a;# LETHARGIC ENCEPHALITIS The Glasgow Epidemic of 1923 Its Incidence and Consequences, from the point of view of Public Health Miss) ASHIE m a in , M.A., M.B.Ch.B., D.P.H. (Glas. Univ.) ProQuest Number: 27660824 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27660824 Published by ProQuest LLO (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLO. ProQuest LLO. 789 East Eisenhower Parkway P.Q. Box 1346 Ann Arbor, Ml 4 8 1 0 6 - 1346 LETHARGIC ENCEPHALITIS. The Glasgow Epidemic of 1923. I ntroduction . A new and strange disease, occurring in epidemic form and profoundly affecting the central nervous system, has, for a full decade, continued to puzzle and evade inquirers throughout various parts of the world. Epidemic encephalitis appeared in Austria in 1917, and In the following year in France and in England. Since then, a great many attempts have been made to obtain data of a previous epidemic of a similar kind, but, m all the history of medicine, nothing has ever been found to compare to this devastating disease in the peculiar character of its manifold phenomena. No disease has been fraught with so many difficulties, particularly directed to the neurologist, as lethargic encephalitis. Epidemic encephalitis made its appearance in Glasgow in 1918, although it was only in 1919, that its prevalence was such as to lead to its recognition. It recurred annually till 1924, and, during this period, the change in the clinical features from year to year suggested ' that it had passed through an evolutionary phase. While ocular symptoms were probably the features most common to all epidemics, prolonged lethargy and somnolence characterized the earlier cases ; choreiform and myoclonic movements were more prevalent in 1920 and in 1921, while, in 1924, there appeared for the first time a considerable proportion of cases with spinal signs and symptoms, which simulated acute attacks of insular sclerosis. When the epidemic of 1923 began, the medical profession in Glasgow was well prepared for its dhignosis. rimrbDnsvreresirppIkxlliytlusIWbcUcal Officer of B:ealtliivlbha memorancium, in which were set forth the manifestations of the disease, which had been noted in the previous epidemics. Provision was made for notification and for hospital treatment, and, in this way, it was possible to form a fairly accurate estimate of the extent and character of the outbreak. The following study is concerned with the cases of the 1923 epidemic, and with these only in a general and limited sense. An attempt is made to present a general view of the (Kiurse oftlie disease, acccuxlhig as it terminated in early recoTnsrriiiscnimciWKa, hiiippanm t convalescence in others, or as, in the majority, it followed a protracted course along diverging lines in the form of characteristic sequelae. To obtain the purpose of the review, it has been necessary to confine the description of the sequelae to outlines of the mam neurological and psychological features. So varied were the phenomena as a whole, and so fleeting inaiiy of Idie niost]prominent pKiÜhologicalsigiw, th at it is exjiedient.in describing the gpmeral course of the disease as an epidemic, to confine attention to the hall-marks, in which its identity is disclosed. The data employed in the analysis have been obtained from several sources. The original list of aU the cases, notified to the Medical Officer of Health, and accepted after observation as possible cases of acute encephalitis, was used as a basis. Along with this list, I have had the notes from hospital records, as weU as the private notes belonging to Dr. Ivy Mackenzie, referring to the initial illness (Table A). A year after the epidemic, Dr. Mackenzie examined all the cases, and I have used the results of his observations as a basis of the review of the condition of the cases in the Spring of 1924. In the construction of this review, I have gone over all the earlier hospital records, and have supplemented the information in Dr. Mackenzie s records by further data, elicited from the patients and their friends (Table B). This reconstructive review of the position, as it was in 1924, has been taken as a basis for the estimate of the later effects, as observed four years later that is in the Spring of 1928 (Table C). In the course of the investigation of Spring 1928, all the cases, reported and accepted as suffering from epidemic encephalitis in the Spring of 1923, have been accounted for. All those surviving, with the exception of two, whose relatives were interviewed, have been examined. I am obliged to the superintendents of the various hospitals and asylums, in which the patients have been resident, for access to the records, to Professor Leonard Findlay for notes on children, the course