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found that whilst the voluntary or Metropolitan Asylums Board's hospitals were
admitting cases of the disease in the first stage (covering a period of about 3-6
months) there was in many instances difficulty in providing the constant and continuous
treatment, under skilled supervision, in the second stage, which may extend
to a further period of 18 months to two years. Accommodation for a limited number
of such cases was accordingly provided by the Metropolitan Asylums Board at
Queen Mary's Hospital, Carshalton. In December, 1924, the Ministry of Health
issued a circular in which it was pointed out that the services of Dr. J. A. H. Brincker
and Dr. J. G. Forbes, together with the resources of the Council's bacteriological
laboratory, are available to medical practitioners, through the borough medical
officers of health, if required. The extent to which advantage was taken during
the year of the services of the Council's consultants in connection with the diagnosis
of affections of the central nervous system will be found on p. 42 of this report in
reference to the work of the bacteriological laboratory.
Encephalitis
lethargica.
The number of cases of encephalitis lethargica notified during the year, viz.,
605, far exceeded the number notified in any one year since the disease was made
notifiable in 1919 (see table below). In 64 cases the diagnosis was revised, thus
reducing the number to 541, of which 122 (22 percent.) proved fatal, as compared
with a fatality rate in the preceding year of 45.9 per cent.
The disease first commenced to make headway in the early spring and during
the last two to three weeks in March 42 cases were notified; the prevalence was
most marked during April and May when 138 and 147 cases respectively were notified
in the London boroughs, dropping to 98 in June, 50 in July, 22 in August, 28 in
September and a monthly average of about 20 for the remaining three months of
the year. The prevalence was more or less evenly distributed over London, with
no outstanding local prevalence.
A report on enquiries into after effects of encephalitis to school children will
be found on p. 109 of this volume.
In former years it had been the practice of borough medical officers to furnish
the Council with detailed particulars of every notified case on an agreed schedule
of enquiry, but this practice was suspended in 1922. In view of the prevalence
during 1924, however, the borough medical officers agreed to resume their former
practice. A card index system was accordingly established with a view to recording
a complete history of the cases.

Influenza and the Influenzal Group of Diseases.
The total number of deaths attributed directly to influenza in 1924 was 1,680.
The wave of prevalence attained its maximum in the 7th week of the year when
the deaths numbered 178. The deaths from pneumonia reached the weekly maximum
of 277 in the 6th week, and those from bronchitis, that of 258, in the 8th week. The
relation of the mortality rates from pneumonia, bronchitis and influenza over a
series of years was shown in the chart on page 22 of last year's report. The chart
on page 24 of the present report shows the relation of the mortality rates from
cerebro-spinal fever, poliomyelitis and polioencephalitis, and encephalitis lethargica
to those of influenza. This chart illustrates what is described in the Ministry of
Health report of 1918 as the "setting" of an influenza epidemic; it will be seen
that the pandemic prevalence of influenza in 1918 was preceded by unusual