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45
It is striking that the sudden increase in 1915 followed upon three years
when cerebro-spinal fever was at a low ebb in London.
Apart from the case mentioned above as having begun in December, 1914,
the first St. Pancras case began on the 20th January, the second on the 12th
February, and from that date onwards the cases were frequent. From the 12th
February to the end of April, 21 cases sickened with the disease. In the early
part of July the number of new cases fell off, and there were subsequently
only two cases taking their onset in August, two in October, and one in
December. The number of cases beginning in the four quarters of the year
were respectively 14, 12, 8, and 3. The highest mortality was in July, in
which month six patients died.
There was an almost entire absence of any indication of a spread of infection
from patient to patient. Amongst the 39 cases (involving 37 houses), in only
two instances was there more than one case in the same family or house ; and
in one other instance a case of the disease occurred in each of two adjacent
houses. The details of these cases are given on the next page. Otherwise
there was no apparent connection between any of the cases.
The distribution of the cases through the borough was fairly even, and
although some districts were affected somewhat more than others, this was not
markedly so. There was certainly no evident tendency for the cases to group
themselves round particular foci. Only three streets besides those mentioned
above had more than one case. These had two each, but no connection could
be traced between the cases.
In regard to schools, the 15 school children affected belonged to 11 schools,
all of which had only one case each except two schools which had two cases
each and one school which had three cases. In these instances, however, there
was no evidence of direct infection, and the cases were well separated as to
time. There was, then, no indication of spread by means of schools. Nor
were any other agents (e.g., milk supply, etc.) discovered to be spreading the
disease.
As to the social condition of the patients, it was found that although the
disease was not confined to the very poor, all the cases were in working-class
families.
No conclusive evidence was obtained as to whether in general the meningococcal
infection was derived from soldiers or sailors. Two of the cases were
in the persons of soldiers who had recently returned from camps. Further,
in about half the total number of cases the patient had recently been in contact
with a soldier, either in the same family or the same house, home on leave
from military duty. There was no reliable history obtainable as to whether
there had been any cases amongst these men's units, though this was said to
be so in two instances. In a few other cases, the patients were known to
have been in contact with soldiers not living in the same house. This
however, is a thing which can now be said about almost everybody, and this
fact makes it unwise to assume without further evidence that the infection
was indeed derived directly from the soldier-contacts. In only two instances
were possibly military "carriers" examined for the presence of the mening-