- Email: [email protected]
NATIONAL REGISTER OF POPULATION.
147 THE STORY OF LETHARGIC
logical
ENCEPHALITIS.
investigations
were
carried
"
.
.
’
Marinesco, whose services
out
by
most THE report on Encephalitis Lethargica, issued j secured through the Medical Research fortunately under the title of an Enquiry into an ObscureICommittee, and by Dr. James McIntosh. Both Disease, by the Local Government Board (NewIemphasise the similarity between the lesions Series, No. 121), may justly be claimed as a brilliant found and those of poliomyelitis-namely, cellular vindication of the application of team-work in the infiltration around the smaller veins in the basal elucidation of a medical problem. Attention was ganglia, the upper part of the pons, particularly in drawn to the appearance of the new syndrome by the grey matter of the floor of the fourth ventricle, Dr. Wilfred Harris in the columns of THE LANCET and to a much less degree in the medulla. Both on April 20th, 1918. The similarity between some failed to find satisfactory evidence of the presence of the symptoms and those which characterise of a specific micro-organism, and the intracerebral infection caused by food contaminated with the inoculation of monkeys with emulsion of diseased Bacillus botulinus created a general anxiety which tissues carried out by Dr. McIntosh was void of A result. The only striking pathological difference was natural in the circumstances of the time. preliminary inquiry was started at once to deter- was one of localisation. Yet here combined work mine whether food contamination could be held supplied the corrective. The masterly analysis of responsible for the outbreak. The result of this the clinical differences set forth by Dr. McNalty, inquiry was entirely negativeno direct or indirect supported as it is by the epidemiological evidence, evidence of an association of the illness with infection leaves no reasonable doubt that the two diseases from food was obtained. On the other hand, certain are separate entities. Sir Arthur Newsholme and features, particularly the pathological examinations, his coadjutors are to be congratulated upon this raised the suspicion that the outbreak might be report as an instance of what can be achieved by one of epidemic anterior poliomyelitis, or Heineorderly scientific investigation. Medin disease. With a view to determining the correctness or otherwise of this suggestion the NATIONAL REGISTER OF POPULATION. present inquiry was instituted on a comprehensive scale. The results of the well-coordinated invesAT a meeting on Jan. 6th of the Commission for tigation-clinical, epidemiological, pathological, the Reconstruction of the National Birth-rate an and bacteriological-are contained in this report, urgent appeal was made on behalf of the Registrarand the conclusion arrived at is briefly that the General by Dr. T. H. C. Stevenson for the establishdisease is identical with that described by Von ment of a national register of population, which Economo in Austria and Professor Netter in should the many partial registers in supersede France, that it is sui generis and distinct, both present use. The list already includes, in addition anatomically and clinically, from analogous to the national and electoral registers, the school affections-e.g., acute poliomyelitis. It belongs attendance and food registers, and those relating to the class of polio-encephalitic diseases which to sickness, unemployment, insurance, and some are infaammatory in nature, but the inquiry has others. Sir Bernard Mallet, in full accord not yielded any conclusive evidence as to the with his predecessors, lay as well as medical, character of the causal agent. When it is con- at the General Register Office, once again sidered that the organism which causes the revives the official demand for a complete analogous disease poliomyelitis is still a matter for registration system on the ground that the debate, although thousands of cases have been Census, which is the only complete register, is investigated from the bacteriological point of revised not more frequently than once in ten view, it is not surprising that the problem of the years. It therefore rapidly becomes out of date, causal agent of encephalitis lethargica is as yet and is of little value except for statistical unsolved. Sir Arthur Newsholme in his introductory purposes. Practically all the registers now in review says :vogue are independently compiled and maintained, " Although a negative finding is unsatisfactory, and affords the information contained in each one being little basis for preventative action, the speedy cessation of seldom available for the purposes of the others. the outbreak makes it necessary, for the present, to leave The Registrar-General accordingly proposes that a the problem at this point. Possibly a larger number of single master register should be inaugurated which cases hereafter may supply material for further epidemiological and bacteriological research and animal experiment." should include every man, woman, and child in the of name, address, sex, Dr. A. S. McNalty, who carried out the clinical part country, giving particulars and date of birth, together with occupation, age, of the work, makes the arresting suggestion that the information as to marriage and family. But inasrelation between acute poliomyelitis and lethargic much as no single register could possibly contain encephalitis may be comparable to that between all needful information, it is proposed to link up typhoid and paratyphoid. He also lays stress on each unit with the general register as part of a the