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AN UNUSUAL EPIDEMIC
415 years this favourable not started until then, the child will stand little chance of ever acquiring fluent
The dates in 1951 when these cases were first seen may be of interest : these were March 13 and 15 ; and Nov. 10, 19, and 28 ; and Dec. 19. C. B. FRANKLIN. Newcastle, Staffs.
auditory discrimination. By 3 period is-over; and if training is
speech.
Many deaf children’s residual hearing is good enough, if properly trained, for them to attend an ordinary school. But they would need training from 6 to 12 months, and this is still unobtainable in most parts of the country. Such children often receive no auditory training at all, all the teaching they receive being by methods intended for the totally or subtotally deaf. By arranging speech and auditory training for all deaf children from the right age, the country would save much But a far more valuable gain would later expenditure. be the number of children saved from a life of sign language and inferior jobs after leaving school, and enabled to play their parts in a normal environment. EDITH WHETNALL. London, W.I.
SIR,—Your annotation prompts
me
to
record five
conforming to the description you give. The patients, seen in March, 1947, in Malaya, were three British soldiers and two Indians, all in their twenties. cases
Onset was sudden and dramatic, with acute vertigo, and the first two were thought to be suffering from Ménière’s syndrome. There was initial fever of100°—101°F with some degree of pharyngitis and well-marked nystagmus to one or other side. There were no other’ abnormal signs in the central nervous system. The fluid was normal in two cases, and was not done in the other three. Bloodcounts were essentially normal; the erythrocyte-sedimentation rate was not above 10 mm. in the first hour. The temperature settled in 24-72 hours, and vertigo had usually disappeared within 48 hours. No special treatment other than rest was given.
cerebrospinal
,
AN UNUSUAL EPIDEMIC
I
SIR,—Your annotation of Feb. 9 gives a good account of acute epidemic labyrinthitis, though it omits pain in the back of the neck, which is a very constant symptom. In 1949 I described1 four cases of this condition occurring in a little epidemic in my practice, and suggested that they might be caused by the virus of influenza. The chief reasons were : (a) history of contact between these cases and cases of clinical influenza in the same households, and (b) the fact that vertigo is not uncommon in otherwise typical influenza. Letters which I subsequently received suggested that the condition was fairly widespread, though not all cases are equally severe. Dr. H. S. Gaskell, commenting on these cases, said :
" Although I find it mentioned in few, if any, books influenza is by far the most common cause of giddiness.... If a patient walks into the consulting-room holding on to the furniture and complaining of a pain in the back of his neck, there is no need for the G.P. to spend much time on the *
diagnosis."
Through the courtesy of Dr. R. M. Fry, of Cambridge, blood from two further cases in the same year was sent to the Virus Reference Laboratory, Colindale, but the results were negative. One girl who had a mild but prolonged attack had a sister living in Chelsea, who was also attacked, and this sister assured us that all the artists in that quarter were reeling about like drunks to the dismay of their baffled practitioners. The condition was known locally as " the staggers." Whatever the cause, it seems that the artistic output of Chelsea was for a while reduced to a mere trickle. Altogether in 1949 I saw twenty or thirty cases ; and each winter since then I have seen a few. This winter I have seen three bad ones, but only one of them was in my own practice. It is interesting to think that people up and down the country may be crashing to the ground in scores ; and yet, because each practice is its own little watertight compartment, awareness of the condition has not reached the medical consciousness of the country as a whole. PETER A. WALFORD. Felsted, Essex. SIR,—In the last eleven months I have seen six cases similar to those described in your annotation. The following features were present in all six : (1) very sudden, severe vertigo ; (2) mixed rotatory and horizontal nystagmus ; (3) vomiting without pronounced nausea; (4) apyrexial course ; (5) no tinnitus or deafness ; (6) no incbordination ; and (7) no evidence then or since of thrombosis of the posterior inferior cerebellar artery, disseminated sclerosis, or Meniere’s syndrome. There have been no recurrences. 1. Brit. med. J. 1949, i, 821.
thought syndrome.
at the time that these
had Gerlier’s
IDRIS JONES.
