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I929
35
living during 1911 to 1914, and then suddenly increased to 45 in
1915. After that it gradually fell to 7 in 1923, and has been
between 7 and 11 in 1928 and 1927, so that the level of 15 years
ago has been established. The mortality since 1923 has been
slightly on the upgrade. The number of deaths in England and
Wales from the disease since 1923 have been
1923 284 1926 365
1924 301 1927 430
1925 354 1928 438
Although the illness occurs usually in epidemics, sporadic
or endemic cases occur frequently as these figures show. Outbreaks
are relatively common in America and in the continent of Europe,
but since the war there have been no extensive outbreaks in tnis
country. There were extensive outbreaks in Glasgow and Belfast
in 1907. During the European war a large increase occurred not
only among the troops but also among civilians. Some authorities
were of opinion that the disease was introduced from Canada, or
at any rate, that a virulent strain was imported.
The disease is compulsorily notifiable, but it is obvious
from the statistical review of the Registrar General that all cases
are not notified. In 1928 there were 438 deaths from the disease
in England and Wales, but only 412 notifications were received.
Last year there was no district in which the disease was
very prevalent. 75 cases were notified in London and 22 in the
County of Middlesex. This disease is most common in children,
the incidence being highest in children under 5 years of age. The
ages of the persons who died from the disease last year was as
follows :—
Under Over
1 1—2 2—5 5—15 15—25 25—45 45—65 65
year. years, years, years. years. years. years, years.
140 54 52 78 52 37 22 3
From the death returns it appears that the disease is slightly
more prevalent amongst males than females. The numbers of
deaths for the past four years were as follows:—
1928 246 males, 192 females
1927 259 „ 171 „
1926 211 ,, 154 ,,
1925 202 „ 152 ,,
The disease is caused by a germ called the Meningo coccus
or diplo-coccus intra-cellularis, discovered by Weischelbaum in
1887. There are probably many strains of this germ, and at least
four different kinds have been isolated. The germ is not very
tenacious, in fact, it is a very delicate organism, very easily
killed by heat or cold. Cultures die readily, and sub-cultures are
necessary every few days if the specimens are to be kept. It will