influence which diminution of resistance in coordinated for the communisystem, providing individuals may have on the " evolution of a cation to each of the special registers of the disease. The virus may well have been fairly information of common interest collected by generally present in the human organism and the the general register, and leaving each of them strain of the years of war may have so altered the to amplify this to individual requireresisting powers of certain individuals that an ments. For this accordingthe general register might purpose ordinarily saprophytic organism had become in code form, the necessary particulars, record, pathogenic for them. Such a suggestion is made and information removals could be commore probable when the widespread sporadic municated to therespecting branches local as required. As distribution of the cases in the recent epidemic this would deal with of millions register many is considered, and this point is very clearly names it would have to be arranged in local brought out by Colonel S. P. James in his sections the country. Nevertheless, it epidemiological survey of the outbreak.l Patho- would bethroughout necessary to maintain at headquarters 1 THE LANCET, 1918, ii., 837. To this an index to the local registers everywhere. Professor
were
148 central index all births, deaths, and removals would of course be referred, but it is essential that all local registers should be controlled and coordinated by the central organisation. With the object of allaying the fears already expressed that the present proposal would result in the exaction of family secrets to which objection might be taken. Dr. Stevenson was able to assure his hearers that the new proposals did not increase in any way the statutory information hitherto demanded from the public. It only altered the form in which it would be required. The Commission resolved" That in the view of the National Birth-rate Commission there is immediate need for the improvement of the vital statistics upon which all its conclusions must be based by the formation of a joint register on the lines advocated by the Registrar-General."
Sir Arthur Newsholme’s impending retirement from the medical officership of the Local Government Board is announced. The good wishes of the Public Health Service, which’ he has served so well, go with him. ____
A COURSE of four lectures on Malaria will bedelivered at noon on Jan. 31st, and Feb. 7th, 14th, and 21st, in the Lecture Theatre of the Medical School, King College Hospital, by Colonel Sir Ronald Ross. Officersand men of the R.A.M.C. are invited to, attend. Microscope specimens and lantern slides will be shown at the two last lectures.
presided over by the Bishop of behalf of the National Council of THE Council of the National Medical EUnion Public Morals. The apparently imminent establishment of a Ministry of Health, and the appoint- decided in December last to invite a mass meeting ment of Dr. Addison and Sir Auckland Geddes of the medical profession to consider the establish. as heads of the departments concerned, would ment of a medical advisory body in connexion with This meeting, indicate the present moment as judiciously chosen the proposed Ministry of Health. for the presentation of the Registrar-General’s which will be open to panel as well as to non-panel request. This seems to us reasonable and necessary practitioners, will be held at the Wigmore Hall, for the discharge of the additional responsibilities London, W., on Sunday, Feb. 2nd, at 4 P.M. which the establishment of a Health Ministry would entail on his department, and for the fulfilment of A special meeting of the Faculty of Insurance will which a complete system of registration would be be held on Tuesday next, Jan. 28th, at 7 P.M., at the indispensable. Central Hall, Westminster, when an address will be delivered by Mr. E. B. Turner (chairman of the THE EUROPEAN FOOD SITUATION. Medical Committee for Combating with Venereal on Venereal Disease considered as an Disease) WE have received from the Provisional Committee on the European Food Situation (77, Avenue Urgent Health Problem. Mr. P. Rockliff (President Chambers, London, W.C. 1) a letter signed by Lord of the Faculty) will initiate a discussion.4 on Parmoor intended to bring the facts of the European Prophylactic Treatment. famine, due to the continuance of the food blockage, before the medical profession and to obtain their AT the meeting of the Medical Society of London opinion upon its probable results. The facts are to be held on Monday next, Jan. 27th, at 8.30 P.M., substantiated as regards Vienna by a translation of a discussion will take place on " The Modern an article published on Dec. 27th in the Arbeiter Treatment of Gonorrhoea of the Genito-Urinary Zeitung by the vice-burgomaster of the city, and of Organs." The debate will be introduced by Colonel the statistical material laid before the Inter-Allied L. W. Harrison, R.A.M.C., who will be followed by Dr. Commission by the burgomaster of Vienna. The D. Thomson, Dr. R. A. Bolam, Dr. A. Cambell, Dr. D. percentage of deaths attributed with certainty to Lees, Dr. David Watson, and Mr. Campbell Williams, malnutrition is given as 7 per cent. or over for each among others. Medical officers of the Colonial and month since last July, and there is a presumption Allied Armies will be welcome at the meeting. that the actual proportion is more than double that The meeting Birmingham
.
given on Wednesday, Feb. 5th, at 8.30 P.M., when Sir John Bland-Sutton will discourse on Gizzards and Counterfeit Gizzards, illustrated by specimens.
was
on
____
figure.
