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14
The question of the disease has been referred to by delegates from Portugal, Poland,
Morocco, Belgium, Spain and Algeria.
In Italy, over 4,000 cases, resulting in 1,018 deaths, have been reported.
It has also made its appearance in various parts of the United States, and in September,
1918, in New York.
In this country, encephalitis lethargica was made a notifiable disease in 1918, and Medical
Officers of Health of Metropolitan Boroughs make careful enquiries into all notified cases occurring
in their respective areas. The facts ascertained are forwarded by each Borough Medical Officer to
the County Medical Offier, who circulates the information thus obtained regarding each London
case to every Borough Medical Officer. In this way Health Officials are acquiring a considerable
amount of knowledge concerning this obscure disease, and it is hoped that the cause and methods for
the prevention of the possible spread of infection may be discovered in the near future.
So far 1 have not heard of two cases occurring in any one house in the Metropolitan area, and
the only outbreak in this country in which a number of cases occurred in a single institution was at
Derby in 1918. Fortunately, the disease, which is formidable, and has a case mortality usually
estimated at 30 to 40 per cent., does not apparently, in ordinary circumstances, spread from case to
case. Evidence, however, accumulates both at home and abroad of the possibility of groups of
cases being due to a common source of infection.
In view of the uncertainty existing in regard to the cause of encephalitis lethargica, when a case
occurs in this Borough, arrangements are made for the disinfection of the premises, the isolation of
the patient, and the observance of the usual precautions taken in regard to other infectious diseases,
in order that no possible spread of infection can be attributed to any omission on the part of the
Council's Public Health Staff.
Poliomyelitis.—Two cases of this disease were notified during the year, viz., a female, aged
24 years, who became ill on August 16th, was removed to Kensington Infirmary, and died on
August 24th. The second case was that of a male, aged 8 years, who was attacked on September
21st, and recovered.
Ophthalmia Neonatorum.—Fifty-three cases of this disease were notified during the year, the
numbers in the preceding three years being 19, 28 and 31.
Ophthalmia neonatorum, or inflammation of the eyes of newly born infants, is in most cases
due to the entrance of gonorrhœal infection into the eyes during the process of birth. It, however,
sometimes results from the entrance of other forms of disease germs at the time of birth, and infection
may also occur at any time afterwards if disease bacteria are brought into contact with the
child's eyes by the unclean fingers of the mother or nurse. In neglected cases ulcers may form on
the outer membrane of the eye, and partial or complete loss of vision may result. In view of the
serious consequences of neglect in treatment, ophthalmia neonatorum was made compulsorily
notifiable in 1914.
During 1920 the Council evinced considerable interest in this disease, and it appears desirable
to review the statistics for the year.
London.
No. of ophthalmia neonatorum cases notified during 1920 1,187
No. of births registered during 1920 123,043
Percentage of ophthalmia cases to births 0.97
Kensington.
No. of ophthalmia neonatorum cases notified during 1920 53
No. of births registered during 1920 4,020
Percentage of ophthalmia cases to births l.32
It will be seen that the percentage of ophthalmia cases to children born is higher in the
Borough than in London generally but, although this suggests that the disease is more prevalent in
this Borough than elsewhere, it is possible that Kensington midwives may be more thorough than
others in regard to the notification of cases to the Medical Officer of Health. It is, however, not
safe to rest content in this belief, which could not be supported without an exhaustive enquiry, and,
consequently, efforts must not be relaxed until the disease is much less common amongst the
newly born.
Of the 53 cases notified in Kensington there were 2 at which a doctor and a midwife were both
in attendance at birth ; in 19 cases a doctor was in attendance without the assistance of a midwife,
and in the remaining 32 a midwife only was present.
There was only one doctor who had more than one case in his practice during the year, and
he notified two. The first occurred on the 2nd February and the second on the 29th April, and the
interval of three months does not suggest that there was any connection between the two. There
were seven midwives who had more than one case, and particulars are shown in the following table,
the dates under each heading indicating those on which the midwife in question notified a case of
ophthalmia to the Medical Officer of Health :—
Midwife A. B. C. D. E. F. G.
Jan. 9th Feb. 24th Apr. 16th May 12th Feb. 7th Jan. 3rd May 26th
„ 26th Sept. 4th June 5th Aug. 9th Mar. 2nd May 27th June 26th
Apr. 5th ,, 7th ,, 12th June 29th July 1st
„ 23rd July 27th Aug. 9th
June 19th Aug. 6th ,, 20th
July 26th ,, 15th Oct. 1st
Aug. 18th