Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/22

212 Fleet-Surgeon : As no one else rises, I should like to open the discussion. In the first place I think the question of the bacteriology of cerebro-spinal fever is not quite so plain as is often considered. We know from fact and experience that there are cases where no organism is found in the cerebro-spinal fluid; thus you have cases clinically indistinguishable from cerebro-spinal fever, in which bacteriologically you cannot prove the disease. I only point that out for what it is worth. Of course, that point has been taken strongly hold of by and others. I think at present one ought to have an open mind from the bacteriological point of view on this question. No doubt it seems so plain: you have got your organism which is infective; you have that organism in the cerebro-spinal fluid, blood, throat, etc.; the organisms may be injected into animals, and can be recovered. These are important points; but there is another one: you can get the organism from the throat of the patient suffering with the disease and yet it is apparently not infective. Why is it not infective? At the same time you get from the throat of another person who is quite well, a similar organism, and it is infective. There are many points to be considered besides the organism itself.

Then with regard to carriers. These carriers, when they are prevalent in the different stages of the epidemic, and in different periods of the year, are not, I think, quite so constant as stated. Carriers vary enormously with the character of the people and the health of the individuals. Take for instance a lot of patients at the London hospitals. If you take a number of contacts from these you get a comparatively high number of carriers. You take a number of very healthy men, for instance in a depot for which I have been lately working, where the number of contacts is very low. It depends a great deal on the health and stamina of the people, and more especially on the age of the people. That plays a very important part. For instance, in the London Hospital there are 10 to 20 per cent, of carriers; that calculation was carried out by a high-class bacteriologist. Speaking with a large experience, out of 4,000 cases, my percentage is only 1.3. Every man before being drafted away had to be examined to see whether it was safe or not, and the percentage worked out at 1.4, so that the health of the person, the conditions under which he lives, and his age, are most important points with regard to carriers.