____
LANCET, AUGUST 24TH, 1918. Manager of THE LANCET would like ta
THE DURING the fourth quarter of 1918 from influenza were registered in Wales ; this number, though given
provisional.
____
98,998 deaths
THE
England and re-purchase officially, is August 24th
or to receive ’copies of the issue offor which readers may have no further use, to enable him to replace copies for libraries and institutions in India and the East which were Such copies lost at sea owing to enemy action. should please be addressed to him at 423, Strand, London, W.C. 2.
general meeting of Fellows of the Royal of Medicine, held on Jan. 14th, the conditions were discussed under which pensioners should be admissible to treatment in civil hospitals. We have been obliged to hold over a detailed report of THE LANCET, VOL. II., 1918: THE INDEX. this important discussion until our next issue.THE Index and Title-page to the volume of* The Council of the Society has decided to have a social-scientific evening once a week for the recep- THE LANCET which was completed with the issue tion of officers attached to the R.A.M.C. and Red of Dec. 28tb, 1918, is now ready, and copies have Cross, and officers of the Medical Services of the been supplied gratis to those subscribers whoDominions, the United States, and other Alliedhave, up to Jan. 22nd, intimated to us their wish Powers. The reception will be held every Wednes- to receive them. Other subscribers will be similarly so long as the stock remains unexhausted, i day evening at 8.30, when a short informal discoursesupplied, will be given, after which it will be free to any on I application to the Manager, THE LANCET Office, present to raise and discuss any question in which423, Strand, London, W.C. 2. Such applications they are interested. The first discourse will beIshould be sent in at once. AT
a
Society
____
logical
ENCEPHALITIS.
investigations
were
carried
"
.
.
’
Marinesco, whose services
out
by
most THE report on Encephalitis Lethargica, issued j secured through the Medical Research fortunately under the title of an Enquiry into an ObscureICommittee, and by Dr. James McIntosh. Both Disease, by the Local Government Board (NewIemphasise the similarity between the lesions Series, No. 121), may justly be claimed as a brilliant found and those of poliomyelitis-namely, cellular vindication of the application of team-work in the infiltration around the smaller veins in the basal elucidation of a medical problem. Attention was ganglia, the upper part of the pons, particularly in drawn to the appearance of the new syndrome by the grey matter of the floor of the fourth ventricle, Dr. Wilfred Harris in the columns of THE LANCET and to a much less degree in the medulla. Both on April 20th, 1918. The similarity between some failed to find satisfactory evidence of the presence of the symptoms and those which characterise of a specific micro-organism, and the intracerebral infection caused by food contaminated with the inoculation of monkeys with emulsion of diseased Bacillus botulinus created a general anxiety which tissues carried out by Dr. McIntosh was void of A result. The only striking pathological difference was natural in the circumstances of the time. preliminary inquiry was started at once to deter- was one of localisation. Yet here combined work mine whether food contamination could be held supplied the corrective. The masterly analysis of responsible for the outbreak. The result of this the clinical differences set forth by Dr. McNalty, inquiry was entirely negativeno direct or indirect supported as it is by the epidemiological evidence, evidence of an association of the illness with infection leaves no reasonable doubt that the two diseases from food was obtained. On the other hand, certain are separate entities. Sir Arthur Newsholme and features, particularly the pathological examinations, his coadjutors are to be congratulated upon this raised the suspicion that the outbreak might be report as an instance of what can be achieved by one of epidemic anterior poliomyelitis, or Heineorderly scientific investigation. Medin disease. With a view to determining the correctness or otherwise of this suggestion the NATIONAL REGISTER OF POPULATION. present inquiry was instituted on a comprehensive scale. The results of the well-coordinated invesAT a meeting on Jan. 6th of the Commission for tigation-clinical, epidemiological, pathological, the Reconstruction of the National Birth-rate an and bacteriological-are contained in this report, urgent appeal was made on behalf of the Registrarand the conclusion arrived at is briefly that the General by Dr. T. H. C. Stevenson for the establishdisease is identical with that described by Von ment of a national register of population, which Economo