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INFLUENZAL MENINGITIS.
189 INFLUENZAL MENINGITIS.
As everybody knows, the construction of the Panama Canal was vastly facilitated by the excellence of the medical service which had charge of the health of all the workers. This service succeeded in cutting down infectious disorders, with malaria at their head, to an extremely low point, and has kept a record of the most interesting cases or types of disease with which it has had to deal during the years of its activity. Between 1908 and 1913 60 cases of meningitis were treated at Colon Hospital;7 of these were influenzal, and’ 5 are described and discussed in a paper by Dr. R. B. Hill and Dr. R. J. Pickard.! Influenzal meningitis, due to the bacillus ifluenzae, is a very fatal disease; 7 out of 63 recorded ca,ses and 1 out of the 7 cases treated at Colon have recovered. Its pathological anatomy is very variable. In some the dura mater is mainly involved, in others the pia-arachnoid ; thick yellow-green pus may be seen, or a merely serous exudate. The brain may be chiefly involved, or the spinal cord, or both together; the involvement of these organs may be either general or localised in irregular patches. The influenza bacillus may always be recovered from the cerebro-spinal fluid, which is increased in amount in these cases, and often from the circulating blood as well. It is thought that the infection of the meninges and blood arises from a previous influenzal infection of the respiratory tract. The symptoms of influenzal meningitis The onset, occasionally ful. are also very variable. minating, is usually gradual, with bronchitis, headache, low irregular fever, malaise, and in children diarrhoea. There may be irregular fever and rigors simulating malaria; the spleen may be enlarged and rose-spots may appear, so that enteric fever
THE PREVENTION OF CONSUMPTION : PROFESSOR DENYS’S ADDRESS.
AT the sixteenth annual meeting of the members of the National Association for the Prevention of Consumption, which was held on Thursday, July 15th, at the office of the association, Professor Denys, of the University of Louvain, delivered an interesting little summary of the present position. He pointed out that until comparatively recently
tuberculosis was universally regarded as a constitutional disease, but that Koch’s discoveries had put the matter at once upon a new basis. The peccant microbe having been identified, further researches into its qualities had revealed certain very important facts-namely, that it multiplies only in the tissues of living beings, and that it requires many special conditions for its propagation, for it will not bear competition with other microbes or withstand the influence of light or the process of desiccation. These facts, Professor Denys showed, reduced the propagation of tuberculosis to two main sources-the sputum of infected human beings and the milk of infected cattle-and in both directions care and organisation were known to effect their successful influence. He concluded by indicating that in order to rid the world of tuberculosis no extreme measures are required, and this is especially important where a movement has to be quite general in its working and dependent for its activities on The prevention the good-will of the population. of consumption, he said, "is only a question of good-will, knowledge, and understanding. On goodwill we may count, especially under the stimulus of example and persuasion. With regard to knowledge, much has already been done in the way of educating public opinion, but much still remains is closely imitated. Characteristic meningitic to be done. New ideas, opposed to familiar habits, symptoms are habitually seen-rigidity of therequire much time to penetrate into the practice muscles of the back and neck, Kernig’s andof the people. No opportunity should be lost of Babinski’s signs, ocular palsies, and photophobia ;reminding them that tuberculosis is a contagious. the pulse, usually rapid in infants, in whom thedisease, but that, by adopting simple precautions, disease is common, is generally slow in adults withthey have every chance of escaping infection. In influenzal meningitis. Herpes is rare ; the hydro-fact, it would be a good thing if these simple of cleanliness were to be universally l cephalic cry is frequently noted, convulsions may precautions The urine shows a diazoadopted. In my opinion the newspapers might occur, and vomiting. an important part in this campaign. l They reaction, or febrile albuminuria. The blood exhibits play a moderate leucocytosis, usually under 15,000, unlessmight publish from time to time the results of some ( the many medical inquiries which prove in so. some complication is present; in the blood, as inof the cerebro-spinal fluid, the leucocytosis is poly- convincing a manner that some careless conmorphonuclear. Dr. Hill and Dr. Pickard point out ;sumptive has infected his comrades in the workthat the prognosis in influenzal meningitis is bad;shop, or that a tuberculous cow has been the source but that as the pathological lesion may be small and of a series of cases of infantile tuberculosis." Provery localised in the disease, it is probable that morefessor Denys makes insufficient allowance for the frequent lumbar puncture and more careful bacterio-limitations of journalism. A certain number of logical examination of the cerebro-spinal fluid in such cases are published in newspapers, both obscure cases of cerebral irritation would prove medical and lay. but the risks of incurring actions the comments being of a nature that influenzal infections of the brain are commonerf:or libel than they are thought to be. Treatment of the t bring home surely to the public mind the carecondition is unsatisfactory. Urotropin seems to be 1essness and callousness of many of its members. of doubtful value. Frequent lumbar puncture to relieve pressure would seem to be more MUNICIPAL CONTROL OF THE MILK-SUPPLY. promising and should always be tried. Specific THE of hygiene at the University of therapy by vaccine or antiserum should have aIParma, professor Dr. E. Bertarelli, has recently occupied future before it; Wollstein, for example, has preIhimself with the problem of preventing disease pared an antiserum with high opsonin content Jdisseminated by impure milk, and asks what can be that cured experimental influenzal meningitis in in this respect, due consideration being e effected monkeys, but no case of the employment of this to the economic conditions and mental g given serum in human beings has yet been recorded. attitude of the public towards it/ Large coma studied the question and 1 R. B. Hill, M.D., and R. J. Pickard, M.D., Proceedings of the munities that have
prevent
Medical Association, Isthmian Canal Zone, 1912-13, Mount Hope, C.Z., 1914, vol. v., Part ii., p.100.
