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cranial nerve affection, very dull and lethargic, lethargy becoming extreme towards the end (would
fall asleep while holding feeder or being spoken to). Cerebrospinal fluid macroscopically normal.
Wassermann reaction negative. Died 21st August. Notified 23rd August. P.M.: Nil, except
macroscopically the vessels seen on section of the brain were congested and very conspicuous.
G. B., female, aged 15. Ward 4 (P). Onset a few days after being vaccinated on 30th November.
Initial symptoms : Increasing drowsiness and irritability, vomited and violent headache;
11th December, lethargy developed (but could be roused), with some pyrexia. Notified and
admitted to North-Western Hospital (M.A.B.) on 13th December. After admission the symptoms
cleared up rapidly, and the case at first was thought not to be E. lethargica, but on comparison
with certain other cases the diagnosis was confirmed. Report on 9th March, 1923 : In good health ;
requires glasses for near work.
L. L., female, aged 20. Ward 6 (J). Admitted to North-Western Hospital (M.A.B.) on 31st
October with a mild attack of diphtheria, and was convalescent when, on 13th December, she
began to exhibit delusions and hallucinations, followed in a few days by gradually increasing lethargy
and some pyrexia. Very slight ptosis for one day on 22nd December. Slight delirium at times.
Tremor of upper limbs. Slight Kernig's sign. Irregular moderate pyrexia from 15th to 31st
December. No lumbar puncture. At her worst about 20th December, and discharged apparently
quite well on 17th January, 1923. The girl was very hysterical and excitable, and there was
a history of " fits " resembling petit mal. Report on 9th March, 1923 : Still has " fits," six or
eight a week, suffers from headaches, looks well.
L. S., female, aged 10. Ward 3 (H). Onset 26th December, 14 days after being successfully
vaccinated. Drowsiness, followed by vomiting and headache. Notified on 29th December and
admitted to North-Western Hospital (M.A.B.) on same day. Lethargy was so marked for a day or
two after admission as to amount almost to coma ; it then decreased and was quite gone by 2nd
January, 1923. Incontinence of urine and faeces. Mental condition normal after lethargy disappeared.
Temperature 101'6 deg. on admission, normal by 31st December. C.s. fluid free from
meningococci and tubercle bacilli. Discharged apparently quite well on 12th January. Report
on 9th March, 1923 : Quite well and attending school.
MALARIA.
Thirteen cases of malaria were notified in 1922, and 1 death was recorded. In all
cases the infection had been contracted abroad. All the cases were visited and such assistance
was given as was necessary.
DYSENTERY.
Three patients were notified in 1922 as suffering from dysentery. In two of these the
diagnosis was afterwards revised. The one actual case was fatal, and the patient had contracted
the infection in the tropics some years before. There were three other deaths from the disease,
not notified, one (bacillary) contracted in the tropics, and two in outlying asylums.
PNEUMONIA.
During the year there were 384 cases of acute primary pneumonia notified, and 189 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 1922 there were registered 155 deaths ascribed to broncho-pneumonia. 66 to
lobar pneumonia, and 44 to pneumonia (type not stated).
Every case notified was promptly visited by a lady sanitary inspector and such assistance
given as the case seemed to require. The District Nursing Associations were paid by
the Council for the nursing of cases of pneumonia and influenza. In 1922, 177 cases of influenza
and pneumonia were dealt with at the Council's expense, 2,465 nursing visits being paid.
The following is an analysis of the cases notified and visited :—
(7947)
h