in Austria and Professor Netter in should the many partial registers in supersede France, that it is sui generis and distinct, both present use. The list already includes, in addition anatomically and clinically, from analogous to the national and electoral registers, the school affections-e.g., acute poliomyelitis. It belongs attendance and food registers, and those relating to the class of polio-encephalitic diseases which to sickness, unemployment, insurance, and some are infaammatory in nature, but the inquiry has others. Sir Bernard Mallet, in full accord not yielded any conclusive evidence as to the with his predecessors, lay as well as medical, character of the causal agent. When it is con- at the General Register Office, once again sidered that the organism which causes the revives the official demand for a complete analogous disease poliomyelitis is still a matter for registration system on the ground that the debate, although thousands of cases have been Census, which is the only complete register, is investigated from the bacteriological point of revised not more frequently than once in ten view, it is not surprising that the problem of the years. It therefore rapidly becomes out of date, causal agent of encephalitis lethargica is as yet and is of little value except for statistical unsolved. Sir Arthur Newsholme in his introductory purposes. Practically all the registers now in review says :vogue are independently compiled and maintained, " Although a negative finding is unsatisfactory, and affords the information contained in each one being little basis for preventative action, the speedy cessation of seldom available for the purposes of the others. the outbreak makes it necessary, for the present, to leave The Registrar-General accordingly proposes that a the problem at this point. Possibly a larger number of single master register should be inaugurated which cases hereafter may supply material for further epidemiological and bacteriological research and animal experiment." should include every man, woman, and child in the of name, address, sex, Dr. A. S. McNalty, who carried out the clinical part country, giving particulars and date of birth, together with occupation, age, of the work, makes the arresting suggestion that the information as to marriage and family. But inasrelation between acute poliomyelitis and lethargic much as no single register could possibly contain encephalitis may be comparable to that between all needful information, it is proposed to link up typhoid and paratyphoid. He also lays stress on each unit with the general register as part of a the influence which diminution of resistance in coordinated for the communisystem, providing individuals may have on the " evolution of a cation to each of the special registers of the disease. The virus may well have been fairly information of common interest collected by generally present in the human organism and the the general register, and leaving each of them strain of the years of war may have so altered the to amplify this to individual requireresisting powers of certain individuals that an ments. For this accordingthe general register might purpose ordinarily saprophytic organism had become in code form, the necessary particulars, record, pathogenic for them. Such a suggestion is made and information removals could be commore probable when the widespread sporadic municated to therespecting branches local as required. As distribution of the cases in the recent epidemic this would deal with of millions register many is considered, and this point is very clearly names it would have to be arranged in local brought out by Colonel S. P. James in his sections the country. Nevertheless, it epidemiological survey of the outbreak.l Patho- would bethroughout necessary to maintain at headquarters 1 THE LANCET, 1918, ii., 837. To this an index to the local registers everywhere. Professor
were
148 central index all births, deaths, and removals would of course be referred, but it is essential that all local registers should be controlled and coordinated by the central organisation. With the object of allaying the fears already expressed that the present proposal would result in the exaction of family secrets to which objection might be taken. Dr. Stevenson was able to assure his hearers that the new proposals did not increase in any way the statutory information hitherto demanded from the public. It only altered the form in which it would be required. The Commission resolved" That in the view of the National Birth-rate Commission there is immediate need for the improvement of the vital statistics upon which all its conclusions must be based by the formation of a joint register on the lines advocated by the Registrar-General."