1 Il
Morgagni, June, 1915.
As everybody knows, the construction of the Panama Canal was vastly facilitated by the excellence of the medical service which had charge of the health of all the workers. This service succeeded in cutting down infectious disorders, with malaria at their head, to an extremely low point, and has kept a record of the most interesting cases or types of disease with which it has had to deal during the years of its activity. Between 1908 and 1913 60 cases of meningitis were treated at Colon Hospital;7 of these were influenzal, and’ 5 are described and discussed in a paper by Dr. R. B. Hill and Dr. R. J. Pickard.! Influenzal meningitis, due to the bacillus ifluenzae, is a very fatal disease; 7 out of 63 recorded ca,ses and 1 out of the 7 cases treated at Colon have recovered. Its pathological anatomy is very variable. In some the dura mater is mainly involved, in others the pia-arachnoid ; thick yellow-green pus may be seen, or a merely serous exudate. The brain may be chiefly involved, or the spinal cord, or both together; the involvement of these organs may be either general or localised in irregular patches. The influenza bacillus may always be recovered from the cerebro-spinal fluid, which is increased in amount in these cases, and often from the circulating blood as well. It is thought that the infection of the meninges and blood arises from a previous influenzal infection of the respiratory tract. The symptoms of influenzal meningitis The onset, occasionally ful. are also very variable. minating, is usually gradual, with bronchitis, headache, low irregular fever, malaise, and in children diarrhoea. There may be irregular fever and rigors simulating malaria; the spleen may be enlarged and rose-spots may appear, so that enteric fever
THE PREVENTION OF CONSUMPTION : PROFESSOR DENYS’S ADDRESS.
AT the sixteenth annual meeting of the members of the National Association for the Prevention of Consumption, which was held on Thursday, July 15th, at the office of the association, Professor Denys, of the University of Louvain, delivered an interesting little summary of the present position. He pointed out that until comparatively recently
tuberculosis was universally regarded as a constitutional disease, but that Koch’s discoveries had put the matter at once upon a new basis. The peccant microbe having been identified, further researches into its qualities had revealed certain very important facts-namely, that it multiplies only in the tissues of living beings, and that it requires many special conditions for its propagation, for it will not bear competition with other microbes or withstand the influence of light or the process of desiccation. These facts, Professor Denys showed, reduced the propagation of tuberculosis to two main sources-the sputum of infected human beings and the milk of infected cattle-and in both directions care and organisation were known to effect their successful influence. He concluded by indicating that in order to rid the world of tuberculosis no extreme measures are required, and this is especially important where a movement has to be quite general in its working and dependent for its activities on The prevention the good-will of the population. of consumption, he said, "is only a question of good-will, knowledge, and understanding. On goodwill we may count, especially under the stimulus of example and persuasion. With regard to knowledge, much has already been done in the way of educating public opinion, but much still remains is closely imitated. Characteristic meningitic to be done. New ideas, opposed to familiar habits, symptoms are habitually seen-rigidity of therequire much time to penetrate into the practice muscles of the back and neck, Kernig’s andof the people. No opportunity should be lost of Babinski’s signs, ocular palsies, and photophobia ;reminding them that tuberculosis is a contagious. the pulse, usually rapid in infants, in whom thedisease, but that, by adopting simple precautions, disease is common, is generally slow in adults withthey have every chance of escaping infection. In influenzal meningitis. Herpes is rare ; the hydro-fact, it would be a good thing if these simple of cleanliness were to be universally l cephalic cry is frequently noted, convulsions may precautions The urine shows a diazoadopted. In my opinion the newspapers might occur, and vomiting. an important part in this campaign. l They reaction, or febrile albuminuria. The blood exhibits play a moderate leucocytosis, usually under 15,000, unlessmight publish from time to time the results of some ( the many medical inquiries which prove in so. some complication is present; in the blood, as inof the cerebro-spinal fluid, the leucocytosis is poly- convincing a manner that some careless conmorphonuclear. Dr. Hill and Dr. Pickard point out ;sumptive has infected his comrades in the workthat the prognosis in influenzal meningitis is bad;shop, or that a tuberculous cow has been the source but that as the pathological lesion may be small and of a series of cases of infantile tuberculosis." Provery localised in the disease, it is probable that morefessor Denys makes insufficient allowance for the frequent lumbar puncture and more careful bacterio-limitations of journalism. A certain number of logical examination of the cerebro-spinal fluid in such cases are published in newspapers, both obscure cases of cerebral irritation would prove medical and lay. but the risks of incurring actions the comments being of a nature that influenzal infections of the brain are commonerf:or libel than they are thought to be. Treatment of the t bring home surely to the public mind the carecondition is unsatisfactory. Urotropin seems to be 1essness and callousness of many of its members. of doubtful value. Frequent lumbar puncture to relieve pressure would seem to be more MUNICIPAL CONTROL OF THE MILK-SUPPLY. promising and should always be tried. Specific THE of hygiene at the University of therapy by vaccine or antiserum should have aIParma, professor Dr. E. Bertarelli, has recently occupied future before it; Wollstein, for example, has preIhimself with the problem of preventing disease pared an antiserum with high opsonin content Jdisseminated by impure milk, and asks what can be that cured experimental influenzal meningitis in in this respect, due consideration being e effected monkeys, but no case of the employment of this to the economic conditions and mental g given serum in human beings has yet been recorded. attitude of the public towards it/ Large coma studied the question and 1 R. B. Hill, M.D., and R. J. Pickard, M.D., Proceedings of the munities that have
prevent
Medical Association, Isthmian Canal Zone, 1912-13, Mount Hope, C.Z., 1914, vol. v., Part ii., p.100.
1 Il
Morgagni, June, 1915.