London, W.1.
SIR,—Your annotation
patients
was a
reassurance
to
myself
three of my colleagues in Oxford who were affected, after Christmas, with acute labyrinthitis ; for we had supposed that we were suffering from the premonitory symptoms of some obscure and unpleasant and
neurological complaint. On three successive mornings when getting out of bed or making a sudden turn of the head, I became giddy and tended to stagger. - The symptom, however, passed off during the course of the day, and in every other respect I was perfectly well. On mentioning the matter to my house-surgeon I learnt that he, too, had had six similar attacks over a period of two weeks, during several of which he had to hold on to something for fear of falling, to the ground. Further inquiry revealed that two other colleagues had had severe attacks of vertigo, one having fallen flat on getting up, regaining his bed only with difficulty. All have recovered completely. So far as I know, there was no evidence of previous sore throats or of auditory or other symptoms. No other members of their families were affected, although it is possible that I myself might have acquired the infection from my house-surgeon. .
,
Radcliffe Infirmary, Oxford.
A. S. TILL. A.
INDUSTRIAL HEALTH SERVICES
SIR,—I read with interest Dr. Parker’s letter in your issue of Feb. 9. It seems to’me that his approach is clearly that of a medical officer of health and not of an industrial medical officer. There is no doubt that industrial medicine is essentially preventive medicine, and mental and physical health are indivisible and
equally important.
’
Dr. Parker mentions management-labour relations and later suggests an annual inspection by the local health staff. Industrial medicine offers one of the most profitable fields for promoting health and good human relations ; and this is effected, not by annual inspections, or even routine inspections at long intervals, but by close personal contact when the medical officer has obtained the confidence of a firm. The statement that " there is no need to provide from our limited man-power a separate industrial. service : the basis exists in the public-health department " is unconvincing. The basis for medium and small firms exists equally in the present factory medical inspectorate with their unrivalled experience, and in the network of appointed factory doctors spread throughout the country. What is needed is additional nurses, doctors, health engineers, and other personnel to make the service truly effective. A group unit such as the Slough Industrial
The dates in 1951 when these cases were first seen may be of interest : these were March 13 and 15 ; and Nov. 10, 19, and 28 ; and Dec. 19. C. B. FRANKLIN. Newcastle, Staffs.
auditory discrimination. By 3 period is-over; and if training is
speech.
Many deaf children’s residual hearing is good enough, if properly trained, for them to attend an ordinary school. But they would need training from 6 to 12 months, and this is still unobtainable in most parts of the country. Such children often receive no auditory training at all, all the teaching they receive being by methods intended for the totally or subtotally deaf. By arranging speech and auditory training for all deaf children from the right age, the country would save much But a far more valuable gain would later expenditure. be the number of children saved from a life of sign language and inferior jobs after leaving school, and enabled to play their parts in a normal environment. EDITH WHETNALL. London, W.I.
SIR,—Your annotation prompts
me
to
record five
conforming to the description you give. The patients, seen in March, 1947, in Malaya, were three British soldiers and two Indians, all in their twenties. cases
Onset was sudden and dramatic, with acute vertigo, and the first two were thought to be suffering from Ménière’s syndrome. There was initial fever of100°—101°F with some degree of pharyngitis and well-marked nystagmus to one or other side. There were no other’ abnormal signs in the central nervous system. The fluid was normal in two cases, and was not done in the other three. Bloodcounts were essentially normal; the erythrocyte-sedimentation rate was not above 10 mm. in the first hour. The temperature settled in 24-72 hours, and vertigo had usually disappeared within 48 hours. No special treatment other than rest was given.
cerebrospinal
,
AN UNUSUAL EPIDEMIC
I
SIR,—Your annotation of Feb. 9 gives a good account of acute epidemic labyrinthitis, though it omits pain in the back of the neck, which is a very constant symptom. In 1949 I described1 four cases of this condition occurring in a little epidemic in my practice, and suggested that they might be caused by the virus of influenza. The chief reasons were : (a) history of contact between these cases and cases of clinical influenza in the same households, and (b) the fact that vertigo is not uncommon in otherwise typical influenza. Letters which I subsequently received suggested that the condition was fairly widespread, though not all cases are equally severe. Dr. H. S. Gaskell, commenting on these cases, said :
" Although I find it mentioned in few, if any, books influenza is by far the most common cause of giddiness.... If a patient walks into the consulting-room holding on to the furniture and complaining of a pain in the back of his neck, there is no need for the G.P. to spend much time on the *
diagnosis."
