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Consultation
risits
During 1925, at the request of borough medical officers of health and general
practitioners, 18 visits were paid in the metropolitan area to assist in the diagnosisof
suspected cases of notifiable disease, e.g., particularly encephalitis lethargica,
and less often, cerebrospinal meningitis and poliomyelitis. Five visits were paid
in the borough of Paddington, three in Westminster and Hampstead, two in Islington
and one in each of the boroughs of Lambeth, Woolwich, Stepney, Hackney and
Ealing. Of the eighteen patients visited at their homes, 13 were regarded provisionally
as suffering from encephalitis, 10 in the acute stage and 3 in the later stages;
of the disease. Two were thought to be possible cases of cerebrospinal meningitis,
and two tuberculous or other form of meningitis. Poliomyelitis and septicaemia.
following tonsillectomy were temporarily diagnosed in the remaining two cases.
The ages of the patients ranged from 15 months to 69 years.
Encephalitis lethargica (Acute stage.)—In seven out of 10 cases, the consultation
opinion supported the provisional diagnosis of encephalitis and notification was.
advised. Lumbar puncture was performed in two cases and yielded practically
normal cerebrospinal fluid. Diagnosis was confirmed by subsequent events resulting
in apparent recovery in two and death in three cases. Of the two not so confirmed,
one patient was ultimately decided to be suffering from mental disorder not attributable
to encephalitis, and the other died two months later from cerebral haemorrhage,
a previous attack of which was probably responsible for the original condition
diagnosed as encephalitis.
Diagnosis of encephalitis confirmed.
1. Male, aged 30 (professional football player). Symptoms.—Sleeplessness (4
nights). Internal squint and diplopia. Nystagmus. Slight disorientation.
Tremor of hands. Temperature 99.2. (two weeks). Result.—Slow recovery.
Attempt to resume employment but proved unfit.
2. Female, aged 53. Symptoms.—Pain in head. Lethargy. Nausea. Transient
diplopia. Clonic muscular spasms. Temporary defective speech. Result.—
Partial recovery, but mental instability.
3. Female, aged 60. Symptoms.—Headache. Increasing lethargy. Inability to
speak or show response. Result.—Death three months after onset.
4. Female, aged 65. Symptoms.—Inability to walk. Insomnia. Temporary
squint and diplopia. Loss of memory, lethargy and coma. Result.—Death two
weeks after onset.
5. Male, aged 53. Symptoms.—Headache. Insomnia. Later gradual and increasing
lethargy. Clonic muscular spasms. Lumbar puncture—normal
cerebrospinal fluid. Result.—Death one month after onset.