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17
senting the symptoms above described, particularly when these symptoms included
a scarlatiniform rash. So that it may be surmised that considerable difficulty might
be felt in distinguishing the Galveston "dengue" from influenza.
The number of cases of cerebrospinal fever and post-basic meningitis notified
during the year 1922 was 86, as compared with 109 for the previous year, thus continuing
the steady decline in the incidence of the disease since 1915. Of the 86 cases
notified, 13 were not confirmed as cases of cerebrospinal fever or post-basic meningitis,
while one was considered to be doubtful. On the other hand, 14 cases were
recorded (mainly through the Registrar General's Death Returns) which were not
notified under the Public Health (London) Act, 1891. The actual number of confirmed
cases was, therefore, 86, of which 71 (825 per cent.) proved fatal. The rise
in the fatality rate may be due to the fact that the only unnotified cases which came
to light were those which proved fatal. This applies more particularly to post-basic
meningitis, concerning the notification of which there seems to be some misapprehension.
The Order of the Council in 1912 making cerebrospinal fever a notifiable
disease applied equallv to the condition known as post-basic meningitis.
Cerebrospinal
fever.
The number of cases of poliomyelitis and polioencephalitis notified during
1922 was 40. In 4 cases the diagnosis was revised, whilst another was considered
to be doubtful.
Poliomyelitis,
polioencephalitis
and
encephalitis
lethargica.
During 1922 there were 72 cases of encephalitis lethargica notified. In 17 cases
the diagnosis was revised, while in one fatal case the diagnosis was considered to be
doubtful. In addition, 2 cases (one which was orginallv notified as cerebrospinal
meningitis) were recorded, which were not notified officially. Of the 56 actual cases,
30 (53.6 per cent.) proved fatal. The incidence was the lowest recorded since the
disease was first made notifiable in 1919.

No cases of plague or cholera were notified during 1922. During the year passengers
from five ships on which plague had occurred, or on which plague rats had
been found, came to London and were kept under observation as contacts.
Plague and
cholera.
During 1922 there were nine cases of Anthrax in London, two ot which proved
fatal. In seven cases the patients were engaged in handling hides, wool or skins
from which the infection was no doubt derived. In another case the patient was
employed as a butcher's assistant on a farm at Edgware and investigation proved
that two horses on the farm had died suddenly. The carcase of one of these
animals was skinned and cut up on the farm, and the patient is stated to have
assisted in this work. These carcases were not submitted to bacteriological
examination, and the exact cause of the death of the two animals was not
established, but it is significant that the case of anthrax occurred very shortly
after the death of these two animals. In the last case, which proved fatal, the
source of infection was not traced.
Anthrax.
Two cases of typhus fever were notified in London during 1922, one in Stepney
and the other in St. Maryebone. In the former case the patient had recently returned
Typhus
fever.