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ENCEPHALITIS LETHARGICA.
In the 53 weeks ended January 1st, 1921, 11 patients were notified as suffering from
encephalitis lethargica, of which 4 were afterwards found not to be suffering from that
disease. One other case was reported without being formally notified. The number of
actual cases reported was therefore 8.
* Two of the cases were fatal, making a case mortality of 25 per cent.
The particulars of the cases were as follows:—
W. H. C. Male. Aged 56. Ward 8 (N). Office caretaker. Not notified. Ill from
about November 13, 1919, with frontal headaches, drowsiness (but restless), and lack of
interest; diplopia apparently dating from a month earlier; marked constipation ; in bed from
about November 28 with lethargic condition (but could be roused), and stiffness of lower
limbs. Admitted to Royal Free Hospital on December 13. Very marked leghargy (but
answered questions), no other paralysis (but difficulty in keeping eyes open for long), or
mental impairment, fundus oculi normal, obstinate constipation, temperature for first two days
only. Progressive weakness, difficulty in breathing, died December 23. Wassermann of blood
and c.s.f. negative, c.s.f. lymphocytes and albumen slightly +: white cells 25,800. P.M.—
brain—surface extremely congested; localised patches of slight meningitis, with exudation
showing cells but no organisms; pin-point haemorrhages about sylvian fissures, spinal cord
congested, but less so.
E. J. S. Male. Aged 54. Ward 3 (G). Schoolmaster. Notified December 30, 1919.
Onset December 14, 1919, with giddiness, vomiting, fever, and diplopia (no headache or
constipation then). In bed from December [20, with evening temperature, some degree of
constipation, marked lethargy (could be roused), no mental impairment, ptosis, diplopia and
fine nystagmus, tremor of hands, a certain heaviness of speech, and no other paralysis.
Not removed to hospital. Recovered, but vision not good and eyes have a staring appearance.
(February 25, 1920.)
F. H. Male. Aged 16. Ward 3 (I). Engineer. Notified May 5th, 1920. Onset a few
days before April 17. Fell from bicycle. Sleeplessness and drowsiness, headaches, constipation,
no pain, diplopia, "eyes crossed" on April 19. Admitted to Middlesex Hospital on
April 21. In hospital—evening temperature, lethargy, no other mental impairment, knee
jerks absent on left side, no paralysis, resented interference at first. Recovery followed by
relapse. Report on February 8, 1921—Movements slow and laboured, face dull and
expressionless. Ocular movements full, but reverse nystagmoid jerks on lateral deviation,
slight rigidity and weakness of right arm with slight tremor, but not on movement, slight
rigidity of right leg, walks stiffly, reflexes normal.
F. R. M. Male. Aged 36. Ward 2 (F). No occupation. Notified June 6, 1920.
Onset about May 18. Pains in shoulders and arms—later generalised—lasted three weeks,
loss of appetite, restless at night, shouted in sleep, diplopia, slight squint, drowsy from
7th June. Admitted to Higligate Hospital on 8th June. Only symptoms T 99, marked
constipation, extreme drowsiness. Condition on January 21, 1921—No ocular or other
paralysis, or tremors; inclined to be lethargic, slow mental processes and unreliable
memory, general debility, headaches, insomnia and constipation persistent, unable to work.
H. T. Male. Aged 14. Ward 6 (J). Cabinet making. Notified July 8, 1920. Onset
about May 29. Lethargy, constipation, weakness of left arm and legs, pain in left leg, no
• These two deaths are counted to 1919 and 1921 (see details of cases).