Cerebro-spinal meningitis/influenza in Epsom, early 1915

From the outbreak of the Great War young men were gathered together in close contact and a widespread epidemic of 'Spotted Fever', otherwise Epidemic Cerebro-spinal Fever or Meningococcal Meningitis, developed. In in the United Kingdom between August and December 1914 22 cases were reported to have occurred amongst the armed forces with 12 fatalities. During 1915 the number increased to 1,088 for the year of whom 434 died. Epsom was caught up with the disease following the arrival of University and Public Schools Battalions and the following examples of casualties arose in 18th Royal Fusiliers: -

Pvt. Geoffrey Lennard Davis [P/S?] 3753
Baptised at Richmond 7 February 1896 - Died 19 January 1915

Geoffrey was the son of Graham James Davis, Solicitor, of Messrs.Edward Lee, Davis & Lee, of Gresham Buildings, London.
Surrey Advertiser - Saturday 23 January 1915:
"Death of Pte. Geoffrey Davis: promising career cut short.
A noble young life, ready for the service of King and country, was cut short by the death on Tuesday of Geoffrey Lennard Davis (Geof.), a private in the 1st Battalion Universities and Public Schools' Brigade (18th Royal Fusiliers), and younger son of Mr. and Mrs. Graham Davis, of The Old Manor House, East Molesey. On his 19th birthday, in November last, he joined the battalion named, and, being nominated for a commission in the regiment in which his only brother holds the rank of Second lieutenant (the 9th Middlesex), he worked extremely hard not only to keep himself a fit and efficient soldier, but also, in the little time he had apart from that training, to prepare himself to take up his commission. Unfortunately, on Friday last week he contracted influenza at Epsom, where his regiment is garrisoned, and complications supervened. He was brought home on furlough the same day by Dr. Knox, under whose care he remained until he died on Tuesday…"

Pvt. Leslie Cecil Munns [P/S?] 1851 of D Company
Born 28 May 1886, Died 21 January 1915

Leslie died from influenza, following meningitis, at Glenwood, St Martin's Ave, Epsom, apparently whilst billeted on Miss Sophia Tudor. He had left Haileybury and Imperial Service College in 1904. His late father Arnold Summers Munns, of Fredericks-place, Old Jewry, solicitor, was a partner in Messrs. Munns and Longden, and he appears to have been articled as a solicitor to that firm, passing the final Law Society examination in 1909. Interred, aged 28, in St John the Evangelist churchyard, Sidcup, Kent, on 23 January 1915.

Pvt. George Edward Cohen [P/S?] 1365
Born Didsbury 1897 - Died 3 April 1915

George had spent a year studying in Switzerland at the Ecole de Commerce at Neuchatel after he left Bedales School but when war broke out volunteered for the University and Public Schools Men's Force. He had been in training at Epsom with 18th Battalion of the Royal Fusiliers when he fell ill and seemed to be on the way to recovery but then relapsed. He died, with his father at his bedside, in the London [Silver Street, Edmonton?] Military Hospital on 3 April 1915, a month short of his 19th birthday, reportedly from meningitis. Registration of his death was for the June Quarter of 1915 in Islington.

In 1916 a Report on Cerebro-Spinal Fever and its epidemia: prevalence among the civil population in England and Wales, with special reference to outbreaks in certain districts during the first six months of for the year 1915 was produced by Dr. R. J. Reece . He observed:- "The outbreak of war in the summer of 1914 brought about a redistribution of the, population. Young men of military age, joining the Colours, became grouped in camps, and troops were concentrated in various parts of England for military reasons. On the advent of winter many of the troops were billeted on the civil population. Overcrowding in barracks, in 'hutments', and in billets took place, pending such time as it became possible to make suitable arrangements for the accommodation of large bodies of troops. Cerebro-spinal fever has, been termed by competent observers abroad as a disease of children and recruits. The result of the altered conditions was keenly watched, and by the end of the year 1914 it became manifest that cerebro-spinal fever in epidemic form had to be reckoned with."

Brian Bouchard. © December, 2016.

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Meningitis - Background Information

Meningitis is an acute inflammation of the protective membranes (called the meninges) covering the brain and spinal cord. The most common symptoms are fever, headache and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises.

Meninges Diagram
Meninges Diagram
Image by Mysid (original by SEER Development Team) Source: US NIH via Wikipedia

The disease is sporadic and seasonal (most cases occur in the first quarter of the year) and often occurs in jails, barracks and overcrowded urban centres. It is more likely to happen after a bout of flu or other event that lowers the body's resistance to infection (e.g. injury, illness, vaccination, fatigue, and stress). The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs.

Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. In a paper published in the British Medical Journal in 1915 by the eminent Sir William Osler he says that although meningitis is not very common it has a higher death rate than any acute infection except plague and cholera and has the capacity to kill within 24 hours and describes a case where a young man died with 12 hours. As with some other diseases people can carry the organisms without suffering the disease.

In the UK Meningitis only became a modifiable disease in England and Wales during September 1912 so accurate figures before then are not available. The following table gives details of civil cases of meningococcal meningitis, the type caused by bacteria, in England and Wales:

Meningococcal Meningitis Civil Cases
Year Number of Cases Age Group Fatality
Male Female 0-5 5-15 15+
1912 139 (55.6%) 111 (44.4%) 46.8% 27.6% 25.6% 70%
1913 154 (55.8%) 122 (44.2%) 43.1% 35.1% 21.8% 69.6%
1914 173 (57.7%) 127 (42.3%) 51.3% 31.3% 17.3% 68.7%

In the first half of 1915 there were 2045 civil cases (468 in the London area) so about 9 times the peacetime rate [Source: Reece Report to the Local Government Board 1916].

During the first world war the soldiers often were forced to sleep in overcrowded huts and barracks with poor heating and ventilation. The overcrowding meant that 2 or 3 times as many men would sleep in a hut as during peace time with the space between beds reduced from 36 inches to 6 inches and some men sleeping on the floor. By the end of the war it was realised that the incidence of meningitis rapidly rose in such conditions and spacing out the beds reduced the risk. During cold conditions the men would often crowd round the only heater in a hut and men sleeping in beds close to the heater were at higher risk.

In the UK the military approach during WW1 to cases of suspected meningitis was to immediately isolate the patient. After full diagnosis he would be sent to an isolation hospital and his bedding and that of his neighbours burned with blankets and clothing sent for disinfection. All the men sharing the room would be isolated and kept under observation and nasal swabs taken. Only after they came back negative would the hut be pronounced infection free. The isolated men would be paraded and drilled separately to others in their unit, they could not communicate directly with the cook house, their feeding utensils scalded with boiling water and each man used his own cups and plates. All waste mater was burned and separate latrines used and checks for vermin, lice etc carried out.