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further periods—the non.epidemic period from May to December, 1916, and the epidemic period January
to April, 1917.

If the second and fourth rows of figures in the six columns of the above table be added together
they give a fair indication of the extent to which a history of suffering from, or one of being exposed to
infection by, an illness resembling influenza, just precedent to attack by cerebro.spinal fever, was forthcoming
in 3 non.epidemic and in 3 epidemic periods. The percentages of such cases to the total number
of cases in the 6 periods were as follows:—
Three Epidemic Periods. Three Non.epidemic Periods.
Jan..May, 1915 12.0 per cent. The year 1914 1.6 per cent.
Jan..April, 1916 5.1 ,, June.Dec., 1915 1.4 „
Jan..April, 1917 9.1 ,, May.Dec., 1916 2.4 ,,
The question as to how far these excessive percentages in the epidemic periods can be regarded as mere
chance coincidences resulting from the wider dissemination throughout London of influenza, was considered
in the Annual Report for 1914, and it was concluded that the number of cases of cerebro.spinal
fever giving a history of (a) recent attack by; (b) contact with cases of influenza; was "greater than
might have been expected as a matter of chance."
Since the question of relationship between influenza and cerebro.spinal fever was discussed for
the first time in the Annual Report for 1914, the subject has received a good deal of attention from both
military, naval, and civilian medical officers. It has become quite clear that the relationship referred
to demands precise study, and now that it is thus recognised that the epidemiological can no longer
be subordinated to the bacteriological aspects of the problem, there is ground, as was suggested two years
ago, for hoping that it may be possible to attain more correct notions with regard to the ætiology
and treatment of cerebro.spinal fever.
Poliomyelitis.
During 1916 there was an increase in the number of notified cases of this disease in London;
197 cases in all were notified, the highest figure previously recorded being 145 in 1913 There was also
increase throughout the country generally, and this was the subject of some comment in the press,
inasmuch as a serious outbreak of the disease was reported in New York about the same time.
Anthrax.
During the year 9 cases of human anthrax occurred in London. In 8 the source of infection was
attributable to the nature of the patient's employment—5 having been engaged in handling hides, 2
were workers in Persian wool and 1 was a brushmaker. The ninth case was that of a woman engaged
in purely household duties. It was ascertained, however, that she was in the habit of paying frequent
visits to her mother, who made brushes from fibre. The fibre was obtained from firms of hair dealers
who kept their stocks of hair and fibre in close proximity in the warehouse. In every instance the patient