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notified in 1915, including such military cases as were notified, was 701. It is to be noted that simple
meningitis, and tubercular meningitis show some increase coincidently both with the occurrence of
the outbreak of February to July, 1915, and the recrudescence of February to May, 1916.

Months containing 5 weeks are marked with an asterisk (*).
Particulars concerning notified cases were circulated to borough medical officers as heretofore, and
also to military authorities. It will be seen that the cerebrospinal fever maximum of 1915 lags slightly
behind that of influenza, but in the recrudescence of 1916 the two maxima correspond. It must be
borne in mind, as regards 1915, that it was only gradually realised that a " new disease " was in question,
and this may account for the later attainment of the maximum in cerebro-spinal fever.

It will be seen that in 1914 the percentage under 10 was 82.2; this fell in the epidemic period
to 50.5 per cent., and then rose to 60.3 per cent, in the two later periods.
Many of the London cases were seen, on request, by one of the Council's bacteriologists, Drs.
Brincker, Forbes and Ross. Reports were made upon cerebro-spinal fluid in some 81 cases, and
upon material from the throats of contacts in some 445 cases. As regards the former, it may be stated
that in 47 cases the diagnosis of cerebro-spinal fever was confirmed, in 5 cases the examination failed
to establish the diagnosis, and in 29 cases another diagnosis was made ; this last group includes 4 of
tuberculous, 2 of serous, 1 of pneumococcal, and 1 of septic meningitis, and 3 cases of acute poliomyelitis
; there were in addition 12 cases of other infectious diseases and 6 other cases. To have
examined all the contacts would have entailed an enormous amount of labour ; it was, therefore,
necessary from the very commencement to make a selection. It was arranged in all cases that investigation
should be made of the degree of contact of the persons concerned, and only those were examined
who had come in close or repeated contact with the patient. Of the 445 contacts bacteriologically
examined, only 49 (11 per cent.) were found to be harbouring meningococci in the nasopharynx.
The question as to whether any variation in this percentage occurred at various stages of the
epidemic prevalence was investigated. During the months of special prevalence, February to June,
10 per cent. of positive results were obtained; from July to December 56 contacts were examined,
and 9 positive results were obtained, roughly 16 per cent.
It was realised from the first that it was not desirable to attempt to isolate positive contacts ; in
several instances, however, it proved impossible to persuade those concerned to acquiesce in the ordinary
precautions advised, and in these cases some restriction of the activities of the contact was unavoidable,
pending receipt of a further specimen of material and obtaining a negative result. As regards persistence
of meningococci in the carrier cases, a positive result was obtained in 10 instances on more than one
occasion ; in 3 of these cases the period of persistent positive results extended to as long as six to eight
weeks.
Looking at the experience gained, as a whole, the London results strikingly confirm those placed
on record by the Special Advisory Committee appointed to collate the military reports, and thus civilian
and military experience are completely in accord in the following respects. First, carriers do not, as
a rule, develop cerebro-spinal meningitis; the Advisory Committee, indeed, say that "out of 690
cases reported, only two cases (are) mentioned, one of which is doubtful." In view of the fact, to be
noted almost immediately, of the not uncommon occurrence of the meningococcus in the throats of
healthy persons, it is indeed difficult to see why any significance should attach to the sequence of events
32681 B
Examinations
made by
the staff of
the London
County
Council.