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squint or diplopia, later tendency to dribble. Admitted to University College Hospital on
July 5th—Extreme lethargy, lateral nystagmus (no ptosis or squint), slight left facial
paralysis, paresis of left leg, tremor left hand, mental condition dull, speech slow.
Condition on 24th January, 1921—General weakness, gets tired easily, slowness of speech
and movements, marked weakness of back and left arm and leg, left knee jerks weaker than
right, paralysis of left superior oblique, marked lateral nystagmus.
E. A. Male. Aged 39. Ward 4 (P). Unemployed. Notified August 20, 1920. Onset
before July 28. Headache, drowsiness, constipation, "queer in the head." Admitted to
St. Pancras Hospital on August 11. On admission—No fever, marked lethargy (could not be
roused), slight nystagmus, but no ptosis or squint, no paralysis, but general weakness, very
slow cerebration, memory very bad, speaks slowly and with jaws nearly closed. Condition
on January 29, 1921—Still in St. Pancras Hospital, just able to sit up, cerebration slow,
rather irritable, right pupil smaller than left, marked constipation, some athetosis.
E. O. Female. Aged 36. Ward 5 (Q). Notified December 10, 1920. Onset August
28. Constipation, stiff neck, very sleepy and tired. On November 16 all her teeth were
extracted, but no improvement, prominence of eyes noticed. Admitted to St. Mary's
Hospital on November 19. Condition in hospital—No fever, very marked lethargy, eyes
slight and passing divergence, temporary loss of accommodation-reflex of pupil and
temporary ptosis, bilateral facial paralysis, tongue kept protruded, general wasting of arm
and leg muscles, temporary foot drop on left side, mental condition quite clear, patient
"fussy," voice monotonous and articulation imperfect, heart dilated, pulse rapid. Condition
on February 3rd, 1921—Still in hospital, getting up, much improved, facial paralysis
diminishing, cannot walk owing to arthritis of the hip joints, with scoliosis.
L. C. Female. Aged 20. Ward 7 (T). Notified December 27, 1920. Onset
December 11. Giddiness, gradual onset of drowsiness, diplopia, constipation, twitching of
face from December 18. Admitted to University College Hospital on December 21. Condition
in hospital—Maximum temperature 103 deg., extreme lethargy, no ptosis or nystagmus, (?) slight
squint, (?) some slight bilateral lower facial weakness, no paralysis, but general weakness,
mental condition obscured by lethargy, no delirium, slight tremor, incontinence. Pyrexia of
typhoid type continued, and patient died on January 4, 1921. P.M.—Diagnosis confirmed.
Microscopic examination of brain showed diffuse perivascular round-cell infiltration of small
lymphocytes. The lesions most marked in the pons, especially the seventh nerve nucleus.
MALARIA.
58 cases of malaria were notified in 1920, and 2 deaths were recorded. In all cases
the infection had been contracted abroad. All the cases were visited and such assistance was
given as was necessary.
dysentery.
4 cases of dysentery were notified in 1920, the diagnosis in one case being afterwards
altered. They were all contracted abroad. Seven deaths from dysentery were registered
during the year.
pneumonia.
During the year there were 142 cases of Acute Primary Pneumonia notified, and 108
of Acute Influenzal Pneumonia. There is reason to believe that the notification of these
diseases is far from complete. This is partly due to uncertainty of definition.
During 1920 there were registered 112 deaths ascribed to broncho-pneumonia, 46 to
lobar pneumonia, and 39 to pneumonia (type not stated).
Every case notified has been promptly visited by a lady sanitary inspector and such
assistance given as the case seemed to require. The District Nursing Associations are paid by