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and Wales on the services, may be gathered from the fact that in 1915 the male civilian deaths
numbered 742, while deaths in the forces numbered 605. These figures become more significant
if the number (488) occurring at ages below 15 be deducted from civil deaths,. The relative numbers
of deaths among males and females are as follows:—
Age group.
Males.
Females.
0.15
15.40
40 +
488
757
102
381
181
65
All ages
1,347
627
These figures do not include posterior basal meningitis.
The Registrar.General in his annual report for 1915, at page xli., refers to the fact that in London
cases of posterior basal meningitis are required to be notified under the heading cerebro.spinal fever,
while elsewhere there is no uniformity of practice in this respect. This fact alone renders the use of
the crude figures relating to registered deaths from this disease and notified cases, of little value for
the calculation of fatality rates. Even if it were possible to obtain a figure which would approximately
represent the notified cases, exclusive of those relating to posterior basal meningitis, and to this were
applied the registered deaths for the determination of a case.mortality rate, there would still remain
a number of considerations for which allowance would need to be made in using the fatality rates thus
obtained. Among these considerations may be mentioned the widely recognised difficulties of
diagnosis, the relatively large proportion of cases in which confirmation of the diagnosis on notification
is wanting, and the considerable number of instances in which it is found that registered deaths have
not been previously notified. In view of all the difficulties, therefore, fatality rates have not been
calculated, it being evident that the records of deaths from cerebro.spinal fever for London bear no
consistent relation either to the cases of cerebro.spinal fever notified or to the actual number of deaths
from this cause.
Examination
of suspects
and contacts.
During the year, 31 patients suspected to be suffering from cerebro.spinal meningitis, were
examined either by Dr. Brincker or Dr. Ross at the request of borough medical officers or private
practitioners. In 10 cases the diagnosis was confirmed either microscopically or culturally; in 4 cases
the meningococcus was not identified, whilst in 6 cases insufficient material was obtained for bacteriological
examination. On 11 occasions lumbar puncture was not performed for various reasons. In
addition to the cases in which the patients were seen by the Council's medical officers, bacteriological
reports were furnished on 12 specimens of cerebro.spinal fluid removed from suspected patients, or on
other material from the brain or cord taken after death. Of these, only 4 were found to contain the
meningococcus. Of the 29 cases in which the meningococcus was not identified, 13 cases proved
ultimately to be cerebro.spinal fever, 5 were tubercular meningitis, whilst in two other instances the
bacteriological examination indicated that they were cases of pneumococcal meningitis. The ultimate
diagnosis of the remaining 10 cases was as follows: influenza (2 cases), pneumonia, broncho.pneumonia,
intestinal toxaemia, febricula, cerebral hæmorrhage, seborrhœic eczema, strangulation of bowels.
In addition to the examination of suspected cases, 291 contacts of cerebro.spinal fever were
swabbed, with the result that 23 were found to be carrying the meningococcus in the naso.pharynx,
or 8 per cent. of the total number examined, as compared with 11 per cent. last year. In most cases
the carriers were free from the germs in a comparatively short time; the longest period was five weeks.
Generally speaking, the selection of contacts to be examined, was determined upon the ground of intimacy
of contact or relationship with the patient.
The relationship between influenza and cerebro.spinal fever.—It will be seen then that in 1916,
as in the two preceding years, outbreaks of influenza, accompanied by increase in mortality from
pneumonia, bronchitis, and cerebro.spinal fever occurred. The outbreak of 1914.15 was the most fatal
of the three; it commenced in November, 1914, attained its maximum in February, 1915, and came
to an end about May. The cerebro.spinal fever, in this outbreak, appeared to lag somewhat behind the
influenza, pneumonia, etc, but as pointed out in last year's report, 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." During the latter part of 1915, there was marked diminution in the mortality
from influenza, cerebro.spinal fever, and the other associated diseases; then at the end of the year
came a recrudescence, and now the influenza and cerebro.spinal fever developed practically pari passu,
reaching maximum prevalence in March and April. This outbreak did not attain the dimensions of that
of the preceding year; it was followed again in its turn by a period of comparative quiescence, and then
once more, in November and December, the influenza deaths rapidly augmented in number, reaching
a maximum in the last week of the year; there was in this outbreak, also, some tendency for the
cerebro.spinal fever to lag behind, inasmuch as the maximum for the latter was not attained until the
last week of February. The number of influenza deaths was highest in the third outbreak—that of
1916.17; the number of cerebro.spinal fever cases was highest in the first of the three outbreaks—
that of 1914.15.
The question of the relationship between cases of cerebro.spinal fever and influenza colds, coughs,
catarrhs, etc., in epidemic and non.epidemic periods was considered in last year's Annual Report. It
is now possible to add to the analysis of the figures for the four periods then examined—those for two
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