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Poliomyelitis
and
Polioencephalitis.
Of the 96 cases notified during 1919, nine were not confirmed as genuine cases of Poliomyelitis
or Polioencephalitis, thus reducing the total to 87. Forms containing detailed particulars of 85 cases
were received from Borough Medical Officers and were circulated in accordance with the customary
oractice.

In the annual report for 1918 reference was made to the group of cases of encephalitis
lethargica which occurred in London in the spring and early summer of that year. It was pointed
out that, of the 78 cases which came under the observation of the Council's medical staff,
only 49 manifested the characteristic symptoms associated with the disease—viz., lethargy, high
temperature, followed by interference with the nervo-muscular system of the eye and facial paralysis.
On the 1st January, 1919, the disease was made notifiable for a provisional period of one year under
the Public Health (Acute Encephalitis Lethargica and Acute Polioencephalitis) Regulations, 1918. It
has since been made compulsorily notifiable sine die under an Amending Order dated 31st December,
1919. Owing to the fact that the disease was made notifiable under Public Health Regulations which
did not render it compulsory for medical officers of health to forward copies of certificates to the
Metropolitan Asylums Board, the statistics with regard to its incidence which are given below are basec
upon information received from medical officers of health of metropolitan boroughs and from independent
enquiries made by the Council's medical staff.
During 1919, 86 cases of encephalitis lethargica came under observation, and schedules of enquiry
containing detailed particulars thereof were received; in one of these cases the diagnosis was withdrawn
in favour of tuberculosis. Of the total number reported 33 died (39 per cent.).
Encephalitis
Lethargica.

It will be noted in the above table that the incidence of encephalitis lethargica coincides very
closely with the most common seasonal prevalence of influenza, viz., December, January and February.
It is also noteworthy that cerebro-spinal fever prevails mainly during the earlier months of the year.
Typhus fever.
Two cases of typhus fever were notified during 1919, one in the Borough of Bermondsey
and the other in Bethnal Green. The former case was subsequently diagnosed as typhoid fever,
scarlet fever and measles (in combination) and the diagnosis of typhus fever was withdrawn.
There was also some doubt as to whether the case which occurred in Bethnal Green was actually typhus
fever. The patient (S. S.) was admitted to the London Hospital on the 26th September, 1919, and
died two days later. The diagnosis of typhus fever was made after a post-mortem examination which
revealed a condition of septicaemia, petechial haemorrhages over the pericardium and haemorrhages
from the bowels; no rash was observed until the last few hours before death. Guinea-pigs were
inoculated, but without result. The deceased man lived practically alone and he had not been out
of England, nor had he had association with any persons who had been abroad, as far as could be
ascertained. No clue could be discovered which would throw light on the source of infection, and in
all the circumstances the diagnosis must be regarded as unconfirmed, a view which was subsequently
supported at the London Hospital.
A list of passengers (on board the S.S. Kaisar-i-Hind, which arrived at Southampton on the 1st
65580 D 2
Encephalitis
Lethargica.