Sir Arthur Newsholme’s impending retirement from the medical officership of the Local Government Board is announced. The good wishes of the Public Health Service, which’ he has served so well, go with him. ____
A COURSE of four lectures on Malaria will bedelivered at noon on Jan. 31st, and Feb. 7th, 14th, and 21st, in the Lecture Theatre of the Medical School, King College Hospital, by Colonel Sir Ronald Ross. Officersand men of the R.A.M.C. are invited to, attend. Microscope specimens and lantern slides will be shown at the two last lectures.
presided over by the Bishop of behalf of the National Council of THE Council of the National Medical EUnion Public Morals. The apparently imminent establishment of a Ministry of Health, and the appoint- decided in December last to invite a mass meeting ment of Dr. Addison and Sir Auckland Geddes of the medical profession to consider the establish. as heads of the departments concerned, would ment of a medical advisory body in connexion with This meeting, indicate the present moment as judiciously chosen the proposed Ministry of Health. for the presentation of the Registrar-General’s which will be open to panel as well as to non-panel request. This seems to us reasonable and necessary practitioners, will be held at the Wigmore Hall, for the discharge of the additional responsibilities London, W., on Sunday, Feb. 2nd, at 4 P.M. which the establishment of a Health Ministry would entail on his department, and for the fulfilment of A special meeting of the Faculty of Insurance will which a complete system of registration would be be held on Tuesday next, Jan. 28th, at 7 P.M., at the indispensable. Central Hall, Westminster, when an address will be delivered by Mr. E. B. Turner (chairman of the THE EUROPEAN FOOD SITUATION. Medical Committee for Combating with Venereal on Venereal Disease considered as an Disease) WE have received from the Provisional Committee on the European Food Situation (77, Avenue Urgent Health Problem. Mr. P. Rockliff (President Chambers, London, W.C. 1) a letter signed by Lord of the Faculty) will initiate a discussion.4 on Parmoor intended to bring the facts of the European Prophylactic Treatment. famine, due to the continuance of the food blockage, before the medical profession and to obtain their AT the meeting of the Medical Society of London opinion upon its probable results. The facts are to be held on Monday next, Jan. 27th, at 8.30 P.M., substantiated as regards Vienna by a translation of a discussion will take place on " The Modern an article published on Dec. 27th in the Arbeiter Treatment of Gonorrhoea of the Genito-Urinary Zeitung by the vice-burgomaster of the city, and of Organs." The debate will be introduced by Colonel the statistical material laid before the Inter-Allied L. W. Harrison, R.A.M.C., who will be followed by Dr. Commission by the burgomaster of Vienna. The D. Thomson, Dr. R. A. Bolam, Dr. A. Cambell, Dr. D. percentage of deaths attributed with certainty to Lees, Dr. David Watson, and Mr. Campbell Williams, malnutrition is given as 7 per cent. or over for each among others. Medical officers of the Colonial and month since last July, and there is a presumption Allied Armies will be welcome at the meeting. that the actual proportion is more than double that The meeting Birmingham
.
given on Wednesday, Feb. 5th, at 8.30 P.M., when Sir John Bland-Sutton will discourse on Gizzards and Counterfeit Gizzards, illustrated by specimens.
was
on
____
figure.
____
LANCET, AUGUST 24TH, 1918. Manager of THE LANCET would like ta
THE DURING the fourth quarter of 1918 from influenza were registered in Wales ; this number, though given
provisional.
____
98,998 deaths
THE
England and re-purchase officially, is August 24th
or to receive ’copies of the issue offor which readers may have no further use, to enable him to replace copies for libraries and institutions in India and the East which were Such copies lost at sea owing to enemy action. should please be addressed to him at 423, Strand, London, W.C. 2.
general meeting of Fellows of the Royal of Medicine, held on Jan. 14th, the conditions were discussed under which pensioners should be admissible to treatment in civil hospitals. We have been obliged to hold over a detailed report of THE LANCET, VOL. II., 1918: THE INDEX. this important discussion until our next issue.THE Index and Title-page to the volume of* The Council of the Society has decided to have a social-scientific evening once a week for the recep- THE LANCET which was completed with the issue tion of officers attached to the R.A.M.C. and Red of Dec. 28tb, 1918, is now ready, and copies have Cross, and officers of the Medical Services of the been supplied gratis to those subscribers whoDominions, the United States, and other Alliedhave, up to Jan. 22nd, intimated to us their wish Powers. The reception will be held every Wednes- to receive them. Other subscribers will be similarly so long as the stock remains unexhausted, i day evening at 8.30, when a short informal discoursesupplied, will be given, after which it will be free to any on I application to the Manager, THE LANCET Office, present to raise and discuss any question in which423, Strand, London, W.C. 2. Such applications they are interested. The first discourse will beIshould be sent in at once. AT
a
Society
____