London's Pulse: Medical Officer of Health reports 1848-1972

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Acton 1924

[Report of the Medical Officer of Health for Acton]

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11
notified also died, but the death was certified to be Meningitis.
The patient was admitted to the Infirmary, and the diagnosis of
Encephalitis Lethargica was not confirmed by the Medical Superintendent.
Only 2 of the patients recovered, but it is possible, and
even probable, that other cases occurred in which the symptoms
were of a mild character.
One of the cases notified here, was of an extremely mild type,
and the characteristic symptoms could easily have been missed by
the doctor in attendance, had the latter not recently seen some other
encephalitis cases.
In another of the cases two specialists, who were called in,
had failed to recognise the nature of the illness, and it was only when a
third specialist who had had exceptional experience in this type
of disease was called in that the illness was diagnosed as Encephalitis
Lethargica.
There are many reasons for the difficulties which may arise
in the diagnosis of the illness. The most important is the endless
variety which the symptoms show.
The original conception of the clinical syndrome now known
as encephalitis lethargica has broadened considerably with increased
experience. In some quarters doubt has been expressed as to the
existence of the disease as a separate entity. Some authorities
have claimed that Encephalitis Lethargica, Spotted Fever and Infantile
Paralysis are simply variants of Influenza. It is now generally
admitted, though, that the disease is a separate entity,
having well-marked and well-recognised symptoms. These symptoms
vary not only in their severity, but also in their character.
In severity the symptoms may vary from those of the mild type
which is often missed and in which no after effects are left to those
in which the disease is rapidly fatal.
The symptoms also may be those of a generalized infection,
or those more directly referable to the central nervous system. In
the latter, lethargy is a prominent symptom in many of the cases ;
the term lethargic is still used in describing the disease. This
however, is by no means a constant symptom. Indeed, insomnia
is an equally striking phenomenon in many cases, and in some
patients both conditions may be present at different times.
From a public health point of view, one of the most serious
questions is the mental after effects of the disease. The conception
of the disease has undergone very considerable modification
since the earlier cases were met with in the spring of 1918. At that
time the disease was regarded as a more or less acute affection,
which, should the patient survive, left residue in its wake somewhat
after the manner of infantile paralysis, although more or less
oomplete recovery might be eventually anticipated in the majority
of cases.