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continued during the year 1919, 199 cases having been notified as compared with 265, 430, 432 and
674 in 1918, 1917, 1916 and 1915 respectively. Of the 199 cases reported 43 were not confirmed as
genuine cases of cerebro-spinal fever, but on the other hand, in 22 instances where a diagnosis of cerebrospinal
meningitis was arrived at, mainly post mortem, official notifications were not received. The
actual number of definite cases recorded therefore during the year was 178. Of these 126 (70 per cent.)
died. The monthly distribution of these cases appears in the subjoined table.
Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total.
Total number of cases 21 13 33 31 21 14 13 15 12 6 10 10 199
notified (2) (2) (1) (5)'
Number of cases noti- 5 3 7 7 3 3 3 3 2 0 4 3 43
fied, but not confirmed
Number of cases not 5 2 1 2 2 5 0 2 1 1 1 0 22
notified (1) (1)
Total number of 21 12 27 26 20 16 10 14 11 7 7 7 178
actual cases (2) (2) (1) (1) (6)
Note.—The number of naval or military cases is shown in brackets.

In 176 cases forms containing detailed information were received from borough medical officers
and were circulated in accordance with the usual practice.
The claims upon the time and services of the Council's expert medical staff in assisting medical
practitioners in the diagnosis of suspected cases of cerebro-spinal fever and other cerebral conditions
have been increasing. During the year 1919 these services were required on 101 occasions either for
visiting the homes of the patient in consultation with the medical attendant, or for examining cerebrospinal
fluid sent up by the medical superintendents of infirmaries and similar institutions. An analysis
of these examinations and the conditions found either at the consultation or subsequently is shown in
the following table:—
Visits to Visits to Visits to patients' homes.
patients' homes. patients' homes.
Fluids Fluids Diagnosis Diagnosis on clinical on clinical grounds.
received Diagnosis after pathological investigation.
• Diagnosis after patological investigation Fluids received received from infirmaries, etc.
Diagnosis on clinical after
grounds, pathological
investigation.
Cerebrospinal men- Miliary tuberculosis — 1 —
ingitis 1 9 15 (2) Pneumonia 1 1 (2)
Tubercular menin- Tonsilitis 1 — —
gitis — 1 19 (3) Rheumatism . — — 1
Pneumococcal men- Diphtheria 2 — —
ingitis 1 1 8 Typhoid fever 1 — —
Serous meningitis — — (1) (also blood
Septic meningitis — 1 — test)
Meningitis of un- Spastic paraplegia 1 — —
determined origin — 1 (1) Acute infective en-
Encephalitis leth- docarditis — 1 —
argica (1) 2 (4) Dilated and fatty
Poliomyelitis or heart — 1 —
polioencephalitis 1 (2) 5 (3) Nephritis and
Influenza 3 — (2) uraemia — 1* —
(1)
Other cerebral conditions
1 1 6
Note.—The figures in brackets denote the number of cases in which provisional diagnoses only were made.
The asterisk signifies that in addition to a lumbar puncture an examination of blood, faeces and urine was carried
out.