Through the courtesy of Dr. R. M. Fry, of Cambridge, blood from two further cases in the same year was sent to the Virus Reference Laboratory, Colindale, but the results were negative. One girl who had a mild but prolonged attack had a sister living in Chelsea, who was also attacked, and this sister assured us that all the artists in that quarter were reeling about like drunks to the dismay of their baffled practitioners. The condition was known locally as " the staggers." Whatever the cause, it seems that the artistic output of Chelsea was for a while reduced to a mere trickle. Altogether in 1949 I saw twenty or thirty cases ; and each winter since then I have seen a few. This winter I have seen three bad ones, but only one of them was in my own practice. It is interesting to think that people up and down the country may be crashing to the ground in scores ; and yet, because each practice is its own little watertight compartment, awareness of the condition has not reached the medical consciousness of the country as a whole. PETER A. WALFORD. Felsted, Essex. SIR,—In the last eleven months I have seen six cases similar to those described in your annotation. The following features were present in all six : (1) very sudden, severe vertigo ; (2) mixed rotatory and horizontal nystagmus ; (3) vomiting without pronounced nausea; (4) apyrexial course ; (5) no tinnitus or deafness ; (6) no incbordination ; and (7) no evidence then or since of thrombosis of the posterior inferior cerebellar artery, disseminated sclerosis, or Meniere’s syndrome. There have been no recurrences. 1. Brit. med. J. 1949, i, 821.
thought syndrome.
at the time that these
had Gerlier’s
IDRIS JONES.
London, W.1.
SIR,—Your annotation
patients
was a
reassurance
to
myself
three of my colleagues in Oxford who were affected, after Christmas, with acute labyrinthitis ; for we had supposed that we were suffering from the premonitory symptoms of some obscure and unpleasant and
neurological complaint. On three successive mornings when getting out of bed or making a sudden turn of the head, I became giddy and tended to stagger. - The symptom, however, passed off during the course of the day, and in every other respect I was perfectly well. On mentioning the matter to my house-surgeon I learnt that he, too, had had six similar attacks over a period of two weeks, during several of which he had to hold on to something for fear of falling, to the ground. Further inquiry revealed that two other colleagues had had severe attacks of vertigo, one having fallen flat on getting up, regaining his bed only with difficulty. All have recovered completely. So far as I know, there was no evidence of previous sore throats or of auditory or other symptoms. No other members of their families were affected, although it is possible that I myself might have acquired the infection from my house-surgeon. .
,
Radcliffe Infirmary, Oxford.
A. S. TILL. A.
INDUSTRIAL HEALTH SERVICES
SIR,—I read with interest Dr. Parker’s letter in your issue of Feb. 9. It seems to’me that his approach is clearly that of a medical officer of health and not of an industrial medical officer. There is no doubt that industrial medicine is essentially preventive medicine, and mental and physical health are indivisible and
equally important.
’
Dr. Parker mentions management-labour relations and later suggests an annual inspection by the local health staff. Industrial medicine offers one of the most profitable fields for promoting health and good human relations ; and this is effected, not by annual inspections, or even routine inspections at long intervals, but by close personal contact when the medical officer has obtained the confidence of a firm. The statement that " there is no need to provide from our limited man-power a separate industrial. service : the basis exists in the public-health department " is unconvincing. The basis for medium and small firms exists equally in the present factory medical inspectorate with their unrivalled experience, and in the network of appointed factory doctors spread throughout the country. What is needed is additional nurses, doctors, health engineers, and other personnel to make the service truly effective. A group unit such as the Slough Industrial