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none was sent in before the onset of the paralytic symptoms. In three instances
the symptoms were of sufficiently recent date to justify giving the convalescent
serum, supplied by the Lister Institute, a trial, but the results were inconclusive.
Cerebrospinal meningitis.
The number of notifications of cerebro-spinal meningitis during 1934, excluding
duplicate notifications and military cases, was 137, compared with 216 in 1933.
The numbers of notifications during the past ten years are shown in the following
statement:—
1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934.
Number of notifications 93 83 93 70 121 88 175 247 216 137
Notifications
Of four cases admitted to the Eastern hospital during the year two died. The
serum used for their treatment was a polyvalent serum.
Treatment.
Ihe medical superintendent of the North-Western hospital (Dr. Joe) has
reported as follows :—
In 1934 a somewhat smaller number than usual of cases of meningococcal meningitis came
under treatment, viz., 8, of whom 3 died. In 6 cases the infecting organism was typed by Dr.
Scott of the Ministry of Health, 4 cases showing a group I, and 2 a group II meningococcus. Of
recent years since cerebro-spinal fever has only appeared in sporadic form in London it has,
fortunately, not been possible to study this disease on any large scale. In the North-Western
hospital during the years 1932, 1933 and 1934, exactly 50 cases have been admitted. The gross
fatality rate was 50 per cent., a disappointing result, made however more encouraging for the
future by the observation that in fatal cases sometimes a very small margin seems to separate
failure from success. It has occasionally appeared that this margin would be covered by the more
intensive drainage and opportunity for serum administration afforded by more frequent lumbar,
cisternal and ventricular puncture, and by the use of the intravenous route. On the whole,
however, whilst these have sometimes appeared advantageous when evaluated on clinical grounds
in individual cases, it cannot be said that they have improved the fatality statistics to any great
extent. In the series of 50 cases mentioned an attempt has been made to estimate the main
factors affecting prognosis. These appear to be the age of the patient and the type of infecting
organism. With regard to the age of the patient the most favourable age period was between
5 and 20, 17 patients in this group showing a case fatality rate of 29'4 per cent. Those under
5, 17 in number, showed a fatality rate of 58-8 per cent., whilst in 16 patients over 20 it was
62-5 per cent. Typing was carried out in 41 of the 50 cases, 28 belonging to group I and 13 to
group II. In group 1 infections the case fatality was 42.8 per cent., whereas in group II, it
reached the high figure of 84-6 per cent. The importance of these two factors must be borne in
mind in evaluating the effect of any form of therapeutics. Surprisingly, the day of disease on
which serum administration was begun did not seem to bear out the commonly accepted view
that advantage is derived from the early injection of serum, for in 22 cases in which serum was
given on or before the 3rd day, the case rate fatality was 45.4 per cent, as against 53.5 per cent,
after the 3rd day, a difference which is not statistically significant. To those who understand the
nature of meningococcal infection, however, this is readily explicable, on the ground that the
group containing the early treated cases will also contain the fulminating types of the disease.
In these, medical aid and admission to hospital are promptly sought, but treatment can do little
to avert a rapid and fatal termination.
Four patients suffering from cerebro-spinal meningitis were under treatment at
the Brook hospital during the year, of whom three died. Three of the patients
showed a group I meningococcus ; in the remaining one the meningococcus was not
typed. In three out of the four cases an experimental antitoxin was used. The
small number of cases does not justify any definite conclusions, but the results seem
to point to the fact that it is not more efficacious than the serum previously employed.
Puerperal fever.
A report by the medical superintendent of the North-Western hospital (Dr. Joe)
and the obstetrician (Mr. J. M. Wyatt, F.R.C.S.) on the work of the puerperal unit
at that hospital during 1934, on the lines of similar reports which have appeared
in Vol. IV, Part I, of the report for the years 1931-3, appears in Vol. IV., Part III,
of this report.
Research into chronic encephalitis lethargica.
The medical superintendent of the Northern hospital (Dr. G. A. Borthwick)
has reported that the research work in the special unit at that hospital into the
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