PNEUMOCOCCUS MENINGITIS.

54 It is fatally easy to feel that all is well with the world if all is well with oneself. There is no doubt that many panel doctors are the richer for the Act; nor do they realise that from the Exchequer point of view that is an a priori objection. That section of us is organised. The objectors are not organised, but scattered, and whether from esprit de corps or the feeling that it is ungenerous to point to the fact sion, Medico-Chirurgical Transactions, London, 1907, that they are being taxed for the panel doctor, they Vol. XC., pp. 615-616. never act, scarcely ever speak. But it is past that now ; here is a chance of helping a nation forward, I am, Sir, yours faithfully, and no man should shirk the question. Two recent F. PARKES WEBER. instances have shown how dangerous a course -we Harley-street, W., Dec. 20th, 1924. are on : (1) the order to make a doctor responsible for the default of a parent to notify a birth within a given time, and (2) the savage fine of £1000 on a doctor ; in both cases by, not a judicial or a legislative PNEUMOCOCCUS MENINGITIS. but an executive body. Unless there is a change To the Editor of THE LANCET. no man henceforward is safe from the bureaucracy. The Act takes illness as the norm and promotes a SIR,—At combined section meeting of the Royal Society of Medicine, reported in your issue of Dec. 20th, health by provision of medical benefit. But all ’1924 (p. 1281), the opinion was expressed by Dr. history shows that national health depends on the J. G. Greenfield, and shared by Dr. D. Nabarro, that standard of living, especially of the poorer classes. pneumococcal meningitis always kiHs. It may The effect of the Act on the standard could clearly therefore be of interest if I give an outline of a case be seen up to the war, and the result was the largest which fought a winning fight. My notes were made increase in phthisical mortality in our records. The war had an almost unique effect on that standard ; it daily at the time. raised it among the poor. The mortality began a In Washington, D.C., on Oct. 29th, 1921, I was called at 8.30 A.M. to see a lad of 16. During the night he had arisen, huge decline during the war. Similar effects have been vomited, and gone back to bed, and at the hour named noticed in the U.S.A. ; its appalling mortality has was found wildly delirious. Lumbar puncture was done suffered a record decline. Now it is a contradiction at 9.30 A.M. in terms to raise that standard of living by a tax Dr. Clarence Rice, of Garfield Hospital, gave the following on production. Such a tax bears hard on the small report on the fluid : "Markedly turbid. Protein : marked employer, hurts not at all the large employer when increase. Cells per c.mm. 16,000. Polymorphs, 92 per cent. ; mononuclears, 8 per cent. Smears : many leucocytes, once he has readjusted prices, bears cruelly on the few lymphocytes, and a few Gram-positive, lancet-shaped, working man with a family, is trivial to the young encapsulated diplococci having the morphological appearance unmarried, unless it cause unemployment. It is of pneumococci. Culture : pure culture of pneumococci." unjust where it strikes, it is futile when it aims at I called Dr. William Hough into consultation and asked the strong. The same evening him to assume control of the treatment. I repeat it is a grave national question, and I Dr. Hough drew off the spinal fluid. Next day this was appeal to those men who have stood aloof, feeling repeated and again every day up to Nov. 7th, with the it is no concern of theirs, especially to the consultants. exception of Nov. 2nd. The fluid on the 7th was clear, contained eight cells per c.mm. and on culture was sterile. Every doctor knows, perhaps has deplored, how the No further puncture was made. On Nov. 18th patient was Labour Party is obsessed by the notion that the out of bed for the first time. On the 22nd a note was made,State is a bottomless well, from which every need " Somewhat slow in convalescing." He was eating well.can be supplied. For humanity’s sake, and England’s, There was ptosis of the left eyelid. On Dec. 5th, headachedo not by inertia encourage that pathetic and and vomiting; on the 7th, giddiness ; on the 8th, much The Commission has consented frontal headache with tenderness on percussion above dangerous fallacy. receive evidence on the principle. To make that right eyebrow. Blood leucocytes, which were 9100 on to Dec. 7th, were now 14,200. On Dec. 9th Dr. Hough was evidence effective, it is desirable to have the support again called. On the llth Dr. Harry Kerr was also of a considerable body of doctors. Will any symsend me a postcard with his or her name, summoned, and it was agreed that there was cerebral abscess. pathiser ] On the 12th Dr. Kerr opened the skull at the spot tender on :and any medical friend’s (not pledging themselves percussion, and at a depth of 4 cm. found pus. He drained1to any particular doctrine), to say that he, she, or with rubber tubing. Convalescence was anxious, but a they deprecate any extension of the Act until the fine recovery took place with unimpaired mentality. basic principle has been thoroughly reconsidered ? An intranasal operation had been done 12 months I am, Sir, yours faithfully, before the illness, and since then life had been a B. G. M. BASKETT. burden to the lad on account of constant drip 29, Daniel-street, Bath, Somerset, Dec. 27th, 1924. of presumably cerebro-spinal fluid. To the patient’s great joy there was after the illness no return of the nasal flux. I am, Sir, yours faithfully, ENCEPHALITIS AND PLEOMORPHISM. JAMES CAMPBELL, M.B., Ch.B. To the Editor of THE LANCET. Lerwick, Shetland, Dec. 24th, 1924. SIR,—Dr. F. G. Crookshank has commented favourably in your columns (see THE LANCET, 1924, vol. ii., p. 1311) on a recent communication of mine to THE ROYAL COMMISSION ON NATIONAL the British Medical Journal. He points out that Dr. Regan’s case of atelectasis INSURANCE: AN APPEAL. in poliomyelitis is a particular instance of a type of To the Editor oTHE LANCET. visceral paralysis which not infrequently occurs in this to and allied diseases-for example, in encephalitis certain that the seems evidence be SiR,-It tendered by the British Medical Association will and in influenza with nervous symptoms. For is it assume the principle of the National Insurance Act not probably a fact that poliomyelitis and encephto be sound, and ignoring the more subtle moral and alitis are less distinct in nature than their names would social effects,will concentrate on benefits, even advise suggest-that they tend, in fact, to run into one extension. It is clear that extension points in the another, as also into the influenzas presenting cerebral direction of State Socialism. Of course, the Associa- and spinal complications, and so eventually into tion cannot plead opposing views officially-i.e., ordinary influenzas ? Dr. Crookshank has provided it is pledged by a group to the support of a political us with an excellent example of that synthetic manner of thinking which medicine so badly needs after theory.

feeble individuals who for years have been accustomed

to open their bowels every other day with purgatives. Following the fluid action of the bowels the damaged mucous membrane permits abnormal absorption of toxic material, doubtless especially from the fluid material left in the rectum. Such persons usually feel at their best on the days between those on which the purgatives act. I referred to this point in a discus-