London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1925
[Report of the Medical Officer of Health for London County Council]
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110
infrequent—e.g., in one particular instance (cases analysed in 1925) the onset occurred
in May of 1924, and in November of the same year the patient was reported by the
Medical Officer of Health to have completely recovered ; in December of the following
year (1925) the patient suffered a renewed attack with fatal result—i.e., eighteen
months after the original attack. Other instances of relapses could be cited.
The following analysis will be of interest as showing the after-effects of the disease in the different age groups:—
| Age groups. | 1 | 5-15. | 15-25. | 25-35. | 35-45. | j 45-55. | Over 55. | Total. |
|---|---|---|---|---|---|---|---|---|
| No. of cases developing sequelae | 5 | 9 | 19 | 11 | 11 | 8 | 3 | 66 |
| Sleep rhythm affected | 2 | 4 | 9 | 7 | 3 | 6 | 2 | 33 |
| 3 | 8 | 10 | 7 | 6 | 6 | 2 | 42 | |
| A.—M.D. or imbecile | 1 | — | 2 | — | — | — | — | 3 |
| B.—Retardation, memory affected, etc. | — | 2 | 5 | 4 | 3 | 1 | 2 | 17 |
| C.—Emotional, depressed, eccentric, apathetic, spiteful, irritable, etc. | 1 | 6 | 8 | 5 | 6 | 5 | 1 | 32 |
| D.—More serious conduct changes | 2 | 1 | – | – | – | – | – | 3 |
| 1 | 6 | 11 | 8 | 9 | 3 | 3 | 41 |
The table indicates that older persons were affected by mental changes to the
same extent as children (though possibly not quite in the same degree). Out of 66
cases, 33 were under 25 years of age, and 33 over 25 years, and mental sequelae were
exhibited in exactly 21 cases in each group, whilst on the physical side there was a
slight preponderance among the older persons.
It will be of interest, in considering the after-effects of the disease, to refer
to the table on p. 110 of the Annual Report of the School Medical Officer for 1924, in
which the mental and physical sequelae in 193 cases are classified.
It may be noticed that, although in a few instances the intellect has been
seriously impaired and, in others, there has been disturbance of conduct, a certain
number, even though showing after effects, have been able to continue at work or
at school with satisfactory progress, and that in one instance, at any rate, a sufferer
has been able to gain a scholarship.
The most distressing feature of epidemic encephalitis is the tendency to relapse,
or for the onset of sequelae to occur after an interval of apparent health. The most
characteristic and peculiar of these is the condition termed "Parkinsonism," in
which the sufferer has a slow speech, unsteady gait, a tendency to stagger back on
initiating or stopping movements of progression, a mask-like unemotional face,
tremors of the limbs and the like, the whole resembling the senile condition. This
sequela seems peculiar to epidemic encephalitis, but many of its other after-effects
are to be found in other disorders, some of a mildly infectious nature, which affect
the nervous system, the whole picture depending on the part of the system affected,
a point which is referred to under the next heading. Some of the features are due
to the irritation or paralysis of function of the nerve cells, owing to poisons
Relation of
some of the
symptoms
find sequelæ
of epidemic
encephalitis
to those of
other
disorders in
children.