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G. S., male, aged Ward 2 (F). Onset April 6th. Drowsiness, with difficulty in
breathing, passing on to coma. Died April 7th. Not notified. No bacteriological or P.M. examination.
H. W., male, aged 13. Ward 2 (E). Onset May 4th. Headache, feverishness, vomiting,
delirium, muscular rigidity. Notified May 10th and admitted to Nortli-Western Hospital (M.A.B.)
the same day. C.s. fluid turbid, and found to contain a diplococcus pneumonia?. Died May 12th.
No P.M.
J. F. M., male, aged 24. Ward 1 (C). Onset June 16th. Notified June 30th and admitted to
Eastern Hospital (M.A.B.) on the same day. Comatose, stertorous breathing, pupils dilated and
react to light. Koenig's sign present, knee jerks very exaggerated. Babinski's sign present, no
head retraction, but head flexion resisted, incontinence and analgsesia. T. 103 ; P. 128. Chronic
morbus cordis. C.s. fluid turbid, depositing large fibrinous clots ; excessive polymorphs with
extra- and intra-cellular gram-negative diplococci. Died July 2nd. No P.M.
It will be noticed that four of the cases were in young children, and that in three of these
there was no bacteriological confirmation of the diagnosis. Four of the five cases were in the
north of the borough (Wards 1 and 2). No connection between the cases and no source of infection
was traced. There were no cases after June.

ENCEPHALITIS LETHARGICA.
Five cases of this disease were reported in 1922, all in females. One case was fatal. No
connection between these cases or source of infection was traced. The particulars were as
follows :—
G. E. P., female, aged 47. Ward 1 (B). Onset 18th June, with diarrhoea and headache.
Seen by doctor on 22nd June, when temperature was 103 deg., tongue dirty, headache and severe pain
in back of neck and back, abdomen distended, slight ptosis, drowsiness though patient complained
of insomnia, consolidation of base of right lung, knee jerks (left sluggish, right brisk), marked
clonus of right ankle. Widal reaction negative. Temperature remained 103—4 in the evening
and 100-1 in the morning until 3rd July. Pulse never over 90, generally 70-86. Bowels costive.
Occasional syncopal attacks. By 6th July the evening temperature was only 99 and the lung was
clearing. The chief symptoms in the case were : Intense headache with drowsiness ; delirium at
night, and marked prostration. These were associated with ptosis and slight squint. Notified
29th June. Diagnosis confirmed by Dr. M. A. Cassidy. On 21st September patient felt well, but
could not walk far without a stick. Slight pains and swelling in lower limbs. Slept well and no
head symptoms.
E. R., female, aged 25. Ward 5 (Q). Onset early in July. Initial symptoms : Pain in legs,
attacks resembling petit mal, excessive thirst and polyuria, drowsy. Admitted to Highgate Hospital
28th July. Occasional pyrexia, some rigidity of lower extremities, flexor plantar reflexes, no