. The 18 cases do not include a certain number of patients who were admitted with obscure
illnesses, and who were found upon post-mortem examination to have died from acute poliomyelitis. The