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Polioencephalitis.
20

Particulars were obtained in 144 of the 164 cases. In 28 the diagnosis was finally definitely
rejected, and in 51 others there remains a more or less decided element of uncertainty, arising, generally
speaking, on bacteriological grounds. In 65 instances the diagnosis was finally confirmed, though only
in about a quarter of these does a rigorous bacteriological diagnosis appear to have been made, and in
only 7 instances is there any reference to demonstration of the presence of a particular type (I., II., III.,
or IV.) of meningococcus.

Poliomyelitis
and
The following table shows how this figure compares with previous years dating back to the Notification
Order of 1911:—
Year.
1911, from
1st Sept
1912.
1913.
1914.
1915.
1916.
1917.
1918.
1919.
1920.
Number of cases
66
132
145
93
97
197
53
53
96
55

Particulars were obtained in 52 of the 55 cases. In six the diagnosis was not finally confirmed,
and in nine others there was an element of doubt. Of the remaining 37 it may be said that all were
examples of infantile paralysis affecting an arm or leg or more than one limb. They include two pairs
of cases in children of the same families. One of the 37 cases was at first notified as cerebro-spinal fever.
Three cases in which there was considerable doubt as to the diagnosis are deserving of special mention.
In case No. 2 the diagnosis was said to lie between influenza with meningeal symptoms, polioencephalitis
or poliomyelitis or encephalitis lethargica. On the whole it was held that the history, the evidence of
meningitis found on post-mortem examination and the character of the cerebro-spinal fluid, seemed to point
to polioencephalitis. In the two remaining cases, Nos. 26 and 28, there was great difficulty in deciding
definitely as to the diagnosis ; drowsiness was marked in both these instances.
In three of the 37 poliomyelitis cases there was concurrent illness possibly of an influenzal nature
in other members of the affected families. Thus the mother of one of the three children (a boy aged 11)
"had bronchitis of influenzal type just previously." In the case of a woman aged 26 her "husband
had influenzal sore throat a week earlier." And in the case of a child of 4 months, a brother (aged 11)
and a sister (aged 2) simultaneously suffered with gastro-enteritis.
In six cases of encephalitis lethargica a history of influenza in the patient was observed, and of
colds or sore throat in six cases, whilst in other members of the same family there were said to have been
attacks of influenza in six cases and of colds in four cases.
No detailed study of cases of epidemic hiccough in London has been made; indeed, a few instances
only of this affection have been reported. The following summary may be given of the replies on the
forms (relating to cerebro-spinal fever, polioencephalitis and poliomyelitis, and encephalitis lethargica)
filled in, at the instance in each case of the borough medical officer of health concerned, returned by him
to 2, Savoy Hill and then circulated to the medical officers of health of all the London boroughs. The
general impression left on the mind is as follows—
The particulars recorded are, as a rule, fairly complete with regard to clinical symptoms; but
the laboratory examinations of cerebro-spinal fluid, etc., are only fully detailed and precise in a few
instances ; and questions relating to the environment of the patient and to other illnesses in members
of the patient's family are only quite occasionally answered.
In London, polioencephalitis was from the outset made notifiable with poliomyelitis, and thus
some overlapping results now that encephalitis lethargica has been made a separately notifiable disease.
This circumstance and the designation encephalitis lethargica given to the supposed "new disease"
have no doubt led to special emphasis being placed upon drowsiness in weighing in the balance as to
whether a case shall be notified as encephalitis lethargica or as one of acute polioencephalitis. Broadly
speaking, the cases notified under all three categories (cerebro-spinal fever, poliomyelitis and encephalitis
lethargica) manifest a certain family resemblance, particularly as regards their initial symptoms. They
appear to be, generally speaking, allocated to one or other of the three groups, on two main underlying
principles of differentiation.
(a) The age of the patient. The youngest ages especially tend to be brought under the
category cerebro-spinal meningitis; those rather older as a rule go to poliomyelitis; and the
average age is considerably higher still in encephalitis lethargica.