Outbreaks in the summer and early fall of an acute febrile disease with peculiar, meningitis-like symptoms and a high mortality rate have long been known in Japan. In the epidemic of 1919 a few years after the reports of epidemic (lethargic) encephalitis in Vienna had come from Economo, medical men and neurologists in Japan first realized that they had been dealing with a type of acute encephalitis differing in seasonal incidence and clinical manifestations from epidemic encephalitis common in Europe. In 1924 there was a widespread epidemic in Kagawa and other provinces, the largest one ever recorded, in which extensive clinical and pathologic investigations were carried out. Occurrence during the summer, abrupt onset with high fever, stormy course with meningitic as well as encephalitic symptoms, and only occasional, transient, ocular manifestations, rapid recovery leaving few residual effects such as parkinsonism, and a striking increase in both incidence and fatality rates
HASHIMOTO H, KUDO M, URAGUCHI K. EXPERIENCES IN THE SUMMER EPIDEMICS OF ACUTE ENCEPHALITIS IN TOKYO. JAMA. 1936;106(15):1266–1268. doi:10.1001/jama.1936.02770150026009
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