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quarters of the year, but it will be seen that largest
number was notified in Fulham during the second
quarter.
Cases occurred at all ages ; one case was notified
at the age of five weeks, and another at the age of 76
years. All four patients over 60 years of age and
three of the four children under the age of five years
died.
Regarding the case mortality 26 of the 63 cases
died, equal to 41.2 per cent. The case mortality was
lowest at school age, as none of the 14 children of ages
five to 14 years succumbed to the disease. The notifications
were almost equally divided between males
and females, 32 cases occurring in males and 31 in
females.
The initial symptoms and signs of this disease are
often ill-defined, and a definite acute stage may be
entirely absent, so that many cases are not detected
until weeks or months after the actual onset. Three
of the cases were proved on post-mortem examination
not to be suffering from encephalitis lethargica, and
it is probable that the margin of error is even greater.
These three cases were due to (1) suppurative meningitis,
(2) acute cerebro-spinal meningitis, and (3) Bright's
disease. The difficulty of diagnosis, therefore, reduces
the value of the statistics to some extent.
In the majority of fatal cases of encephalitis
lethargica death occurs within a few weeks of the
commencement of the illness, and in 13 of the 26
deaths in Fulham death ensued in less than three weeks.
One death was due to suicide and occurred seven
months after the onset of the disease.
The results of encephalitis lethargica are disastrous ;
as already stated, 26 of the cases notified died. Three
of these were, however, cases wrongly diagnosed. Of
the remainder, only 11 have been able to return to
ordinary work or school, two are doing light work,