of whose subsequent history has been followed, and to Dr. Ivy Mackenzie.for the use of his records, and for his assistance and suggestions in my own examination of the patients, and in the interpretation of the varied courses, which their diseases have followed. In this way, it has been sought to delineate the course of a phase of the epidemic, and so, by observing the character of the scar, which its imprint on the populace has produced, to provide a standard of reference, by which this form of encephalitis may be compared with polio - encephahtis on the one hand, and, on the other, with the type which follows in the wake of influenza. It is-necessary to make a reservation, in claiming for the description a representative character ; for, as suggested already, the phase of 1923, while typical for the disease as a whole, differed in some respects from the other annual visitations ; it did not bring the profound and prolonged somnolence, as in victims of the earher phase, and there was an absence, from the series, of cases simulating disseminated sclerosis, such as characterized the phase of 1924. It has, however, the advantage that practically all the cases, which occurred in that period, must be included, and that it has been possible to follow their fate for a period of five years. Three appendices have been added. Appendix I. in which are given detailed histories of all the seventy cases in the series, examined at one and five years after the initial illness. Appendix II., in which are qet forth details of the chnical examination, observed both in the initial stage of the disease and at the time of the examination five years later, with a classification of the cases referable to the present condition. Appendix III., which is a summary of the particulars of these initial symptoms and the finding five years later, a statistical comparison having been made between the initial symptoms and the sequelae. The following (Table A) comprises all the cases (70) of the original list, which were notified to the Medical Officer of Health in 1923 as possible cases of Encephahtis Lethargica, and includes a summary of the symptoms present during the initial phase of the illness. TABLE A. List of names, including a summary of the initial symptoms (1923), and index to present classification with reference to Appendix II. -g I 1-3 ... ! . h g bC I n d e x to A p p e n d ix II. § 5 § Name. 1 •S o -g Classification according to 1 o § present condition. 03 IIP?P 1 1 Î 1 1 Ü II 1 j t j II I J Perversion of Conduct. 1 Attwell, David 8 p — + + p — + ————-- Died. 2 Blackwood, John - 11 — + ■ Hr + — p —— + — Died. 3 Blane, Mary - 11 + —— + — -r p — + 4 Blue, John - 28 P — + + — + + Parkinsonian (A). + + + Eliminated. 5 Boyle, John - 24 Died. 6 Buchanan, Mrs. - 33 — + — + — p —— p Recovery complete. 7 Cameron, Donald - 47 + — + — + — + — + 8 Campbell, Lily - - 10 — + + + + + + — 4- Parkinsonian (A.) Recovery incomplete (B.) Carnegie, John 7 — + + —— p —— + + 9 Recovery incomplete (C). 10 Cohen,Isaac 19 — p + p —— + — + —- P - Parkinsonian (A). 11 Crawford, Janet 24 — + + + Recovery incomplete (E). Crossan, Eliz. - - 12 -p — — + ———— — 12 Recovery incomplete (C). Curran, Sarah - - 26 _L —— p ——P + p 13 Recovery incomplete (C). 14 Dillon, Agnes (Mrs.) - - 27 —— -f — p — — + — + Recovery incomplete (E). 15 Drummond, Hannah - 11 — + p p + p — — + — + P Eadie, Archibald - 7 — + — + —P— + —— + Parkinsonian (B). 16 Parkinsonian (B). Forsyth, Eliz. - - 7 — + — -r —— — —- 17 + Recovery incomplete (C). Fraser, Janet - - 19 — 18 + + Perversion of conduct. 19 Gallacher, Thomas - + — P Gibson, Ninian - 13 ———— + + — + Parkinsonian (B). 20 Died. 21 Higgins, Sarah - - 56 — p + P — + —— P — Hitchcock, Jeanie - 16 — ——— p — + + — Recovery incomplete (C . 22 + + Recovery incomplete (C). 23 Houston, Millicent - - 23 + — + — — + — + + + — — Hutchison, David - 23 P + — + + + —— —— Parkinsonian (A). 2^ + + Parkinsonian (A). Joyce, George - - 11 — + — + — + + — p —P 25 + Recovery incomplete (A). Kearny, Maiy - - — + + — —— 26 1& Died. 27 Kelly, Jack - 8 + + —P + — - 12 — + — p + P Recovery complete. 23 Leckie, Sarah - + Recovery incomplete (C). 29 Lloyd, James - - 12 + — + p p + — + + M'Alister, Eliz. - 15 — P p — P + + + Recovery incomplete (C). 39' - Parkinsonian (A). M'Alpine, Robt. - 40 -P P -f ——— — P 31 Recovery complete. M'Caithy, Jane (Mrs. Muir) - 19 ——— + — — + ■ -i- — 32 Recovery incomplete (C). M‘Coll, Mary - - 14 + — + —— -r — — + 33 Died. 34 M'Crorie, David - 27 — + + + + T - 81 Eliminated. 35 McDonald, Hay Recovery incomplete (A). 36 McDonald, Margt. - - 8 + —— + — -r —— -r — - 13 — p + — P — Parkinsonian (A). 37 M'Ewan, Hugh + + + + Parkinsonian (A). MTadden, Joseph - - 12 — + + —■ — p ——P — 33 Died.